TST-FC: Helping Caregivers Understand Trauma’s Impact on Children

For chil­dren who have expe­ri­enced trau­ma, a seem­ing­ly unre­mark­able detail — the smell of cig­a­rette smoke, an inci­den­tal touch or the sound of someone’s accent — can trig­ger a ​“fight, flight or freeze” reac­tion that can seem like mis­be­hav­ior, inso­lence or worse to kin or fos­ter parents.

“Some care­givers think, ​‘I can’t deal with these kids,’ and they leave fos­ter par­ent­ing,” says Tracey Feild, man­ag­ing direc­tor of the Casey Foundation’s Child Wel­fare Strat­e­gy Group. ​“The toll on kids is ter­ri­ble: They not only have to change homes, but they begin to believe they are unwor­thy of an adult’s love and atten­tion. Their belief in them­selves suf­fers; so does their school­work and rela­tion­ships with others.”

To help fos­ter par­ents under­stand kids in their care, keep kids from mov­ing from one fos­ter home to anoth­er and reduce turnover among care­givers, the Foun­da­tion has sup­port­ed devel­op­ment of Trau­ma Sys­tems Ther­a­py for Fos­ter Care (TST-FC).

Stages of Behav­ior (The Four Rs)

“TST-FC pro­vides care­givers with the skills to under­stand that their child is not being defi­ant or vio­lent for no rea­son,” Feild says. ​“The cur­ricu­lum gives fos­ter par­ents a process for eval­u­at­ing what hap­pens before a child melts down, so care­givers can more eas­i­ly iden­ti­fy trig­gers and learn how to avoid them.”

The TST-FC train­ing cur­ricu­lum is avail­able online with­out charge. It pro­vides child wel­fare agen­cies with a pow­er­ful tool to help care­givers rec­og­nize and meet the needs of kids and teens who have expe­ri­enced trau­ma. The cur­ricu­lum includes detailed facil­i­ta­tor guides, train­ing pre­sen­ta­tions, hand­outs and a fos­ter par­ent resource guide. Dur­ing TST-FC’s four inter­ac­tive group ses­sions, facil­i­ta­tors guide care­givers through role play­ing, hands-on exer­cis­es and reflec­tive con­ver­sa­tions to con­nect what has hap­pened in a child’s life to his or her behav­ior. Fos­ter par­ents prac­tice skills such as de-esca­lat­ing dif­fi­cult behav­ior, help­ing a child regroup after a melt­down and rec­og­niz­ing when a child is being remind­ed of a trau­mat­ic experience.

The Impact of Trau­ma, the facil­i­ta­tor guide for TST-FC’s first ses­sion, intro­duces care­givers to the phys­i­cal, men­tal and emo­tion­al effects of trau­ma. It starts by defin­ing trau­ma as ​“a life-threat­en­ing or extreme­ly fright­en­ing expe­ri­ence — for the child or some­one they care about — that over­whelms the child’s capac­i­ty to cope.” It also covers:

• Preva­lence: Near­ly half of chil­dren from birth to age 17 have expe­ri­enced at least one type of trauma.<.li>
• Types of trauma: 
  • Acute: a sin­gle, time-lim­it­ed event (such as a car accident)
  • Chron­ic: repeat­ed abuse or neglect
  • Com­plex: a sub­group of chron­ic trau­ma that occurs before the age of 5 and that inter­feres with healthy brain development
• Sur­vival-in-the-moment states: a ter­ri­fy­ing expe­ri­ence — or a reminder of trau­ma — that trig­gers a fight, flight or freeze reaction
• Trau­ma reminders: the ​“cat” (actu­al threat of harm) and the ​“cat hair” (reminders of dangers)
• The four stages of children’s behav­ior: reg­u­lat­ing, revving, re-expe­ri­enc­ing and reconstituting

The TST-FC cur­ricu­lum was writ­ten by Kel­ly McCauley of KVC Health Sys­tems, Inc., with con­sul­ta­tion from Dr. Glenn Saxe of NYU Lan­gone Health. It was test­ed in two pub­lic child wel­fare agen­cies and a pri­vate provider sys­tem and eval­u­at­ed by ChildTrends.