Treating Trauma in Youth Takes More Than Medication

BY CHRISTINE STONER-MERTZ | contracostatimes.com

I applaud Karen de Sá for her investigation of the use (and overuse) of psychotropic medications for foster youth. Her most recent article on proposed legislation suggests that there are differing views on how to solve this complex problem. I would offer some additional points to the discussion about use of medication, alternative approaches to behavior management and the effects of trauma on children and youth.

As policymakers consider proposed legislation being developed to remedy the issue of overuse of medication for foster youth, it is important to understand that merely reducing medications without having a comprehensive treatment program in place will only result in more foster children being sent to psychiatric hospitals.

I hope that there is also attention to the corresponding need for resources to support California's foster care and children's mental health systems. These systems have seen cuts and rate freezes for more than 10 years, which ultimately means we are trying to maintain high-quality services with inadequate resources.

Lincoln Child Center embarked on a transformational change in 2007 that focused on moving away from the use of psychotropic medication and later, physical containment to manage behavior.

Many foster youth behaviors result from trauma created by frequent moves in the foster care system, as well as the traumatic situations that bring children into foster care in the first place (abuse, neglect, domestic violence, mental illness, substance abuse and poverty). Although de Sá's article focused attention on the reduction of medication use that took place at Lincoln, there were many critical components to successfully changing organizational culture and treatment approaches that ultimately led our organization to focus on in-home and in-school services.

These components included teamwork, family involvement, training and increased staffing levels. Lincoln was fortunate to have the support of Alameda County social services and behavioral health care agencies, who ensured that we had the funding to provide a high ratio of staff to children (one adult per two youth).

Staff training and support is essential. Organizational culture changes do not come easy, and making sure that there was training, discussion and support for a culture change took over two years.

When use of medication is lowered and physical behavior management reduced, there is often a spike in challenging behaviors, some of which can result in staff being injured or property destroyed. While it is the right thing to do, it requires resources and buy-in throughout the organization.

Lincoln had strong support from its board of directors, its supporters, its funders, its managers and the staff working with youth to make this change.

A sense of belonging is paramount to healing from trauma. Although children placed in foster care have been removed from a parent or guardian, it does not mean that they do not have family. Locating and engaging extended family, or developing other nonrelative relationships with people who will remain committed to the youth can have as strong an impact as other interventions in reducing problem behaviors. Every child needs to feel as though they have family, wherever they might be living.

Finally, every person responsible for treating and supporting a young person in care -- therapists, psychiatrists, counseling staff, family members, case workers, friends, and the young person herself -- must work as a team toward the goal of that child having a permanent home.

At Lincoln, that team approach is the crux of our success. It cannot just be about reducing medications alone, although this is a critical step among others. We must all work together, listen to the youth and the family, and know that healing takes time, patience and resources.

Christine Stoner-Mertz is the president and CEO of Lincoln Child Center in Oakland.

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