COMPLEX TRAUMA CARE

COMPLEX TRAUMA CARE

The term complex trauma describes both children’s exposure to multiple traumatic events, often of an invasive, interpersonal nature, and the wide-ranging, long-term impact of this exposure.

These events are severe and pervasive, such as abuse or profound neglect. They usually begin early in life and can disrupt many aspects of the child’s development and the very formation of a self. Since they often occur in the context of the child’s relationship with a caregiver, they interfere with the child’s ability to form a secure attachment bond. Many aspects of a child’s healthy physical and mental development rely on this primary source of safety and stability.

Also available in this section:

  • Effects of Complex Trauma
  • Assessment of Complex Trauma
  • Treatment for Complex Trauma
  • Complex Trauma Resources

General Information on Complex Trauma

Many children with complex trauma histories suffer a variety of traumatic events, such as physical and sexual abuse, witnessing domestic and community violence, separation from family members, and revictimization by others. Complex trauma can have devastating effects on a child’s physiology, emotions, ability to think, learn, and concentrate, impulse control, self-image, and relationships with others. Across the life span, complex trauma is linked to a wide range of problems, including addiction, chronic physical conditions, depression and anxiety, self-harming behaviors, and other psychiatric disorders.       
 
Beyond the consequences for the child and family, these problems carry high costs for society. For example, a child who cannot learn may grow up to be an adult who cannot hold a job. A child with chronic physical problems may grow up to be a chronically ill adult. A child who grows up learning to hate herself may become an adult with an eating disorder or substance addiction.       
 
Children whose families and homes do not provide consistent safety, comfort, and protection may develop ways of coping that allow them to survive and function day-to-day. For instance, they may be overly sensitive to the moods of others, always watching to figure out what the adults around them are feeling and how they will behave. They may withhold their own emotions from others, never letting them see when they are afraid, sad, or angry. These kinds of learned adaptations make sense when physical and/or emotional threats are ever-present. As a child grows up and encounters situations and relationships that are safe, these adaptations are no longer helpful, and may in fact be counterproductive and interfere with the capacity to live, love, and be loved.

Click here to learn more about the effects of complex trauma. Click here to learn more about the assessment of complex trauma, including guidelines and tools for mental health professionals, as well as additional resources for non-mental health professionals and parents / caregivers.

Treatment for Complex Trauma

Descriptions of many of the clinical treatments, mental health interventions, and other trauma-informed service approaches developed by members of the National Child Traumatic Stress Network (NCTSN) are available under NCTSN Empirically Supported Treatments and Promising Practices.

The following interventions have been developed specifically for Complex Trauma and were designed to address a range of developmental concerns and competencies: 

For children, adolescents, and young adults:

  • ARC: Attachment, Regulation & Competency
  • TST: Trauma Systems Therapy

For adolescents and young adults:

  • ITCT-A: Integrative Treatment of Complex Trauma for Adolescents
  • SPARCS: Structured Psychotherapy for Adolescents Responding to Chronic Stress
  • TARGET-A: Trauma Affect Regulation: Guide for Education and Therapy

For children and their parents or caregivers:

  • ITCT-C: Integrative Treatment of Complex Trauma for Children
  • RLF: Real Life Heroes

For the entire family:

  • SFCR: Strengthening Family Coping Resources

While not specifically designed for complex trauma, TF-CBT (Trauma-Focused Cognitive Behavioral Therapy) and CPP (Child-Parent Psychotherapy) have also been utilized effectively to reduce PTSD and related difficulties in select complex trauma populations and settings. Please consult with a certified trainer for guidance on how to adapt TF-CBT or CPP for complexly traumatized populations.

Complex Trauma Resources

What is Complex Trauma: A Resource Guide for Youth and Those Who Care About Them (2017) (PDF) 
This Guide was developed for youth who have experienced, or know someone who has experienced, Complex Trauma. Older youth, adolescents, and young adults can explore the information in this Guide on their own to help make sense of their experiences and understand themselves better. Clinicians, caregivers, and other adults can also use the Guide to have conversations with youth about what Complex Trauma is, how it can impact them, coping strategies that can help and those that can cause problems, and strategies for making things better. 

