Topic: Mental Health

Child Maltreatment and Trauma: Treating the Whole Family

Over the past three months, we’ve been exploring the topic of childhood trauma and its impact on mental health. Child maltreatment is the most common cause of trauma for youth and commonly the adult perpetrators, who were also subject to maltreatment in their youth. The perpetrator’s experience is then transmitted to their family. Trauma may also be the result of other events. Trauma is the reaction to frightening, often life-threatening, and violent experiences and while our focus is on child maltreatment, a traumatizing event may be experienced by any or all members of a family and then may lead to maltreatment, disruption of relationships and impede family functioning. Regardless of the trauma type, every trauma is a family trauma.

The National Child Traumatic Stress Network notes that all families experience trauma differently, and some factors such as a child’s age or the family’s culture or ethnicity may influence how the family copes and recovers from a traumatic event. Trauma changes families as they work to survive and adapt to their circumstances and environment. While this adjustment may be less difficult for some, for others the stress and burden cause them to feel isolated, overwhelmed, and less able to maintain vital family functions.

At Kempe, we believe that every family who has faced trauma deserves access to treatment so that they may heal and recover together. That’s why the Kempe Center’s IMHOFF Clinic takes a whole family approach and provides services for children, as well as their parents, caregivers and siblings who may also be dealing with symptoms related to stress, trauma and adversity.

We recently connected with Dr. Steven Berkowitz, a visiting professor at the University of Colorado Anschutz Medical Campus who is working in collaboration with Kempe to grow the IMHOFF Clinic’s whole family care approach.

Why is a family-focused approach a more effective way to address trauma?

Very often, children who experience trauma have parents or caregivers who were also traumatized in their youth and never received treatment to address the emotional, cognitive and behavioral consequences. Because trauma can be transmitted across generations, we see these children experience the same things that happened to their parents and caregivers. As a treatment provider, it is important to assess everyone in the family to identify any significant issues or psychological symptoms that may be related to an intergenerational history of trauma. In order for the child to successfully recover from their own traumatic experiences, we must take a whole family perspective and treat everyone in the family unit.

What is unique about your work at the IMHOFF Clinic?

We are building the IMHOFF Clinic into a family-focused clinic that provides services for children, youth and adults dealing with symptoms related to stress, trauma and adversity. Our multidisciplinary treatment team works together with children and their families in a much more integrated way. In the past, if we saw a parent or caregiver struggling alongside their child, we would have to refer them to another treatment provider in a completely different location. Here, the treatment is in one place and we offer a range of individualized therapies and pharmacology to any family members who need it.

What are you hoping to achieve at the IMHOFF Clinic?

This group is on the forefront of providing the most comprehensive and evidence-based assessments and treatments that focus on stress and trauma throughout the lifespan. We are working to develop a model program that helps to unify the various departments of the University of Colorado, School of Medicine and Children’s Hospital Colorado in order to better serve the families that come to Kempe for help. We’d also like to develop an effective home-based program for children and families so that treatment can happen in the least restrictive, most normative setting possible, with the goal being to help families live and function successfully at home.

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De-Bunking the Myths of Mental Health

Over 200,000 children and adolescents in Colorado have diagnosable and treatable mental health conditions. Alarmingly, less than one quarter of these children and adolescents receive any type of professional care. Only in recent times are social services and community resources focusing on the prevention of toxic stress, its impacts on mental health, and the promotion of healthy social and emotional development.

On February 7, 2019, we convened a group of pediatric and mental health experts to help educate our supporters and partners on mental health issues facing Colorado’s children and their families. Here, we de-bunk the four most common myths of mental health and share what we learned from this important discussion:

Myth #1: Behavioral health and mental health are the same thing.

Although the terms are often used interchangeably, to do so is incorrect. Mental health focuses on a person’s psychological state, whereas behavioral health is a broader term that includes mental health. Behavioral health looks at how behaviors impact an individual’s physical health and well-being, but does not necessarily address all of the external, environmental factors that may influence an individual’s well-being, such as poverty, discrimination or abuse.

The negative stigma that surrounds mental health has pushed many healthcare and education professionals to reference behavioral health when talking to individuals and families because it’s an easier entry point into a discussion about mental health. Ultimately, the most important thing is to engage people in conversation and identify the appropriate treatment, regardless of how the topic is presented.

Myth #2: Mental health issues are hereditary.

Some psychiatric diagnoses, like schizophrenia, bipolar disorder, depression and ADHD, are likely to be hereditary, meaning they are caused by a gene mutation that is inherited from a parent. But other mental health issues are likely a combination of genetics and lifestyle, which means that certain genes may increase your risk of developing a mental illness, and environmental factors may trigger it.

The vast majority of children and youth in mental health treatment programs have histories of maltreatment, traumatic exposure and chronic stress or adversity. These adverse childhood experiences (ACEs) can damage the developing brain and lead to problems in learning and behavior, as well as increased susceptibility to physical and mental illness. So, although hereditary and genetic factors can influence mental health, our environments, relationships and external supports are significantly more impactful.

Myth #3: If you have a mental illness as a child, it’s something you must live with for the rest of your life.

