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To Help Youth with Trauma Brain, Treat Entire Family

Cathy Anthofer-FialonIn juvenile justice we have been making space to recognize and address the traumas youth have experienced. However, juvenile justice still lacks in addressing parental trauma of these youth. Can we treat, heal and prevent reoffending in a youth if we have not treated and healed the primary parent of the youth?

The juvenile justice system has evolved and continues to evolve from a mentality of accountability = punishment. The latest evolution has those of us working in juvenile justice donning our trauma-informed lenses, working to decipher what traumas may have adversely impacted the youth we’re working with. This practice is supported by research and opinion.

For more information, visit the JJIE Resource Hub

The research now informing practice demonstrates that more than half of adjudicated youth report four or more Adverse Childhood Experiences. For many in the field this has provided new interventions and practices. Language is beginning to change, use of detention versus treatment is being balanced. Juvenile courts are working to make sense of trauma-brain-driven actions versus choice and accountability. The focus mostly rests on examining the adjudicated youth for trauma, treatments, healing and accountability.

However, we can’t talk trauma without talking family. We can’t talk family without actually talking to the family about the trauma experienced by the youth. The family may not be the cause of the trauma; however, family is central to healing.

Long before research supported the trauma/delinquency link, delinquency and family were only linked in theories of social control. These social control theories argue that delinquency occurs when a youth has a weak bond to society and these bonds are ultimately learned in the family.

Now science tells us differently. Now we know that a brain consistently met with adverse childhood experiences like witnessing domestic violence, not having enough to eat, having a biological parent leave or go to prison, being sexually or physically abused actually changes a child’s brain.

The child’s brain can become a “trauma brain.” This trauma brain develops after being locked in a state of fight/flight/freeze with the corresponding hormones flooding the body, impacting physiological health and mental health. Juvenile justice professionals are recognizing this reality, and the system is slowly evolving to make space for trauma.

For example, most juvenile probation officers no longer talk about “dirty” drug tests or tell a youth they are “dirty” for testing positive on a drug test. We have learned this kind of language can retraumatize or trigger a youth who has experienced abuse, especially sexual abuse. Similarly, those who work with delinquent youth are learning that trauma may contribute significantly to poor decision-making, anger, substance use and even defiant attitudes. But what is the trauma source? What is the trauma magnifier?

[Related: Report Looks At Best Practices for Addressing Trauma in Diversion]

If we only treat the trauma, but don’t consider the sources or the magnifiers, then that youth may stay locked in trauma brain. That youth may be at greater risk for probation violations or committing future crimes or even move into committing adult crimes.

We must be willing to look beyond the youth in front of us. If the adverse childhood experience originated in the family, then we must consider the family. If the adverse childhood experience originated outside the family (i.e.: adopted youth, sexual abuse originating outside the family, natural disasters), we must still address the family’s reaction to the traumatized youth.

Most importantly, we must make space for trauma members of the family may have experienced. If a parent abuses a youth, it is likely the parent was abused. Has the parent’s trauma been addressed or just punished?

We cannot expect a delinquent youth to heal from trauma if we place the youth right back into the environment where the trauma occurred, even if the trauma has stopped. For example, if a child witnesses domestic violence, science tells us that the child is more likely to have health issues, school issues, substance abuse issues and/or delinquency issues.

Even if the battered parent becomes the primary parent and separates from the abuser, we know that battered parent’s brain has probably been changed by trauma. How can an adult with a traumatized brain be the sole support for a youth with a traumatized brain? We can’t expect change if the youth is to return to a home of chaos, where the trauma occurred.

The solution lies in working with the entire family. Wrap-around services begin to address this problem. However, not all families qualify for wrap-around services. Family courts have a history of ordering family therapy to address issues in the family, which is important.

However, family therapy does not allow a parent of trauma to fully address individual issues. Research informs us: “when a mother had 3 or more ACEs, she was more likely to have mental health problems in the year after she had her baby, and she also tended to struggle with the feeling like she wasn’t a good parent.” To truly impact the negative effects of Adverse Childhood Experiences in delinquent youth, they must live in families where the adults have support to address their own Adverse Childhood Experiences and/or recent traumas separate from family therapy.

We can no longer ignore the negative impacts of Adverse Childhood Experiences and their ability to not only imprint, but steer, all future generations in a family. Work must be done to address the traumas, heal the traumas and build resiliency in all members of the delinquent youth’s family.

