October 1st, 2011

Cuts to child trauma network affect programs

Since Congress formed the National Child Traumatic Stress Network in 2001 to develop, evaluate and improve treatment models for children suffering trauma, it has achieved one of its primary goals: to increase child and family access to services and programs across the country.

The network’s numbers back its success: Between July 2002 and Sept. 2009, when the organization compiled these statistics, the network’s 140 nationwide participating clinics and universities served 322,681 children in 38 states; the network developed 178 downloadable information “products” to educate law enforcement and medical communities about warning signs and trauma treatments, all available at the network’s Web site; and it trained 901,441 professionals from police officers to school officials helping traumatized children.

Various national organizations fund NCTSN. But with the country’s abounding financial uncertainty, the Obama administration has proposed a 70-percent cut to its budget. Some $40 million will evaporate from the organizations that depend on grant money to fund community treatment and outreach sites. Many of those programs were funded through 2012 and will struggle to maintain their operations. Three such organizations in New England are the Trauma Center at Justice Resource Institute in Brookline, Mass; the Institute for Health and Recovery in Cambridge, Mass., and Family Services of Rhode Island.

Understanding the cuts means understanding the breadth of NCTSN’s accomplishments. In the realm of government, it’s relatively new: the network’s adult counterpart, for example – the national Post Traumatic Stress Disorder Network – has been serving veterans and people coping with PTSD for nearly 40 years. Some involved with child trauma feel that for a group that has had little time to prove itself, there is much more work to be done. Others wonder if the government’s drastic cut is because NCTSN’s outreach numbers, people trained and uptick in products for the public are all so high.

“We’ve just started to get treatment for prototypical kids – homeless, developmentally delayed, the deaf, kids who are more vulnerable – but virtually no work [has been done] with lesser known [high-risk] groups,” says Joseph Spinazzola, Ph.D., an expert in assessing and treating childhood trauma as it manifests in children and adults. He notes east-Asian immigrants as one example of an underserved population.

Spinazzola has advocated for the NCTSN through his role as executive director at the Trauma Center at Justice Resource Institute (JRI), which provides comprehen

sive services to traumatized children and adults and their families. Funded by NCTSN since 2001 and a substantial subcontractor since 2003, JRI is also an affiliate of Boston University School of Medicine. In addition to clinical services, JRI offers training, consultation and educational programming for post-graduate mental health professionals.

NCTSN comprises three categories of sites and in 2009, JRI became a Category 2, designating it a national expert center on specific types of traumatic events, population groups and service systems for communities across New England and in some cases, other parts of the United States.

“Our goal is to feed trauma-informed initiatives,” says Spinazzola. “Our special area is victims of chronic trauma or ongoing neglect. Between 2005 and 2009, we trained over 40,000 providers primarily in New England. A quarter is in train-the-trainer programs – really intense – and serving thousands of kids. Our numbers would’ve been a fraction of that without the network.”

Several of JRI’s initiatives will end next year without NCTSN because the network funds one-third of JRI’s budget.

The Institute for Health and Recovery (IHR) has provided statewide service, research, policy and program development to care for youth and families affected by mainstream triggers of trauma in children and adolescents: alcohol, tobacco, drug use, mental health issues and violence. Its programming includes a list of licensed substance abuse outpatient services and clinical services for adolescents, emphasizing trauma informed services. The majority of its work is done in clients’ homes.

IHR’s budget is a patchwork of funding. According to Executive Director Norma Finkelstein, Ph.D., more than 50 percent comes from five or six state agencies like the Department of Children and Families, and the Department of Mental Health. Its largest comes from NCTSN.

Project BRIGHT highlights one of IHR’s focuses: women and children. Through a grant slated to run from 2009-2012 with now-dashed hopes of carrying beyond, Project BRIGHT has been addressing traumatic stress in children aged 0-5 and their parents in recovery from substance use disorders and co-occurring disorders. Treatment has been delivered in eight family residential treatment programs across Massachusetts. Through trained clinicians, child-parent psychotherapy was to be provided to 100 children and families. So far 60 have been served.

“It’s an unusual program,” says Karen Gould, LICSW, program director of Project BRIGHT. “Women don’t usually want to go into a residential treatment program if they’re going to be separated from their children.”

“The network provides so many valuable things…online publications on addressing trauma, a wealth of clinical interventions and literature,” says Finkelstein. “This is a country that is really concerned about prevention, and there is no more critical population to focus our prevention than these children.”

Eight years ago, Family Service of Rhode Island hired
Susan S. Erstling, LICSW, Ph.D., to run a replication in Providence of the Yale Child Study Center’s “Child Development-Community Policing” program, which provides 24/7 clinical response to children exposed to violence and trauma. As she grew the program, she and her colleagues realized a need for more follow-up and community-based services for children and families that was trauma informed and outcomes based. Family Service of Rhode Island was awarded a NCTSN grant to provide trauma-focused cognitive behavior therapy to sexually abused, physically abused and neglected children and their families. However, that may come to an end.

“This grant has allowed us to bring our trauma services to the R.I. Child Welfare System, and to integrate trauma-based knowledge into their work,” says Erstling, who has provided mental health services for 35 years. “For years, child welfare systems have operated without a trauma-focused lens, which neglects the basic underlying dynamic that exists for children in the child welfare system: that it is their experience of abuse,
neglect and loss that drives their behavioral and emotional issues.”

Erstling says that without NCTSN money, the ability for the child mental health and the child welfare system to work together is being threatened. “This will be a dramatic loss for all of us, and a disruption of collaborations which have begun all over the country.”

At greater risk is providing services to those who can least afford it.

“We will no longer be able to provide any direct service that is not funded by insurance; will have no funds to continue collaborative learning, research, school-based services, consultation or partnership initiatives,” says Erstling. “The progress that has been made will come to a dead end.”

Spinazzola says strong legislative efforts and appeals are being made to the powers that be to retain as much NCTSN funding as possible. Even after cuts are made, Spinazzola believes that the network’s archives will remain available for people to download.

By Jennifer E Chase

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