Udayan Care: Concept Note
Consultation on ‘Trauma Informed Care: Concepts & Practices for children in Alternative care’
March 17, 2017, New Delhi
‘Trauma is when people live with more fear than hope’ – Anonymous
The Sustainable Development Goals adopted in 2015 have set out a vision for a world where all children are happy, healthy and protected. Goal 3 particularly mandates “Good Health and Well-Being,” for all, thus ensuring healthy lives and well-being for all children too. This mandate essentially includes mental well being too. In certain vulnerable situations, the focus on ensuring mental well being becomes more critical. Alternative care setting is one such situation. Millions of children get separated from their natural families due to a gamut of reasons and where it is not possible to return to their birth families, children live in Alternative Care, which can be adoption, foster care, living in child care institutions or aftercare. Such Out of home care (OHC) children often have experiences of extreme forms of trauma, abuse and neglect and need special care and attention. Often the experience of abuse, trauma and neglect at early ages get carried forward into adolescence and lead to stress, anxiety and difficulties during the course of their life.
Trauma is not an event itself. It is a response to one or more stressful events that negatively impact the ability to cope with it, if unaddressed. Such experiences in OHC children often result in creating hurdles at the social, emotional and academic fronts. As children get older traumatic experiences often push them towards substance abuse, smoking, overeating, or even taking to crime and delinquent behaviour. Negative childhood experiences can make permanent lifelong damage to the health of a person and undermine their opportunities in life. Living in Alternative Care has its own set of challenges such as frequent change of families or institutions, regulations and monitoring by the system, change in caregivers and interface with agencies who control and decide for their lives. Unlike a biological family, elements of permanency, attachment and trust are difficult to build and hence often missing. Such children are hence extremely prone to extreme vulnerabilities of getting into re-trauma if exposed to discrimination or prejudice. Dealing adequately and sensitively with the trauma becomes a non-negotiable in such care settings and caregivers need to pay closer attention in being equipped to enable all OCH children to grow and develop as resilient human beings. Without this, the care and protection provided is not adequate nor rights based.
Trauma informed care or TIC is an “organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma” and it also emphasizes physical, psychological and emotional safety for both consumers and providers, and helps survivors rebuild a sense of control and empowerment. for OHC children is about providing them with an opportunity to live with more hope than fear and in being able to equip such children and youth to survive with adequate and effective coping skills. TIC is a process that requires not only knowledge acquisition and behavioral modification in child friendly ways. This entails understanding the impact of trauma on children’s development and learning ways that can effectively reduce or mitigate the ill effects without causing any further trauma. TIC means that children are treated with respect and dignity in a rights based manner. TIC provides a new paradigm under which the basic premise for organizing services is transformed from ‘What is wrong with you’? to ‘what has happened to you’?
Most Western and European countries have elaborate and developed trauma based care at advanced stages but in India and most South Asian countries this is still at a nascent stage. In India, there is a complete lack of organized trauma care in any setting of childcare, to the extent that even child care professionals lack clarity or a deep understanding of how to go about dealing with such issues. Often injury and trauma are used interchangeably and this can be very harmful for children’s holistic development. Hence it becomes imperative to initiate discussions, dialogues and debates around this subject, especially in the setting of care for children who live in alternative care and are deprived of a care from natural family support. Such children have faced abuse, neglect, abandonment and at times exploitation and after that their care, growth and transition is dependent on a range of different caregivers and external service providers. Addressing trauma in childcare settings is hence, critical.
Rationale for the Consultation
This consultation examines specific problems that arise in the following settings in the context of children living in alternative care: the juvenile justice enforcement system (including courts and police stations), child care homes, foster families, adoptive families, educational institutes, hospitals and in accessing other service facilities. Once children leave the care setting and transit into independent life, the chance of trauma revisiting them is high especially because we have undeveloped aftercare mechanisms in India. In each space and every stage of their life, the adults who are caregiver, service provider or decision makers have a unique role to play, and that is to extend full care, protection ad support to the child and the young adult. This is possible only if these adults are informed and understand concepts of trauma care. It is equally important to understand the real reason of why a certain child behaves in a particular way. Understanding of the specific needs is important. If caregivers and those responsible for the care of children (such as police officers, CWC members, Juvenile Justice board members, counsellors, school teachers, doctors and hospital staff) understand the possible consequences of trauma and how to deal with it, they can easily identify the underlying causes of some children’s difficulties with learning, behavior and relationships. This further allows the child to rely on a close caregiver for comfort and safety, thus enhancing trust, attachment and resilience in the child. Incorporating a trauma informed care approach is hence an essential component to developing programs that most accurately address the needs and rights of children and youth living in alternative care.
Workshop date – Friday 17th March 2017 (full day)
Key Objectives of the Workshops
- Initiate discussion and dialogue on importance of TIC in working with OHC children.
- Identify gaps and challenges faced by caregivers, service providers and decision makers in addressing situations of TIC to minimize re-trauma in children living in alternative care.
- Seek inputs from professionals, experts and practioners iand form a core group that carries forward the agenda of incorporating TIC in all programs of and for children living in alternative care.
- To launch the 7th issue of Udayan Care’s international bi-annual journal on Alternative Care: ‘Institutionalised Children: Explorations and Beyond’, (ICEB)
Expected Outcomes of the Workshops
- Stakeholders’ understanding of TIC and its benefits while working for children in alternative care
- Assessment of current stakeholders understanding and challenges faced while working on mental health needs of children.
- Setting up of an informed group / core group to take forward the agenda on long term basis.
Participants in the Workshop
Social workers, Volunteers, Police officers, School teachers and Principals, Members of the CWC and JJBs, counsellors, therapists, Psychologists, neurologists, psychiatrists, NGOs
Session Plan for the workshop
| Session No | Session Theme | Resource person |
| 1. | Launch of ICEB – March 2017 issue | |
| 2. | Key Note / Overview on the concept of Trauma informed care (TIC) and
Address by Chief Guest |
Dr. Monisha Nayar-Akhtar
To be identified |
| 3. | TIC in the context of the juvenile justice system (CWC, JJB, Courts, Police) | To be identified |
| 4. | TIC and its application in child care institutions | To be identified |
| 5 | TIC in the context of schools | To be identified |
| 6. | TIC in the context of hospitals | To be identified |
| 7. | Case studies and Group Work | Dr.Monisha Nayar-Akhtar |
| 8. | Way forward and constitution of Core group | Dr. Kiran Modi |
The Organising Committee for the Consultation shall comprise of Dr. Kiran Modi, Dr. Monisha Nayar-Akhtar, Dr. Jitendra Nagpal and Dr. Deepak Gupta.
References (for those interested in further reading)
What is trauma: The TIP Guide defines trauma as experiences that overwhelm an individual’s capacity to cope. Trauma early in life, including child abuse, neglect, witnessing violence and disrupted attachment, as well as later traumatic experiences such as violence, accidents, natural disaster, war, sudden unexpected loss and other life events that are out of one’s control, can be devastating.
(http://bccewh.bc.ca/wp-content/uploads/2012/05/2013_TIP-Guide.pdf)
Common Questions About Trauma – This pamphlet explains trauma and its effects in plain language and can be a useful resource to share with clients.
(www.camh.net/About_Addiction_Mental_Health/Mental_Health_Information/commonquestionsabouttrauma.html)
What is TIC and how to become trauma informed: http://www.traumainformedcareproject.org/
Becoming trauma informed school: http://www.apmreports.org/story/2016/12/16/trauma-informed-school
Brain Story Certification – http://www.albertafamilywellness.org/training