How can you apply trauma-informed principles to outreach with children and families?

Trauma in children and adolescents is often manifested through a range of disturbances, I've found self-loathing and outward-directed rage being the most common. Unable to regulate emotions, or ill-equipped with tools for emotion regulations, children often use aggression as a way to release unknown and scary feelings. I've found that withdrawal, anxiety, and depression come with older age (late teens, young adults, and adults). However, those are my observations in practice.

A child is a vulnerable person and should always be treated as such. Being vulnerable does not mean lacking intelligence just real world experience. They are not "little adults" or have an inane ability to bounce back from difficulties. Most kids who are clients of Community Outreach programmes, whether for their mental or physical health, family problems such as domestic violence, CSA or poverty, educational reasons or as part of the criminal justice system, they need care, a non judgemental listening ear and treated as victims/survivors.

When you have had to survive in your so-called home or family, your brain switches off the ability to connect, trust and sometimes even love. Attachment Theory (John Bowlby and Mary Ainsworth) is a psychological concept that highlights the huge complications that can be caused by our main caregivers, father and mother etc., when kids are not brought up being loved, cared for and wanted. This can make them extremely challenging to deal with. Even so, care for them, show that you are dependable - if you say you will be there at 10 am then do it - don't blow them out! Allow them to talk, don't shout or talk at them but to them.

I feel that consistency is an important key when working with disturbance in adolescents. Often presenting trauma resulting from disorganised or avoidant attachment parenting styles, children of those parents struggle to trust people, make connections, following endocrinated belief that "everyone's going to abandon them", and only repetition (consistency) in messaging can remove those blocks. On top of that, discussed in advance, clear boundaries in regards to patient-specialist's interaction and conduct, a list of rules, limited yet clear, (or expected behaviour in therapeutic/hospital settings), and consistency in "being there" - those I found to be most important tools in establishing long-lasting rapport with service users (clients).

Every patient, in every setting, must have their say in their treatment plan. Therefore, before any treatment can begin, a treatment plan should be discussed with the patient. This plan should be informed by the client's triggers, past traumas, and experiences.

I've found that the majority of traumatised children don't recognise a safe or stable environment when they're first introduced to it. Following their previous behaviour pattern, they're hyper-alert in new settings, not sleeping or eating - they simply don't know what safety looks like. Only over time, with consistency, their trust in their new carers, or health providers, will come. Tools like schedules or timetables, and availability of their carers can expedite that process.

It often could be hard, but it is important, when working with parents of children in care or traumatised children, to employ non-judgmental wording when talking to them, provide them with a safe and open environment. It's important to remember that potentially they could be repeating the parenting style, or behavioural pattern that was used with them when they were little.

Knowing one's limitations when working with service users is one of the most efficient ways to guard oneself from further trauma and burnout. Those limitations are usually identified through supervision and counseling sessions (past history, traumas, preconceived beliefs etc.) For example: I know that I won't be able to provide a supportive and non-judgemental environment to clients who admitted perpetrating child abuse in the past. Although knowing that that is based on my personal past trauma, I won't be working with those clients, as it's the first step in safeguarding my wellbeing.