The growing volume of research on childhood trauma and its link to behavioral health problems, medical problems, criminality, suicide, violence, and living on the margins of society are clear. If we are to reduce the prevelence of these problems, we must solve the problem of child maltreatment, domestic violence, and paucity of family supports. It is important to eliminate the idea that Children and Teens are “bad.” They have likely expereinced trauma in childhood, often before the age of 6.
To change this situation we must look at the likely source of childhood toxic stress, which is child maltreatment, often within families. When we look at the source of this phenomenon, we find families in poverty, with family members suffering from substance abuse and mental illness. This is a source of childhood trauma within families.
Our support and help for families in poverty, and suffering from substance abuse and mental illness is insufficient in the US and perhaps around the world. It is a difficult topic to admit that caregivers are unable to provide adequate care for their families without help. While the social infrastructure bill is under discussion, it is important to also look at the needed support of families in distress, leaving the children of those families growing up in toxic stress resulting in substance abuse, criminality and violence. The goal should be to prevent substance abuse, mental illnesses, criminal behavior, and violence through increased family supports, services, and treatment.
Therefore, the recommendation is to provide more services for families and the children in their care. Departments of Social Services and behavioral health agencies need to be funded at a higher level and provide treatment services for youth and families. We could also follow the lead of some European coutries in combining departments of social services and departments of juvenile services, thus supporting youth and their families together. To do this we must see the connection between childhood trauma and the social problems that they generate.
Increase funding universally for behavioral health agencies, Departments of Social Services (DHS), and departments of juvenile services
Provide sufficient behavioral health treatment services in any home where there is child maltreatment or domestic violence.
When a youth enters a Department of Juvenile Services, provide behavioral health services for the entire familiy, not just the youth that enters the system.
Link services of Behavioral Health Agencies to Departments of Social Services and Departments of Juvenile services
Treat the entire family, not just the youth that has come to the attention of a public agency.
For Mental Health awareness week, Gov. Hogan issued a proclamation recognizing the association of trauma with mental and behavioral health issues. He stated that all mental health services should identify any trauma which requires treatment to support the treatment of any mental health issues.
I recommend that the ACE’s Questionnaire in any of its variants be filled out on all clients so that if Trauma-informed care is needed, it can be provided.
The various types of trauma include:
child abuse and neglect
exposure to violence
treating someone with disrespect or harshness
a child’s parents or caregivers being arrested or incarcerated for illegal activity
Being belittled or treated with emotional harshness
Substance abuse by parents or caregivers resulting in neglect of youth in their care
The results of childhood maltreatment are:
functioning at a developmental level less than would be expected given one’s age
neurological disruption of ability to self soothe when upset and exercise emotional dyscontrol when upset
cognitive disruption resulting in learning problems
Difficulty getting along with others
Aggression toward others
lack of rule-following
Getting in trouble with the law or school authorities
Association with peers that get into trouble with school or law enforcement authorities.
Ways to Reduce the Risk of aggression toward others, breaking school rules, and law-breaking includes a combination of:
Neuro and biofeedback
Increase in structure and rule enforcement
Behavior modification and use of behavior contracts
I started out with the idea of summarizing information about the Trace newsletter that I receive, but I decided this organization was too important to minimize. So, here is the link to a publication dedicated entirely to a broader perspective on violence prevention, http://thetrace.org
The New Your Times reported, “The United States experienced its biggest one-year increase on record in murders in 2020, according to new figures released Monday by the F.B.I., with some cities hitting record highs.”
I am sure that the pandemic had some effect on the US violence rate in 2020. However, prevention and treatment of those at higher risk for violence is a solution-focused view of this problem.
Trauma-informed treatment can be very effective in reducing the potential risk of violence. Another solution-focused intervention based on research would be to ensure that child maltreatment is eliminated and that traumatized children get effective treatment which often includes family treatment. It is important that children are properly cared for in homes where violence is a recurring event. Additionally, many children in foster care have been maltreated. This is a population that needs effective trauma-informed care.
I just read an article on Meditation being used to help those involved in the criminal justice system. The authors reviewed multiple studies. They found that regular meditation reduced re-offending in all categories of offending including sex offenders. Another article reviewed information about the connection between trauma and externalized behavior problems (harm toward other people) and found a significant correlation between childhood trauma and offending behaviors.
Third and fourth articles on my newsfeed.
There is an active shooter in a grocery store in Collierville, TN. One is reported dead as well as the shooter and there are several reported injuries.
The death of Gabby Petito is a homicide. Authorities have found the remains of her boyfriend, Brian Laundrie. Mr. Laundrie was seen being verbally and physically aggressive toward others, including Gabby, on their trip to the Grand Tetons.
When are we going to look seriously at prevention of Domestic violence? A big piece of the violence problem has to do with the maltreatment of family members and the failure to protect and provide treatment for abused and neglected women and children in the US.
Mental Health experts are now recognizing the importance of trauma-informed care in addition to treatment for anxiety and depression.
