Trauma Sensitive Schools

1. Trauma Sensitive Schools Karen Yost, MA, LSW, LPC,NCC, ALPS, MAC, CCDVC, CSOTS Prestera Center

2. 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.

3. 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?

4. 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.

5. 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

6. 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.

7. 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

8. 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

9. 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

10. 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

11. 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.

12. 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)

13. 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

14. 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.

15. Trauma can occur at any age. Trauma can impact anyone.

16. 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)

17. Adverse childhood experiences increase the risk of: 4 or more traumatic experiences shorten life expectancy by 20 years

18. Adverse childhood experiences increase the risk of: 4 or more traumatic experiences shorten life expectancy by 20 years

19. 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

20. 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

21. 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.

22. 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

23. 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.

24. 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

25. 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)

26. 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

27. 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.

28. 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.

29. 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.

30. 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

31. 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

32. 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

33. 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

34. 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.

35. 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).

36. 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

37. 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

38. TRIGGERS For trauma survivors, it is different…

39. What is a Trigger? This Not This A conditioned response that happens automatically when faced with a stimuli associated with traumatic experiences

40. 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.

41. Our experience. A trauma survivor’s experience.

42. We all have buttons that can be pushed…

43. Your response is key- Greater chance for a Greater chance for a

44. 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

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

46. TRAUMA–SENSITIVE PRACTICE

47. TRAUMA-SENSITIVE PRACTICE

48. TRAUMA-SENSITIVE PRACTICE (Fallot & Harris, 2002; Cook et al., 2002, Ford, 2003, Cusack et al., Jennings, 1998, Prescott, 2000)

49. 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?”

50. 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