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Trauma Sensitive Schools. Karen Yost, MA, LSW, LPC,NCC, ALPS, MAC, CCDVC, CSOTS Prestera Center. Learning Objectives. As a result of this training, participants will:

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trauma sensitive schools

Trauma Sensitive Schools

Karen Yost, MA, LSW, LPC,NCC, ALPS, MAC, CCDVC, CSOTS

Prestera Center

learning objectives
Learning Objectives

As a result of this training, participants will:

  • Understand the prevalence & impact of traumatic experiences on the health & well-being of students, including the impact on the ability to learn
  • Be able to define & promote the principles & components of trauma-sensitive care
  • Be able to identify evidence-based practices for students who have experienced trauma in the school setting.
have you ever had a student who was
Have you ever had a student who was…
  • irritable or hostile?
  • avoidant of school?
  • chronically poor in self-care health habits?
  • exhibiting confusion or poor memory when being questioned?
  • stoic and reluctant to admit to problems, or extremely needy and/or demanding?
  • presenting with a history of alcohol/substance abuse, depressive symptoms, chronic relationship difficulties and/or intermittent employment history?
  • problems with learning?
you are not alone
You Are Not Alone!
  • Youth with histories of trauma are likely to present to schools with some (or many) of these characteristics.
  • Their behavior can interfere with learning, student-teacher communication, impede compliance with instructions/rules, and generally, frustrate the school staff.
  • More importantly, these youth are at high risk for academic failure and deteriorating health.

Most youth who have experienced traumas do not seek mental health services.

take home message
Take Home Message
  • Trauma is pervasive
  • Trauma’s impact is broad, diverse and often life-shaping
  • School personnel can prevent retraumatization:

Do No Harm

  • Educators and providers can have a healing effect: Healing Happens in Relationships
trauma defined
Trauma Defined…
  • “an emotional shock that creates significant and lasting damage to a person’s mental, physical and emotional growth.”
  • Traumatic experiences can significantly alter a person’s perception of themselves, their environment, and the people around them. In effect, trauma changes the way people view themselves, others and their world.
  • Can impact safety, well-being, permanence.
slide7
Trauma occurs in layers, with each layer affecting every other layer. Current trauma is one layer. Former traumas in one’s life are more fundamental layers. Underlying one’s own individual trauma history is one’s group identity or identities and the historical trauma with which they are associated.

Bonnie Burs

prevalence
Prevalence
  • 70‐80% of mental health clients have severe trauma histories
  • In state hospitals, estimates range up to 95%
  • 90% or more of women in jails and prisons are victims of physical or sexual abuse
  • Up to 2/3 of men and women in substance abuse treatment report childhood abuse or neglect
  • Similar statistics exist for foster care, juvenile justice, homeless shelters, welfare programs, etc
  • Boys who experience or witness violence are 1000 times more likely to commit violence
vulnerable populations
Vulnerable Populations
  • Children & women
  • American Indian/Alaska Native
  • Veterans
  • Refugees and immigrants
  • People who are homeless
  • People who are institutionalized in mental health or criminal justice systems
staggering financial burden of childhood abuse trauma
Staggering Financial Burden of Childhood Abuse & Trauma
  • Annual Direct Costs: Hospitalization, Mental Health Care System, Child Welfare Service System, Law Enforcement = $33,101,302,133.
  • Annual Indirect Costs: Special Ed, Juvenile Justice, Mental Health & Health Care, Criminal Justice System, Lost Productivity = $70,652,715,359.
  • Total Annual Cost: $103,754,017,492 (over $184 million dollars a day).

Economic Impact Study. (September, 2007). Prevent Child Abuse America

trauma is
Trauma is…
  • NOT a diagnostic category
  • A series of experiences that elicits feelings of terror, powerlessness, & out-of-control psychological arousal; result in survival driven behaviors, thoughts, emotions, & needs.
  • Often misinterpreted & assigned as symptoms of disorders (depression, Bipolar Disorder, ADHD, Oppositional Defiant Disorder, Conduct Disorder, Attachment Disorder, etc.).
  • These diagnoses generally do not capture full extent of developmental impact of trauma.
slide12

Exposure to Trauma

  • Trauma can be:
    • A single event
    • A connected series of events
    • Chronic lasting stress

Trauma is under-reported and under-diagnosed.

