Helping Young Children Who Have Experienced Trauma: Policies and Strategies for Early Care and Education
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Helping Young Children
Who Have Experienced
Trauma: Policies and Strategies
for Early Care and Education
April 2017
Authors Acknowledgments
Jessica Dym Bartlett, MSW, PhD We are grateful to our reviewers, Elizabeth Jordan,
Senior Research Scientist Jason Lang, Robyn Lipkowitz, David Murphey,
Child Welfare/Early Childhood Development Cindy Oser, and Kathryn Tout. We also thank
Child Trends the Alliance for Early Success for its support of
this work.
Sheila Smith, PhD
Director, Early Childhood
National Center for Children in Poverty
Mailman School of Public Health
Columbia University
Elizabeth Bringewatt, MSW, PhD
Research Scientist
Child Welfare
Child Trends
Copyright Child Trends 2017 | Publication # 2017-19
Helping Young Children Who Have Experienced Trauma: Policies and Strategies for Early Care and EducationTable of Contents
Executive Summary..............................................................1
Introduction...........................................................................3
What is Early Childhood Trauma?.................................. 4
The Impacts of Early Childhood Trauma.......................5
Meeting the Needs of Young Children Who Have
Experienced Trauma............................................................7
Putting It Together: Trauma-Informed Care for
Young Children......................................................................8
Promising Strategies for Meeting the Needs of
Young Children Exposed to Trauma...............................9
Recommendations............................................................. 12
Conclusion............................................................................ 14
Appendix A......................................................................... 24
Helping Young Children Who Have Experienced Trauma: Policies and Strategies for Early Care and EducationExecutive Summary
Many young children are exposed to traumatic
life events.1,2 Almost half of children in the United
States—approximately 35 million—have experienced
one or more types of trauma,3 and young children
are at especially high risk compared to older
children. Over one quarter of all children with
confirmed cases of child abuse and neglect are
under age 3, and victimization is most common
for children under 12 months old.4 Unintentional
injuries, such as drowning, falls, burns, choking,
and poisoning, also occur most frequently among
children ages 5 years and younger.5 In addition,
children who experience domestic violence are
disproportionately young, with 60 percent under
age 6 at the time of exposure.6
Early childhood trauma occurs when a young child
experiences an event that causes actual harm or
poses a serious threat to the child’s emotional In this report, we describe early childhood trauma
and physical well-being. These events range from and its effects, offer promising strategies for ECE
experiencing abuse and neglect to having a parent programs and systems to help young children
with substance abuse issues or being separated who have experienced trauma, and present
from a parent.7 Trauma is different from regular life recommendations for state policymakers and other
stressors because it causes a sense of intense fear, stakeholders looking to support trauma-informed
terror, and helplessness that is beyond the normal ECE for this vulnerable group.
range for typical experiences.8
Trauma has been shown to negatively impact early Promising strategies for trauma-
brain development, cognitive development, learning, informed care in early care and
social-emotional development, the ability to develop
secure attachments to others, and physical health.9
education
However, each child’s reaction to trauma is To address the needs of young children who have
unique and depends on the nature of the trauma, been exposed to trauma, ECE programs and
characteristics of the child and family, and the systems can provide trauma-informed care (TIC).
overall balance of risk and protective factors in the TIC supports children’s recovery and resilience
child’s life. While almost all children experience using approaches that have been shown, through
distress immediately after a traumatic event, most evaluation, to work—that is, TIC uses evidence-based
return to their typical functioning over time with approaches.12
supports from parents and other caregivers.10
Generally, trauma that begins early in life, takes Although TIC is a relatively new approach, several
multiple forms, is severe and pervasive, and promising approaches to TIC have emerged:
involves harmful behavior by primary caregivers
has been linked to the most serious symptoms of • integrating trauma-informed strategies into
posttraumatic stress and negative child outcomes.11 existing ECE programs to support children in
those programs who have experienced trauma,
Despite trauma being widespread and detrimental
to the well-being of infants, toddlers, and • building partnerships and connections between
preschoolers, few early care and education (ECE) ECE and community service providers to
programs and state systems are prepared to offer facilitate screenings of and service provision to
care that is trauma-informed—with all adults able children and families,
to recognize and respond to the impact of trauma
on young children, and to infuse trauma awareness,
• implementing professional standards and
training for infant and early childhood mental
knowledge, and skills into program culture,
health consultants that emphasize TIC, and
practices, and policies.
1 | Helping Young Children Who Have Experienced Trauma: Policies and Strategies for Early Care and Education• supporting the professional development 3. Provide children who have experienced
and training of the ECE workforce in working trauma with high-quality, stable early care and
with and supporting young children who have education and strong early learning supports.
experienced trauma.
a. Establish policies for ECE programs that
promote continuity of care and participation
Recommendations in ECE for children who have experienced
Policies can play an important role in developing trauma.
and supporting the programs and professionals in
b. Establish policies that promote the
the lives of young children who have experienced
placement of young children who have
trauma. The following recommendations would
experienced trauma in high-quality ECE
increase the availability of and access to high-
programs.
quality, trauma-informed ECE and related supports
for young children’s healthy development. These c. Develop policies that severely limit or
recommendations have direct relevance to state- prohibit the suspension and expulsion of
level policymakers, but also apply to program young children, and require appropriate
directors, community, state, and federal leaders in interventions for children who have
the field of early childhood, as well as advocates experienced trauma and have social-
for other aspects of high-quality ECE programming emotional or behavioral difficulties.
