trauma-informed_practice_guide.pdf

Healing Families, Helping Systems:
A Trauma-Informed Practice Guide
for Working with Children, Youth and Families
J A N UA RY 2017

Acknowledgments
WRITERS

Nancy Poole, Christina Talbot and Tasnim Nathoo,

BC Centre of Excellence for Women’s Health

WORKING GROUP

Julie Adams, BC Ministry of Children and Family

Development (MCFD), Child and Youth Mental

Health Policy

Leslie Anderson, MCFD, Child Welfare Policy

Dayna Long, MCFD, Youth Forensic Psychiatric Services

Dr. Natalie Franz, MCFD, The Maples Adolescent

Treatment Centre

Janet Campbell, MCFD, Regional Child and Youth

Mental Health Coordinator, Coast Fraser Region

Karen Sam, MCFD, Aboriginal Services Branch

Terry Lejko, MCFD, Director of Practice,

Coast North Shore SDA

Kim Dooling, MCFD, Practice Consultant,

Provincial Practice Branch

Kim Hetherington, MCFD, Early Childhood

Development/Children and Youth with Special Needs

Chris Burt, Hollyburn Family Services

Ben Eaton, School District 8 (Kootenay Lake)

ADVISORY COMMITTEE

Robert Lampard, MCFD, Child and Youth Mental
Health Policy

Aleksandra Stevanovic, MCFD, Child and Youth
with Special Needs, Autism and Early Years Policy

Karen Bopp, MCFD, Child and Youth
with Special Needs, Autism and Early Years Policy

John Yakielashek, MCFD, Director of Practice,
South Island

Stephanie Mannix, MCFD, Aboriginal Policy Branch

Twila Lavender, Ministry of Education,
Comprehensive School Health

Kelly Veillette, Ministry of Health, Health Services
Policy and Quality Assurance Division

Christine Westland, First Nations Health Authority

Judith Wright, Victoria Child Abuse Prevention
and Counselling Centre

Julie Collette, Families Organized for Recognition
and Care Equality ( The F.O.R.C.E.) Society for Kids’
Mental Health

Traci Cook, The F.O.R.C.E. Society for Kids’ Mental Health

Dan Malone, Foster Parent Support Services Society

Angela Clancy, Family Support Institute of BC

THIS GUIDE IS INTENDED to guide the professional work of practitioners assisting children,
youth, and families in British Columbia.

IT IS BASED ON: findings from current academic and grey literature; lessons learned from implementation
in other jurisdictions; and ideas offered by practitioners from the Ministry for Children and Families in BC in
web meetings held in February 2015.

AN IMPORTANT GOAL OF THE GUIDE is to build upon existing promising practices to improve support
and expand relationships with families, other practitioners and other systems of care.

THIS DOCUMENT IS AVAILABLE AT gov.bc.ca/traumainformedpractice

1TRAUMA-INFORMED PRACTICE GUIDE FOR WORKING WITH CHILDREN, YOUTH AND FAMILIES

Contents
1. INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

1.1 Project Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

1.2 Intended Audience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

1.3 The Rationale for this Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

2. UNDERSTANDING TRAUMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

2.1 Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

2.2 Trauma Prevalence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

2.3 Effects of Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

3. TRAUMA-INFORMED – DEFINITION AND PRINCIPLES. . . . . 10

3.1 What do we mean by Trauma-Informed? . . . . . . . . . . . . . . . . . . . . 10

3.2 What do we mean by Trauma-Specific? . . . . . . . . . . . . . . . . . . . . . . 11

3.3 Principles of Trauma Informed Practice . . . . . . . . . . . . . . . . . . . . . . 13

4. IMPLEMENTING TRAUMA-INFORMED APPROACHES . . . . . 15

4.1 TIP in Interactions with Children and Youth . . . . . . . . . . . . . . . . . . 16

4.2 TIP in Interactions with Families . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

4.3 TIP for Worker Wellness and Safety . . . . . . . . . . . . . . . . . . . . . . . . . 24

4.4 TIP at the Organizational Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

4.5 TIP at the Leadership Level – Relational System Change . . . . . 29

OVERVIEW OF GUIDE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

GUIDE SUMMARY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

APPENDIX 1: PRACTICAL TIP STRATEGIES
FOR WORKING WITH CHILDREN, YOUTH
AND FAMILIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

