Working With Traumatized Youth in Child Welfare

Working With Traumatized Youth in Child Welfare is a significant addition to the limited literature on the interface among trauma, child welfare, and psychopathology. Child welfare and mental health agencies have established systemic barriers to identifying and providing care to extremely vulnerable youth. The book seeks to bridge that gap, between the worlds of child welfare and mental health, by presenting a multidisciplinary approach to caring for traumatized children and adolescents.

The book was edited by Nancy Boyd Webb, an expert in child welfare studies and play therapy, who has organized the contributions of a multidisciplinary group of clinician-scholars into a useful text. Dr. Webb divided the book into three sections. The first section, “Theoretical Framework and Practice Context,” contains five chapters that review the scope of trauma in children and adolescents remanded to child welfare systems. The authors examine different theoretical constructs of development, attachment, and neurodevelopmental theories, in an effort to establish a framework for understanding the needs and vulnerabilities of traumatized children. The framework is also used by authors later in the book to describe how to work with these children.

“Helping Interventions and Issues” is the title of the second section of the book. Eight chapters describe matters salient to professionals working with specific populations of traumatized youth, including cultural sensitivity, empowering disabled youth, trauma, adolescent motherhood, and managing aggression in youth remanded to out-of-home placements. The authors acknowledge obstacles to working with traumatized youths, including how resource limitations hinder efforts to develop novel interventions for this population. Scholars suggest that, at times, child welfare agency agendas that focus on permanency and a need to substantiate maltreatment have diminished the mental health care needs of traumatized youth.

The book describes critical situations and offers reasonable solutions. For example, one author states that one of the critical needs in foster care systems is better triage and mental health needs assessment of youth. The author also opines that increased training for child welfare workers in assessment and triage of psychiatric illness is critical to improving access to care.

The third section, entitled “Issues and Proposals for Collaboration Between Child Welfare and Mental Health,” contains two chapters. Pediatricians Vincent J. Fontana (deceased) and Mayu P. B. Gonzales coauthored “The View from the Child Welfare System,” and child and adolescent psychiatrist Marilyn Benoit contributed “The View from the Mental Health System.” These chapters provide a useful approach to initiating discussions with nonphysician clinicians and childcare professionals regarding how medical and mental health providers perceive matters involving traumatized children and adolescents.

One of the main strengths of this book is its multidisciplinary approach. A significant portion of the child welfare and child trauma literature heretofore has been compartmentalized by discipline. Yet multidisciplinary collaboration is an essential component for professionals seeking to make a positive impact in this field. The book also includes sound analysis of the multivariate factors at play in producing negative outcomes for child victims of maltreatment.

Other strengths of the book are the special sections, including chapters on cultural competency and intergenerational transmission of family violence. Also, the authors acknowledge the relationships between race and class as factors contributing to overrepresentation of certain groups of youths in the foster care system. One chapter examines different ethnic groups and describes specific vulnerabilities that create disparities in health care. The authors of that chapter state that cultural competency should be a mission and a goal of child welfare agencies nationwide, and they give concrete examples of how that mission can be actuated. The book includes useful references, including a large appendix of professional organizations, national child welfare centers, training programs, and certification groups and journals. A useful list of assessment tools and standardized measures is also included.

Although this book was written for social workers, I recommend it for clinical professionals who work with youth in foster care and correctional settings. It may also be useful to forensic psychiatrists who work with traumatized children and adolescents, as it provides a frame of reference for productive dialogue with other disciplines.

• American Academy of Psychiatry and the Law