MARK BRODIE: As the work continues to reunite children and parents who are separated at the border some social workers and case workers are talking about what they've observed in these children. Tom Crea works with migrant children. He's an associate professor of social work at the Boston College School of Social Work. And, Tom, speaking broadly, how does the trauma these kids have experienced manifest itself?

TOM CREA: Well a lot of times what you see is, well, there's multiple levels. So you see kids who have left their countries of origin sometimes with their parents sometimes without. And various experiences they've had can negatively affect them. So a lot of kids are experiencing violence in their countries of origin then they're experiencing violence on the migration journey. Then in some cases they are separated from their parents. As we've seen in the recent situation which then serves as an additional source of trauma.

BRODIE: Do the different kinds of trauma manifest themselves differently? For example, you know, fleeing extreme poverty violence whatever situation they're leaving in their home country. Is that a different kind of trauma than the kind of trauma they might face if for example they're sent to a detention center or separated from their parents?

CREA: That's a good question. I think that trauma manifests itself differently in different individuals. Really, trauma is defined as an overwhelming situation where an individual is not able to cope and they shut down and they respond with either a fight, flight or freeze response. Then that trauma dictates a lot of future behaviors and is highly correlated with substance abuse and mental health disorders. But essentially when a child is in a new situation and they've been traumatized their brain is sort of frozen or locked. And they in some ways are re-enacting, reliving,re-experiencing the situations that they've been exposed to in the past.

BRODIE: I'm curious about a specific type of counseling called a trauma informed care. What is that and how does it work?

CREA: So trauma informed care is essentially a set of principles to help caseworkers and clinicians understand how children's experiences have affected their well-being. So when you are looking at a child whose been exposed to some of the multiple forms of violence and deprivation that we've seen with a lot of these kids that we can interpret their behaviors as being a result of some of those previous experiences.

BRODIE: So then as a counselor or somebody trying to help. Do you have to try to work to sort of understand what in the child's past might be causing that behavior and molded treatment plan based on that?

CREA: That's exactly right. And it takes time to do that. So you have to set a environment of safety. You have to build a relationship with the child. And over time than what we've seen is the child is often able to build rapport with the caseworker or clinician and then slowly let them know what's happened to them in the past. But a lot of times they're not willing to share these things and sometimes children aren't even aware of how their experiences have affected them.

BRODIE: I would imagine that would be really difficult to get to especially in younger kids. I mean, even if they would want to describe what had happened they might not have the vocabulary or the emotions to really do it.

CREA: That's right. The younger children especially it's a big problem with the family separation situation because kids are in care they're not able to articulate what has happened to them. They don't understand why they've been separated from their parents. They don't understand where they are. So they're not able to really put their emotions into words and even have an understanding of their current situation.

BRODIE: I have to say that this technique sounds not dissimilar from what I would imagine counselors and case workers might help a child of divorce or somebody who has gone through some other trauma in their life. Maybe not to the same extent as having to flee violence in your homeland or being separated from your parents, you know, crossing into new country. But the concept of trying to get an understanding of what in a child's past is causing current behavior doesn't sound all that unique to me.

CREA: It's not unique in terms of development. I mean, there's the adverse childhood experiences and that's a list of situations that children are exposed to that can cause trauma and harm over the life course. What's unique in this situation is that you've basically taken two adverse child experiences you have parental incarceration is one. And another is the parental separation and you've combined those into one event and then you accumulate that on top of the other experiences they've had. And so it's definitely not a good thing for kids. But the response is going to be similar in the sense that you build rapport. You try to understand their experiences and how they're coping with those experiences and then identify sources of resilience for these kids to help them work through this situation.

BRODIE: Is there evidence yet to suggest how successful this technique might be able to be?

CREA: There is growing body of literature on trauma informed care. The complication, though, is that with kids from different cultures we really know very little. The trauma informed care model is based mostly on Western European and United States kind of mindset and understanding of how mental health works. We don't have that same level of understanding for kids from different cultures and particularly for kids from Central America.

BRODIE: So is there a way around that? Other than, I guess, maybe having caseworkers and counselors from Central America.

CREA: Well that's one option and another option is having caseworkers and clinicians who are culturally competent who are bi-cultural who understand both cultures and can serve as sort of a bridge between those cultures. And then we also have just best practices we may not have hard empirical evidence on what works for these kids but we do have a set of best practices in general that we can use as a guide. Until we get that harder empirical evidence.

BRODIE: All right. That's Tom Crea, an associate professor of social work in the Boston College School of Social Work. Tom, really good to talk to you. Thank you.

CREA: Great to talk to you too. Thanks Mark.