(e.g., Quality Rating and Improvement Systems,a
infant and early childhood mental health d. Establish screening and educational support
consultationb). policies that respond to both the social-
emotional and early learning needs of
1. Strengthen the early care and education children who have experienced trauma.
workforce by increasing early care and
education professionals’ capacity to provide Historically, society has overlooked the impact
trauma-informed care. of early childhood trauma, perhaps due to
misconceptions that very young children do not
a. Incorporate strategies that benefit children fully perceive traumatic events, or that they will
who have experienced trauma into ECE always “bounce back” from them. In reality, the first
professional development. few years of life constitute a period during which
children are highly sensitive to trauma—more so
b. Increase the capacity of infant and early
than during any other time of life.
childhood mental health consultants to
incorporate trauma-informed approaches.
c. Increase support to ECE professionals who
experience high levels of stress at work as a
result of working with children who exhibit
challenging behaviors related to trauma.
2. Expand initiatives that help early care and
education programs connect families with
community services.
a. Invest in initiatives that help ECE programs
connect families with children who have
experienced trauma to screening and
services that can address their needs.
a
The U.S. Department of Health & Human Services’ Office of Child Care defines QRIS as “a systemic approach to assess,
improve, and communicate the level of quality in early and school-age care and education programs. Similar to rating systems
for restaurants and hotels, QRIS award quality ratings to early and school-age care and education programs that meet a set of
defined program standards.” See https://qrisguide.acf.hhs.gov/index.cfm?do=qrisabout.
b
The Substance Abuse and Mental Health Services Administration defines IECMHC as “an evidence-based approach that pairs
mental health professionals with people who work with young children and their families.” See https://www.samhsa.gov/iecmhc.
2 | Helping Young Children Who Have Experienced Trauma: Policies and Strategies for Early Care and EducationIntroduction
In almost every early care and education (ECE) challenges of children who experience trauma, of
program across the country, there are children their families, and of their teachers. It is equally
who have experienced trauma or who will, during important to identify features of programs (both
their early childhood, experience traumatic events. center-based and in homes) that help these children
Trauma in early childhood takes many forms, form positive relationships, feel safe and secure,
including abuse or neglect, witnessing violence, and enjoy learning and playing with their peers and
and having prolonged separation from or loss caregivers.
of a parent. An extensive body of research has
documented the negative impacts of trauma on This report includes:
young children’s behavior, learning, and other long-
term school- and health-related outcomes.
• a definition of early childhood trauma, including
different types, and its prevalence;
The prevalence of early childhood trauma is
difficult to establish, as researchers typically focus
• the impacts of early childhood trauma on the
child, family, and ECE programs;
on specific forms (e.g., child abuse and neglect).
However, one study found that 70 percent of • the special needs of young children who have
children endure three or more adverse childhood experienced trauma;
experiences—highly stressful or traumatic events—
by the time they reach 6 years old.13 The high • a description of trauma-informed care;
prevalence of trauma and the potential magnitude
of its effects underscore a critical mandate for ECE • promising program strategies to support the
programs and associated systems: to identify and healthy development and learning of young
implement promising strategies for supporting the children in ECE; and
healthy development of children who are victims of
trauma.
• recommendations of policies that could increase
the capacity of ECE providers to help children
Children in families at all economic levels experience who have experienced trauma learn and thrive.
trauma, but early childhood trauma occurs more
often in families facing financial hardship.14 Because
many young children spend long hours in ECE
programs,15 it is important to understand the
3 | Helping Young Children Who Have Experienced Trauma: Policies and Strategies for Early Care and EducationWhat is Early Childhood Young children also are more likely to be victims
of abuse and neglect,23 drowning, burns, falls,
Trauma? suffocation, and poisoning,24 and to live in homes
with domestic violence.25 For example, over one
Early childhood trauma occurs when a young child quarter of all children with confirmed cases of
(here, birth to age 6) experiences an event that child abuse and neglect are under age 3, and
causes actual harm or poses a serious threat to victimization is most common among children
the child’s emotional and physical well-being.16 under 12 months old.26 Unintentional injuries (e.g.,
Trauma is different from regular life stressors, drowning, falls, burns, choking, poisoning) occur
because it causes a sense of intense fear, terror, and most frequently among children 5 years and
helplessness that is beyond the normal range of younger.27 Children who are exposed to domestic
typical childhood experiences.17 Common types of violence also are disproportionately young, with 60
trauma during this developmental period include: percent under 6 years old.28
• abuse and neglect; Research on adverse childhood experiences (ACEs)
suggests that many young children also endure
• serious, untreated parent mental illness or
complex trauma. Approximately 70 percent of
substance abuse;
children experience three or more ACEs by the
• witnessing domestic violence; time they reach 6 years old.29 Certain types of
• prolonged separation from or loss of a loved trauma are especially likely to co-occur in young
one; and children’s lives. For example, between 30 and 60
percent of maltreated children live in homes with
• incurring serious injuries or undergoing painful domestic violence,30 and as many as 79 percent of
medical procedures. children in foster care have experienced both child
Some children face multiple types of trauma maltreatment and parental substance abuse.31
simultaneously or over time. Trauma exposure that The prevalence of trauma exposure among children
begins early in life, takes multiple forms, is severe who are enrolled in ECE programs is not well
and pervasive, and involves the caregiving system understood. However, one national study of children
(parents and other primary caregivers) is referred to who have experienced child abuse and neglect
as complex trauma.18 found that almost 30 percent of child-welfare-
Historically, society has overlooked the impact involved children were in child care programs, with
of trauma on young children, perhaps due to 21 percent in Head Start.32
misconceptions that infants, toddlers, and
preschoolers are not capable of perceiving or Early childhood trauma is unique.
remembering such circumstances or events.19
Research shows that early childhood trauma differs
Another myth is that young children always “bounce
from trauma that occurs later in life.33 Not only
back” from adversity. In fact, research demonstrates
is it especially prevalent in early childhood, but
that the first few years of life constitute a period
young children have different responses to trauma
during which children are highly sensitive to trauma,
than do older children and adults. Infants and
and more vulnerable to its negative effects than
toddlers cannot verbalize their feelings, talk about
during any other period of life.20 Children are aware
frightening events, or describe their nightmares.