(NTAC, 2004)

types of traumatic experiences
Types of Traumatic Experiences
  • Loss of a loved one
  • Abandonment
  • Accidents
  • Homelessness
  • Community/school violence
  • Bullying, including cyber-bullying
  • Domestic violence
  • Neglect
  • Frequent moves
  • Serious medical Illness
  • Physical abuse
  • Sexual abuse
  • Emotional/verbal abuse
  • Man-made or natural disasters
  • Witnessing violence
  • Terrorism
  • Refugee and War Zone trauma
slide14

Types of Trauma

A single traumatic event that is limited in time.

The experience of multiple traumatic events.

Vicarious Trauma

Both exposure to chronic trauma, and the impact such exposure has on an individual.

The traumatic removal from home, admission to a detention or residential facility or multiple placements within a short time.

slide15

Trauma can occur at any age.

Trauma can impact anyone.

impact of trauma over the life span
Impact of Trauma Over the Life Span

ACE Study - effects are neurological, biological, psychological and social in nature, including:

  • Changes in neurobiology
  • Social, emotional and cognitive impairment
  • Adoption of health-risk behaviors as coping mechanisms
  • Severe and persistent behavioral health, physical health, social problems, and early death

(Felitti)

adverse childhood experiences increase the risk of
Adverse childhood experiences increase the risk of:

4 or more traumatic experiences shorten life expectancy by 20 years

adverse childhood experiences increase the risk of1
Adverse childhood experiences increase the risk of:

4 or more traumatic experiences shorten life expectancy by 20 years

impact of exposure to trauma
Impact of Exposure to Trauma

Can cause impairments in many areas of development & functioning, including:

  • Attachment – Difficulty relating to & empathizing with others; believe the world to be uncertain & unpredictable
  • Biology – problems with sensation & movement, including hypersensitivity to physical contact & insensitivity to pain; physical symptoms & increased medical problems
impact of trauma cont
Impact of Trauma, cont.
  • Mood Regulation – difficulty identifying & controlling emotions & internal states
  • Behavioral Control - poor impulse control, self-destructive behavior, aggression, risk taking behavior
  • Dissociation – feeling detached, as if observing something happening to them that is not real
impact of trauma cont1
Impact of Trauma, cont.
  • Cognition – difficult focusing & completing tasks or anticipating future events; learning difficulties & problems with language development
  • Self-concept – feeling shame/guilt; low self-esteem, disturbed body image
  • Loss & Betrayal - loss of part(s) of their life; distrust of others
  • Powerlessness – perceive self as victim; have no say in what happens to them; unable to control their lives, etc.
impact on learning school behavior
Impact on Learning & School Behavior
  • Loss of pleasure in learning & displays inconsistent or little effort
  • Belief that they are not smart - especially LD students
  • Re-live the painful, burning memories of shaming experiences
  • Exhibit chronic, habitual anger toward teachers and those in authority
  • Inconsistent attendance/truancy
  • Low appetite for risk-taking academically and in other areas (“I don’t care”)
  • Behavior problems
a vignette
A Vignette

Robert, Ben, and Sam were walking home from high school. A car drove by playing loud music. Ben recognized a gang member in the car who had earlier threatened him. "Let's get out of here!" he said. Before the boys could get away, the car stopped and four gang members surrounded them. All three boys were beaten. Ben's nose was broken, Robert's front teeth were knocked out, and Raul received a black eye and a fractured rib. In the weeks that followed, each had a very different reaction in school.

Robert became reluctant to attend school. When he went to school, he did not participate in discussions as much as before and was more irritable with his friends and teachers. Previously a conscientious student, Robert began giving excuses for not completing his homework and did poorly on his most recent exam.

Ben seemed to enjoy the notoriety given him from being jumped, and tended to become more aggressive and outspoken with his peers. In class, Ben expanded his role as class clown, now including the teacher in his sarcastic remarks, for which he was repeatedly sent to the office.

Sam showed no obvious signs at school following the experience. He continued in the same manner with his friends and in the classroom. According to Robert, however, each day Raul insisted on taking a different route home from school from the one they took when they were beaten.

school related impact
School-Related Impact
  • Frequently moved from school to school with poor transitions for new students
  • Labeled as “less than” academically – high referrals for Special Education
  • Have experienced humiliation in a variety of ways and for many reasons-academics, physical characteristics, popularity, social class-in the school setting
  • Considered to be “less than,” “wrong,” or “not capable” – lowered expectations by school staff
  • Staff interventions may be counterproductive or retraumatizing
trauma and the brain
Trauma and the Brain
  • Has serious consequences for normal development of children’s brains, brain chemistry & nervous system.
  • Trauma-induced alterations in biological stress symptoms can adversely effect brain development, cognitive & academic skills, & language development.
  • Result in increased levels of stress hormones (impacts response to future stress)
trauma and the brain cont
Trauma and the Brain, cont.