I have a copy of a list of non-allowed MH diagnoses in Maryland that I find disturbing. I do not know if Optum or BHA make these decisions. I want to raise the issue of re-evaluation of these non-allowed diagnoses such as post-partum depression (F53) and eating disorders (F50.01 & F50.02) and Bulemia (F50.2). I think at least one of these (Post-partum depression, F50..0) raises a women’s rights issue and a clinical issue and I think it needs to be re-evaluated. I certainly think that Autism and Aspergers as a disallowed diagnosis need re-evaluation. This method of coding reduces the number of services that can be provided for these diagnoses in rural areas, where specialty services are less likely to be found.
These restrictions come from conventions that result from a view of mental health which does not take into account trauma or the reality that very few people have only one diagnosis. Many people have multiple diagnoses and all
problem areas need to be treated and resiliency strengthened.
Let me begin by saying that it is very clear from the research on CCBHC’s that multidisciplinary integrated care works best for clients. These are diagnoses that can be approached from multiple angles for better care. Research has also made it very clear that childhood trauma is at the root of some of these diagnoses such as eating disorders. Without treating the root, it is very difficult to help people heal.
My question is that if behavioral health agencies cannot bill to treat post-partum depression, who treats the mental health part of postpartum depression. Postpartum depression has at least 1 mental health symptom, depression. If Behavioral Health does not treat postpartum depression, who treats it? The physician? The physician is not trained to treat a mental health disorder.
The other one that stands out to me is eating disorders. Eating disorders are often related to trauma and have multiple mental health symptoms. If behavioral health does not treat eating disorders, who does treat this? The physician? They are not trained to treat mental health disorders. This is also a diagnosis where coordination between the physician and the mental health therapist is essential. There is not systemic means for mental health professionals to coordinate with physicians here in Maryland.
What this comes back to is coordinated care for better outcomes instead of the silos of the past.
I have one other issue to raise. Registered Psychology Associates are allowed to refer clients to PRP. I have verified this through Optum’s staff. However, that credential is not on the drop-down menus allowing for those credentialed in this way to refer clients to PRP. We have reported this to Optium, as well. I supervise a registered Psychology Associate and I review and used to sign for all referrals she makes to PRP, but when she put me as a co-signer on the referral, she was told that I cannot refer to myself. That makes no sense and has been partially corrected. It is still not in the drop-down menu.
The following short article explores the role of interpersonal violence in establishing power over those with whom we disagree, get one’s needs met, and solve problems.
Using negotiation and interpersonal discourse instead of violence to meet our personal needs or achieve a goal is a skill learned and practiced from the ages of 2-5. Trembly, et al. In 2005 in their book, Developmental Origins of Aggression, stated that when persons above the age of 5 use aggression toward others to get their needs met, they have not mastered the skills of communication cooperation, and negotiation needed to be used in their interpersonal engagements. The children that have not accomplished these skills are often the victims of childhood abuse and neglect (ACEs, CDC.GOV). What they learn in childhood is that violence is a legitimate means to solve problems and get one’s needs met. Dr. Moffitt established with her research that externalities behavior problems among youth can have a lifelong trajectory (2019). The research of other research also established that the trajectory can be interrupted through family and youth interventions and effective treatment.
Interpersonal violence accounts for 180,000 deaths and 16 million non-lethal traumatic injuries in emergency departments over the last decade. In an introduction to a group of articles in the Harvard Review of Psychiatry, 1/2/21, Issue 1, Pages 1-5 by Jeffery Swanson proposes that the available data indicates that only 3-5% of those committing interpersonal violence are “mentally Ill.” This introduction uses only 3 major mental illnesses, Bipolar Disorder, Schizophrenia, and Major depression to describe the complexity of mental illness and the need to reassess our understanding of what is mental health and what is mental illness.
The siloing of mental health, addictions, developmental issues, neurodiversity, trauma, criminal justice, child abuse and neglect over the last century have hidden the complexity of the roots of interpersonal violence. It is in the interactions of mental illnesses and brain disorders that scientists will discover the complexity of the origins of acts of interpersonal violence.
The new terminology which we should be examining and using is relationship and behavioral heath which encompasses mental illness and substance abuse. It also includes the concepts of conduct disorder in youth and personality disorders in adulthood. These very outdated terms are pejorative misnomers for the effects of childhood trauma on the brains and development of children which last a lifetime when not sufficiently treated. These misnomers influence us to miss the point when looking at the need for treatment and legal and social interventions to stop the abuse and neglect of children in our society. Untreated childhood abuse and neglect is where we will find answers to the origins of interpersonal violence.
See how the CDC is pushing for a health approach to violence prevention. I received this email from cure violence global at cvg.org.
“We continue to witness the shifting of the paradigm related to treating violence as a health issue. Most recently, we see this in the Centers for Disease Control’s (CDC’s) prioritization of funding for studies on gun violence prevention through a public health lens: “I’m not here about gun control. I’m here about preventing gun violence and gun death.” said CDC Director, Dr. Rochelle Walensky. CVG applauds Dr. Walensky and the CDC for their continued recognition of violence as a public health issue and for Congress’s renewal of funding for research on gun violence prevention after a 20-year lapse.”
Ben Warrington has created a site with ideas for reducing stress. He focuses on Grad School students, but his ideas are good. He is now following the CARE2 site. Visit for ideas about stress reduction.