Researcher Engages with Policymakers and Providers to Help Children Cope with Trauma

Katie Rosanbalm A decade of work with children damaged by horrific experiences has shown a Duke researcher that the first step forward is ensuring the child knows that trauma is not destiny. “It’s saying something bad happened to you, not that you’re a bad kid,” says Katie Rosanbalm, research scientist at the Center for Child and Family Policy.

For the past 10 years, Rosanbalm has been working with local school systems and child services agencies in North Carolina to better identify and treat children who have had Adverse Childhood Experiences (ACEs). These can be physical or sexual abuse, loss of a parent, homelessness because of a hurricane or other traumatic incidents.

ACEs can lead to long-term health and social consequences, and children who have experienced them are often misdiagnosed with behavioral disorders.

One current project is in Rowan County, located 30 miles north of Charlotte. There, Rosanbalm is partnering with the nonprofit organization Benchmarks to improve the way providers diagnose and treat children coping with trauma. They are piloting a detailed trauma assessment tool and training practitioners to provide evidence-based services that help children build resilience.

These services include teaching children how to self-regulate and also teaching their caregivers how to promote healthy behaviors and provide a supportive environment. The goal is to get kids to these services before a more serious problem occurs. Four years into the pilot project, her team is witnessing promising outcomes.

“We’re seeing fewer crisis services, fewer hospitalizations, and fewer psychiatric residential treatment placements,” Rosanbalm said. Instead, more kids are receiving outpatient services and preventive care. Her team is showing that behavior problems often result from adverse experiences outside of the child -- rather than something wrong inside the child.

Moreover, far fewer youth are being diagnosed with conduct or attention deficit disorders, and more are instead diagnosed with post-traumatic stress disorder (PTSD). That’s promising, Rosanbalm said, because kids’ diagnoses influence how they’re handled in the classroom and, in some cases, the courtroom.

Rosanbalm and Benchmarks have expanded their pilot to Cleveland and Davidson counties, and she has begun doing additional work with schools in Rowan and Edgecombe counties as part of the North Carolina Public School Forum’s Resilience and Learning Project. She says she’d like to see resilience built in as an education policy goal, with a person leading resilience work in each county.

Laying the infrastructure for successful interventions and policy engagement takes time. With local health care providers and social workers, Rosanbalm began “system mapping” in 2012—following the process of what happens to a child after he or she is referred to social services because of an allegation of maltreatment.

“We said ‘where are there challenges?’ and ‘where are there opportunities for change?’” Rosanbalm said.  She held focus groups with providers, managed care organizations, and the N.C. Department of Social Services to answer these questions.  

“When I’m doing my research, I’m speaking with the practitioners and the people involved [and] getting to know them really well. Because I know the people on the ground, I get to know people up the ladder, as well. I’m really invested in community-based research, where we’re asking people what they need and figuring out how to help them do it.”

This story is part of a Duke Policy Bridge series highlighting the policy engagement work led by faculty and researchers across campus. You can read more about Rosanbalm’s research here. To inquire about our engagement story series, email patience.wall@duke.edu.