APPENDIX 2: TRAUMA-INFORMED
PRACTICE PRINCIPLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

2 TRAUMA-INFORMED PRACTICE GUIDE FOR WORKING WITH CHILDREN, YOUTH AND FAMILIES

1. Introduction

1.1 Project Objectives
This guide is concerned with advancing
understanding and action about trauma-informed
approaches that support program and service
delivery for/with children, youth and families.
A trauma-informed approach is a system-wide
approach that is distinct from, yet linked to,
the delivery of trauma-specific treatments and
interventions.

This guide is the result of a project of the Ministry
of Children and Family Development in British
Columbia with the following objectives:

• TO IDENTIFY TRAUMA-INFORMED
APPROACHES to supporting children, youth
and families, from the academic and non-
academic literature and from the experience of
those delivering child and youth services in B.C.
(child protection, youth justice, child and youth
mental health, children with special needs, early
years services, and family, youth and children
in care services and adoption services).

• TO RAISE AWARENESS among those
delivering child and youth services in
B.C. of evidence-informed approaches to
trauma-informed service delivery.

• TO INCREASE CAPACITY amongst
service providers delivering child and youth
services in B.C. to better serve children,
youth and families impacted by violence
and trauma, and thereby improve outcomes
for those engaged with these services.

1.2 Intended Audience
This Trauma-informed Practice ( TIP) Guide is
designed to inform the work of leaders, system
planners and practitioners working with children,
youth and families within the service areas of
the British Columbia Ministry of Children and
Family Development and Delegated Aboriginal
Agencies. This document may also be relevant to
those working with children, youth and families in
other settings such as schools, hospitals and other
community-based settings.

1.3 The Rationale for this Guide
Experiences of trauma, arising from childhood
abuse, neglect, witnessing violence and disrupted
attachment, as well as other life experiences such
as accidents, natural disasters, sudden unexpected
loss, war/terrorism, cultural genocide and other
life events that are out of one’s control – affect
almost everyone in child and youth serving
agencies. Children and their caregivers, therapists
and administrators, program planners and support
staff are all affected by these types of traumatic
experiences, either directly or indirectly.

Trauma-informed approaches to serving children,
youth and families recognize how common the
experiences of trauma are, and the wide range of
effects trauma can have on both short-term and
long-term health and well-being. Trauma-informed
approaches involve a paradigm shift to support
changes in everyday practices and policies to factor
in the centrality of trauma for many children, youth,
and families, and our growing understanding of how
to promote resilience. The overall goal of trauma-
informed approaches is to develop programs,
services, and environments that do not re-traumatize
while also promoting coping skills and resilience.

3TRAUMA-INFORMED PRACTICE GUIDE FOR WORKING WITH CHILDREN, YOUTH AND FAMILIES

FURTHER READING/LINKS

• Harris, M., & Fallot, R. (2001). Using trauma
theory to design service systems.
San Francisco: Jossey-Bass.

• Hodas, G. (2006). Responding to childhood
trauma: The promise and practice
of trauma-informed care. Retrieved
from Echo Parenting and Education
http://ccyp.vic.gov.au/childsafetycommissioner/
downloads/calmer_classrooms.pdf

• Trauma-informed Practice Guide (2013)
British Columbia Centre of Excellence for
Women’s Health  and Ministry of Health,
Government of British Columbia. http://bccewh.
bc.ca/2014/02/trauma-informed-practice-guide/

• Truth and Reconciliation Commission of Canada:
Calls to Action (2015).
http://www.trc.ca/websites/trcinstitution/
File/2015/Findings/Calls_to_Action_English2.pdf

WEBSITES

• National Child Traumatic Stress
Network website: www.nctsn.org

• National Center for Trauma-Informed Care
website: http://www.samhsa.gov/nctic

• The Adverse Childhood Experiences (ACE)
Study website: http://acestudy.org

• The National Collaborating Centre for
Aboriginal Health: www.nccah-ccnsa.ca

• PHSA San’yas Indigenous Cultural Safety:
http://www.sanyas.ca

The foundation of trauma-informed approaches is
the wealth of research we now have on integrated,
evidence-informed approaches that support brain
development and resilience. Providing safety, choice,
and control to individuals who have experienced
trauma is the starting place and encourages us all
to work in ways that can make a positive difference
by reducing the short-term effects of trauma,
supporting long-term healing, and creating systems
of care that support staff, children, youth and
families alike.

