“Trauma in children is kind of the invisible disease because the connections are not clearly made a lot of times. It is prevalent,” said Kimball Franck.
The Diagnostic and Statistical Manual of Mental Health Disorders, DSM, defines trauma as “an incident a person directly experiences that has resulted in serious injury to the person or serious injury or death to someone close to them who was present at the time of the trauma.” The reactions among children to trauma could include fear, helplessness and/or horror.
However, the clinical definition of trauma is evolving due to recent research findings suggesting that trauma may not be as specific as described above.
“Abandonment of a parent may not have been included in the DSM a few years ago, but we are learning that children are responding to those types of events in a way that looks like trauma and that is impacting their development in a traumatic way,” she explained.
Kimball Franck is among a growing number of clinicians who are now seeing trauma-related symptoms stemming from exposure to community violence or bullying and/or teasing at school.
The proposals for the new DSM include other reactions and incidents, including abandonment by a parent, chronic neglect or a parent being a chronic substance abuser.
Crisis Stabilization at the VTCC
In her clinical role as an acute unit therapist at VCU’s Virginia Treatment Center for Children, Kimball Franck works with a team that includes Valerie Bishop, L.C.S.W., chair of the Division of Social Work in the Department of Psychiatry, helping children and families through crisis stabilization – a process that entails a combination of daily meetings with their psychiatrist, daily individual or family therapy, occupational and recreational therapies, nursing interventions and school interventions, including educational case management. The work is extremely fast-paced and the status of a child can change daily.
“We look at all the dynamics of anything that may be contributing to the child’s crisis,” said Bishop. “We ask about the stressors that are involved and provide processing of the crisis incident including teaching coping skills and providing other resources to manage their symptoms.”
More than two-thirds of the children the team at the VCU Virginia Treatment Center for Children works with have a history of trauma – and usually it’s a history of complex trauma that means multiple different traumas and/or chronic trauma. These children are often affected by more than just a brief, single incident.
Kimball Franck has also frequently observed the classic types of trauma including sexual or physical assault, auto accidents and natural disasters. It’s estimated that one in four girls and one in six boys have experienced some type of sexual trauma by the time they reach 18 years of age. Other types of trauma could include exposure to domestic violence, medical trauma, traumatic grief, and refugee and war zone trauma.
Bishop said children who have experienced trauma are in the hospital for an average of five days to seven days, but it can vary. During this time, their mood and behavior are stabilized. The child then transitions back to their community providers and school.
The VTCC offers a “Bridge Clinic,” which provides the child services during the period when they leave the hospital to when they see their regular mental health provider, or are scheduled to see one. Bishop said they also help connect the child and family to community resources upon discharge.
“Trauma is something that people endure – but kids are resilient and our goal is to help them get back to a place where they can be back in control,” said Bishop.
What parents can do
Kimball Franck said it is important for parents to be aware of changes in their child’s behavior that set off a red flag.
“A parent may not always know their child has been traumatized. Sometimes parents will see certain behaviors or symptoms and not understand where it’s coming from – it could be coming from trauma, it may not,” said Kimball Franck.
“I always tell parents to trust their parental instincts and if you feel like something is not right – it probably isn’t – don’t ignore that and ask for help,” she said.
Sathya Achia Abraham
VCU Communications and Public Relations