Affects “cross-talk” between brain’s hemispheres, including parts that:

  • regulate emotions
  • manage fears, anxieties & aggression
  • sustain attention for learning & problem solving
  • control impulses & manage physical responses to danger
  • allow realistic appraisal of danger & safety
  • promote consideration of consequences of behavior
  • allow ability to govern behavior & meet longer term goals
the influence of culture
The Influence of Culture
  • People of different cultural, national, linguistic, spiritual & ethnic backgrounds may define & describe “trauma” differently
  • Assessment of trauma history should always take into account cultural background & modes of communication of assessor and family
  • Strong cultural identify & community/family connections can contribute to strength & resilience or can increase risk for & experience of trauma.
the influence of development
The Influence of Development
  • Child traumatic stress reactions vary by developmental stage.
  • Children with traumatic experiences may spend much energy responding to, coping with, & coming to terms with the experience – results in delays in mastering age-appropriate developmental tasks – delayed development
  • The longer traumatic stress goes untreated, the farther children tend to stray from appropriate developmental pathways.
the influence of developmental stage
The Influence of Developmental Stage

Child traumatic stress reactions vary by developmental stage.

Children who have been exposed to trauma expend a great deal of energy responding to, coping with, and coming to terms with the event.

This may reduce children’s capacity to explore the environment and to master age-appropriate developmental tasks.

The longer traumatic stress goes untreated, the farther children tend to stray from appropriate developmental pathways.

slide30
Young childrenwho have experienced trauma may:

Become passive, quiet, and easily alarmed

Become fearful, especially regarding separations and new situations

Experience confusion about assessing threat and finding protection, especially in cases where a parent or caretaker is the aggressor

Regress to recent behaviors (e.g., baby talk, bed-wetting, crying)

Experience strong startle reactions, night terrors, or aggressive outbursts

The Influence of Developmental Stage:Young Children

slide31
School-age childrenwith a history of trauma may:

Experience unwanted and intrusive thoughts and images

Become preoccupied with frightening moments from the traumatic experience

Replay the traumatic event in their minds in order to figure out what could have been prevented or how it could have been different

Develop intense, specific new fears linking back to the original danger

The Influence of Developmental Stage:School-Age Children

slide32

The Influence of Developmental Stage:School-Age Children, cont.

School-age childrenmay also:

  • Alternate between shy/withdrawn behavior and unusually aggressive behavior
  • Become so fearful of recurrence that they avoid previously enjoyable activities
  • Have thoughts of revenge
  • Experience sleep disturbances that may interfere with daytime concentration and attention
slide33
In response to trauma,adolescentsmay feel:

That they are weak, strange, childish, or “going crazy”

Embarrassed by their bouts of fear or exaggerated physical responses

That they are unique and alone in their pain and suffering

Anxiety and depression

Intense anger

Low self-esteem and helplessness

The Influence of Developmental Stage:Adolescents

slide34
These trauma reactions may in turn lead to:

Aggressive or disruptive behavior

Sleep disturbances masked by late-night studying, television watching, or partying

Drug and alcohol use as a coping mechanism to deal with stress

Over- or under-estimation of danger

Expectations of maltreatment or abandonment

Difficulties with trust

Increased risk of revictimization, especially if the adolescent has lived with chronic or complex trauma

The Influence of Developmental Stage:Adolescents, cont.

the influence of developmental stage adolescents trauma substance abuse
The Influence of Developmental StageAdolescents, Trauma, & Substance Abuse

Adolescents who have experienced trauma may use alcohol or drugs in an attempt to avoid overwhelming emotional and physical responses. In these teens:

Reminders of past trauma may elicit cravings for drugs or alcohol.

Substance abuse further impairs their ability to cope with distressing and traumatic events.

Substance abuse increases the risk of engaging in risky activities that could lead to additional trauma.

Counselors must consider the link between trauma and substance abuse and consider referrals for relevant treatment(s).

slide36

The Influence of Developmental Stage:Specific Adolescent Groups

Homeless youthare at greater risk for experiencing trauma than other adolescents.