A key aspect to trauma-informed practice is that it is
delivered in a culturally safe manner to people from
diverse backgrounds [2, 3]. This includes cultural
sensitivity toward Aboriginal peoples, refugees,
immigrants, and people of different religions,
ethnicities and classes, and requires a commitment
to ongoing professional development in cultural
agility. Current Truth and Reconciliation processes
are assisting Canadians to become more aware
of the devastating intergenerational impacts of
residential schools and other forms of institutional

abuse on Aboriginal people’s cultural identity,

health, and parenting. Trauma-informed practice

is a component of broader healing strategies that

help address historic and intergenerational trauma

experienced by Aboriginal peoples.

Being trauma-informed is a fundamental tenet of the

Circle process outlined in the Aboriginal Policy and

Practice Framework in British Columbia (APPF) and this

guide respects and aligns with that document [3].

The APPF is a trauma-informed framework that

recognizes the importance of culturally safe

interactions with Aboriginal communities. The

APPF provides context to the historical and

intergenerational component of gathering the

Circle. This Trauma-Informed Practice Guide was

developed to align with the values and principles

outlined in the APPF, and can help to inform those

working to incorporate the APPF into their practice

with Aboriginal children, youth and families. Utilizing

these two documents in tandem will help to

strengthen culturally safe and holistic practice.

http://www.trc.ca/websites/trcinstitution/File/2015/Findings/Calls_to_Action_English2.pdf

http://www.trc.ca/websites/trcinstitution/File/2015/Findings/Calls_to_Action_English2.pdf

http://www.nctsn.org

http://www.samhsa.gov/nctic

http://acestudy.org

http://www.nccah-ccnsa.ca

http://www.sanyas.ca

4 TRAUMA-INFORMED PRACTICE GUIDE FOR WORKING WITH CHILDREN, YOUTH AND FAMILIES

2. Understanding
Trauma

This section defines trauma, provides some data on
how common it is, and briefly describes key effects
of trauma on children and youth.

2.1 Definitions
Trauma has been described as having three aspects:
exposure to harmful and/or overwhelming event(s)
or circumstances, the experience of these event(s)
which will vary from individual to individual, and
effects which may be adverse and long-lasting
in nature [3, 4].

There are a number of dimensions of trauma,
including timing of first exposure, magnitude,
complexity, frequency, duration, and whether it
occurs from an interpersonal or external source.
Two types of trauma particularly relevant to children
and youth are developmental and intergenerational
trauma. Developmental trauma results from
exposure to early traumatic stress (as infants, children
and youth) and is related to neglect, abandonment,
physical abuse or assault, sexual abuse or assault,
emotional abuse, loss and separation, witnessing
violence or death, repeated grief and loss, and/or
coercion or betrayal [5-8]. Developmental trauma
can also be related to prenatal, birth, and perinatal
experiences such as experiences involving poor
prenatal care, a difficult pregnancy or birth and/
or early hospitalization. Often the term complex
developmental trauma is used to acknowledge the
impact of multiple or chronic exposure to trauma in
the caregiving relationship. Children and youth may
also experience system-induced trauma through
exposure to invasive medical treatments, youth
incarceration or involvement in the justice system,
and multiple moves in foster care.

