Diagnosing Children Impacted by Trauma

EFFECTS OF TRAUMA

Effects of Trauma

Part 1

1. What triggered the fight/flight/freeze response for this child?

The fight/flight/freeze response triggers were memories of her mother being beaten by her father, missing her brother, and the trauma she suffered at home. Zoe experienced and saw her mother being beaten by her father numerous times, and when she tried to intervene, the father would turn on her. For example, in the first part of Removed, her father throws the book she is holding away and chases her. Zoe runs out of the house, and her father runs after her, grabbing her and carrying her back into the house (Matanick, 2014, March 11). The recollection of such memories can be traumatic for a child, causing her to fight/flight/freeze response. When Zoe was separated from her brother, it impacted her emotionally, and she never knew how to process the emotions. Her body was responding in ways she did not understand. She knew that she was hurting, and being away from her brother was too much torture for her.

The fight response that led to her being taken to a therapist was due to her picture of herself and her brother. The picture she hung on her school locker triggered a memory that resulted in her fighting her teacher and caregiver. The picture reminded her of her brother and how she will never be with him again. Numerous things in her present life trigger memories of the trauma she suffered. For example, when her caregiver gifts her a pink dress, it triggers her memories of how it was at home, and she responds through a fight (Matanick, 2015, June 14). Although not a physical fight, she screams and shouts at her caregiver as her way of fighting. Memories of what happened to her and what she experienced at home, seeing her mother beaten or roughed up by their father, are triggers that she carries with her every day. The triggers propel her to respond by either fighting, running away, or freezing.

2. How did the adults who were trying to help, unknowingly mimic the behaviors of adults who had been hurtful in her life? Give examples.

The adults who rescued Zoe from her abusive home were trying to help her, but they did it in the wrong way. For starters, when they arrested her father, Zoe ran away and was chased by one of the adults, who, upon catching up with her, treated her in the same way her father treated her (Matanick, 2014, March 11). Grabbing her and dragging her back to her house mimicked her father’s behaviors. When Zoe was taken away from her home, she was placed with a foster couple who treated her almost like her father did. They screamed at her, roughed her up, and even punished her for eating fruits from the garden. Zoe was treated like a stranger and unwanted child in her first foster home. The couple’s behaviors were well-intentioned, but they mimicked the same behaviors she had experienced at home, where she experienced torture and mistreatment.

The CPS officers did not understand her need for proper guidance and the importance of reducing her trauma. They treated her in the same way her parents did, and she was never allowed to speak or make a decision (Matanick, 2015, June 14). All decisions were being made for her, and she had to comply with them. The decision to take her brother by the adoption parents was harsh, and it mimicked the same behavior she suffered at home. Instead of allowing Zoe to say goodbye to her brother, they opted to take him without her knowing, thinking that would be best. However, it triggered memories of her past, where she was denied autonomy and forced to do what the adults wanted. The adults who took her brother thought they were doing the right thing, but they were hurting her further. In court, the decision to either keep Zoe with her mother or place her in a foster home was made for her. Zoe did not have a say in what was happening in her life and where she wanted to live.

3. Identify and discuss examples of trauma-informed care and when trauma-informed care was not provided.

Trauma-informed care recognizes trauma symptoms and acknowledges the role of trauma in a person’s life. For Zoe, all adults who handled her failed to recognize that she was traumatized and continued to traumatize her further when handling her. The first time was when she was taken away from her home and separated from her brother. When she was first rescued, it should have been noted that or assumed that she is more likely to have a history of trauma, and trauma-informed care should have been initiated. Building trust and transparency is the other principle of trauma-informed care (Allen et al., 2020). It is vital to build trust with the client when one wants to understand and assist them overcome the trauma they suffered. Informing the client about what is happening and letting them process the information is vital for building trust and transparency. Trauma-informed care was not provided for Zoe when she was separated from her brother the first time and even when her brother was adopted. In the second instance, Zoe knew her brother would be adopted, and while she would have fought or been against it, no one wanted to give appropriate information. Zoe found out her brother was taken away after it had happened, which triggered her trauma again (Matanick, 2015, June 14).

According to Allen et al. (2020) empowerment of the client to enable them to process and deal with the trauma they have undergone is vital for overcoming or managing the trauma symptoms. The failure to recognize that Zoe was traumatized when she lived with her parents prevented the adults who wanted to care for her from recognizing the need to empower her. Zoe should have been taken to a therapist immediately after being removed from her home and encouraged to share her story. Zoe could have learned about the options available to her and her brother through therapy, allowing her to better process the information. After her brother was adopted and she threw a tantrum at school, Zoe was taken to a therapist who recommended drugs instead of taking her through trauma-informed therapy.