Dr. Cathy Anthofer-Fialon is the program manager for the 13th Circuit Family Division in Grand Traverse County, Michigan. She's passionate in moving her local community and region to become trauma-informed and active in building resilience.

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Report Looks At Best Practices for Addressing Trauma in Diversion

Teenager boy worried sitting on the floor

When officials in four states were asked several years ago what tools they would need to divert youth from the juvenile justice system, a better understanding of trauma was at the top of all their lists.

They wanted to help youth with behavioral conditions when they are evaluated for probation but said they couldn’t do so most effectively without understanding how traumatic experiences had affected the adolescents.

A new report sets out a  framework for trauma-informed diversion that grew from those states’ experiences and additional research into best practices. It’s intended as guidance for other juvenile justice officials considering reforms to address trauma.

Karli Keator, division director at the National Center for Mental Health and Juvenile Justice
Karli Keator, division director at the National Center for Mental Health and Juvenile Justice

“If four independent states are identifying this as their biggest challenge, they’re not the only ones,” said Karli Keator, division director at the National Center for Mental Health and Juvenile Justice. The center and the Technical Assistance Collaborative Inc. worked with the four states — Georgia, Indiana, Massachusetts and Tennessee — as part of the 2014-15 Policy Academy-Action Network Initiative and released the report.

hub_arrow_2-01Research shows many youth who have contact with the juvenile justice system are dealing with mental health or substance use disorders, and most also have experienced at least one traumatic event. Because trauma can interact with mental health or substance use disorders in ways that intensify those issues, a trauma-informed system plays an important role in helping youth, according to the report.

“By more effectively responding to traumatic stress, probation officers and others in the justice system can expect youth to experience increased levels of success with diversion services and more fully comply with dispositional requirements. Better life outcomes should also be realized,” the report says.

It identifies nine key elements needed to develop a trauma-informed diversion program for youth with behavioral conditions. The elements include leadership, cross-sector collaboration, policy and procedures, funding strategies and workforce development.

The elements are rooted in a report about trauma by the Substance Abuse and Mental Health Services Administration but tailored to the needs of juvenile justice systems.

The report details each element and provides case studies from the four states. Under leadership, for example, the report shows the importance of identifying champions and linking leaders across systems, such as law enforcement, education and public health. Under policy and procedures, the report includes information on internal policies, memoranda of understanding between agencies and legislation.

The case studies tell of the role of a probation officer in Georgia who championed reform, engaging youth in Tennessee, and family involvement in Massachusetts.

Keator said much work remains to be done across the country to build trauma-informed diversion policies. States also will need to think about how to best identify kids in need, make appropriate referrals to services that are designed to address trauma and provide follow-up support.

“It’s not a one-and-done approach. We need a continuum,” she said.

In Georgia, state officials and their community partners built on earlier efforts to build a trauma-informed system. They were able to pinpoint when and how to screen youth in ways that are so far showing success, said Christine Doyle, director of the Office of Behavioral Health at the Georgia Department of Juvenile Justice.

“The information we have anecdotally is that it’s going well. The kids are responding to the screenings. They’re answering the questions, the referrals are being made and the kids are getting services,” she said.

Doyle said that while every state will have its own needs and solutions, collaboration is critical no matter the situation.

“Building a strong team is an essential piece to doing this work. No one organization or agency can do it alone,” she said.

Report: Juvenile Justice System Must Substantively Revamp Treatment of Girls

Gender Inequality - System-Level Juvenile Justice for GirlsJuvenile justice reformers risk leaving girls behind if they fail to consider how traumatic experiences push girls into the system, says a new report.

Officials and advocates are more aware than ever of the way trauma affects girls’ behavior, but too few reforms are tailored to those experiences, said Francine T. Sherman, lead author of the report and a clinical law professor at Boston College Law School.

“Not only are we not fixing it, we are in an unfair and biased way penalizing girls for their background,” she said.

The report, “Gender Injustice,” examines how trauma shapes girls’ behavior and how girls end up in the juvenile justice system, and recommends reforms to help girls rather than penalize them.

Sherman and co-author Annie Balck call on the juvenile justice system to end policies that criminalize such behaviors as running away or fighting at home, to engage families, to use trauma-informed approaches, to promote positive youth development, to limit secure confinement and to use health care funding to help girls who have experienced trauma.

