Introduction

Addressing Trauma to Promote Social

and Emotional Well-Being: A Child
Welfare Imparative

or too long, child welfare has focused exclusively on the twin goals
F of safety and permanency. Well-being is often mentioned as a
third aim of child welfare systems, yet it is almost universally short-
changed when it comes to the provision of services as usual. As
Wulczyn, Barth, Yuan, Harden, and Landsverk (2005) purport,
well-being is in fact a construct in which safety and permanency are
embedded. Further, the domains comprising well-being are self-
reinforcing, meaning that as well-being improves, permanency and
safety become more likely. So too do physical and mental health,
educational success, and positive lifelong connections.
I believe the time has come to address the social and emotional
well-being of children and youth who come into contact with the
child welfare system. In recent years, volumes of epidemiologic
research have verified what child welfare practitioners have histori-
cally observed: among children who experience abuse or neglect, a
startling majority develops a complex array of social, emotional, and
behavioral challenges that, if left unaddressed, often have a long-
lasting and devastating impact on their future.
As Director of the Illinois Department of Children and Family
Services (DCFS) from 2003–2007, I saw firsthand the unintended
consequences of dedicating too few resources to achieving healing
and recovery from maltreatment. Children and youth who did not
achieve permanence exhibited higher rates of emotional distress,

Child Welfare • Vol. 90, No. 6 19

Child Welfare Vol. 90, No. 6

developmental delays, educational difficulties, and lower social com-

petencies. As a result, a group of dedicated professionals took steps
to improve the lifetime outcomes of children in out-of-home care
by introducing trauma-based interventions throughout DCFS and
instituting a comprehensive mental health assessment for all chil-
dren entering foster care to document their broad social and emo-
tional functioning. These efforts were the beginning of an ongoing,
system-wide shift in the care and treatment of children who have
experienced abuse and neglect.
The connection between maltreatment and trauma has risen in
national prominence in recent years. For the first time, trauma asso-
ciated with child maltreatment has been recognized in federal
legislation. 2011’s Child and Family Services Improvement and
Innovation Act (P.L. 112-34), which reauthorized Title IV-B of
the Social Security Act, includes new language requiring states to
develop plans for identifying and addressing “emotional trauma
associated with the child’s maltreatment and removal from home.”
This shift in federal policy moves the child welfare field to effec-
tively, efficiently, and systematically incorporate what is now known
about the centrality of trauma to the experience of children who
have been maltreated into its work. The paradigm shift toward
trauma responsiveness must be accompanied by parallel improve-
ments in policies, programs, and practice. The child welfare system
is in the process of making such advancements, and this special
issue of Child Welfare provides new evidence to inform this criti-
cal work.

The Changing Shape of Child Welfare

Between 1980 and 1997, the number of children in foster care doubled
in size, from 303,000 to 559,000 (U.S. Department of Health and
Human Services [USDHHS], Administration on Children and
Families [ACF], 1998, 2002–2011). Troubled by this seeming pop-
ulation explosion, Congress passed the Adoption and Safe Families
Act of 1998 (P.L. 105-89) with a new focus on permanency, specifi-
cally adoption. Since then, the size and shape of the nation’s child

20
Samuels Child Welfare

welfare population has significantly changed and, moreover, has

become known about the needs that children who have been mal-
treated bring with them as they enter foster care.
In the most recent 15 years for which data are available, the
number of children in foster care has decreased both steadily and
dramatically. Nationwide, 27% fewer children were living in out-
of-home care on September 30, 2010 than on that same date in
1998. The trend in admissions to foster care tells another chapter
of the same story: 16% fewer children were taken into protective
custody in 2010 than in 1998 (USDHHS, ACF, 2002–2011). While
data appear to indicate that youth who enter care between the ages
of 13 and 17 are staying slightly longer in foster care, the median
length of stay among children 12 and under declined between 2000
and 2005. Likewise, children discharged from foster care to per-
manency grew less likely to reenter care (Wulczyn, Chen, & Hislop,
2007). By these measures, today’s child welfare system is better at
ensuring the safety and permanency of children in its care than
ever before.
Yet in Illinois, where the population in foster care followed similar
trends to those observed nationally, children entering care still brought
significant challenges with them. Data from comprehensive assess-
ments revealed that one-quarter of the children in foster care exhibited
clinical levels of trauma symptoms. Traumatic grief/separation and
adjustment reactions were most common, followed by avoidance,
reexperiencing, numbing, and dissociation (Griffin, McClelland, Maj,
N., Stolback, Holzberg, & Kisiel, in press).
National data indicate that whether or not they are brought into
foster care, children known to the child welfare system have strik-
ingly similar experiences of trauma and display alarmingly high rates
of trauma symptomatology. This compelling observation is drawn
from the National Survey of Child and Adolescent Well-Being
(NSCAW),1 the source of the most comprehensive data describing
the experiences and outcomes of children who come to the attention
of the child welfare system. Among this population, more than 1 in
10 children display trauma-related symptoms at a level requiring clin-
ical or therapeutic intervention (Casaneuva, Ringeisen, Wilson,