4. Discuss how the diagnosis and medication treatment was being misused and provide examples of her symptoms that were trauma-related, explain.

The therapist that saw Zoe did not pay close attention to her symptoms and instead preferred to prescribe medications for managing her behavior (Matanick, 2015, June 14). There was a failure to recognize Zoe’s trauma, and her diagnosis was based on presenting symptoms and not her underlying trauma symptoms. Therefore, the medication would only address her presenting issue, and her trauma will continue. The therapist even recommended increasing the dosage if the current one is ineffective. For example, when Zoe was taken to the therapist, it was after she attacked her teacher upon realizing she was living a different life than the one she had always imagined. Her words demonstrate the trauma she suffered and how it has impacted her life to a point where she no longer recognizes the person she is becoming. Zoe is struggling to make sense of her present life, and anytime she thinks she is making progress, something happens that reminds her of the past.

Zoe has undergone a lot for a child her age. She has lived through violence at home, and she has been separated from those she loves. The separation from her mother makes her wish she could hear her say it will all be okay and see her mother dance to her favorite song. Specific triggers remind her of her past. For example, when her foster mother bought her a dress, it reminded Zoe of her mother and caused her to remember the violence she suffered at home. Her reaction to the dress is a demonstration of the symptoms of trauma. In the drawings she makes, she references a tornado and a girl being stuck in the tornado, she is referring to herself. Zoe understands that a star is formed from tornados that occur in the atmosphere, and she believes she can overcome her current situation and become a star.

Part 2

1. After reading Amber’s case, detail the signs of a dissociative response. How might you recognize this in various settings (i.e., school, home, hospital, office, etc.).

From Amber’s case, we can see that signs of a dissociative response are unexplained unconsciousness, remarkably low heart rate, unarousable, shallow breathing, and signs of self-harm like cutting or deep scratching (Perry & Szalavitz, 2017). While it might be difficult to identify the signs immediately, it might be possible to notice them after careful observation. Amber was found unconscious in the school bathroom, and the first thing was to call 911. Unconsciousness can be due to multiple factors, and identifying a dissociative response from it might be difficult. The best way to identify signs of dissociative responses in a school setting is to observe the student, trying to see if they have hurt themselves. Amber used to wear long-sleeved shirts even when it was warm. Other signs to watch out for are that a well-performing student suddenly becomes disinterested in class or declining school performance (Perry & Szalavitz, 2017). A bright student with a traumatic past will suddenly struggle to concentrate in class, affecting their overall performance.

If such a patient presents in the emergency room and all tests turn negative in a hospital setting, they might show signs of a dissociative response. All the tests Amber was taken through turned negative, and there was no way to determine what was wrong with her (Perry & Szalavitz, 2017). Understanding the signs of dissociative response allows one to quickly determine the right approach for the patient’s treatment. In an office setting, it could be noted that such a person would be daydreaming a lot, and they would be unarousable during these daydreaming episodes. While we all do daydream, a dissociative response to daydreaming can lead a person to become unarousable, and they will not be easily woken up from their daydream. We should also be looking out for changes in behavior like becoming withdrawn out of the blue, a person keeping to themself, and increased anxiety or fear. These signs demonstrate the person is struggling with something, and we could seek assistance for them.

2. Discuss your overall thoughts about the book, cases presented, lessons learned, etc.

The book demonstrates the importance of gathering as much information as possible before making a medical decision. Using real-life examples allows the reader to connect with the case and diagnosis, increasing their understanding and knowledge. I gained thorough knowledge and experience from reading the cases, allowing me to understand different presentations of traumatic events better. The book is informative and can be relied upon later in practice to uncover underlying issues when faced with a patient presenting with almost similar symptoms. A student being given theory without being related to a patient makes it hard to understand what is being taught. However, the book presents cases that the author has faced and how they have managed to handle the cases. The background information offered allows the reader to connect with each case as it progresses, and the demonstration of how they approach each patient can be used in practice by others.

The lessons learned are that it is possible to connect with a client even in the most challenging cases, provided there is a willingness on the therapist’s part. Patients want to know there is someone who cares and is willing to assist them. Therefore, it will be vital for the therapist to ensure they do not sow fear in real-life situations. Instead, they should always appear confident in their proposal and be truthful to the client. The author has shown us that most clients become receptive and open up easily by being honest with the client. More information was uncovered when reading the case than possible had the author opted to present the information as an ordinary book. What comes out is that these are real cases that the author handled, and they demonstrate how they approached each case. With the examples shown in the case, I can apply the knowledge in my clinical practice.

3. Provide personal reflection and the impact the readings had on you. Discuss how the chapters further inform trauma practice.

