Rosa Cueto, holding a drawing by her daughter in her children’s bedroom, ran away from an abusive home as a teenager. The trauma has played out in her own experience as a parent: Six children have been removed from her home at different times.

Noelle Haro-Gomez / for the Arizona Daily Star

Children might end up in foster care after enduring abuse or neglect. Maybe a birth parent is an addict or has an untreated mental illness. Perhaps the children witnessed domestic violence.

Whatever the reason for the trauma, its effects are insidious and difficult to address — and they can last a lifetime, even spanning generations. Children raised in dysfunction often grow up and raise their own kids in similar households, making trauma a key reason for Arizona’s recent spike in children’s removal from their families. Arizona ranks first nationwide for the number of children in out-of-home care, with 15,300 removed by Child Protective Services statewide and 5,000 in Pima County.

Enduring trauma in childhood not only increases the future risk for addiction and mental-health challenges, but it also heightens a child’s likelihood of developing a chronic illness.

Research on trauma has exploded in recent years, and many who work with abused and neglected children and their families say it is one of our most complex issues: How do social workers and mental-health-care providers undo what is so deeply ingrained?

Tucsonan Rosa Cueto’s childhood was devoid of healthy relationships. She became so mired in dysfunction that she is now left longing to carry out the one thing she wants to do most: mother her two youngest children.

Her story illustrates the lasting impacts of trauma and the agony a parent can go through when she wants her children back, but because of her parenting history and personal struggles, might not get another chance.

Arizona worst for kids

Arizona was deemed the nation’s worst place to be a child after the Centers for Disease Control and Prevention recently completed its largest study on trauma.

Using data from the Centers’ Adverse Childhood Experiences, or ACE, study, the National Survey of Children’s Health found last year that 44.4 percent of Arizona’s children ages 12-18, and 31.1 percent of all children 18 and younger, have experienced two or more traumatic childhood events. The national average was 22.6 percent.

When these children are removed from their homes, they are often re-traumatized by losing what’s familiar, even if it’s unhealthy or unsafe. Pima County Juvenile Court data show that 80 percent of children who have been removed from home by CPS have a mental health issue such as anxiety or depression, disorders often brought on or exacerbated by trauma.

About 21 percent of the foster care system’s alumni experience post-traumatic stress disorder, a higher rate than war veterans, says a 2012 report by the National Resource Center for Permanency and Family Connections.

“We have a public-health issue here in Pima County,” says Chris Swenson-Smith, head of Child and Family Services at the Juvenile Court Center and a former CPS caseworker, “and it’s trauma.”

How a teacher sees it

As a second-grade teacher at Walter Douglas Elementary School, Whitney Weigold sees how some of her students and their families struggle with poverty, unemployment, low wages and stress. Some students regularly miss meals, don’t receive medical care when they need it or lack adequate clothing or shoes.

Without these basic needs being met, she wonders, how can she possibly expect them to pay attention and do their homework? She wishes she could do more to help. “We have families and children going through more trauma than I will ever see in my lifetime,” she says.

Trauma results from being exposed to an inescapable and stressful event that “overwhelms a person’s coping mechanisms,” University of Maryland sociology professor Carolyn Knight wrote in her book for social workers, “Working With Adult Survivors of Childhood Trauma.

Cueto could be Knight’s poster child.

When she was a girl, Cueto and her siblings were abused and so became involved in the child-welfare system.

Cueto said she was taken from her home and returned several times until, at 14, she ran away with a boyfriend. He became her abusive partner of 15 years, deepening her childhood scars and reinforcing the dysfunction. They lived in cars and hotel rooms, sold drugs and, she says, “did what we could to survive.”

They also had four children, all of whom were taken away by CPS.

Now 35, Cueto has had two more children with other men — the first boyfriend was deported and the second one died. She said she is trying to live a better life, but she suffers from severe panic attacks and multiple health problems, including fibromyalgia and a migraine disorder she developed after being shot in the head at age 14.

One year ago, her two youngest children, both under 10, were taken away by CPS. The charges included exposure to domestic violence and substance abuse.

“I love my children more than anything in the world,” she says, through tears. “They are my life.”

But dealing with the aftermath of her own upbringing while trying to negotiate what she finds a complicated and often dispassionate child-welfare system has left her defensive, and, at times, hopeless.

“I feel intimidated by these people,” she says. “I wish someone had tried to understand my story. It’s not something that gets better overnight.”

Heartbreak on the line

Cueto says trauma in her life has been “like a chain that never ends.” When CPS removed her children, she became hysterical and was prescribed several drugs to help, but she says they left her barely able to function.

Phone calls with her children in those initial months were overwhelming.

“I would talk to the them on the phone and it was so awful. They would cry and cry and cry because they wanted to come home,” she says. “This is trauma for them. I know how I feel not holding them and touching them and combing their hair. Can you imagine how they feel?”

But Cueto has also failed to carry through with some of the requirements she needs to follow to get her children back. She says being overmedicated during those initial months made it difficult, and that she still becomes overwhelmed with grief and fear.

Her case, like her life, is complex. There are no easy answers.

During a hearing scheduled this week, her attorney will ask a Juvenile Court judge to give Cueto more time to do what she needs to do to get her children back — for more time to unlearn a lifetime of trauma.