of traumatic experiences when they occur and can
Preschoolers have not yet fully developed the skills
show signs of distress beginning in the first weeks of
to express feelings of being afraid, overwhelmed,
life; long-lasting trauma symptoms have been found
or helpless. As a result, young children exhibit a
to begin in infants as young as 3 months old.21
range of behaviors that adults may not recognize
as reactions to trauma (e.g., excessive crying,
The prevalence of trauma in early distress, regression, aggression, withdrawal, physical
childhood is high. symptoms, acting out traumatic events during
play).34
Trauma is common in early childhood. Almost 35
million children in the United States (approximately Some of these behaviors may look similar to
48 percent) have been exposed to one or more those of their peers, yet may not be amenable
types of trauma,22 and young children are at to typical approaches that adults use to address
disproportionate risk compared to older children. challenging behavior (e.g., redirection, helping a
4 | Helping Young Children Who Have Experienced Trauma: Policies and Strategies for Early Care and Educationchild express feelings Impact on brain development. Early experiences
Early childhood trauma in a constructive way, influence brain development, and trauma can
generally refers to the removing a child interfere with brain in several ways, including
traumatic experiences that from the situation). interfering with executive function and self-
occur to children ages Sometimes, even regulation, and limiting brain volume (which is
zero to 6. strategies that critical to emotion regulation, cognition, and
normally work well behavior).41 Executive function and self-regulation
Because infants’ and
to promote positive skills are the mental processes that allow individuals
young children’s reactions
behavior (e.g., praise, to engage in planning, focus our attention,
may be different from
a gentle touch on the remember instructions, and balance multiple tasks
older children’s, and
shoulder, a reward) at once.42 Traumatic stress can reduce children’s
because they may not
increase a child’s ability to cope with stress effectively, leading them
be able to verbalize their
stress, because they to overreact or fail to respond appropriately.43
reactions to threatening
remind the child of a Moreover, chronic trauma (e.g., neglect) is linked to
or dangerous events,
traumatic event.35 smaller brain volume; poor information processing,
many people assume
self-regulation (the ability to control impulses, focus
that young age protects Because early attention, solve problems, and organize behavior),
children from the impact childhood trauma and attention; and mental health disorders later in
of traumatic experiences. can be both difficult life.44
However, young children to identify and to
are affected by traumatic address successfully, Impact on cognitive development and learning.
events, even though they it is essential that Young children who experience trauma show
may not understand what the adults who care cognitive and language delays that place them at
happened. for young children— risk for early learning difficulties and later academic
including ECE challenges.45 One study found that over one quarter
Source: National Child professionals—learn of maltreated children had serious language
Traumatic Stress Network. how to recognize delays.46 A fifth of maltreated children had very low
Available at http://www.nctsn. trauma reactions scores on a measure of attention, understanding
org/trauma-types/early- and respond of concepts, and other cognitive skills that
childhood-trauma appropriately.36 predict school readiness. Without intervention,
early difficulties with language or attention, or
other delays, can persist and undermine school
The Impacts of Early performance among young victims of trauma.47
Childhood Trauma Impact on social-emotional development. Early
trauma is associated with myriad social-emotional
Impact on children problems in childhood, adolescence, and adulthood.
Short-term consequences include difficulties coping
Trauma takes a toll on children, parents, families, with stress, feelings of helplessness, worthlessness,
workers in ECE programs, and society generally. and hopelessness, low self-esteem, and feeling
Many children return to functioning normally after responsible for bad things that happen.48 Behavior
a traumatic event, particularly if it was a single problems are also common,49 and may lead to more
incident. Others, especially those who experience serious behavior problems and poor social skills.50
complex trauma, suffer serious and long-lasting Post-traumatic stress disorder (PTSD) also can occur
consequences.37 Generally speaking, more severe in early childhood. Approximately 39 percent of
and chronic trauma leads to more problematic child preschoolers develop PTSD following a traumatic
outcomes.38 However, the particular impact—and a event,51 and PTSD has been described in infants
child’s ability to recover—depends on the age of the as young as 12 months old.52 Young children who
child, the nature of the trauma, and the presence experience trauma also are at high risk for anxiety
of other risk factors (e.g., parental mental illness, and depression, difficulty with social situations, and
poverty, community violence, social isolation) and trouble accepting praise later in life.53
protective factors (e.g., a nurturing caregiver, social
support, concrete supports).39 For instance, young Impact on attachment. Trauma threatens young
children who live in poverty and are exposed to children’s ability to form and maintain secure
trauma are more vulnerable to its negative effects attachment relationships.54 Problems with
than are children living in higher-income families. attachment can stem from issues in relationships
5 | Helping Young Children Who Have Experienced Trauma: Policies and Strategies for Early Care and Educationwith primary caregivers (e.g., loss of a parent, abuse, develop. In some cases, family members endure
neglect, domestic violence) and create a blueprint enforced separations and dangerous circumstances,
for relationships later in life. Children may show such as those associated with domestic violence
mistrust, withdrawal, or aggression with others. They or child maltreatment.65 Finally, adults may miss
may also have difficulty developing and maintaining time at work because ECE programs have difficulty
healthy friendships, romantic relationships, and managing children’s challenging behaviors and may
positive interactions with authority figures.55 Thus, suspend or expel children, or send them home early.66
it is critical when working with young children who
have experienced trauma to support their primary Impact on early care and education
attachment relationships.56
programs
Impact on physical health and development. Some
ECE programs are impacted by early childhood
traumatic events can cause immediate physical harm
trauma through children’s challenging behaviors,
(e.g., a car accident, physical abuse). In other cases,
and the strain they place on ECE professionals who
physical effects appear over time. For example, early
must manage them. Young children’s externalizing
childhood trauma can have long-lasting effects by
(acting out) behaviors, in particular, have negative
causing biological disruptions that lead to health
effects on ECE teachers and classrooms.67 ECE
problems in adulthood, including heart disease,
teachers may experience high levels of stress,
cancer, alcoholism, depression, drug abuse, obesity,
burnout, and turnover. Other negative effects of
and smoking.57
early childhood trauma on ECE programs include
disruptions to routines, activities, and learning
Impact on parents and families among other children.
