Bryan Samuels: Why removing a child from harm’s way should not simply mean ‘case closed’

IMG_5433 (10)The University of Chicago’s Bryan Samuels during his presentation to this year’s Helping Families Change Conference at Beurs Van Berlage  in Amsterdam.

Mounting evidence of the cumulative effects of complex trauma, toxic stress and adverse childhood experiences has helped shift the way that child support services are delivered across a number of US states, this year’s Helping Families Change Conference (HFCC) was told.

In his keynote address to the 17th annual HFCC in Amsterdam, the former director of the Illinois Department of Children and Family Services, Bryan Samuels, said that for the past 15 years, US state administrators had focused on the safety and permanency of children in the welfare system at the expense of outcomes based on child welfare.

“There is no doubt that children in harm’s way should be removed from a dangerous situation,’’ Mr Samuels said. “However, simply moving a child out of immediate danger does not in itself reverse or eliminate the way that he or she has learned to be fearful. The child’s memory retains those learned links and such thoughts and memories are sufficient to elicit ongoing fear and make a child anxious.’’

Conference delegates were told that children exposed to maltreatment experience a number of both immediate and delayed physical, cognitive, emotional and behavioural reactions (Briere and Scott 2006b; Foa, Stein and McFarlane, 2006; Pietrzak, Goldstein, Southwick and Grant, 2011).

Mr Samuels said the problem for welfare agencies in the US has been that removing a child from their home and finding another arrangement doesn’t necessarily mean “case closed’’. Problems can persist and sometimes increase following placement either back in the family home, in foster care or with relatives (Bellamy, 2008, Roller White et al, 2007, Simmel et al, 2007).

Trauma in childhood can affect a child’s ability to form friendships and healthy relationships later in life, in the development of their sense of self, in their ability to regulate emotional and physiological experiences, and in their cognitive abilities such as controlling and focusing attention, controlling impulses and acting meaningfully with the world.

Trauma in early life also can disrupt learning, memory and social behaviour. Long-term health effects include heart, liver, autoimmune and pulmonary disease. Evidence also shows that delayed behavioural reactions can include increased use of alcohol, drugs and tobacco while emotional reactions include anxiety, mood swings, depression, instability and emotional detachment.

“Removing a child from a dangerous environment will not by itself undo the serious consequences or reverse the negative impact of early fear learning,’’ Mr Samuels said.

“Simply focusing on getting the kids out of the system makes no sense when even the kids not in the system are struggling. You have an obligation to those children that goes beyond just getting the child out of the system.’’

In order to make the case that agencies need to focus on child wellbeing as a major outcome as well as safety and permanency, it was important to first understand and focus on the research. This included understanding the role of toxic stress.

Mr Samuels identified three levels of stress:

  • Positive: Brief increases in heart rate, mild elevations in stress hormone levels
  • Tolerable serious: Temporary stress responses buffered by supportive relationships
  • Toxic: prolonged activation of stress response systems in the absence of protective relationships

He said changing the system from within had required the development of staff and caregivers on the impacts of maltreatment and trauma, the creation of screening mechanisms to gather information from a number of sources and the redesign of case planning and management.

Next steps included the successful scaling up of evidence-based approaches, the creation of measurement and accountability systems and fostering co-operation among those with shared interests.

A copy of Professor Samuels’ presentation is available here.

Next year’s Helping Families Change Conference will be held in Banff, Alberta.