There has been significant progress in developing trauma-informed and evidence-based treatment programs that can shift negative trajectories and improve outcomes for children. Here locally, Children’s Hospital Colorado is home to a wide array of outpatient, day treatment and inpatient services that provide a coordinated, multidisciplinary approach to evaluation and treatment for children and adolescents ages 5 to 17.

While medical professionals can effectively treat most children, it is more challenging to address the environmental factors that trigger mental health issues in children. There has been a movement toward mental health treatment providers working collaboratively with patients and their families to identify the underlying triggers and help them through crises together. When everyone in the family is provided with the resources and skills to help a child get better, the positive outcomes are considerably more sustainable.

Myth #4: When a child acts out, it is clearly a behavioral health issue.

Dr. C. Henry Kempe often remarked that if you do not understand someone’s behavior, you do not understand their history. When someone acts out violently or aggressively, it is likely because they have experienced a traumatic event or series of events. Breaking the stigma of mental health requires us to look at the issue through a different lens – one that considers an individual’s history and recognizes the myriad of factors contributing to their current well-being. As a community, we can help build up children’s resilience and promote healthy behaviors by ensuring they have supportive relationships and positive environments that nurture their growth and development.


The mental health crisis is one of many threats to the healthy development of Colorado’s children. Over the next few months, Kempe will continue to bring together community partners to help shine a light on these connections and how we can partner as a community to end the cycle of abuse and positively impact child development. We appreciate your support of our efforts to give all children the opportunity to thrive.

 

 

Evidence-Based and Family-Focused Mental Health Care in Colorado

Trauma is a costly public health problem for all Coloradans. Most often, trauma occurs as a result of physical, sexual or emotional abuse, neglect, violence, disaster and other emotionally harmful experiences. Traumatic events induce feelings of powerlessness, fear, hopelessness and a constant state of alert, as well as feelings of shame, guilt, rage and isolation.

Without treatment, children who experience repeated exposure to traumatic events have an increased risk of developing mental and substance use disorders, suicide and chronic physical ailments. They are also more likely to experience increased involvement with the child welfare and juvenile justice systems, and may even face premature death.

We recently connected with Shannon Van Deman, PhD, who leads the Pediatric Mental Health Institute at Children’s Hospital Colorado and asked her to share more about how they are addressing childhood trauma.

 

What is the role of the Pediatric Mental Health Institute?

At Children’s Hospital Colorado, we have a fundamental responsibility to provide mental health care for our patients. Our services are child-centered and family-focused, meaning we work collaboratively with our patients and their families to help them through crises and empower them to develop the resources and skills to get better.

The Pediatric Mental Health Institute is one of the largest providers in the Rocky Mountain region that offers a full continuum of psychiatric care and provide a broad spectrum of psychiatric services, including outpatient, day treatment and inpatient services for children and adolescents. I’m particularly proud of our Medical Day Treatment program, which is a joint venture with Aurora Public Schools. It’s an accredited school program that employs two certified teachers along with two paraprofessionals from the Aurora Public School system. The program is also staffed with nurses, a psychologist, social worker and other medical professionals who work together with youth and families to reach academic goals and improve physical and emotional health.

What do you want Coloradans to know about trauma?

Today in Colorado, suicide is the leading cause of death for children ages 10 to 24, and an estimated one out of six teens has a diagnosable mental health condition. At Children’s, we’ve seen the need for psychiatric treatment go up year over year, and we’ve tripled the number of outpatient services in the last five years. Prevention, early identification, early intervention and treatment are needed now more than ever, and we’ve been working alongside Kempe to ensure Colorado’s health care providers are educated on the complexities of trauma and how it impacts their delivery.

How can we positively shape the mental health of Colorado children?

It is completely normal for children and adolescents to have difficulty managing their thoughts and feelings, but some aspects of our culture have told us we need to face these challenges alone. My hope is that through our work, we will help families engage in more conversations that break the stigma of mental health. It’s incredibly valuable for individuals and families with this lived experience to talk about their challenges and tell their story to others going through the same things. It’s also very important for Coloradans to advocate for child-focused legislation because public policy decisions can dramatically shape the health of children, for better or worse. I encourage anyone who wants to learn more about advocacy for child health to sign up as a Child Health Champion.

 

Feb. 7 Youth Mental Health Event

Join Kempe for our winter Uniting Communities for Kids event featuring a panel of experts on mental health issues facing children and their families in Colorado and learn what can be done to protect and heal.

Thursday, Feb. 7
7:30-9:00 a.m.
Wellshire Events Center – 3333 S Colorado Blvd. Denver, CO

Over 200,000 kids and teens have diagnosable mental health conditions in Colorado, but less than a quarter of them receive any type of professional care. What should be done to better identify and treat mental health conditions in our youth.

Moderator:
Don Mares- Executive Director, Denver Department of Human Services

Panelists:
Steven Berkowitz, MD – Visiting Professor of Psychiatry, University of Colorado, School of Medicine

Evelin Gomez, PhD – Department of Pediatrics, The Kempe Center

Shannon Van Deman, PhD – Vice President, Pediatric Mental Health Institute, Children’s Hospital Colorado