Caring for a child affected by trauma can be
Impact on preschool suspension and expulsion.
challenging for parents and other primary caregivers
Some young children entering ECE programs have
(e.g., grandparents, other family members and
problems severe enough to limit their ability to
kin; hereafter referred to as “parents”). A child’s
participate in routine activities, and thus to reap the
trauma can have a strong influence on other family
full benefit of ECE.68 Families of these children may
members and their relationships.58 Parents are most
even be asked to leave ECE programs. In fact, the
often children’s source of support after a traumatic
national rate of preschool expulsion in state-funded
event. A parent’s warm response following a child’s
pre-kindergarten programs is over 3 times the rate
trauma exposure is associated with fewer symptoms
of expulsion in kindergarten to 12th grade (6.7 versus
of PTSD,59 whereas their overprotectiveness or
2.1 per 1,000 children enrolled).69 In private child
avoidance may increase a child’s risk for PTSD.60
care programs, the rate of preschool expulsion has
Impact on parents. Caring for a young child who is been found to be even higher.70 Black children and
a victim of trauma is stressful, which may negatively boys are at especially high risk for expulsions and
affect parenting. For instance, parents’ distress may suspensions, due in part to implicit bias by teachers
interfere with their ability to respond sensitively, and programs.71
contributing to further distress in the child.61 Parents
Impact on teacher stress, burnout, and turnover.
and other caregivers may also have been involved
Job stress reduces the capacity of ECE professionals
in the same traumatic event as their children (e.g.,
to work effectively with children who have emotional
domestic violence, natural disaster, war).62 In such
and behavioral problems.72 For example, high levels
instances, negative reactions from either the parent
of workplace stress have been shown to lead to
or the child may intensify symptoms in the other.63
teacher-child conflicts in Head Start.73 Many ECE
A child’s trauma may be an emotional trigger for a
professionals feel unprepared to cope with these
parent who has been a victim of trauma. In some
children, and may feel torn between attending to a
cases, parents may be overwhelmed by these
particular child’s needs or focusing on the group.74
triggers, and may respond to their own needs before
The demands of managing children with severe
those of their children.64
emotional and behavior needs, especially in the
Impact on families. Caring for a young child who absence of adequate training, support, and self-care,
has experienced trauma also affects other aspects often leads to secondary traumatic stress (feeling
of family life. When families are stressed and their mentally, emotionally, or physically exhausted or
emotional resources are limited, daily routines overwhelmed by working with children affected by
may become more difficult, and conflicts within trauma), burnout, and turnover among staff.75
the parenting couple or sibling relationships may
6 | Helping Young Children Who Have Experienced Trauma: Policies and Strategies for Early Care and EducationSuch stressors, in combination with other factors • protect children from re-traumatization, and
(e.g., insufficient compensation, limited support
from leadership) may contribute to high rates of • promote children’s self-regulation skills.84
teacher turnover. Each year an estimated 25 to 50
percent of preschool teachers leave their jobs,76 ECE professionals have a critical role in helping
and almost one fifth of center-based staff leave young children recover from trauma. Many young
the field entirely.77 Turnover disrupts teacher-child children spend much of their day in ECE programs
attachments, adversely impacts children’s learning, (in 2011, approximately 60 percent of children under
and threatens the emotional well-being of all age 5 were in child care; preschoolers spend an
children in ECE programs.78 average of 33 hours per week in care).85 Children
benefit from relationships with ECE professionals
who care for them in trauma-sensitive ways. To
Impact on society
provide this type of care, ECE professionals need
Early childhood trauma places a heavy burden on adequate training on the impact of trauma on young
society. The behaviors and conditions associated children, on effective strategies for identifying and
with early trauma can lead to dependence on a wide addressing trauma, and on helping families access
range of systems, such as child welfare, juvenile and community services. To prevent secondary traumatic
criminal justice, and physical and behavioral health. stress86 (the experience of feeling mentally,
In addition, trauma that goes unaddressed early emotionally, or physically exhausted or overwhelmed
in life can manifest in later behaviors that disrupt by working with children affected by trauma), ECE
school and work environments.79 Moreover, there are professionals also need reflective supervision—a
financial consequences. For example, in the United collaborative relationship between supervisors and
States, the estimated total lifetime cost to society program staff that promotes professional growth
associated with one year of confirmed cases of child and improves program practices and quality.87 And,
maltreatment is $124 billion.80 they need time for self-care.
Children benefit when ECE staff also promote
Meeting the Needs of parents’ well-being. When parents’ physical, mental,
and emotional needs are met, they are more likely to
Young Children Who Have give sensitive care. A positive alliance between ECE
professionals and parents, in which staff recognize
Experienced Trauma families’ strengths and values, encourage families
to participate in children’s education, and engage
All children benefit from stable, safe, and nurturing family members in planning to make progress
relationships and environments.81 However, these toward their goals, is essential to children’s social-
relationships and environments are particularly emotional well-being. ECE programs can help young
important for young children who have experienced victims of trauma by working with parents and other
trauma. Their presence and stability can help caregivers to help them gain access to concrete
children recover from past trauma and develop the supports (e.g., medical, mental health, educational,
skills to cope and thrive.82 and legal services), emotional supports (e.g., social
support, self-care), and other community services
Presence and continuity of a nurturing caregiver.