Intergenerational trauma describes the
neurobiological and/or psychological effects that
can be experienced by people who have close
connections with trauma survivors. Coping and
adaptation patterns developed in response to
trauma can be passed from one generation to the
next [9]. The historical and intergenerational trauma
related to colonization (past and present), the Indian
residential school experience, Indian Hospitals, the
‘60s Scoop and other forms of systemic oppression
experienced by Aboriginal peoples in Canada has
had a devastating impact on Aboriginal families and
communities [10, 11]. Manifestation of trauma is
illustrated by the elevated levels of suicide, mental
health issues and substance use amongst Aboriginal
communities and is associated with continuing
family separation, high levels of incarceration and
high rates of violence against Aboriginal girls and
women [12]. Involvement with institutionalized
services may be triggering for some Aboriginal
people, who may in turn appear disinterested or
disengaged from the service. Disengagement is
likely due to collective post-traumatic impacts
based on a shared history of colonization and
the imposition of a Western model of health than
it is about the dislike of any particular worker.
“Embarking on a pathway towards restorative policy
and practice is impossible without understanding
the shared history of colonization and the attempted
destruction of Aboriginal cultures.This history
continues to intergenerationally impact the lives of
Aboriginal children, youth, family and communities
today and continues to contribute to a climate of
mistrust and divisiveness.” [3].

The workforce in systems of care serving children,
youth, and families affected by trauma can also be
affected. Some of the terms that have been used
to describe the effects of trauma exposure in the
workplace are: vicarious trauma; trauma exposure
response; secondary trauma; compassion fatigue;
and empathic stress. Vicarious traumatization refers
to “the cumulative transformative effect on the
helper working with the survivors of traumatic life
events” [13]. The effects of vicarious trauma occur

5TRAUMA-INFORMED PRACTICE GUIDE FOR WORKING WITH CHILDREN, YOUTH AND FAMILIES

on a continuum and are influenced by the amount
of traumatic information a practitioner is exposed to,
the degree of support in the workplace, personal life
support, and personal experiences of trauma.

Post-traumatic growth refers to the positive
psychological growth some people report once
they have had the opportunity to heal from their
negative experience(s) [14, 15]. For example,
some people report a greater appreciation for life,
increased compassion and empathy for others and/
or an increased recognition in their human potential
and personal strengths.

While developmental, intergenerational, historical
and vicarious trauma are most relevant to this
guide, there are many other forms of trauma and
responses to trauma which can affect children, youth
and families (as mentioned in the Rationale section
above). Readers are encouraged to follow up on the
links identified throughout this document for further
information on types of trauma and approaches
to mitigating its effects.

2.2 Trauma Prevalence
Trauma arises from many forms of neglect, abuse,
violence, loss, witnessing of violence and other
overwhelming life events. Individuals react to and
cope with these potential sources of trauma in
different ways. We do not have Canadian data on
prevalence for all forms of trauma, nor details on
how prevalence rates vary by different subgroups
of children, youth and families. The following
5 examples are drawn from available data:

• A 2008 survey of 10,000 Canadian youth revealed
high rates of trauma; 21% of girls and 31% of
boys reported physical abuse, while 13% of girls
and 4% of boys reported sexual abuse [16].

• In the 2013 BC Adolescent Health Survey, 5% of
females and 10% of males reported being physically
attacked or assaulted, 13% of females and 4% of
males were sexually abused, and 4% of all students
who completed the survey experienced both sexual
and physical abuse (6% of females; 1% of males).
Students were asked to report on stress, despair,
sadness, self-harm and suicide attempts. Of those
youth who reported self-harm, 43% also reported
using substances to “manage stress” compared

to 14% of all students who tried substances [16].

• Rates of endorsement of traumatic distress and
thoughts of suicide were notable in a Canadian
evaluation of youth in a concurrent dis s
program, with 90% of female and 62% of male
youth endorsing concerns with traumatic distress
[17]. Such findings highlight the need for trauma-
informed services, early identification of concerns
and access to specialized interventions [18].

• In a study of the prevalence of mental dis s
and mental health needs among incarcerated
male and female youth in British Columbia, it was
found that, when compared with males, females
had significantly higher odds of presenting
with substance use/dependence dis s;
current suicidal ideation; sexual abuse; PTSD;
and symptoms of depression and anxiety [19].

• In a review of 31 cases of critical injury or death
of children in care reported to the Office of the
Representative for Children and Youth in BC for
the period of 2010-2011, all had experienced
trauma earlier in their lives. Early traumatic
experiences within their family of origin included
physical abuse by a family member, sexual abuse
by a family member, neglect by their family,
exposure to domestic violence, and/or exposure
to problematic substance use in the family [20].

