A Texas hospital helps children build resilience after trauma

Building resilience is key to helping children overcome traumatic events, like a school shooting or a hurricane.

Dr. Julie Kaplow, director of the Trauma and Grief Center at Texas Children’s Hospital in Houston, leads several initiatives focused on understanding how resilience works and how it can be used to heal trauma.

Why is it important for children to receive treatment early in life as opposed to as adults?

We know there are significant long-term effects of not addressing trauma early. For example, we know that if individuals experienced chronic trauma as children, they have a smaller brain volume, they are more at risk for suicide, more at risk for depression and have higher chances of developing unhealthy relationships. They are also more at risk for the intergenerational transmission of trauma and post-traumatic stress.

If we don’t address these things early, the kids will carry those symptoms with them and are likely to pass them to their own children as they get older.

That’s what is usually known as the cycle of abuse, correct?

Yes. Oftentimes what we see is that, if children grow up in a home where they are abused, if they are not treated for the trauma, they’ll often choose relationships that mimic what they experienced as children. They will likely choose a partner who is also abusive because that is what they are familiar with. Similarly, that can get transmitted over the generations where it becomes a natural part of what feels comfortable to them.

How different is the treatment for each kind of disaster?

It has been surprising to me that the treatments seem to work really well regardless if the trauma was due to a natural disaster or a due to a mass shooting. I think part of the reason is because we can readily tailor the treatments for the children who need them. I have been pleasantly surprised that the treatments we have used so far have been worked well regardless of the kinds of trauma.

In Houston, 44.5 percent of the population is Latino, and many are recent immigrants. Has that played a role in how mental health treatments are administered?

Yes. We adapted all of our trauma and bereavement-informed treatments to ensure they are culturally sensitive and appropriate for our Latino youth. We have also ensured our standardized assessments and treatment materials are all translated into Spanish. The traumas that many of our immigrant youth have experienced are unique and require careful attention and consideration.

Has the increase of Latino patients who have a bicultural and a bilingual background had an impact on how the TCH Child and Grief Center recruits clinicians?

We always want to ensure our clinicians reflect the population we serve, and that youth can relate to our clinicians. For this reason, we made a concerted effort to identify excellent, bilingual clinicians who can provide trauma-informed treatments in the child’s native language whenever necessary and be attuned to the unique needs of Latino youth.

What additional initiatives is your team working on?

There are several programs we are excited about. We are now going to Puerto Rico to help children and families who were impacted by Hurricane Maria. We are providing guidance to define the kinds of assessments and interventions that may be most helpful for those kids.

In Santa Fe, we have a resiliency center where we assist the children of families who were impacted by the school shooting. In addition, we have another program we are working on in Pasadena. It is called “Handle With Care,” and it links the police with schools to be able to identify children who may have experienced trauma. The police alert the schools when a child has experienced a potentially traumatic event so that the teacher is made aware and the child receives immediate support in the classroom if it is needed.

You became chief of the Psychology Department in January. How would you describe life in the past eight months?

The journey has been amazing. I have been so grateful for the opportunity to lead an amazing group of psychologists. Within my division, we have 57 psychologists who are amazingly talented. I have learned that challenges represent big opportunities. It was a big challenge to provide a vision for the group of psychologists that would allow us to address the needs of the community. Now, we have programs dedicated to addressing the needs of children affected by Hurricane Harvey and the Santa Fe School shooting.

Why did you choose this field of study?

During my undergraduate studies at the University of Michigan, I had the privilege of working with a professor who studied bereaved children. Even as a freshman in college, I interviewed children who had recently lost a parent. I was so struck by the resilience I saw in those kids. For most children losing a parent is the scariest thing that could ever happen, and for many of these kids, they seemed to adjust to their new normal. I started to wonder about how that happens, how they get through that experience.

Is that what eventually became the cornerstone of the programs you currently oversee?

Yes, and that is because my undergraduate studies strongly led me to become interested in the overlap of trauma and grief. So many of the kids I treated who had experienced trauma had also experienced significant loses. I became extremely curious and interested in how that worked. The areas of concentration for what would eventually lead to my work at Texas Children’s Hospital centered on the overlap of post-traumatic stress disorder and grief, how we treat it and how we build in that natural resiliency that most kids have into the treatment to make it more effective.

Can you talk about the training you provide for professionals?

We recognize many of our community providers throughout Houston have not received training in trauma and grief in children. Because this initiative is supported by grants, it is free, and we also provide free ongoing supervision to those clinicians for an entire year.