(e.g., evidence-based trauma treatment and other
An extensive body of research shows that children
mental health services, primary medical care,
who do well despite adversity have at least one
supports from child welfare, Early Intervention,c
stable and nurturing adult caregiver in their lives.83
home visitingd).
Adults who serve in this role can:
Environments that promote safety and trust.
• facilitate children’s coping with trauma by
Environments that promote safety and trust, both
helping them process events and giving meaning
at home and in ECE programs, help young children
to experiences,
heal from traumatic experiences by restoring a
c
Early Intervention are services for children, birth to age 2 with disabilities, and their families provided through The Program for
Infants and Toddlers with Disabilities (Part C of IDEA). See http://ectacenter.org/partc/partc.asp for additional information.
d
Home visiting consists of services that are offered on a voluntary basis to pregnant women, expectant fathers, and parents and
caregivers of children from birth to kindergarten entry, that target outcomes including maternal and child health; prevention
of child injuries; reduction in/prevention of child abuse, neglect, and emergency department visits; school readiness and
achievement; reduction in domestic violence; parenting skills; and referrals to community resources and supports. See https://
homvee.acf.hhs.gov/HomVEE_Executive_Summary_Summary_03162017.pdf
7 | Helping Young Children Who Have Experienced Trauma: Policies and Strategies for Early Care and Educationfeeling of control and predictability. Consistent informed is
routines and appropriate expectations are also challenging, due
A trauma-informed child- and
important. In addition, ECE professionals can to variations in
family-service system is one
identify and limit those experiences that may re- interpretation of
in which all parties recognize
trigger a child’s trauma (e.g., smells, sounds, sudden its components.
and respond to the impact of
movements).88 They can prepare children to cope The National
traumatic stress on those who
with these triggers, provide a safe space for verbal Child Traumatic
have contact with the system,
children to talk about their experiences and feelings, Stress Network’s
including children, caregivers,
and offer opportunities for parents, too, to learn definition of a
and service providers.
these skills and create safe environments at home. trauma-informed
Programs and agencies within
service system is
Environments that promote self-regulation and such a system infuse and
a helpful starting
social-emotional skills. Promoting children’s self- sustain trauma awareness,
point (see text
regulation skills can help them heal from trauma.89 knowledge, and skills into
box).
Young children’s experiences in the first years of life their organizational cultures,
affect their ability to calm themselves, communicate TIC includes all practices, and policies. They act
effectively, get along well with peers and adults, of the people in in collaboration with all those
take pride in their accomplishments, and become young children’s who are involved with the child,
more aware of their feelings and behaviors. ECE lives. For an ECE using the best available science,
providers also can help children by practicing co- program, TIC to facilitate and support the
regulation—nurturing interactions in which they means increasing recovery and resiliency of the
model and coach self-regulation skills when children knowledge and child and family.
face stressful situations or trauma triggers. They skills among bus
Source: National Child
can also work with families to learn how to support drivers, classroom
Traumatic Stress Network
children’s self-regulation skills. assistants,
http://www.nctsn.org/
teachers, family
Environments that promote early skills needed to resources/topics/creating-
service workers,
succeed in school. To avoid serious delays in the trauma-informed-systems
program
language skills that promote self-regulation and leaders, families,
success in school,90 children who have experienced mental health
trauma are particularly in need of environments in consultants, and anyone else who comes into
which adult caregivers, including ECE professionals, contact with young children.
actively promote their language development
through conversations, interactive book reading, In TIC, training ECE staff and increasing their
and activities that help build vocabulary and the awareness about early childhood trauma is critical,
ability to understand and use increasingly complex but it is not enough.93 TIC also requires collaboration
language.91 Similarly, these children benefit from with other community service organizations
environments that offer strong supports in the to address the needs of traumatized children
social-emotional, early math, and language domains, proactively and to establish program, local, and
so that they enter school ready to learn.92 state policies that address their unique needs.94
Successful TIC requires coordinated efforts at all
levels.
Putting It Together:
If we overlook the impact of trauma on young
Trauma-Informed Care for children, we may inadvertently prolong their
exposure, cause re-traumatization, and impede
Young Children their process of recovery. ECE programs that
become trauma-informed and trauma-responsive
Researchers, practitioners, and policymakers
settings, and that collaborate with other service
recognize that addressing childhood trauma will
systems, support the optimal development of
take more than any single individual, service,
all children, including children with and without
or intervention. Thus, helping young children
formally documented trauma. Fortunately, there
overcome traumatic experiences cannot be the sole
are a number of promising TIC strategies for young
responsibility of parents, the mental health system,
children that can be effective in ECE systems.
or ECE staff. Rather, a systemic approach, often
called trauma-informed care (TIC) or a trauma-
informed approach, is needed. Defining trauma-
8 | Helping Young Children Who Have Experienced Trauma: Policies and Strategies for Early Care and EducationPromising Strategies for Kids in Transition to School (KITS) is a curriculum
for ECE programs that promotes psychosocial
Meeting the Needs of and academic school readiness among children in
foster care and/or at high risk for school difficulties.
Young Children Exposed Delivered during the transition from preschool to
kindergarten, KITS includes playgroups to enhance
to Trauma children’s social-emotional skills and literacy, and
parent workshops to promote involvement in early
Despite the fact that the majority of ECE professionals literacy and positive parenting practices. Evidence
work with traumatized children every day, promising from RCTs indicates that children in KITS had lower
strategies within ECE programs and systems for levels of oppositional and aggressive behaviors
addressing the needs of those children have only compared to children in the control group;96 KITS
recently begun to emerge. Moreover, few strategies also had positive effects on early literacy and self-
have been rigorously evaluated. Nevertheless, (though regulation skills.97
not all of these have been evaluated), a number of
innovative approaches, including initiatives within Let’s Connect (LC) is an intervention that promotes
existing ECE programs, have been implemented. resilience and well-being among caregivers and
children who have experienced stressful life events
Here, we review some of these promising practices. such as trauma. LC includes teacher training,
See “Appendix A” for more detailed descriptions of modeling positive interactions with children and
these strategies and evidence of their effectiveness. their caregivers, live coaching of teachers, and
ongoing consultation with teachers by a therapist.
