A Comfort Case: A Trauma-Informed Intervention

This post was contributed by Suzanne Friedman, PhD.

I don’t recall exactly when I first heard about Comfort Cases, but I do remember the instant it struck me that children entering the foster care system are complex trauma survivors. A local children’s community theater group, Ovations Theatre, was holding a donation drive for Comfort Cases because its mission aligned with the themes of their current production. I was listening to Barrie Carr, Comfort Cases Community Engagement Coordinator (and fellow theater mom!), describe how and why Rob Scheer founded the organization, what a Comfort Case provides, and how children continue to suffer. And the connection hit me like a ton of bricks.

Complex trauma refers to when, how often, and at whose hands traumatic experiences occur. In childhood we learn our value, ways to manage emotions and stress, and whether others are trustworthy. But when a child repeatedly encounters experiences for which she/he could not have adequate skills - experiences like abuse, neglect, poverty, witnessing violence, living with people who struggle with addiction or mental illness, and being removed from the only home they know - time and energy is taken up trying to survive. There just isn’t the space to learn the skills that other kids are learning. The impact of chronic trauma exposure will settle into the child’s nervous system and, understandably, cause the child to behave in self-protective ways. Indeed, most adults do not have the requisite skills to manage the layers of chaos many children in foster care live with every day.

We are fortunate that our nervous system is organized to protect us from danger. Say, for example, you happen to see a Gray Wolf in your path. A natural threat response will activate to ensure your survival. One part of your nervous system automatically releases a cascade of stress hormones designed to shut off the portion of your brain that learns and thinks and plans, because stopping to consider your next move would surely be deadly. Concurrently, your body will attempt to fight or flee. Your heart rate increases, pupils dilate, and muscles tense. None of these changes are actions you choose freely - it’s how our nervous system is designed to respond to life threatening situations.

But what if the threat is your home? In your environment? What if the Gray Wolf is someone upon whom you rely for safety, security, and love? That complicates the story immensely.

Children are wired to first reach out to someone close to them when they are afraid - a parent, a family member, a teacher. If these people are not safe, that fight/flight response will engage. Unfortunately, for children living in homes characterized by chaos or abuse, or for children pulled from their homes, neither fight nor flight is usually possible. Children are left unsafe and with no way out, creating an unsolvable dilemma in which the biological drive for protection takes them toward sources of danger. Their traumatized physiology can move into a collapse mode as a way of self-protection. Traumatized children are chronically afraid - frozen, with a compromised ability to think, rationalize, and respond - and usually view relationships as dangerous.

Although we are all wired for belonging, traumatized children may experience kindness and generosity suspiciously. Their physiology may tell them that connection to others is unsafe. But they do want to belong, as we all do. Their response is the natural adaptation to the situation in which they lived and, as such, it is learned. And the good news is that it can be unlearned, although the pace is slow and requires patient and trauma-informed adults who can ask “what happened to this child” instead of “what is wrong with this child?”

The Comfort Case is a wonderful trauma-informed intervention. Children who have learned that they are unimportant receive new things of their own. Toiletries and dental supplies communicate the importance of self-care and self-worth. The stuffed toy and blanket help soothe and comfort. The book provides a healthy distraction and intuitively teaches an important component of stress management. The journal and coloring book helps to calm distressing feelings. Not only are these cases provided to children during an acutely frightening transition, but each item addresses an important life skill in an understanding and non-threatening way. It’s brilliant.

Suzanne Friedman, Ph.D., is a licensed psychologist in private practice with a special interest in trauma and PTSD, eating disorders and body image, and career counseling and coaching. Dr. Friedman has more than 20 years of experience in clinical work, supervision, higher education teaching and outreach. She earned her Master’s and Doctorate degrees in Counseling Psychology at the University of Maryland College Park, and completed her pre-doctoral internship at the Towson University Counseling Center.