The readings offer further information on trauma practice and create awareness of its impact on children later in life. There is a tendency to believe that children are not affected by trauma because there are never clear signs. However, as they grow and become adults, we can see evidence of how the trauma they suffered affected their development. Failure to offer them the assistance they need further deteriorates their mental health and leads them down a road that few understand. For example, people who are not aware of the impact of trauma rarely can spot it when presented with patients who were traumatized when young. As was the case for Amber, all physicians and specialists were confident there was an underlying issue they had not uncovered. With a trauma-informed approach, Dr. Perry was able to identify the symptoms and determine what could be the cause of Amber’s symptoms (Perry & Szalavitz, 2017).

Trauma practice should be something taught to all medical professionals. Without trauma practice and knowledge, most healthcare professionals tend to believe the cause of symptoms is something else. They can push the patient to undergo numerous tests, all coming back negative. From the readings, we have seen different cases where patients are taken through test after test, only to be discovered they are suffering from the trauma they face early in life. Readings focusing on brain development demonstrate how children’s brains develop and the importance of love and care when young. The lack of care results in underdevelopment of the brain, and children will not function properly as they grow (Perry & Szalavitz, 2017). An underdeveloped brain leads to challenges in the child’s development where a child will not be acting their age. The readings have opened my eyes to understanding the importance of proper brain development. It is inspiring to learn that a child can recover from the trauma they suffered early in life with healthy relationships.

4. Discuss what core concepts apply to the cases presented in the chapters.

The core concepts that apply to the cases presented are

· Traumatic events often generate secondary adversities, life changes, and distressing reminders in youth’s daily lives.

· Danger and safety are primary concerns in the lives of youth who have had traumatic experiences.

· Trauma and post-trauma adversities can strongly influence development.

· Protective and promotive factors can reduce the adverse impact of trauma.

Secondary adversities are generated that remind the youth of the trauma they underwent. In the case of Amber, the voice of Duane on the phone reminded her of her past trauma and caused her to lose consciousness (Perry & Szalavitz, 2017). Amber confessed to the doctor that she gets reminders of the trauma whenever she smells alcohol, similar to what Duane used to take. These reminders trigger her anxiety and numbness, forcing her to return to her safe space where she used to go when she was being abused.

Danger and safety are primary concerns in the lives of youth and cause most children to be less trusting of people (NCTSN Core Curriculum on Childhood Trauma Task Force, 2012). Their senses are on high alert, and they tend to believe that everyone is judging them or is trying to harm them. However, the reality is that they have a perception that makes their beliefs come true. Amber did not trust people, and she assumed they were looking for a way to harm her.

Trauma and post-trauma adversities can strongly influence the development of a child. The trauma Peter faced as a toddler interfered with his brain development. The interference meant that he could not behave at his age, which caused him to be shunned by his agemates. The lack of care and touch from adults caused his brain to be underdeveloped, and neural connections were missing. However, by having supportive parents and classmates, Peter created strong, healthy relationships that allowed him to overcome the effects of the trauma he suffered as a child.

Part 3

1. “What is social work’s role in policy practice, and how can we ensure client voice is represented in policy work?” Consider how policy practice can advance social justice in your response.

Policy practice attempts to eliminate environmental barriers and enhance available opportunities to clients and their families. Advocacy is the cornerstone of social work, and it is so vital that it has been framed in three sections of the NASW code of ethics. Policy practice is not something social workers do if they have extra time. It is a requisite. Therefore, social work plays a crucial role in policy practice in that social workers have to ensure that available policies meet the needs of the population being served. Social work has the potential to make a difference in the lives of millions of Americans, provided they take a crucial role in policy practice. Policy practice focuses on lobbying key individuals to implement a law, program, or funding for something affecting the local population (Bent-Goodley & Hopps, 2017). Social work is charged with gathering accurate information, delivering recommendations, and securing resources for clients. With the gathered information, the social worker can determine where there are lapses in implementation and what can be done to overcome the challenges. They can then make accurate recommendations to improve the services to meet the client’s needs. Social workers can determine how a program can be implemented to meet the clients’ needs and push for the funding of specific projects.

Clients might be unaware of a program, or there might be restrictions to accessing certain services, denying them the opportunity to attain success in various aspects of their lives. Social work can educate a client by letting them know of existing programs that can benefit them. When there are restrictions, it is the work of the social worker to determine how they can overcome the restrictions and ensure the client receives the services they need. For example, an elderly individual could be eligible for the local Meals on Wheels program though they never seem to receive any meals. The social worker can get in touch with the Meals on Wheels program to determine why the individual does not receive meals. The social worker can discover that the program does not cover the road where the elderly person lives by calling them. To ensure the elderly individual receives their meal, the social worker could petition the local authorities to increase the radius covered by showing them how many people are being missed by failure to cover certain roads. If funding is lacking, the social worker can push for additional funds by advocating for the program.