Integrating trauma-informed care into It can be integrated with evidence-based parent
early care and education programs treatment (e.g., Trauma Focused Cognitive-
Behavioral Therapyf). LC has been used in Head
Several early childhood trauma strategies have Start programs and schools. Pilot studies indicate
been designed to be integrated into existing that LC activities are feasible to implement, and
ECE programs. Some take the form of curricula are viewed positively by caregivers. They also
emphasizing evidence-based or evidence-informed found improvement in caregivers’ communication
approaches to meeting the needs of young, trauma- of positive emotions and their connection and
impacted children and their families. Others focus on emotion-support skills with family members, and
establishing partnerships between ECE and mental reductions in their communication of negative
health. Still others offer services in a wide range of emotions with family members from pre- to post-
settings that include ECE. Below are a few examples of treatment.98 An RCT of LC in Head Start is underway.
promising approaches to the integration of TIC in ECE.
Safe Start was developed by the U.S. Office of
Trauma Smart (TS) is an early education/mental Juvenile Justice and Delinquency Prevention
health partnership designed for Head Start (OJJDP) to mitigate the negative consequences
classrooms. The goals of TS are to reduce the stress of children’s exposure to violence and to enhance
of chronic trauma, support children’s social and the well-being of children and adolescents through
cognitive development, and develop an integrated, preventive interventions. Programs use different
trauma-informed culture for young children, parents, approaches: some provide services only to children;
and staff. TS includes training, classroom consultation, others serve children and their families. All include
intensive evidence-based clinical treatment, and peer a therapeutic component, and many offer case
mentoring of teachers. An evaluation of TS found management and/or service coordination for
that teachers reported significant improvements in families. Intervention sites vary (e.g., homes, clinics,
children’s externalizing behavior (including defiant and shelters, child centers, Head Start classrooms).
oppositional behavior) and attention. Parents reported An RCT of Safe Start in a Michigan Head Start
significant reductions in externalizing behaviors, program found significant improvements in reported
internalizing behaviors (depression, anxiety), and symptoms of child PTSD, and in social-emotional
inattention/hyperactivity.95 A rigorous evaluation competence and academic achievement.99
(a randomized controlled trial [RCT]e) is currently
underway.
e
An RCT is a study in which participants are assigned by chance to different groups. See https://www.ncbi.nlm.nih.gov/
pubmedhealth/PMHT0025811/.
f
For additional information about Trauma-Focused Cognitive Behavioral Therapy, see https://tfcbt.org/about-tfcbt/.
9 | Helping Young Children Who Have Experienced Trauma: Policies and Strategies for Early Care and EducationTherapeutic early care and education Partnerships between early care and
programs education and community service
Some licensed child care programs provide a providers
specialized therapeutic environment for children
To meet the needs of young children who have
who have experienced trauma. This approach
experienced trauma and their families, some
differs from those that emphasize general inclusion
ECE programs develop close partnerships with
of young children with disabilities, including
community agencies that can provide additional
social-emotional disabilities such as PTSD, in high-
services. Examples include trauma screening,
quality early childhood programs.100 The programs
referral, and service coordination, including linking
described below have demonstrated positive
children and families to evidence-based trauma
outcomes for children, and use specific strategies
treatments and practices. ECE programs also can
that may be applicable to inclusive classrooms and
help connect families to court and legal services that
to the broader field of ECE.
are trauma-focused. Below are several promising
Childhaven Childhood Trauma Treatment (CCT) initiatives in these areas.
provides therapeutic child care and optional
The Centralized Referral System (CRS; “LINK-
specialized services for maltreated and/or drug-
KID”) provides free statewide trauma screening,
affected children and their families. Treatments
referral, and follow-up services to evidence-based
focus on the child and caregiver together, using
treatments for children in Massachusetts exposed
evidence-informed approaches. Results of an RCT
to trauma through a toll-free number staffed by
showed that families in CCT showed more parental
master’s-level social workers. An initial evaluation
responsiveness and a more positive emotional
found that the average wait for a first appointment
climate compared to families in the control group.
was 25.5 days, compared to 180 to 360 days for
Children displayed less aggression, fewer physical
children seen in area local mental health agencies.104
complaints, less anxiety/depression, fewer social and
attentional problems, fewer internalizing behaviors, Help Me Grow (HMG) promotes early identification
and a greater degree of social acceptance by of and supports for children at risk for
peers.101 developmental and behavioral problems. Core
components include (1) outreach to child health
Children’s Relief Nurseries (CRN) offer services to
care providers to support their use of screening
families with young maltreated children and those
and HMG resources; (2) a centralized telephone
at high risk for child welfare system involvement.
