Download Endres: Trauma Informed Strategies

TRAUMA INFORMED
STRATEGIES FOR STRONGER
STUDENTS & SCHOOLS
NCHE
• Operates the U.S. Department of Education’s technical
assistance & information center on homeless education
• Offers:
• Website: www.serve.org/nche
• A toll-free helpline: Call 800-308-2145 or e-mail
[email protected]
• A listserv: Visit www.serve.org/nche/listserv.php for
subscription instructions
• Free resources: Visit www.serve.org/nche/products.php
TODAY’S DISCUSSION
• Define trauma & examine its effects
• Distinguish poor decision-making from trauma related
behaviors
• Share strategies for mitigating the effects of trauma
• Consider ways to help students cope & build resiliency
• Connect the discussion to the culture in your agencies
WHY THIS DISCUSSION IS IMPORTANT
• One in four school children has experienced a
traumatic event
• Higher rates of anxiety & depression in homeless
children vs. their peers
• More than 90% of low-income & homeless women
experienced physical & sexual assault
• The SHiFT Study found that trauma severity predicts
long-term housing instability
WHY THIS DISCUSSION IS IMPORTANT
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Trauma can impact school performance
Decreased reading ability
Lower GPA
Higher rate of school absences
Increased drop-out
More suspensions and expulsions
Decreased reading ability
- Child Trauma Toolkit for Educators (NCTSN)
THE POWER OF HOME
9/11
Hurricane Katrina
• Survivors ran
toward home
• 5% of survivors
developed PTSD
• Survivors ran
from home, lost
home
• 33% of survivors
developed PTSD
DEFINITION OF TRAUMA
• A very difficult or unpleasant experience that causes
someone to have mental or emotional problems, usually
for a long time
• External events that overwhelm a person’s coping
responses
• An emotional response to a terrible event
• While these feelings are normal, some people have difficulty
moving on with their lives
TRAUMA CAN IMPACT
• Groups, organizations, communities, & individuals
• Every aspect of life: particularly important when
identifying trauma in children
• Physical health
• Behavioral health
• Ability to learn
• Relationships
LEVEL OF IMPACT
• Trauma occurring early in life has greater impact & is
more likely to result in greater damage
• Long-term implications of harm to developing brains & bodies
• Harm at the hands of an authority figure is particularly
damaging
• Multiple sources of trauma or repetitive experiences of
trauma magnify the impact
SIGNS OF TRAUMA
• Immediate response: shock, denial
• Long-term reactions
• Unpredictable emotions
• Changes in thoughts or behavior patterns
• Strained relationships
• Physical symptoms like headaches or nausea
• Flashbacks
PERSON IN
ENVIRONMENT
There is an objective reality
out there, but we view it
through the spectacles of
our beliefs, attitudes, and
values.
-Dr. David Myers
THINGS TO REMEMBER
No two people respond exactly the same
Trauma can affect cultures differently
• Gender
• Religion
• Age
• Income
• Race
• Education & profession
• Nationality
• Location: urban, rural,
etc.
TRAUMA & STRESSOR RELATED DISORDERS
From the DSM-5
• Acute Stress Disorder
• Adjustment Disorders
• Post Traumatic Stress Disorder
• Reactive Attachment Disorder
SECONDARY TRAUMA
• Presence of post-traumatic stress disorder (PTSD)
symptoms caused by at least one indirect exposure to
traumatic material
• Can have same level of impact as direct, or primary,
trauma
• Sometimes referred to as compassion fatigue
BURNOUT
• Emotional exhaustion, lowered sense of
accomplishment, or depersonalization
• Develops as a result of general work-related stress
• Does not result from exposure to a traumatic event
Secondary Trauma is not typical stress, nor is it burnout!
SIGNS: SECONDARY TRAUMA
• Minimizing
• Anger & cynicism
• Sleeplessness or chronic
exhaustion
• Insensitivity to Violence
• Illness
• Loss of creativity
• Poor boundaries
• Disconnection
• Inability to embrace
complexity
• Inability to listen,
avoidance of others
• Guilt
• Hopelessness
• Hypervigilance or fear
DISTINGUISHING POOR DECISIONS FROM
TRAUMA-BASED RESPONSES
THE BRICK
A successful executive was traveling down a neighborhood street, going a bit
too fast in his new Jaguar. Watching for kids darting out from between parked
cars, he slowed down when he thought he saw something. No children
appeared, but a brick smashed into the side of his Jag. He slammed on the
brakes & backed up. Jumping out of the car, he grabbed the nearest kid &
pushed him up against a parked car shouting, "Just what the heck are you
doing? That's a new car! You just cost me a lot of money. Why did you do it?"