21
Child Welfare Vol. 90, No. 6

Smith, & Dolan, 2011). Disaggregating by setting does not yield sta-
tistically significant differences; however, the magnitude of clinical-
range problems2 among children still in the home or in kin care is
nearly double that of children in foster care, group, or residential
settings (Figure 1).
As several articles in this Special Issue demonstrate, children
with clinical diagnoses of posttraumatic stress disorder (PTSD) are
not the only young people experiencing reactions to trauma.
Research has demonstrated that, among children who have experi-
enced maltreatment, behavioral, emotional, cognitive, and relational
deficits are common (Frederico, Jackson, & Black, 2005). Children
in the NSCAW sample population exhibit strikingly high rates of
clinical-level difficulties extending beyond trauma-related stress
(Figure 2). While the maltreatment experience of children known
to child welfare may not be labeled as trauma per se, there is little
doubt among researchers or practitioners that, for many children,
the fallout of abuse and neglect manifests as challenges to future
functioning.
The children represented in Figure 2 have or are at risk of devel-
oping diagnosable mental health disorders, including major depressive
disorder, attention deficit/hyperactivity disorder, conduct disorder, and
oppositional defiant disorder, among others. As the child welfare sys-
tem increasingly recognizes the role of trauma in the development and
functioning of children who have been maltreated, the workforce must
become more adept at (1) identifying those children who display post-
traumatic stress reactions in response to maltreatment and (2) refer-
ring those children for evidenced-based, trauma-focused treatment.

1 Children in the nationally representative sample were the subject of a child protective services (CPS) report
and received an investigation. NSCAW follows these children at intervals spanning four years, whether or
not the initial report was substantiated, the child and family received services, or the child was taken into
foster care. At each interval, several assessments of child and family functioning are administered, track-
ing well-being across multiple dimensions. There are two iterations of NSCAW: the first, NSCAW I,
includes 5,501 children who were the subject of a CPS report between October 1999 and December 2000;
NSCAW II includes 5,873 children whose reports were made between February 2008 and April 2009.
Data collection for NSCAW II is ongoing as of this article’s publication. The following data are drawn
from NSCAW II.
2 “Clinical range” was defined as a standardized score of 65 or more on the Trauma Symptom Checklist.

22
Samuels Child Welfare

Figure 1
Percent of Children Scoring in the Clinical-Range on the Trauma Symptom
Checklist for Children’s Postraumatic Stress Subscale by Setting
(Data Source: National Survey of Child and Adolescent Well-Being II)

There are significant implications for treatment and prevention of the

mental health disorders listed previously and other negative outcomes.

Articles in This Issue

This Special Issue of Child Welfare helps to elucidate the ways in which
emerging bodies of literature about the impact of maltreatment on
child development and well-being can be translated into child wel-
fare practice and system changes. It demonstrates that superficial
adjustments to the child welfare system will be insufficient to mean-
ingfully respond to the needs of children who have experienced abuse
or neglect. Rather, for the child welfare system to be truly trauma-
informed, fundamental shifts are necessary at the levels of policy,
agency, program, and practice.
A critical facet of becoming trauma-informed is acknowledging
that a child’s initial exposure to trauma may have occurred prior to
his or her involvement with the child welfare system and may be