“The strategies are out there, but they’re not being applied intentionally,” Sherman said. “There are all these opportunities to do a better job.”

[Related: Girls in Justice System Often Traumatized Victims of Abuse]

She pointed to diversion from the juvenile justice system into community programs as one method that many jurisdictions pursue but that could be more effective for girls if it targeted their experiences.

At the other end of the system, jurisdictions should look carefully at their secure facilities for girls, where often only a few girls are being held, Sherman said. Girls have sometimes been an afterthought because they are so few, but that’s precisely why systems should look for solutions, she said.

The report was released through The National Crittenton Foundation and the National Women’s Law Center.

History of trauma

Research has shown girls in the justice system often have experienced abuse, violence, adversity and deprivation. Studies have found 31 percent of girls in the juvenile justice system have experienced in-home sexual abuse and 84 percent have experienced family violence.

Those experiences lead to behaviors that push girls toward the justice system, the report said.

The researchers highlighted data that shows girls’ share of the juvenile justice system has grown during the past 20 years at all stages, including arrest, court caseloads, detentions and probation.

In 2012, girls were 29 percent of youth arrested nationwide, compared with 20 percent in 1992, even as the number of arrests declined overall. Girls’ arrests were disproportionately for offenses that were not public safety threats, such as prostitution or theft.

Once girls are arrested, they risk moving deeper into a system that is not prepared to meet their needs, the report said.

Girls also are more likely than boys to be detained for status offenses (behaviors such as running away or breaking curfew, which would not be crimes if committed by adults), technical violations and for simple assault.

Those are offenses that would be better dealt with in girls’ communities than in detention, the report said.

Liz Ryan, chief executive officer of the Youth First! Initiative, said the report is a road map for how to change that experience — and comes at a time when reformers are open to ideas about girls.

“There’s this rhetorical phrase a lot of us have: ‘What about the girls?’ I want to get to a point where I don’t have to ask the question in meetings,” she said.

Ryan said the report highlights important concrete strategies to help girls, such as ending the valid court order exception for status offenses (which lets judges issue detention orders) and ensuring mandatory arrest policies for domestic violence don’t inadvertently affect girls.

The report also looks at how particular populations of girls are affected by the juvenile justice system. Girls of color and lesbian, bisexual, questioning/gender-nonconforming and transgender girls face additional barriers to appropriate care, the authors said.

Reformers also need to think carefully about the particular needs of girls who are pregnant or parenting, have run away or are victims of sex trafficking or in-home violence, the report said.

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Report: Trauma Work in Connecticut Must Continue

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Report: Trauma Work in Connecticut Must Continue

Many services for children and families in Connecticut incorporate trauma-informed care, but more needs to be done to improve outcomes for children, according to a new report from the Child Health and Development Institute of Connecticut.

The group recommended expanding trauma screening and access to evidence-based care, developing a statewide plan to address trauma and including trauma-informed care training for all professionals who work with children.

Trauma can have lifelong adverse effects on children’s emotional and physical well-being. It has been linked to developmental delays, behavioral health problems and difficulties in school and is associated with chronic health issues such as diabetes and emphysema, according to the report.

Jason Lang, a clinical psychologist and co-author of the report, said too many children are suffering in silence. The outcomes associated with trauma should be a call to act as urgently as if a toxic chemical or disease were harming children, he said.

“It’s a concern that’s not talked about as much as it could be,” he said.

Since 2007, more than 50,000 children in Connecticut have been screened for exposure to trauma, the report said. That leaves nearly 800,000 children who have not.

In addition, more than 8,600 professionals in the state have been trained in trauma-informed care and more than 8,700 children have received trauma-focused, evidence-based care.

The report looked at four areas of a trauma-informed system: workforce development, practice changes and use of evidence-based practices, screening and collaboration.

Each area includes a checklist that other states or cities could use to see how they can improve. The report also includes specific recommendations for how Connecticut can improve in those areas.

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Girls in Justice System Often Traumatized Victims of Abuse

Girls in Justice System Often Traumatized Victims of Abuse

Deborah Wood SmithThe concern about the increasing number of girls in the juvenile justice system and a lack of adequate programming is nothing new. Policymakers have been advocating for attention to these issues for decades.