line that a parent, early childhood professional,
Services are free, and include therapeutic ECE in
pediatrician, or other concerned person can call to
classroom settings, home visits, parent education
obtain information about screening and services
and support groups, respite care, case management
for a family; (3) community outreach to encourage
and assistance accessing basic resources and other
service providers to use HMG and network to
community services. Some nurseries focus on
coordinate services; and (4) data collection that
responding to trauma. For example, Portland’s CRN/
helps identify gaps in services for families that can
LifeWorks NW provides Child-Parent Psychotherapy
inform policy initiatives. Implementation research
(CPP),102 adult mental health treatment, and other
on HMG showed that 85 percent of children and
intensive programming. A recent evaluation found
families referred were connected with community-
that CRN parents read more frequently to children,
based programs and services, and that services were
family functioning improved, and parent-child
associated with an increase in protective factors.105
interactions were more positive. Parents had fewer
risk factors (out of 23 targeted by the intervention; Safe Babies Court Teams (SBCT) is an initiative
e.g., child welfare and foster care involvement, in which courts coordinate with child welfare
mental and physical health, poverty, and family agencies and other organizations to facilitate service
violence) and reported high levels of satisfaction delivery to infants and toddlers in the child welfare
with services.103 system. SBCTs have been replicated across the
country. Each team is a public–private collaboration
between ZERO TO THREE,g local courts, community
leaders, child and family advocates, child welfare
g
ZERO TO THREE is an organization that uses the science of early development to develop resources, tools, and policies to
ensure that infants and toddlers have a strong start in life. https://www.zerotothree.org/.
10 | Helping Young Children Who Have Experienced Trauma: Policies and Strategies for Early Care and Educationagencies, ECE providers, government agencies, guide development for professionals who work with
private philanthropies, nonprofit and private service infants and their families. Such systems can help
providers, and attorneys committed to improving equip ECE providers to work with young trauma
community response to child maltreatment. victims. However, the majority of professional
Evaluation findings show that SBCT is associated with development and training efforts have not yet been
significant gains in key child welfare outcomes (safety, rigorously evaluated. Below are several examples of
permanency, well-being).106 A second study found that promising approaches to professional development
children in SBCT reached permanency 2 to 3 times and training.
faster and exited the foster care system one year
earlier than did children in a matched comparison The Michigan Association of Infant Mental
group, and they were more likely to find a permanent Health (MI-AIMH) Competency Guidelines and
home with a member of their biological family.107 Endorsement offers a guide for individuals working
with pregnant women and families with children
from birth to age 5, and for those who provide
Infant and early childhood mental
training to those workers, on culturally sensitive,
health consultation relationship-focused practices that promote infant
mental health. Practitioner skills and knowledge in
Currently operating in more than half the states,
child trauma are a key component at all four levels
early childhood mental health consultation
of endorsement.113 As of 2016, 27 states and 18 state
(IECMHC) is a multi-level preventive intervention
infant mental health associations were using the MI-
where mental health professionals work with ECE
AIMH Competency Guidelines.
professionals, programs, and families to improve
children’s social, emotional, and behavioral The Child Trauma Training Toolkit for Educators
health and development. The approach includes provides resources on child trauma for educators
observations, individualized strategies, and early and parents working with different age groups,
identification of children with and at risk for including preschool-aged children. It also includes
mental health challenges.108 Most IECMHC does not information on traumatic grief (an intense response
specifically focus on child trauma. However, Project to grief following the death of a loved one), and
Play in Arkansas has a trauma focus, prioritizing on self-care for educators to address secondary
consultation services to ECE programs that serve traumatic stress.114
children in foster care, helping staff understand
children’s behavior in relation to trauma, and Trauma Informed Care: Perspectives and Resources
placing a particular emphasis on working with ECE is a web-based, video-enhanced resource tool that
professionals to strengthen features of care that offers eight modules designed to enhance federal-,
are important for children who have been exposed state-, local-, and provider-level work to become
to trauma (e.g., continuity of care, and a nurturing trauma-informed. Each module includes an issue
relationship). A review of 14 studies that used brief, a video, and a resource list.115
rigorous methods reported generally positive results
for key outcomes, including an increase in positive High-quality early care and education
child behaviors and a reduction in challenging
behaviors.109 Studies also show that IECMHC High-quality ECE is an essential foundation
prevents preschool expulsion,110 reduces parental for trauma-informed care. ECE programs that
stress and missed work time,111 and decreases meet high quality standards have the potential
teacher stress and turnover.112 for both immediate and lifelong benefits for
all young children, but particularly those from
Professional development and disadvantaged backgrounds, such as children
who have experienced trauma. For example,
training maltreated children in ECE programs with better
quality have better school readiness outcomes,116
Accompanying increasing recognition of the
compared to children in ECE programs with lower
mental health needs of very young children has
quality. Moreover, a recent analysis of two well-
been interest in related professional development
known high-quality ECE programs—the Carolina
and training opportunities for ECE professionals.
Abecedarian Project and the Carolina Approach to
A number of web-based trainings on child trauma
Responsive Education—found significant benefits for
show promise. In addition, endorsement systems
disadvantaged children across multiple life-domains
for competence in infant mental health have helped
11 | Helping Young Children Who Have Experienced Trauma: Policies and Strategies for Early Care and Education(health, quality of life, education, employment, Increase the capacity of infant and early childhood
crime), and found a return on investment in high- mental health consultants to incorporate trauma-
quality early childhood programs of up to 13.7 informed approaches. As a widely embraced,
percent per year.117 evidence-based, ECE program capacity-building
strategy,121 infant and early childhood mental health
Recommendations consultation (IECMHC) is well-positioned to promote
a trauma-informed ECE workforce. States have
This section presents recommendations of policies increasingly invested in IECMHC, which has been
and practices that can help increase access to high- shown to decrease teacher stress and turnover,122
quality, trauma-informed early care and education. prevent preschool expulsion,123 and reduce problem
While these recommendations have particular behaviors among children.124 To increase the return
relevance to state-level policymakers, they also on their investments and reach young children
apply to program directors, community, state, and affected by trauma, states should implement
federal leaders in the field of early childhood, as well professional standards and training for IECMHC
as advocates of other aspects of high-quality ECE consultants that emphasize TIC.
programming (e.g., Quality Rating and Improvement
Increase support for early care and education
Systems, infant and early childhood mental health
professionals who experience high levels of stress
consultation).