Complex Trauma Facts

Complex Trauma: Facts for Directors, Administrators, and Staff in Residential Settings (2016) (PDF) 
Beginning with a case example, this 6-page fact sheet gives information for staff in Residential Treatment Centers (RTCs) on how to understand behavior through a trauma lens, as well as specific recommendations for directors and administrators on trauma-informed residential policies, staff training and self-care, and the developmental and educational needs of youth.

Complex Trauma: Facts for Treatment Staff in Residential Settings (2016) (PDF) 
This 4-page fact sheet details the importance of a holistic, multidisciplinary, multi-level approach to addressing the needs of youth with complex trauma in Residential Treatment settings. The fact sheet offers general guidelines for treatment providers in RTCs, challenging them to “avoid a . . . view of youth behavior that is limited solely to behavior management.”

Complex Trauma: In Urban African-American Children, Youth, and Families (2017) (PDF) 
This 4-page fact sheet discusses how families living in racially and economically segregated communities must also cope with the effects of historical trauma and intergenerational racism, and presents the specific barriers that African-Americans face in obtaining needed services. Finally, the fact sheet presents ideas for providers on building supportive relationships with African-American children and families who have experienced complex trauma. 
 
Complex Trauma: In Juvenile Justice System-Involved Youth (2017) (PDF)
This 7-page fact sheet delineates the path from complex trauma exposure to involvement in the juvenile justice system; describes the “survival-oriented coping” that youth adopt to manage their lives; and explores the many challenges these youth face in managing their emotions, physical responses, and impulses. The fact sheet presents recommendations for judges and juvenile justice program administrators, parents and family members, and adults who supervise youth.

Complex Trauma: Facts for Service Providers Working with Homeless Youth and Young Adults (2014) (PDF)
Offers information on how to support teens and young adults who are homeless and may have experienced multiple traumas.

Complex Trauma: Facts for Shelter Staff Working with Homeless Children and Families (2014) (PDF)
Guides shelter staff in how best to support the homeless children and families with whom they work.

Complex Trauma: Facts for Caregivers (2014) (PDF)
Helps parents and caregivers recognize the signs and symptoms of complex trauma and offers recommendations on how to help children heal.

Complex Trauma: Facts for Educators (2014) (PDF)
Explains the ways complex trauma may affect learning and offers recommendations for educators to support students and take care of themselves. 

Addititonal Resources

Remembering Trauma: Connecting the Dots between Complex Trauma and Misdiagnosis in Youth
This short film (16 minutes) highlights the story of a traumatized youth from early childhood to older adolescence illustrating his trauma reactions and interactions with various service providers (including probation officer, school counselor, and therapist). This product was created to support the critical importance of using a trauma lens in your work within child-serving systems and the potentially detrimental impact of not incorporating a trauma framework.

Complex Trauma Speaker Series  
Featuring experts from the NCTSN, this series includes presentations on the neurobiology of complex trauma, assessment and treatment planning, and a wide range of evidence-based interventions. All presentations are available for free through the NCTSN Learning Center for Child and Adolescent Trauma, and continuing education credits are available.

Polyvictimization and Complex Trauma: Understanding Special Populations, Enhancing Multidisciplinary Responses to Polyvictimization 
This webinar series, a collaborative effort between the OVC National Action Partnership on Polyvictimization and the NCTSN Complex Trauma Workgroup and Complex Trauma Treatment Network, focuses on complex trauma and polyvictimization as they affect a wide range of populations and offers useful tools to a broad range of professionals, including educators, mental health workers, law enforcement, judicial personnel, and child welfare workers.

Complex Trauma in Children and Adolescents (2003) (PDF 
The original white paper on this topic developed by the NCTSN Complex Trauma Task Force.

Complex Trauma in Children and Adolescents (2007) (PDF)
This article appeared in the winter 2007 issue of the journal Focal Point. It is an adaptation and update of the Network white paper listed above. Click here to access the article. Focal Point is a publication of the Research and Training Center on Family Support and Children's Mental Health.

Complex Trauma in the NCTSN (PDF)
Results of an NCTSN survey on complex trauma exposure, outcomes, and treatment approaches for impacted children and their families who received intervention and/or comprehensive assessment services in 2002.