Child Complex Trauma & Good Outcomes Blog Series by Dr. Jane Gilgun

The purpose of this blog series is to describe complex trauma, to show the importance of secure relationships, and to show factors associated with good social service outcomes when children have experienced complex trauma. Case materials bring the issues to life.

My post this week will refer back to the case study involving Ian, his father David, and their case manager Mary. (Click here to review last week’s post if you would like to.)

Ian’s case illustrates the multiple factors associated with good outcomes when children have experienced complex trauma and are at risk to behave in aggressive ways. Ian had experienced complex trauma that included violent acts: witnessing the beating and death of his niece and sexual abuse by the man who committed the murder. These traumas and the other traumatic losses constitute complex traumas whose violent natures created risks that Ian would also act out in ways that harm others.

In short, Ian’s exposure to violence and direct experience of sexual and emotional abuse were risks for antisocial behaviors. Ian required professional attention that he did not receive until David was convinced of the need for it. The discussion that follows draws not only upon Ian’s and David’s case, but upon case study research that I have conducted for more than 30 years.

Good Outcomes

I define good outcomes as children doing well at home, in school, and in the community. Doing well means harmonious family relationships, appropriate expression of emotions in families, clear family structures and routines, and prosocial family beliefs. In school, good outcomes include passing grades, few if any behavior problems, good peer relationships, and involvement in school activities. In the community, good outcomes include prosocial friends, engagement in positive activities, and appropriate expression of emotions.

Individual good outcomes include steady moods, capacities for handling stress and conflict constructively, optimism about the future, and resources and willingness to use resources to work toward a positive future. Good outcomes also include no problems with the law, respect for rules and for the rights of others, and no self-destructive behaviors. If individuals have neurological or mental health issues, they are managed.

Ian

Ian had many of these qualities before he received social services. The work Mary did built upon these resources and also helped develop them. Ian’s involvement in the activities of the ACE program, for example, provided some basics about appropriate expression of emotions and engaged him in prosocial activities. Through referrals from Mary, he received professional services for his complex traumas. Ian did not have neurological issues, but he did have mental health issues related to complex trauma. He did in general follow rules, but he also infringed on the rights of others when he sexually abused them.

Factors

As the previous discussion shows, factors associated with good outcomes include:

  • Parents are willing to do whatever it takes to ensure their children’s healthy development.
  • Parents deal directly with their own issues; facilitate respectful communication, clear rules and boundaries; teach children respectful ways of interacting with others; espouse prosocial belief systems; protect children from abuse, neglect, and other traumas; and facilitate enjoyable family activities.
  • Children have secure relationships with caring adults: Children can talk about personal issues and find doing so helps, and children identify with caring adults and want to emulate them.
  • Parents and children have good working relationships with professionals.
  • Children are able to deal directly with the effects of trauma with parents and professionals.
  • Children actively use resources such as emotional availability of families and extended families, good relationships with other adults, teachers who understand and empathize with children’s trauma, professional services, playground and sports fields, and recreation centers.
  • Case managers build relationships with children and parents. Family work is essential when children experience complex trauma. Case managers are reliable: They do what they say they will do, and they show up. They work effectively with other professionals who provide service to children and families.

    They have resources to offer children, such as the recreational activities that Mary offered Ian—ACE case manager who had a budget that they used to pay for school supplies, clothing and equipment for sports teams, and dues to recreational centers, among other resources.Like parents, case managers do whatever it takes to promote children’s well-being.

  • A favorable environment: Many circumstances influence case outcome besides willingness of parents, children, and professionals to form relationships and to use available resources. When outcomes are good in social services, either the external environments in which the families live are favorable or the families have the capacities for coping with unfavorable events. The families typically have stable housing, reliable income, meaningful relationships with people outside of the family, and recreational opportunities.

Sometimes families are doing well according to the guidelines discussed earlier and then a devastating event occurs, such as the murder of a family member or sudden homelessness when families can’t pay the rent or mortgage. In these circumstances, children and parents may act out and parents may become abusive and neglectful. Social service professionals can do little to prevent such events. Their roles are to be sources of emotional support, to advocate for families, and to help families secure resources that they require.

Ups and Downs

Long-term stability of prosocial functioning is the hope most social service professionals have for service users, but experience shows that families have ups and owns, typically in response to family crises that may be traumatic or at least de-stabilizing. Deaths, separations, losses, unemployment, food insecurity, and any number of other external events can undermine families. When the outcomes are good overall, families eventually manage the crises and resume stability. In my research with ACE, good working relationships with ACE case managers are of great help to families experiencing crises.

Questions To Consider

Please feel free to leave a comment below with your input on the questions posed here.

  • What are some ways that you, as a child welfare practitioner, can help support families as they address their complex trauma and work toward good outcomes?
  • What can you do as a child welfare practitioner if you are working with a family who is striving to overcome their traumas and needs certain resources but cannot access them, whether due to financial constraints, lack of time, ineligibility, or other reasons?

Next Week

The last post of this series will be next week. I will wrap up the series with a discussion on key factors in good outcomes for children who have experienced complex trauma, based on my research.