at work. The stress commonly experienced by
Some of these recommendations emphasize ECE professionals who care for children who have
increased state and federal funding to expand experienced trauma is not only detrimental to the
supports for ECE programs, while others focus on well-being of ECE staff, but also can interfere with
state program standards, professional competencies, positive teacher-child interactions.125 A recent report
and administrative policies, such as states’ plans for of the National Research Council, Transforming
the Child Care and Development Fund (CCDF), the the Workforce for Children Birth Through Age
largest source of funding for child care assistance 8,126 discusses several potential strategies for
for low-income families.118 Because individual ECE reducing teacher stress, including training on self-
programs cannot be expected to meet all the needs care and mindfulness. As the evidence base for
of these children and families, the recommendations stress reduction strategies grows, states should
also call for policies that help ECE programs connect promote their use through professional competency
families to other community services. standards and training. This will ensure that infant
and early childhood mental health consultants
Recommendation: Strengthen the and professional development specialists acquire
the skills they need to support the well-being of
early care and education workforce by ECE professionals who work with children who
increasing professionals’ capacity to experience trauma.
provide trauma-informed care. Recommendation: Expand initiatives
Incorporate strategies that benefit children who that help early care and education
have experienced trauma into ECE professional
development. Although research evidence is lacking programs connect families with
for specific models in ECE programs that benefit community services.
children who experience trauma, professional
development (PD) is a component of a number of Invest in initiatives that help early care and
promising interventions that help ECE professionals education programs connect families with children
acquire trauma-informed knowledge, skills, and who have experienced trauma to screening and
practices.119 State CCDF plans and professional services that can address their needs. Many
development offered through quality rating and ECE programs do not have the capacity to meet
improvement systems should include strategies used the many unique needs of children who have
in these interventions that help ECE professionals experienced trauma. Some need specialized
implement trauma-informed practices.120 In addition, treatment, and many live in families facing
as the evidence base for particular strategies grows, challenges that pose ongoing risks to young
states should promote their use through professional children, such as parental depression, housing
competency standards and training, and by ensuring and food insecurity, and social isolation. State and
that state professional development plans include TIC. federal investments in linkage systems, such as
12 | Helping Young Children Who Have Experienced Trauma: Policies and Strategies for Early Care and EducationThe Centralized Referral System (LINK-KID) and Establish policies that promote the placement of
Help Me Grow, can help ECE programs connect young children who have experienced trauma in
families to child and family services, including high-quality early care and education programs.
trauma screening, evaluation, and evidence-based Children who have endured trauma show more
treatment, that complement the supports provided learning and social-emotional growth when ECE
in the ECE classroom. These systems also can programs meet high quality standards. Examples of
help families obtain services, such as treatment high-quality programs include Head Start Programs
for parents’ mental health problems or financial and Early Head Start (HS/EHS), ECE programs with
assistance, that can help reduce stress and increase their state’s highest quality ratings, and programs
the odds of resilience among these children and accredited by the National Association for the
their families. Education of Young Children. Currently, children in
foster care are categorically eligible for HS/EHS,
Recommendation: Provide children regardless of family income.128 The new Child Care
and Development Block Grant Acth regulations
who have experienced trauma with encourage states to provide vulnerable children,
high-quality, stable early care and including children who are homeless and in foster
care, with access to child care.129 Several states use
education and strong early learning
contracts to create slots in HS/EHS and other high-
supports. quality child care for vulnerable children, including
those who have experienced trauma.130 In addition,
Establish policies for early care and education
increased state and federal investments in initiatives
programs that promote continuity of care and
such as Safe Babies Court Teams, that promote
participation in early care and education for
collaboration among the courts, ECE programs,
children who have experienced trauma. Children,
and other child-serving organizations, would help
particularly those who have experienced trauma,
improve access for this population to high-quality
need and benefit from stable, nurturing care in ECE
ECE programs.
programs. QRIS and other ECE program standards
should require that all infants and toddlers, including Develop policies that severely limit or prohibit the
those who have experienced trauma, have a primary suspension and expulsion of young children, and
caregiver. When there is one adult who consistently require appropriate interventions for children who
cares for an infant or toddler, the child can develop have experienced trauma and have social-emotional
a close, trusting relationship.127 States also should or behavioral difficulties. Children who have
promote continuity of program participation. experienced trauma are at higher risk for expulsion
Federal Child Care Development Fund regulations than other children because they often demonstrate
require states to provide 12 months during which challenging behavior as a symptom of their distress;
the family is continuously eligible (according behaviors such as hitting, biting, or behaving
to state guidelines for eligibility) for subsidized recklessly may result in ECE programs’ refusing to
child care. If a parent experiences permanent serve some children and families. Recent federal
job loss or the end of an education or training guidance directs states to establish prevention
activity, the state must give families a minimum strategies, including infant and early childhood
of 3 months of extended child care assistance if it mental health consultation and professional
elects to terminate families’ assistance under these development, that help ECE professionals address
circumstances. However, states have the option of challenging behavior, and policies that eliminate
extending assistance beyond this 3-month period preschool suspension and expulsion.131 The need
or not terminating assistance before 12 months. In for such policies is critical for children who have
addition, CCDF rules offer a graduated 12-month experienced trauma and would endure further harm
phase-out for parents whose incomes rise above the by losing the social-emotional and learning supports
state’s income eligibility threshold. State policies provided through high-quality ECE.
that offer extended assistance to provide continuity
of participation in ECE could greatly benefit this Establish screening and educational support
population of young children, who might otherwise policies that respond to both the social-emotional
experience disruptions in care. and early learning needs of children who have
experienced trauma. Young children who are victims
of trauma have a heightened risk for delays in
h
CCDGB is the main source of federal funding for child care subsidies provided to low-income working families and for
improvements in child care quality.
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