Policy practice can advance social justice by assisting clients in advocating for themselves. Social workers can educate and inform clients about programs and policies that exist that could be of benefit to them. The client can then take up the push individual or other community members demanding services. Policy practice can empower clients to become advocates by encouraging them to push for what they want. For example, a social worker can encourage the client to make a call to the government agency to complain about their landlord. Doing this empowers clients to take action for themselves and not rely on the social worker. The client becomes encouraged, and they can do the same for different aspects of their life where there is a need for change. The goal of social work is to open the access doors and opportunities for everyone in need through policy practice. People can then determine where they are being treated unfairly and determine the actions they can take to push for change. The client’s voice is represented by educating the client or community when they are being marginalized or disenfranchised. The social worker gives the community the materials and knowledge to advocate for change. Giving the client or community the ability to do the work of pushing or demanding a change ensures the client’s voice is heard.

Part 4: Social Justice Analysis

1. Describe the nature of the social injustice. Choose among concepts of oppression, structural violence, human rights, and/or historical trauma and explain how it impacts the client population (or a segment of the client population) that your organization serves. Explicitly state the nature of social injustice and how it negatively impacts the clients’ social, emotional, vocational, mental, and/or physical development.

Racial discrimination is widespread in the country. We live in a country torn apart by differences, and the American youth struggle to fit in primarily with Black American youths. Big Brothers Big Sisters of America (2022) recognizes racial discrimination’s impact on the youth. There are systemic obstacles for the youth of color, preventing them from attaining their potential in life. The majority of clients served by BBSA are people of color. The organization had to take a stance to implement programs that will assist their clients in overcoming the racial injustices they face in their communities. There is a general lack of resources in neighborhoods with most black people. The lack of resources leads to increased violence, insecurity, and police presence. The clients struggle to pull themselves out of the dilapidated communities, but they face systemic obstacles that make it difficult to overcome some of the challenges. Coming from a neglected community means the schools are less funded, leading to reduced chances to advance in the classroom. Insecurity and violence lead to reduced social opportunities for the client because it is unsafe to stay outside.

The systemic racial discrimination the youth faces impacts their mental state because they cannot receive the same opportunities their white peers receive. Healthcare becomes a challenge making it hard for the youth to access vital services to support them. The people in authority have neglected these communities, and they implement policies that continually discriminate against people of color. Racial discrimination denies the youth a chance to rise above their current situation. It makes it hard for the youth to succeed in life or become productive members of their communities. With reduced opportunities, the youth are forced to join gangs or become drug addicts trying to escape their current situation. Juvenile delinquency rates have become high due to the increased number of youth offenders. BBSA recognizes these challenges and attempts to create better opportunities for the youth of color by offering mentors who guide and direct the youth to better opportunities.

2. Propose social action strategies. Describe one specific strategy that can be implemented to address the problem you describe. Define the strategy (the WHO, WHAT, WHEN, WHERE, WHY, and HOW). Draw from outside literature to support your use of these strategies and you should be explicit about your Theory of Change.

To fight systemic racism, we need to take aggressive action to address policies, structures, and practices that contribute to the wealth gap, health disparities, and educational inequalities. The best strategy would be to fight education inequalities. An educated nation can create better outcomes for its youth since they will have the necessary skills needed to join the workforce and strive to overcome the other issues with a good education. Eliminating education inequality begins with increasing funding for schools located in black communities (Bloome et al., 2018). Proper funding of schools increases the number of teachers and motivates them to impart knowledge to the students. Eliminating the property tax as the source of school funding will ensure schools in low-income areas receive the same funding as those in high-income areas. The federal and state governments should develop more major resources that ensure every child gets a fair share of the pie.

Provision of books for low-income families to expose their children to reading early. For kids to have a head start in education, they should be read to early, exposing them to books in their early formative years (Bloome et al., 2018). Feeding the brain with books instead of television will encourage the kids to study and motivate them to perform better even if they come from underprivileged areas. Increased funding to low-income school districts will ensure that children have access to books and a library where they can read and borrow books. An equitable funding system should be introduced where all schools receive the same funds. Initially, the neglected schools should receive more funds to allow them to build and innovate in the neglected areas. Once they have become at par with the others, they can continue being funded equally to ensure they maintain their standards. Some schools and students will be starting from the point of deep disadvantage due to decades of discrimination. Therefore, policies should favor at-risk schools where funding increases exponentially to support after-school mentoring programs, teacher-hiring programs, and arts or sports programs.