Trauma-Informed Supervision in Early Childhood

By: Olivia Leverich, Psy.D., Clinical Psychologist, Clinical Manager of Psychology, Harbor, Toledo, Ohio

Dr. Leverich and several members of the clinical team at Harbor participated in the Child Parent Psychotherapy (CPP) cohort, training multiple infant/early childhood mental health providers in Lucas and Scioto Counties in this unique infant mental health model designed to address early life trauma. The CPP cohort was funded by HRSA through Ohio’s Safe Babies project and organized by Groundwork Ohio, with support from local partners in Cuyahoga, Lucas, and Scioto Counties.

Two decades ago, Trauma-Informed Care (TIC) was just emerging and not yet taught widely in grad schools or explored during my early years of supervision. Rarely did I consider trauma in the context of early childhood therapy, assessment, or supervision, much less how it might show up within the supervisory relationship itself.

“Trauma-Informed Care?” I remember feeling intrigued before my first TIC collaborative, “It’ll be a good learning opportunity,” I thought. I recall feeling the gravity of the concept and being eager to embody the concept of TIC for myself and my agency even though I still barely understood it. Over time, ideas like safety, transparency, collaboration, and empowerment (SAMHSA, 2014) became the background music guiding the dance of rapport-building and treatment. I’ve spent years regularly attending trauma trainings, each one reinforcing how much more there is to learn.

As a psychologist who specializes in child assessment, specifically developmental delays, autism, and AD/HD, I’ve always enjoyed the problem-solving aspect of diagnosing. Always trying to find the true source of the problem, not necessarily the easiest or most popular diagnosis. As I became more trauma-informed, the assessment puzzle became more tangled and layered. What used to appear to be AD/HD, language delay, or autism, more clearly revealed itself as TRAUMA. Searching for the trauma has now become my first instinct, and far too often, it’s found, lurking in the corner that lies in shadow or under the precisely placed area rug.

Over time, I’ve learned that most don’t want to talk about their trauma or even conceptualize the experience(s) as “trauma.” They minimize and tuck it away. When working with caregivers, conversations about trauma can feel especially vulnerable and complex. Maybe the caregiver isn’t aware of the experience or believe it occurred so long ago as to not be remembered or to not have an impact because “they never talk about it.” Yet, again and again, I see how deeply trauma shapes mental health, development, and relationships.

Two years ago, I had the opportunity to join another kind of TIC collaborative: Child-Parent Psychotherapy (CPP) training. Learning (I’m very much still learning) CPP has been transformative, especially for a clinician who grew up in the culture of Cognitive-Behavioral

Therapy being king. Through this 24-month training, my understanding of how trauma impacts young children has shifted the entirety of my clinical practice. I’ve cast off the perception shared by many, that babies, toddlers, KIDS, don’t remember, and am learning how the remembering of trauma manifests in children. Their memories live in behavior, relationships, and emotional responses. This opportunity has motivated me to adapt my treatment techniques for young children and even adults, shifting from a behavioral approach which rarely took relationships into consideration to an approach built on the foundation that healing happens in relationships (Perry; Yalom).

What is the value of this wisdom if not imparted to the next generation, our supervisees? Talking with colleagues, it becomes clear that formal training for treatment/assessment of young children is not broadly provided and may be on the decline. So, it’s up to us! I’m striving to shift my supervision approach to encompass knowledge gained through my CPP training. Helping supervisees learn about development in the context of trauma is complex; we’re learning as we go. I buy and borrow textbooks (Murch & Hefron, 2010; Slade, Sadler, Eaves, & Webb, 2023). I receive supervision on supervising. While I remain a work in progress as a clinician and supervisor, I humbly offer these suggestions as a starting point for trauma-informed supervision:

• Start wherever opportunity presents itself, be that during intake and diagnostic formulation or when they are neck-deep in treatment.

• Ask what supervisees know and what they don’t about the child/system; as we say in CPP “We do not target for change what we do not yet understand”

  • Encourage ongoing curiosity and reflection on the child/family/system.

  • Conceptualize each involved family member in the context of their own history.

• Empower supervisees to be confident and not shrink away from what they perceive as uncomfortable conversation (either in session or in supervision). When they feel the most pressure to turn away, encourage them to lean closer.

• Help supervisees see through the eyes of the child and caregiver, learn mentation, and follow emotions.

• Instill that behavior IS communication.

• Encourage reading the works of pioneers in trauma and neurodevelopment like Van der Kolk and Perry.

• Guide supervisees in identification and management of their own emotions in session and supervision and demonstrate reflection.

• Preach self-care!

  
  

Lastly, this work calls us, as supervisors, to continuously attend to our own regulation. A dysregulated supervisor cannot effectively support a supervisee navigating complex emotional material. Modeling calm, reflective presence is not simply beneficial; it is essential. In many ways, supervision mirrors the therapeutic relationship itself as growth occurs through safety, attunement, and connection.

Dr. Leverich graduated from Indiana State University in 2005 and has been providing early childhood psychological testing and mental health services at Harbor for 20 years. She has been supervising psychology trainees and assistants, interns, and other clinical team members for over 15 years. Dr. Leverich enjoys providing training both within her agency and in the community and actively participates in Safe Babies of Lucas County, Lucas County Youth Coalition, and the Lucas County Trauma Informed Care Coalition.

References:

Murch, T., & Hefron, M., C., (2010). Reflective Supervision and Leadership for Infant and Early Childhood Programs. Zero to Three.

SAMHSA (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. https://www.nctsn.org/resources/samhsas-concept-of-trauma-and-guidance-for-a-trauma-informed-approach

Slade, A., Sadler, L. S., Eaves, T., & Webb, D. L. (2023). Enhancing Attachment and Reflective Parenting in Clinical Practice; A Minding the Baby Approach. The Guilford Press