Over the past few decades, a culture developed that seemed to place a higher value on bureaucratic outcomes of health care than on fostering positive human connections. The effort to make a sweeping shift in the practice of behavioral health has come to be known as trauma-informed care.
Put simply, trauma-informed care is a concept and practice used in professions ranging from child welfare to criminal justice that is grounded in behavioral science and recognizes that traumatic experiences can powerfully shape an individual’s behavior for years or even decades.
A NEW APPROACH TO HUMAN SERVICES TAKES HOLD
Health and psychological researchers have investigated the lasting physiological effects of trauma since the Vietnam War, when a flood of soldiers returned to the United States with complex mental health symptoms, many of which were eventually diagnosed as part of post-traumatic stress disorder.
In the ensuing decades, researchers and practitioners found that symptoms of trauma were common in the civilian population as well. In the 1990s, a study of 17,000 people linked adverse childhood experiences, which can often be traumatizing, with health risks in adulthood. This research, commonly known as the ACE study, was a watershed moment in the public understanding of adversity and trauma and their effect on public health.
Meanwhile, advances in neuroscience showed that children who have suffered severe neglect or abuse during critical stages of brain development — essentially any point during childhood — often have differently-structured brains than their peers. These brain changes are linked to a range of behavioral challenges, including aggressive outbursts, dissociation, depression and anxiety, though there is no uniform response to trauma.
Armed with the scientific evidence that trauma is common, that it affects people in many different ways and to varying degrees, and that it can lead to behavioral challenges common in child welfare and criminal justice settings, advocates of trauma-informed care have called for expanding its use, including in Wisconsin.
A TRAUMA-INFORMED JUDICIAL SYSTEM
Judge Mary Triggiano is no stranger to trauma. Presiding over cases in Milwaukee County Family Court over many years, she has witnessed countless times the lasting behavioral effects that trauma imparts on children. Triggiano’s interest in the effects of trauma took root in the late 2000s, as she attempted to make sense of the wrenching cases before her.
“I was at children’s court handling very, very difficult cases,” said Triggiano. “Cases that involved child abuse and neglect, kids committing crimes, and I was just trying to understand what was going on and asking myself ‘Why do we have this type of behavior? If we could understand this better, we might have better solutions.'”
At the time, Triggiano said she was vaguely aware of research connecting trauma in children to the types of behavior she was seeing. That hazy awareness crystallized in 2009 when Triggiano was asked to take part in a panel discussion that included one of the lead authors of the ACE study. She looked up the research and read about the potential power of adverse childhood experiences to alter behavior.
Triggiano then applied the ACE study’s findings to four of her cases and realized that the people involved in each — all at different stages of life and dealing with different behavioral problems — had faced adversity of the type that can alter brain structure and affect behavior. This revelation spurred her to delve into the subject matter more closely, and she began talking to her colleagues about how the local courts could apply trauma-informed practices in the pursuit of better outcomes.
“It was sort of new in the community, so we started having more conversations about the impact of adversity and toxic stress on adults and kids in the justice system,” said Triggiano. Research into the effect of toxic stress on infant brains was of particular interest to her.
Triggiano’s been spreading the word within the justice system ever since. She said all parts of this system — law enforcement officers, judges, prosecutors, defenders and correctional staff — can improve criminal justice outcomes by heeding lessons at the core of trauma-informed care, in particular creating conditions that minimize re-traumatization.
“The environment we create in our courts and systems is really important for reducing recidivism and holding people accountable,” Triggiano said. “We started to do more training including for parents in court because we realized if we were trauma-informed, we’d have better outcomes.”
Perhaps the most prominent result of this trauma-informed approach is Milwaukee’s Healthy Infant Court, which was created to help make sure that infants with caretakers in the criminal justice system have a better chance at healthy brain development.
“We did a pilot with a woman from the family drug treatment court who was struggling interacting with her baby,” added Triggiano. “And we had some really tremendous results and were invigorated by that and launched the court.”
Triggiano no longer presides over the Healthy Infant Court, but she is continuing to advocate for the trauma-informed practices together with many colleagues, and has trained over 500 people in the criminal justice system on how to apply these approaches to their work.