Beginning in the late 1990s, experts began to notice the increase in the number of girls in the juvenile justice system. With recent research on brain development and trauma, more data on girls in the juvenile system and concerns over human trafficking the time has come for these problems to be addressed in a constructive manner.

The late Robert E. Shepherd Jr. pointed to studies in the 1990s showing that girls were more often arrested for status offenses such as running away, had greater mental health needs including suicide attempts and prior psychiatric hospitalizations, and a history of trauma and abuse. He also noted that girls of color were overrepresented in the system.

A recently released report from the Georgetown Center on Poverty and Inequality notes many of these same problems persist today. High rates of sexual abuse and overrepresentation of girls of color continue to be the norm in juvenile justice systems nationally.

Additionally, girls are often victimized at a younger age and are the victims of multiple acts of abuse, the report says. It describes this as the “sexual abuse to prison pipeline” taking the name from the “school to prison pipeline” term that has been used for decades. While the school to prison pipeline has typically been thought of as affecting black boys, a recent report found that in the 13 Southern states that had 55 percent of suspensions and 50 percent of expulsions nationally, black girls were suspended and expelled at higher rates.

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Girls’ and boys’ brains do not mature in the same way. Abigail Baird looks at juvenile development through the lens of neuroscience. She found that boys and girls do not react to stimuli in the same way because of biological differences. According to Baird, boys tend to be less afraid of punishment or risk and girls tend to be better at relationship building based on differences in brain development.

Girls are very sensitive to punishment and in extreme cases may become suicidal when their relationships are threatened. So punishing someone who is not afraid of risks is not effective but punishing someone who is very sensitive to punishment can have detrimental effects.

The Adverse Childhood Experiences (ACE) Study shows a connection between abuse and later mental health issues just as studies on development of the brain indicate that trauma and abuse affect the actual architecture of the brain.

While girls account for almost 30 percent of the juvenile justice population fewer studies focus on this group. The OJJDP Beyond Detention series provides several reports on a longitudinal study of detained youth and looks at differences in abuse patterns between boys and girls.

[Related: When We Fail To Ask Why: Sexually Abused Girls Funneled into Juvenile Justice System]

Girls are more likely to have been sexually abused and boys are more likely to have been physically abused. Girls represented 35.9 percent of the participants and had a mortality rate of nearly eight times that of the general population. Girls in the system are more likely to have a history of physical and sexual abuse and have a high rate of psychiatric disorders (as many as three-quarters). Intimate partner violence is of particular concern for these girls.

Some studies have found that girls are twice as likely as boys to suffer from post-traumatic stress disorder when exposed to a traumatic event. Suicidal ideation and attempts are a particular problem for incarcerated youth but especially for girls. One study found that Hispanic girls had the highest rates of suicidal thoughts. When these youth were examined three years after release, significantly more girls had impairment in the domains of moods, emotions and self-harm.

These findings are not surprising based on the neuroscience that shows girls’ brains develop in a way that makes them more sensitive to punishment. The special needs of these victims of trauma are often not being addressed in the juvenile system, which may retraumatize them. Girls are more likely to be arrested for less serious offenses but are more likely to have serious problems, including a history of physical and sexual abuse, psychiatric disorders, family violence and suicidal ideation.

Girls tend to create strong sharing social groups, which have an evolutionary purpose, according to Baird. This survival instinct becomes common for girls beginning in middle school. Unfortunately, it also means they are more apt to use “relational aggression” and to suffer more than boys when it is used on them. Girls who are ostracized from the social group in this fashion are at risk for suicidal thoughts.

A study of adolescent girls found that those with less sensitivity to relational aggression had more mature development or more activity in the prefrontal cortex. Childhood trauma and abuse can disrupt the brain development of these youth. It is not surprising that behaviors such as running away or fighting with peers and family follows.

Unfortunately, this is often the entryway for girls into the juvenile justice system. Detention is still disproportionately used for girls charged with status offenses such as running away. In 2011 girls represented 53 percent of petitions for running away.

For the most part, state juvenile justice systems were designed with boys in mind. Recent research on trauma and brain development in boys and girls can improve programming for both populations.

Treatment needs to focus on the unique needs of girls exposed to trauma. Gender-specific programs such as Girls Court in Hawaii, specialized girls drug courts and programs that address girls charged with prostitution or involved in human trafficking are being developed.

