Children who come into our care here at Upbring have often experienced significant trauma due to abuse and neglect. While there is no universal way trauma affects a child or presents its symptoms, it’s not to be discredited or ignored. Frank Lopez shares his expertise on how to spot signs of trauma in children and how to provide the best support and care needed. Follow along below to a Q&A session with Frank Lopez.

Is there a standard system or method to assess the effects of traumatic experiences during childhood?

Children coming into care have a Child and Adolescent Needs and Strengths (CANS) assessment completed within 30 days of placement. This comprehensive behavioral health assessment is completed by a qualified assessor or clinician and provides recommended treatment based on the responses given. This assessment serves as the standard system for children in foster care. Additionally, each child who receives behavioral health services may have more specific assessments completed by a mental health clinician, psychologist or physician. A comprehensive list of several additional instruments that assess for trauma can be found here.

Is it common for a child to experience more than one type of traumatic experience? And if yes, how are these experiences measured by trauma experts?

Yes, and multiple traumatic events are known as Complex Trauma. Complex Trauma can impact an individual in various ways that interfere with forming attachments, physical ailments and emotional responses to common situations. There are several assessments used by mental health clinicians to measure the effects of trauma. This provides the foundation for treatment modalities to be effectively utilized. Our standard of care at Upbring is for our youth to receive behavioral health services that work to identify and treat those traumatic experiences. Additionally, trauma experiences can extend into adulthood. The ACE Study, developed by the CDC & Kaiser Permanente, includes the use of an adverse childhood experience questionnaire (ACE), which is used to survey adults. An ACE score is a point value score used to measure Adverse Childhood Experiences that include abuse, neglect and family challenges. The higher the score, the higher the probability of health and social-related problems as an adult. Modified versions of the ACE Questionnaire such as those developed by the Center for Youth Wellness have been developed in order to assess early on the impact of trauma.

What are the types of trauma measured in the ACE study?

The ACE study measures physical abuse, verbal abuse, sexual abuse, physical and emotional neglect of the individual. It also measures dynamics within the family in regard to violence, substance abuse and incarceration. These experiences are collectively viewed by many as traumatic. It should be noted that this questionnaire does not take place of formal screening for trauma. This questionnaire is the foundation for additional screening and assessment of trauma. Information about the ACE study can be found here.

What is considered a high ACE score?

The study indicates that those with a score of 4 or higher are at a higher risk of health-related problems as an adult such as obesity, smoking, physical inactivity, mental health concerns and engaging in high-risk behaviors such as using illicit drugs.

What are some of the effects a high ACE score can have on children?

The effects impact social, emotional and cognitive impairment as a child, which can result in engaging in high-risk behaviors and possibly an early death as an adult. While this does not mean that every child with a high ACE score will engage in damaging behaviors or experience health issues later in life, success rates are higher when intervention occurs.

What resources are available for foster parents who care for children who have a high ACE score?

There are many trainings available to help caregivers understand how a high ACE score impacts all areas of one’s life. Upbring foster parents receive eight hours of Trauma-Informed Care (TIC) training before caring for children. Additionally, foster parents are required to attend two hours of annual training in TIC. There are many treatment models for specific concerns such as substance abuse, health-related concerns, mental health diagnosis, etc. Children receiving behavioral health services can seek support/resources from a licensed mental health clinician to help manage symptoms of trauma. A list of additional resources can be found on our website.

What factors in a child?s life increase resilience?

Protective factors such as safety, supportive and nurturing caregivers, meeting basic needs and access to health care all increase resilience in children. These protective factors allow the child to form secure attachments that help meet developmental milestones, socialization skills, good decision-making and overall improve the quality of life. With training, foster parents can provide these protective factors to children under their care.

While trauma can have a significant impact on a child’s well-being, it doesn’t have to dictate the rest of his or her life. Intervention and trauma-informed care provide a chance for a child to heal from the wounds of his or her past and move toward a brighter future. For resources and information on child abuse awareness and prevention, visit


Frank Lopez currently serves as the Family Services Clinical Director for Upbring. He has held several positions within the organization over the last several years. In his current role, he is responsible for the clinical, training and adoption programs of the foster care and adoption division of the organization. Frank is involved in identifying research-based interventions essential for children and families, leading family-team meetings, support groups and staff development. Additionally, he serves as a member of the child’s service plan team.

He is a social work practitioner in the areas of child welfare, mental health and higher education who graduated with a Master of Social Work degree from the Worden School of Social Service at Our Lady of the Lake University in San Antonio, Texas. He holds licensure as a Licensed Clinical Social Worker, Licensed Child-Placing Agency Administrator and Certified Anger Resolution Therapist.

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