The young boy said, "Please, mister...please! I'm sorry but I didn't know what
else to do," he pleaded. "I threw the brick because no one else would stop!"
With tears dripping down his face & off his chin, the youth pointed to a spot
just around a parked car.
"It's my brother," he said. "He rolled off the curb & fell out of his
wheelchair. I can't lift him up." Now sobbing, the boy asked the stunned
man, "Would you please help me get him back into his wheelchair? He's
hurt & too heavy for me." Moved beyond words, the driver tried to
swallow the rapidly swelling lump in his throat. He hurriedly lifted the boy
into his wheelchair, took out a linen handkerchief & dabbed at the fresh
scrapes & cuts. A quick look told him everything was going to be okay.
"Thank you & may God bless you," the grateful child told the stranger.
Too shaken up for words, the man simply watched the boy push his
wheelchair-bound brother down the sidewalk toward home. It was a
long, slow walk back to the Jaguar. The damage was very noticeable, but
the driver never bothered to repair the dented side door. He kept the
dent there to remind him: "Don't go through life so fast that someone has
to throw a brick at you to get your attention!“
TRIGGERS
• Something that sets off an action, process, or series of
events
• Sometimes referred to as a threat cue
• Can include:
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Not being listened to or tone of voice
Loud noises or yelling
People being too close
Someone opening the student’s desk or locker
Withholding food
TRIGGERS
• Time of day or year
• Start or end of day
• End of school year
• Time of year when student experienced trauma
• Particular activities
• Essays about summer activities
• Painting a picture of family or home
• Particular items that remind people of loss or harm
DISTRESS SIGNALS
Physical symptoms of distress that may signal dangerous
proximity to a trigger
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Restlessness
Agitation
Pacing
Shortness of breath
Sensation of tightness in chest
Sweating
Skin picking, rubbing, or similar
DISTRESS SIGNALS
• Clenching teeth or fists
• Eating food excessively fast
• Hand wringing
• Rocking
• Bouncing legs
• Swearing
• Shaking
• Coloring so hard it tears paper
• Crying
• Hostility
• Giggling
• Isolation
• Pounding heart
• Refusal to look at others
• Singing or yelling
CONSIDER
• The student’s history & the frequency of the behavior
• Events, sounds, smells that occur before the behavior
• The student’s ability to rationalize or be logical
• The accuracy of the student’s perceptions
• Context of behaviors: reasonable responses vs. over the top
• Identified IEP needs
• Discipline trends: different teachers tolerate different behaviors
• The five why’s
• Asking the student
DEALING WITH TRAUMA BEHAVIORS &
BUILDING RESILIENCY
A LOOK AT INDIVIDUALS AND ORGANIZATIONS
WHAT WOULD YOU DO?
Ryan is an 8th grade boy. This morning, when he arrived at
school, his teacher asked him for his homework and Ryan did
not have it. She expressed frustration & took away his recess
as a consequence. A short time later, his deskmate accidentally
bumped Ryan. Ryan punched him in the stomach. His teacher,
upset by this outburst, began to yell at Ryan to stop. Ryan
began to scream, kick chairs & hide under his desk. After 10
minutes of trying to get Ryan out from under the desk, he was
brought to the principal’s office & given a five day suspension
for fighting & disruptive behavior.
-Joyce Dorado, Ph.D (2013) Child and Adolescent Services, UCSF/SFGH
REGULATE
• When overwhelmed by a trigger, the parts of the brain
become disassociated
• Logical, speaking side of brain shuts down
• Emotional, reactionary side of brain takes over
• In the midst of the trigger, the person may need help
regulating
• Over time, they’ll become better at self-regulating
Remember: the behavior is bad, the student is good
REGULATE
• Remove the trigger
• Change the type of activity
• Do anything calming
• Listen to music
• Read in the corner
• Allow students to have transitional objects
• Form from Massachusetts Department of Mental Health
www.mass.gov/eohhs/docs/dmh/forms/form-trauma-deescalation.pdf
THINGS TO CONSIDER
• Safety first, but take a second to register which student is
acting out
• What your role is, what you bring to the environment
• Be alert to students who are coping by re-enacting trauma
• Avoid being drawn into “role-playing” the trauma
• The long term best interest of the student
• “Tagging out” if you can so a different adult is interacting
with the student
Fear, Avoidance,
Aggression,
Uncontrolled
Emotion
Perceives
Safe Place
(School) as
Threat
Cycle of
Re-Enacting
Trauma
Trauma
Re-writes
World View,
Stress
Response
Chronic
Trauma
Fear, Avoidance,
Aggression,
Uncontrolled
Emotion
PROACTIVE STRATEGIES
• Chronic trauma damages executive functioning
• Goal setting, organizing, planning, anticipating consequences
• Resetting distorted inner representations of world
Discuss at your table: what are things you can do in your
classrooms, schools, or offices to help students
strengthen executive functions?