Many have run away to escape recurrent physical, sexual, and/or emotional abuse

Female homeless teens are particularly at risk for sexual trauma

Special needs adolescentsare 2 to 10 times more likely to be abused than their typically developing counterparts.

Lesbian, gay, bisexual, transgender or questioning (LGBTQ) adolescents contend with violence directed at them in response to suspicion about or declaration of their sexual orientation and gender identity

variability in responses to traumatic events
Variability in Responses to Traumatic Events

The impact of a potentially traumatic event depends on:

  • Individual’s age & developmental level
  • Individual’s perception of the danger faced
  • Whether the individual was victim or perpetrator
  • Individual’s relationship to victim or perpetrator
  • Individual’s past experience with trauma
  • Adversities the individual faces following the trauma
  • Presence/availability of others who can offer help/support/protection
slide38

TRIGGERS

For trauma survivors, it is different…

what is a trigger
What is a Trigger?

This

Not This

A conditioned response that happens automatically when faced with a stimuli associated with traumatic experiences

slide40

T

Triggers

  • Seeing, feeling, hearing, smelling something that reminds us of past trauma
  • Activates the alarm system…
                • The response is as if there is current danger.
        • Thinking brain automatically shuts off in the face of triggers.
  • Past and present danger become confused.
slide41

Our experience.

A trauma survivor’s experience.

slide43

Your response is key-

Greater chance for a

Greater chance for a

slide44

Protective Factors

  • Parental/caregiver resilience
  • Social connections
  • Knowledge of parenting and child development
  • Concrete support in times of need
  • Nurturing and attachment/social and emotional competence of children
slide45

“It’s about the right to have a present and a future that are not completely dominated and dictated by the past.”

Karen Saakvitne

slide48

TRAUMA-SENSITIVE PRACTICE

(Fallot & Harris, 2002; Cook et al., 2002, Ford, 2003, Cusack et al., Jennings, 1998, Prescott, 2000)

slide49

Trauma Informed Systems

UNIVERSAL PRECAUTIONS

Presume that every person in a treatment setting has been exposed to abuse, violence, neglect, or other traumatic event(s).

“What has happened to you?”

slide50

Though no one can go back and make a brand new start, anyone can start from now and make a brand new ending.

Carl Bard

what matters most
What matters most…

How people cope with trauma determined by:

  • How they experience what they are exposed to
  • Who they were exposed to in their traumatic past
  • What they are exposed to in the present

environment

trauma sensitive care
Trauma-Sensitive Care

Trauma-Sensitive Care provides a new paradigm under which the basic premise for organizing services is transformed from

“What’s wrong with you?”

“What happened to you?”

To

trauma sensitive paradigm
Trauma-Sensitive Paradigm
  • Understanding of Trauma
  • Understanding of the Student/Survivor
  • Understanding of Services
  • Understanding of the Service Relationship
understanding of trauma
Understanding of Trauma
  • Traumatic events are not rare; experiences of life disruption are pervasive and common
  • The impact of trauma is seen in multiple, apparently unrelated life domains
  • Repeated trauma is viewed as a core life event around which subsequent development organizes
  • Trauma begins a complex pattern of actions and reactions which have a continuing impact over the course of one’s life
understanding student survivor
Understanding Student/Survivor
  • An integrated, whole person view of individuals and their problems and resources
  • “Symptoms” are understood not as pathology but primarily as attempts to cope and survive; what seem to be symptoms may more accurately be solutions
  • A contextual, relational view of both problems and solutions
  • Appropriate and collaborative responsibility allocation
understanding of services
Understanding of Services
  • Primary goals are empowerment and recovery
  • Survivors are survivors; their strengths need to be recognized
  • Intervention priorities are prevention driven
  • Risk to the student is considered along with risk to the system and the school
understanding of service relationship
Understanding of Service Relationship
  • A collaborative relationship between the student and the school staff, particularly teacher
  • Both the student and the staff are assumed to have valid and valuable knowledge bases
  • The student is an active planner and participant in the education process
  • The student’s safety must be guaranteed and trust must be developed over time
a culture shift core principles of a trauma sensitive system
A Culture Shift: Core Principles of a Trauma-Sensitive System
  • Safety: Ensuring physical and emotional safety
  • Trustworthiness: Maximizing trustworthiness, making tasks clear, and maintaining appropriate boundaries
  • Choice: Prioritizing choice and control
  • Collaboration: Maximizing collaboration and sharing of power with students
  • Empowerment: Prioritizing student empowerment and skill-building
essential elements of tsc
Essential Elements of TSC
  • Maximize one’s sense of security
  • Assist individual in reducing overwhelming emotion.
  • Help individual make new meaning of trauma history & current experiences.
  • Address impact of trauma & subsequent changes in one’s behavior, development & relationships.
  • Coordinate services with other agencies/systems.
essential elements cont
Essential Elements, cont.
  • Utilize comprehensive assessment of trauma experiences & their impact on development & behavior to guide services
  • Support & promote positive & stable relationships in the life of the individual.
  • Provide support & guidance to the school staff and family/caregivers.
  • Manage professional & personal stress.
what can a school counselor do
What Can a School Counselor Do?

