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Treating Childhood Trauma Becoming a Public Policy Priority

States and cities are trying to use science to create better policies and programs. New federal foster care rules are complicating their efforts.

Scared child sits in corner hugging a stuffed animal.
There’s a lot that’s indisputable about childhood trauma. Emotional or physical abuse early in life impacts health outcomes as children grow up. Community- and family-based approaches to dealing with trauma are better than institutional settings. And children of color are more likely to face traumatizing childhood experiences.

Those events can include something as common as divorce, but also encompass circumstances such as having an incarcerated parent, living with someone with a substance abuse disorder or being exposed to domestic violence. Traumatized children, experts know, are not only more likely to develop mental health problems but also to suffer from physical health challenges such as diabetes or heart disease later in life.

But despite what experts know, there’s still a lot they don’t, and in the past year or so there’s been a groundswell in the research and advocacy communities to understand more about what causes trauma in childhood and what are effective ways to address it. “The science is clear, but what we don’t know is how to apply it at the policy and practice level,” says Jennifer Jones, director of child and family systems innovation at the Alliance for Strong Families and Communities.

Last year, Wisconsin first lady Tonette Walker convened 11 governors’ spouses to learn from specialists about the science of childhood trauma and explore promising community approaches. This summer, “untreated trauma is the underbelly of violence” was the tagline for a public awareness campaign in New Orleans highlighting the need for people to talk to the “difficult” children in their neighborhoods. The Washington State Institute for Public Policy completed an in-depth cost-benefit analysis of all of the state’s trauma care programs. And there’s been a push around reshaping how to speak to traumatized children, such as asking, “What happened to you?,” rather than the more traditional -- and loaded -- question, “What’s wrong with you?”

Complicating the situation is federal legislation affecting how states will treat children needing foster care, who disproportionately have traumatic childhood experiences. Under the Family First Prevention Services Act passed in February, the feds will stop reimbursing states for children who stay for more than two weeks in group homes that aren’t certified to serve youngsters with severe mental health needs. The federal government will, however, offer financial incentives for states to try evidence-based programs that keep families together.

While child welfare advocates applaud upstream efforts like family preservation, the move away from group homes will be difficult for states to achieve before the October 2019 deadline, given how hard it already is to find foster families: From 2012 to 2017, half of the states saw decreases in their rolls of foster families, according to The Chronicle of Social Change.

The new federal rules “would be like if the Affordable Care Act said it wasn’t going to cover hospital stays,” says Matthew Stagner, vice president and director of human services at Mathematica Policy Research. “Of course we want to move away from residential housing, just like we want to reduce hospital stays. But this is a pretty blunt instrument.”

For now, those who research and deal with childhood trauma and its lifelong aftermath hope Washington will allow states to be creative. “We have to ensure that these promising practices are science-aligned and using the latest advances in neural science,” says Jones of the Alliance for Strong Families and Communities. “We also want to make sure we’re leaving room for innovative solutions, since we are still learning what works.”

Mattie covers all things health for Governing.

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