GENDERED PREVALENCE
OF CHILD AND YOUTH TRAUMA

The experiences and effects of trauma among
children and youth are different based on sex and
gender identity. Boys are more likely to experience
physical assault, physical bullying, and physical
threats, and are slightly more likely to have
witnessed violence [21, 22]. One study found that
boys reported significantly greater exposure to both
interpersonal and non-interpersonal traumatic life
events [24].

However, girls are more likely to experience sexual
victimization, psychological and emotional abuse,
internet harassment, and emotional bullying. One
study found that girls were more likely than boys to
have experienced sexual abuse and to report greater
clinical levels of PTSD symptoms and disassociation
symptoms [25].

6 TRAUMA-INFORMED PRACTICE GUIDE FOR WORKING WITH CHILDREN, YOUTH AND FAMILIES

Rates of childhood sexual abuse are typically higher
among girls (25% vs 16%) [23]. Girls in residential
group care report high rates of childhood sexual
abuse [24]. Rates of forced sexual activity are also
higher among girls and young women, and have
also been linked with trauma symptoms and
antisocial behaviours [25].

CHILDREN AND YOUTH WHO
ARE PARTICULARLY VULNERABLE

Children and youth are vulnerable to the negative
effects of traumatic experiences due to the
predictable and sequential process of brain
development. Emerging research on the developing
brain indicates that children who have experienced
abuse and neglect in infancy and early childhood
are at a greater risk for developing maladaptive
behaviours and mental health problems as they
get older [26].

Some children and youth are more likely to
experience traumatic events than others. Vulnerable
groups include: children and youth living on a
low income or living with a parent with mental
illness or their own unresolved trauma histories
[27-29]; lesbian, gay and bisexual youth [30-34];
transgender children and transsexual children
and youth, including two-spirit youth; Aboriginal
children and youth [35, 36]; and children and youth
with disabilities [37, 38]. For example, lesbian,
gay and bisexual youth report very high rates
of verbal victimization [39], as well as sexual and
physical abuse and assault at school [32], and
sexual orientation victimization among this sub-
group has been associated with post-traumatic
stress symptoms [31]. Rates of sexual and physical
abuse and maltreatment (both in the home and in
institutional settings) are much higher among deaf
children and youth, and the communication barriers
that these youth experience may prevent disclosure
and/or exacerbate trauma [40]. Youth with hearing
loss report greater and more severe physical abuse
than other youth [41].

Trauma also appears to increase the risk for
involvement in the youth justice, child welfare and
foster care systems. Several studies reveal that youth
involved in the justice system [41-43], youth who are

incarcerated [44] and youth in foster care [45] and
child welfare systems [45, 46] report very high rates
of traumatic experiences.

2.3 Effects of Trauma
Our understanding of the effects of trauma on
children and youth is ever expanding. A key study
that has influenced our understanding and action
is the Adverse Childhood Experiences Study, which
linked early childhood trauma to long term health
and social consequences (See http://www.acestudy.
org/). Our increasing understanding of trauma is
aided by our ability to link evidence of the effects
related to brain functioning, with those related
to the social determinants of health, and to apply
both these sources of evidence in our practice and
policy. This section provides a brief overview of the
potential effects of trauma on children, youth and
families. A key principle of trauma-informed practice
is becoming aware of these effects, so that we offer
welcoming, compassionate, culturally competent
and safe support universally in child serving systems.

The centrality of trauma to development:
For children, exposure to trauma can have a range
of consequences, impacting brain development,
attachment, emotional regulation, behavioural
regulation, cognition, self-concept, and the
progression of social development [47].

Many factors affect an individual’s trauma response:
Culture, gender, age/developmental stage,
temperament, personal resilience, trauma type
(acute, chronic, complex, intergenerational, historical
and vicarious) as well as the duration and onset will
influence the way an individual responds.

Experiences of trauma can have a range of negative
effects: Following a traumatic experience, the
majority of children and youth will experience acute
symptoms [48]. While these symptoms may decrease
with time, the period of recovery is dependent
on many factors including: duration and severity
of trauma, emotional health, caregiver support
following trauma, and previous exposure to other
traumatic events [21, 48-50]. Such symptoms may
include:

http://www.acestudy.org/

http://www.acestudy.org/

7TRAUMA-INFORMED PRACTICE GUIDE FOR WORKING WITH CHILDREN, YOUTH AND FAMILIES

Physical effects such as:
• fatigue
• headaches
• pain
• insomnia
• gastrointestinal upset
• exacerbation of existing health issues [48]

Emotional effects, such as:
• anxiety
• fear
• panic
• depression
• feelings of helplessness [48]

Relational issues may include trust or attachment
issues with caregivers, and a decrease in academic
performance in school [48, 51].