23
Child Welfare Vol. 90, No. 6

Figure 2
Percent of 1.5- to 17-Year-Old Children with Clinical-Level3 Behavioral Problems
According to Child Behavior Checklist Caregiver Report by Setting
(Data Source: National Survey of Child and Adolescent Well-Being II)

continual. Additionally, problems in functioning may be the result

of exposure to traumatic events other than maltreatment, such as
witnessing domestic violence or community violence. It has been
well-documented that the age of trauma onset, the chronic nature
of maltreatment, and the experience of multiple trauma types each
impact the development of symptomatology (Appleyard, Egeland,
van Dulmen, & Sroufe, 2005; Frederico, Jackson, & Black, 2008;
Perry, 2008).
In this volume, Collins and colleagues build on these concepts
and explore the infusion of a trauma focus into Family Connection
(FC), an existing family focused evidence-supported intervention, in

3 “Clinical range” was defined as a standardized score of 64 or more on the Child Behavior Checklist Caregiver
Report.

24
Samuels Child Welfare

order to address the needs of families exposed to multigenerational

trauma and/or current trauma. The Trauma Adapted Family Connec-
tions (TA-FC) manualized model uses trauma-informed evidence-
based interventions aimed to alleviate trauma symptomatology,
strengthen family functioning, and prevent child abuse and neglect.
The focus of the Special Issue then turns to the importance of
developing trauma-informed child maltreatment investigations to
reduce the potentially negative impact of further trauma on children
and families already being investigated. Pence’s development of a
trauma-informed forensic child maltreatment investigative protocol
and training provides a much needed resource for the child welfare
field, as most trauma-informed child welfare initiatives target chil-
dren after they enter care.
Next, several articles explore the importance of and strategies for
screening and assessment of trauma symptoms among children and
families involved with the child welfare system. Drawing on experi-
ence in Illinois using the Child and Adolescent Needs and Strengths
(CANS) assessment tool (Lyons, Small, Weiner, & Kisiel, 2011) to
assess every child entering into care, Griffin and colleagues empha-
size the importance of assessing the impact of trauma regardless of
whether or not a child demonstrates mental health symptoms.
Further explicating the need for improved screening and assess-
ment, Greeson and colleagues examined a large national sample com-
prised of youth engaged in the child welfare system in 56 National
Child Traumatic Stress Network grantee sites. In this sample, the
authors found significantly high rates of complex trauma exposure
and even higher rates of internalizing problems, posttraumatic stress,
and clinical diagnoses. These results further demonstrate the need for
screening and assessments that go beyond the event preceding a
child’s entry into foster care and address trauma histories.
With much attention given to the experiences that impact chil-
dren’s functioning, Chemtob and colleagues turn their attention to
the trauma histories and trauma-related symptoms of caregivers. The
authors found that mothers involved with the child welfare preven-
tion services have been exposed to a wide range of traumatic events,
particularly interpersonal violence, and have high rates of PTSD

25
Child Welfare Vol. 90, No. 6

and/or depression. However, the large majority of mothers with

trauma-related disorders were not receiving mental health services.
Having demonstrated the connection between trauma and mental
health, Conradi and colleagues discuss using screening and assess-
ment to more effectively bridge child welfare and mental health serv-
ices. They argue that child welfare professionals should know when
and how to screen for children trauma, what screening tools are avail-
able and commonly used, and when to refer a child for a trauma
assessment or comprehensive psychological evaluation.
Given that trauma is an extraordinarily common experience
among children and families coming to the attention of the child wel-
fare system, the risk of developing secondary traumatic stress (STS)
symptoms among caseworkers tasked with serving this population is
high. Sprang and colleagues verify that indeed the rates of STS,
burnout, and PTSD are higher among child welfare caseworkers
compared to other groups of professionals, indicating that, in addi-
tion to child- and family-level initiatives, child welfare workforce
strategies ought to be trauma-informed as well.
The remaining three articles address efforts to make broad changes
at the system level to become more trauma-informed. Taking differ-
ent approaches, Henry and colleagues and Hendricks and colleagues
explore the critical role that the broader child welfare community
plays throughout the development of trauma-informed child welfare
systems, from assessment of readiness to dissemination of knowledge.
Conradi and colleagues focused more narrowly on exploring the col-
laborative partnership between the child welfare agency and their
mental health counterparts to help advance trauma-informed child
welfare practice leading to broader system level changes. Using the
Breakthrough Series Collaborative model and methodology (Institute
on Healthcare Improvement, 2003), the authors describe how nine
states have begun to make improvements in permanency for children
in care. In all three approaches, helpful tools have been developed to
assist child welfare agencies and their partners, resource parents (birth,
foster, kin, and adoptive), youth, mental health professionals, juvenile
justice staff, courts, and other community stakeholders to take con-
certed steps to become trauma-informed.