Recognize that exposure to trauma is the rule, not the exception, among children in the child welfare system.

Recognize the signs, symptoms & cumulative effect of child traumatic stress and how they vary in different age groups.

Recognize that children’s “bad” behavior is sometimes an adaptation to trauma.

Understand the impact of trauma on different developmental domains.

Help teachers understand how their own communication style brings on behavior that hinders learning (disruption, passivity, anxiety).

slide66

What Can a School Counselor Do?

Recognize that education system responses/interventions have the potential to either exacerbate or decrease the impact of previous traumas.

Lessen the risk of system-induced secondary trauma by serving as a protective and stress-reducing buffer for children:

Develop trust with children through listening, frequent contacts, and honesty in order to mitigate previous traumatic stress.

Avoid repeated interviews, especially about experiences of sexual abuse.

Avoid making professional promises that, if unfulfilled, are likely to increase traumatization.

approaches to assessment of trauma
Approaches to Assessment of Trauma

Three basic approaches to assessment of trauma and post-traumatic sequelaethrough tools and instruments:

  • Instruments that directly measure traumatic experiences or reactions
  • Broadly based diagnostic instruments that include PTSD subscales
  • Instruments that assess symptoms not trauma specific but commonly associated symptoms of trauma

Wolpaw & Ford 2004

screening diagnosis issues
Screening/Diagnosis Issues
  • Identification of PTSD or sub-threshold PTSD symptoms is complicated by the fact that these symptoms mimic symptoms of anxiety and depression
  • Many individuals with PTSD also abuse alcohol and drugs
  • If trauma screening isn’t conducted, these individuals are usually treated as people with just depression, or just anxiety, or just AOD
hallmark ptsd symptoms
Hallmark PTSD Symptoms
  • Reexperiencing the traumatic event (nightmares, intrusive memories, flashbacks, etc.)
  • Intense psychological or physiological reactions to internal or external cues that symbolize or resemble some aspect of the original trauma
  • Avoidance of thoughts, feelings, places, &/or people associated with the trauma
  • Emotional numbing (detachment, estrangement, loss of interest in activities, etc.)
  • Increased arousal (heightened startle response, sleep disturbance, irritability, etc.)
universal screener for mental health substance abuse trauma
Universal Screener for Mental Health, Substance Abuse & Trauma

Screening Questions for Mental Health

  • Have you ever been worried about how you are thinking, feeling, or acting?
  • Has anyone ever expressed concerns about how you were thinking, feeling, or acting?
  • Have you ever harmed yourself or thought about harming yourself?

Screening Questions for Trauma

  • Have you ever been hit, kicked, choked, or received a more serious punishment from a parent or other adult?
  • Has anyone ever touched you in a sexual way or made you touch them when you did not want to?
  • Have you had an experience that was so frightening, horrible, or upsetting that you have nightmares, upsetting thoughts or memories that come to your mind against your will or have bodily reactions (felt numb or detached from others/surroundings, been constantly on guard/watchful or easily startled, fast heartbeat, stomach churning, sweatiness, dizziness, etc.) when you are reminded of the event?
thoughts from helen keller
Thoughts from Helen Keller
  • The extraordinary Helen Keller, despite being blind and deaf, achieved so much in her life. She once said:“The world is moved not only by the mighty shoves of the heroes, but also by the aggregate of the tiny pushes of each honest worker.”Each of you is a “honest worker” caring and giving so much of yourselves to help others. If you all push a little you can move mountains and yourselves. You are so intertwined, you caregivers and care recipients, that rules and regulations that are aimed at helping them also help you, and rules and regulations that are designed to help you also help them.