Disproportionate school discipline of girls also needs to be addressed. Truancy and running away need to be recognized as a possible symptom of abuse or trauma rather than misbehavior. Evaluation of the effectiveness of these types of programs is crucial to make sure that victims of trauma are not being further traumatized.

Now that epidemiology and neuroscience have come together to show us the connection between childhood trauma, behavior, and mental and physical health, it is time to address these issues as early and as effectively as possible.

Deborah Smith is a senior knowledge and information services analyst with the National Center for State Courts. Before coming to the center she worked as a juvenile public defender and as a special education advocate.

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Girls Incarcerated Longer for Less Serious Offenses, Texas Study Shows

Gender and Traumatic Experiences
A chart from the report "The Influence of Gender and Traumatic Experiences on Length of Time Served in Juvenile Justice Settings" shows the difference gender makes in discharge time.

Girls serve longer sentences than boys in the Texas juvenile justice system, and for less serious offenses, according to a new study from the University of Texas at Austin.

Researchers studied 5,019 juveniles in three large, urban Texas counties over two years, finding that a female’s likelihood of remaining in confinement was 12.5 percent greater than that of a male.

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Females were held longer for less serious offenses, the study found. They were released at a much slower pace than their male counterparts for “status offenses,” such as running away from home or skipping school, and spent an average of five days longer in pretrial detention for less serious offenses than male counterparts.

Girls in the juvenile justice system are also more likely to have a mental health issue and to have experienced trauma prior to incarceration, the study said.

Lead researcher Erin Espinosa said trauma might influence the longer confinements.

Certain aspects of detention, such as a door slamming or footsteps coming down the hall, can trigger girls who have experienced sexual abuse or assault to act in self-defense, Espinosa said, leading to new charges and a longer stay.

In a fight or flight scenario, girls in detention don’t have an opportunity to flee, so they fight, she said.

[Related: When We Fail To Ask Why: Sexually Abused Girls Funneled into Juvenile Justice System]

Advocates called for better trauma-informed therapies within detention facilities, and more community-based programming outside them to reduce the time girls spend locked up.

Girls “end up languishing in these facilities that are meant to help treat their underlying issues … yet these facilities don’t have sufficient programming to support their recovery,” said Elizabeth Henneke, policy attorney with the Texas Criminal Justice Coalition.

There is a need for “an investment in community programming specifically directed to girls and youth who are struggling with issues that can be best resolved in the community rather than in a facility,” she said.

Lisa Pilnik, deputy executive director of Coalition for Juvenile Justice, said locking girls up for status offenses is a misguided approach to protecting them.

“I think the best solution is for most of these kids not to be in a facility in the first place — to be getting trauma-responsive services in their communities,” she said.

Kids who do need to be detained need trauma-informed and gender-responsive programming, she said.

A 2015 report from the Council of State Governments found that juveniles in community-based supervision programs were less likely to reoffend than those in confinement.

“If the system is designed to be rehabilitative in nature … then what are we really achieving by keeping them locked up just because they’re girls?” Espinosa said.

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Childhood Trauma Threatens National Well-Being: DOJ Task Force

Acting Assistant Attorney General Mary Lou Leary, Acting Associate Attorney General Tony West, U.S. Attorney General Eric Holder and Acting Administrator of the OJJDP, Melodee Hanes, at a federal interagency meeting on juvenile justice Wednesday. Photo by Kaukab Jhumra Smith.

WASHINGTON, D.C. - Two out of three children in the United States experience or witness violence, crime or abuse while growing up, a public health crisis that harms their emotional, physical and intellectual development and makes them more likely to perpetrate the same trauma upon their own children, a national task force appointed by U.S. Attorney General Eric Holder said this week.

The long-term well-being of the country is at stake unless federal and local governments and their communities act to reduce the incidence and impact of such trauma upon young Americans, the National Task Force on Children Exposed to Violence concluded in its final report.

The report detailed 56 policy recommendations for reducing such exposure to trauma and treating its fallout. Such exposure could occur anywhere, the report said: at home, at school, in the community and on the Internet.

“There is a moral component to this question,” Holder said at a public meeting of the federal interagency Coordinating Council for Juvenile Justice and Delinquency Prevention, which approved the report’s release. “This is about what kind of America do you want to have. This is a question of who we are as a nation.”

