Working with a Traumatized Child: Creating a Frame and Minimizing Harm

When conducting an interview with someone who has experienced trauma – especially a child – remember that you have the power, and they have the hurt. How do you give a child a sense of power and control? How do you help them tell their story?

Working with a traumatized child or caregiver is no easy task. Be sure to anticipate barriers and devise strategies for addressing them in advance. Set realistic goals for yourself, establish boundaries up front and frame your conversation honestly.

What do trauma and depression symptoms look like in children?
  • Preschool:
    • High anxiety, separation problems
    • Regressive behaviors including loss of milestones (toileting, motor skills, language)
    • Social withdrawal
    • Aggression
    • Repetitive play
    • Flat presentation
    • Attachment disorganization
  • School age:
    • Mistrust
    • Fear of events occurring again
    • Flashbacks, exaggerated startle response
    • Poor concentration
    • Sleep problems
    • Aggression/irritability
    • Somatic complaints
    • Conduct problems
    • Phobias
  • Adolescents:
    • Aggression/Anger
    • Withdrawal
    • Interpersonal difficulties
    • Nightmares/Flashbacks
    • Feelings of guilt
    • Depression
    • Meaning-making shaped by violence
Techniques when working with children
  • Asking Permission
    • “Would it be ok if I…?”
  • Displacement
    • “Some kids feel…?”
  • Reflecting Back
    • “I hear you saying… is that right?”
  • Mastery
    • “I would like you to help me so I can tell other kids about…”
    •  “Can you teach me about…”
       

Create a “frame” for yourself and the child in every interaction. That frame is conceptual for you, and organizing for the child. Below are seven steps for creating that frame and minimizing harm:

Step one: Consent
  • For you: Gain consent from adult guardian; Share as much information as possible about where the material will go.
  • For the child: Let them know you have asked their adult for permission.
    • “I talked to your Aunt and she said it’s ok for us to talk, as long as you want to talk. It’s up to you.”
Step two: Anticipate and ask permission
  • For you: Determine to the best of your ability your timeframe for the interview.
    • I’ll try to talk to this child for 30 minutes and then save 10 minutes for wrapping up.
  • For the child: Share with the child the general timeframe and topic.
    • “I would like to talk to you about what happened in your country. I was thinking we could sit here and talk for about 30 minutes. Would that be ok with you?"
Step three: Rapport building
  • For you: To get a sense of the child’s demeanor, ability to communicate and level of stress.
  • For the child: To ease him or her into talking
    • “I’d like to learn about you. Can you help me learn some things?”  
    • “Let’s write your name together”
    • Show them a map
    • Show them your notepad or camera
    • Ask about school (if not in a refugee camp), work or siblings
    • “What else would you like me to know about you?”
Step four: Introducing content
  • For you: What do you want to know about? What would ONE area be where you’d like to get some information?
  • For the child: Setting the stage for what you will ask.
    • “I heard from some of the people here that bad things happened when you left your country. I would like to hear about that if you want to tell me.”
    • “I was wondering if we could talk about your country now and the war that happened. Would that be ok?”
Step five: Reflecting back what you hear
  • For you: Helps you verify information and also show the child that you are listening.
  • For the child: Provides validation of what he or she said.
    • “I want to tell you what I learned from you. Is that ok? I heard you say that it was really scary when the men came into your village. I heard you when you told me that you thought they might make some people dead (Be sure to use the child’s words).”
    • “What you’re telling me is so important. Can I tell you what I heard you tell me?  I heard you say that you feel scared at this camp because you saw men pointing guns at people in the camp.”
Step six: Wrapping up actively
  • For you: Allows you to feel closure and provide positive feedback.
  • For the child: Helps the child to shift out of narrative mode and to feel a degree of mastery.
    • “You’ve done such a good job today. You really helped me learn a lot. I am so glad we talked. We will stop talking soon. Do you want to tell me anything else?”
    • Show your notes: “See how you helped me learn so that I can write about your country?”
    • Show them digital photos
    • Tell them what you will do next
Step seven: Enhancing coping through displacement
  • For you: May help with your feelings of impotence or guilt.
  • For the child: Can actively move a child towards coping.

Displacement and Mastery

  • “A lot of kids like to think of something they are going to do to feel good after they talk about something sad. One kid told me that she likes to go play soccer. I wonder if you have advice for kids when they feel sad. I would like to learn from you so I can share with other kids who are in refugee camps.”

Displacement and social support

  • “I know that some kids feel bad after they talk about home. Some kids ask their mom for a big hug when they feel bad.”