Neurobiological contributions to our understanding
of trauma: Traumatic experiences that take place
during the critical window of the first five years of
early childhood impact the brain in multiple areas
and can actually change the structure and function
of the developing brain, including structures
involved with regulating stress and arousal [6]. Since
the brain develops in a use-dependent manner,
chronic activation can lead to the development of an
overactive and overly reactive stress response system
[52, 53]. The cortisol response in those exposed to
childhood trauma is typically dysregulated, resulting
in an overactive immune response which may
increase their risk of stress related dis s as well as
infections and chronic health issues [54, 55]. Children
and youth who have experienced traumatic events
may have a reduced ability to regulate emotions and
poorer intellectual functioning [56]. Children who
have experienced severe traumatic experiences such
as neglect, may exhibit cognitive impairments and
communication issues [57, 58]. These changes in
brain function may continue into adulthood and be
associated with heart disease, diabetes, substance
use problems and other chronic health problems.
It can be seen how central trauma can be to the
ability to self-regulate, communicate and learn.

Acute trauma and complex trauma can have
different effects:

Acute trauma refers to the response to a single
traumatic event. Acute trauma may result
in trust and security issues, issues regarding
development of independence and autonomy,
separation anxiety and temper tantrums among
young children (age 0-5) [48]. Among somewhat
older children, acute trauma may result in sleep
disturbances, stunting in physical growth, poor
concentration and lower academic performance,
issues with impulse control, irritability and
behavioral issues [48]. Acute stress dis is
linked to acute trauma[59]. It is similar to post-
traumatic stress dis (see below), causes
significant distress or impairment, but symptoms
are not as severe and recovery in functioning
happens more quickly.

Complex trauma refers to the response to
ongoing traumatic events, particularly by
interpersonal experiences perpetrated by
caregivers. Complex trauma may have more
significant effects on emotional, physical and
behavioral health than acute trauma [48, 56].
Among young children (age 0-5 years), complex
trauma is associated with: developmental delays,
trust and security issues, hyper-arousal and
disassociation, issues with emotional regulation,
attachment issues, temper tantrums, and severe
separation anxiety [48, 54, 60]. Among older
children and youth (age 6 and older), complex
trauma has been associated with medical
problems, sleep issues, decreased growth,
learning disabilities, issues with boundaries
and impulse control, apathy, low self-esteem,
problems with peer relationships, oppositional
behaviours, and suicidal ideation [48, 54, 61].
It is important to remember that ‘multiples
matter’: repeated traumatic experiences create
higher risk. It is also important to remember that
traumatic events are not the only adversity that
children and youth may experience: children
and youth with more complex or multiple
needs are more likely to have experienced
multiple adversities such as parental mental

8 TRAUMA-INFORMED PRACTICE GUIDE FOR WORKING WITH CHILDREN, YOUTH AND FAMILIES

illness and substance use challenges, poverty,
family conflict, divorce, and other family and
community level adversities[62]. A trauma-
informed approach includes understanding
how the presence of protective factors and
family strengths can mitigate the risks of
trauma exposure, and how their absence
can increase risks.

Post-traumatic stress dis (PTSD): Post traumatic
stress dis is a mental health dis arising
from exposure to trauma involving death or the
threat of death, serious injury, or sexual violence.
Not all children and youth who experience traumatic
events develop post-traumatic stress dis ,
but many children who experience physical
or sexual abuse or who are exposed to violence
develop at least some of the symptoms such as
numbing, arousal, re-experiencing the traumatic
event or avoidance [63].

Protective buffers: A developing fetus or child may
experience traumatic or toxic stress if they are
exposed to chronic threat or traumatic stress in
the absence of protective buffers [64]. A protective
buffer is a care provider who is attuned to the child’s …