The imperative to act on the epidemic was not simply moral, it was economic, Holder said. A person impacted by childhood trauma who went “down a criminal path” would cost the country $3 million over his or her lifetime, Holder said. “By contrast, the cost of effective prevention is typically only a few hundred or a few thousand per person.”

The task force’s report emphasized that argument. “The financial costs of children’s exposure to violence are astronomical. The financial burden on other public systems, including child welfare, social services, law enforcement, juvenile justice, and, in particular, education, is staggering when combined with the loss of productivity over children’s lifetimes,” it read.

The outcomes are worst for children whose exposure to trauma goes unnoticed and who don’t receive support from parents, caregivers or their communities, said Dr. Steven Marans, a member of the task force and a professor of psychiatry at Yale University’s Child Study Center and School of Medicine.

Co-chaired by baseball legend Joe Torre, who grew up aware of his mother’s abuse at the hands of his father and who now heads a foundation against domestic violence, the task force based its recommendations upon the latest available research and testimonials from public hearings attended by community residents, researchers, child welfare workers and advocates from 27 states and the District of Columbia.

The task force examined different programs, strategies and services to help young people develop and thrive, said task force member Georgina Mendoza, the director for community safety in Salinas, Calif. It found that the most promising programs are those that take a multidisciplinary and multi-jurisdictional approach and coordinate responses between agencies and organizations serving the same populations, she said.

“There are so many different aspects of people’s lives. They don’t live in a silo’ed world. We do,” Mendoza said of child welfare practitioners.

Agencies that serve children and families should also develop their understanding of the cultural origins of members of their community and incorporate within their programming the challenges faced by children of immigrants, rural communities, tribal communities, inner cities and other marginalized groups, Mendoza said.

Young people who break the law should be screened for their exposure to violence and trauma as part of the standard of care at juvenile justice facilities, and should be prosecuted within the juvenile system and not in the adult criminal justice system, said Robert Listenbee Jr., the co-chair of the task force and the chief of the juvenile unit at the Defender Association of Philadelphia.

Young people must be included in community efforts to address their exposure to violence and crime and allowed to develop leadership within them, Mendoza said. If young people are not consulted, she said, they will not feel ownership or accountability over those efforts and the efforts will fail.

Holder upheld participation by young people as a key part of the solution. “I do think that involving our young people in this effort and reaching out other young people will make this much more effective,” Holder said.

The findings of the task force will play a critical role in guiding federal and local efforts for years to come, Holder said.

“We have to keep pushing to raise the consciousness of the American people about the nature, the depth and breadth of this problem,” Holder said. “This is not going to be shelved. This will be a priority for the Justice Department and for this administration.”

Child Trauma Linked To Prison Time

The majority of American youth behind bars have suffered trauma during their childhoods, a newly released report by the Justice Policy Institute (JPI) says. According to Healing Invisible Wounds: Why Investing in Trauma-Informed Care for Children Makes Sense, of the more than 93,000 children currently incarcerated, between 75 and 93 percent have experienced at least one traumatic experience, including sexual abuse, war, community violence, neglect and maltreatment.

“Incarcerated youth already face significant challenges, but youth who have experienced trauma are even more acutely affected,” says author Dr. Erica Adams. The brief, published by the Washington, D.C.-based organization that promotes the reduction of the nation’s prison population, notes that youth who engage in delinquent behavior should be held accountable but also strongly suggests that judges consider  trauma exposure when deciding where youth are placed. Young people who receive treatment in the community tend to have better outcomes than those placed in correctional facilities, the report says.

“We simply cannot afford to ignore the evidence and prevalence of the long-term effects of untreated childhood trauma,” says JPI Executive Director Tracy Velázquez. “If we are to have strong healthy communities, then we must start with these children whose unseen and untreated wounds hinder their ability to become healthy, productive adults.”

JPI researchers say youth who suffer trauma are more likely to develop lifelong psychiatric conditions, including personality disorders, conduct disorder, ADHD, depression, anxiety, substance abuse disorders and posttraumatic stress disorder (PTSD).

They are also more likely, they say, to have learning disabilities and lower IQ levels along with, in many instances, school dropout and expulsion rates nearly three times higher than their peers who had not experienced trauma.

The report’s many suggested changes include more in-depth investigations into a child’s living conditions conducted by trained professionals, specialized treatment referrals for traumatized youth and their families along with an increase in trauma prevention programs funded on the state level.