26
Samuels Child Welfare

Moving Forward
Together, this collection of articles approaches trauma in child welfare
at the micro, meso, and macro levels to provide a telescoping view of
the issue. They provide compelling evidence that incorporating a
trauma-focus into child welfare is not only appropriate, but also nec-
essary. Most importantly, this volume presents research-supported, use-
able strategies for creating trauma-informed child welfare systems that
can improve the social and emotional well-being of children and youth
involved with the child welfare system. This is the urgent charge for
child welfare, and indeed all systems serving vulnerable young people.

Bryan H. Samuels
Commissioner of the Administration on Children, Youth and Families, in
the Department of Health and Human Services

References
Appleyard, K., Egeland, B., van Dulmen, M. H., & Sroufe, L. A. (2005). When more is not
better: The role of cumulative risk in child behavior outcomes. Journal of Child Psychology
and Psychiatry and Allied Disciplines, 46(3), 235.

Casanueva, C., Ringeisen, H., Wilson, E., Smith, K., & Dolan, M. (2011). NSCAW II base-
line report: Child well-being [OPRE Report #2011-27b]. Washington, DC: Office of
Planning, Research, and Evaluation, Administration for Children and Families, U.S.
Department of Health and Human Services.

Frederico, M. M., Jackson, A. L., & Black, C. M. (2005). Reflections on complexity: The 2004
summary evaluation of take two. Bundoora, Victoria, Australia: School of Social Work and
Social Policy, La Trobe University.

Frederico, M. M., Jackson, A. L., & Black, C. M. (2008). Understanding the impact of abuse
and neglect among children and young people referred to a therapeutic program. Journal
of Family Studies, 14(2/3), 342.

Acknowledgment: I thank Kate Stepleton for her assistance in the writing of this article.

27
Child Welfare Vol. 90, No. 6

Griffin, G., C., McClelland, G., Maj, N., Stolback, B., Holzberg, & Kisiel, M. (in press).
Diagnosing trauma before mental illness in child welfare. Child Welfare.

Institute on Healthcare Improvement. (2003). The breakthrough series: IHI’s collaborative model
for achieving breakthrough improvement [IHI Innovation Series white paper]. Boston:
Author.

Lyons, J. S., Small, L., Weiner, D. A., & Kisiel, C. (2011). Child and adolescent needs and
strengths: Illinois department of children and family services version 2.0. Chicago: Praed
Foundation.

Perry, B. P. (2008). Child maltreatment: A neurodevelopmental perspective on the role of

trauma and neglect in psychopathology. In T. P. Beauchine & S. P. Hinshaw (Eds.), Child
and adolescent psychopathology (pp. 93–128). Hoboken, NJ: John Wiley & Sons.

U.S. Department of Health and Human Services, Administration on Children and Families.
(2002–2011). AFCARS Reports Nos. 11–18. Washington, DC: Author.

U.S. Department of Health and Human Services, Administration on Children and Families.
(1998). Analysis of state child welfare data: VCIS survey data from 1990–1994. Washington,
DC: Author.

Wulczyn, F., Barth, R. P., Yuan, Y. T., Harden, B. J., & Landsverk, J. (2005). Beyond common
sense: Child welfare, child well-being, and the evidence for policy reform. New Brunswick, NJ:
Aldine Transaction.

Wulczyn, F., Chen, L., & Hislop, K. B. (2007). Foster care dynamics 2000–2005: A report from
the multistate foster care data archive. Chicago: Chapin Hall Center for Children at the
University of Chicago.

28
Copyright of Child Welfare is the property of Child Welfare League of America and its content may not be
copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written
permission. However, users may print, download, or email articles for individual use.