THROUGH THEIR EYES
• Revisit the Blue Eyes-Brown Eyes exercise (Jane Elliott)
• Activities that increase anxiety
• If you already lost it all, competition is not motivating
• Groupwork: if you have problems connecting, you probably
have problems in a group
Discuss: What about your school makes students feel safe or
welcome? Parents feel safe or welcome?
If you saw an adult who was struggling with students, how
would you respond?
Instead of
“Fill out this paperwork”
Closing the office door
Try this instead
“Thank you for coming in today. If
you can help me by completing
this paperwork, I’ll be able to…”
Ask the parent or student if it’s ok
to close the door
Telling a parent they must speak Offer to schedule an appointment
to someone, but you don’t know with the parent
when the person will be in
Sending a parent a notice their
child is being expelled due to
absences/tardies
Contact the parent to express
concern about the family, offer
transportation services
CREATING A TRAUMA INFORMED CULTURE
TRAUMA INFORMED APPROACH
“A program, organization, or system that is trauma
informed:
1. Realizes the widespread impact of trauma & understands
potential paths for recovery;
2. Recognizes the signs & symptoms of trauma in clients, families,
staff, & others involved with the system;
3. Responds by fully integrating knowledge about trauma into
policies, procedures, & practices; &
4. Seeks to actively resist re-traumatization.”
http://www.samhsa.gov/nctic/trauma-interventions
TRAUMA INFORMED KEY PRINCIPLES
• Safety
• Trustworthiness & transparency
• Peer support
• Collaboration & mutuality
• Empowerment, voice, & choice
• Cultural, historical, & gender issues
TRAUMA & YOGA
• The Trauma Center at Justice Resource Institute
evaluated the progress of a group of women with
Post-traumatic Stress Disorder (PTSD) that was
unresponsive to treatment
• Sixty-four women took yoga classes for 10 weeks
• Experienced a 33% decrease in symptoms
• 52% no longer qualified for the PTSD diagnosis
TRAUMA & YOGA
• Study results not only showed a decrease in
symptoms, but they were significant in comparison to
a control group
• Improvements were comparable to research-based
psychotherapy & pharmacologic treatment
• Posited that yoga helps individuals
• Tolerate physical and sensory experiences associated with
fear & helplessness
• Increase emotional awareness & affect
SUPPORTING STUDENTS EXPOSED TO TRAUMA (SSET)
• National Institutes of Health funded the development of
a model for use by teachers & other educators
• Based on a model designed for mental health clinicians
• Targets students grade 5 thru 9
• Includes 10 weeks of classroom interventions
SSET
• Sessions follow lesson plan format
• Manual provides all handouts, worksheets, & instructions
• Focuses on helping students
• Feel more normal by explaining common trauma reactions
• Link thoughts to feelings, combat automatic emotion-based
thoughts
• Relax their bodies to combat anxiety
• Develop a trauma story that moves from the community to the
individual
SSET
• Initial pilot showed
• Small reductions in trauma symptoms
• Parents & students reported good to high satisfaction with
program
• Teachers reported small improvements in student behavior
https://traumaawareschools.org/sset
COMBATTING SECONDARY TRAUMA
We are stewards not just of those who allow us into their lives but
of our own capacity to be helpful.
-Jon R. Conte
• Handout on Secondary trauma, including resources:
nctsn.org/sites/default/files/assets/pdfs/secondary_traumatic_tress.pdf
THE TROUBLES TREE
The carpenter helping me restore an old farmhouse had a rough first day on the job.
A flat tire made him lose an hour of work, his electric saw quit, & now his ancient
pickup truck refused to start. As I drove him home, he sat in stony silence. On
arriving, he invited me in to meet his family. Near the front door, he paused briefly
at a small tree, touching the tips of the branches with both hands. After opening the
door, he underwent an amazing transformation. His tanned face was wreathed in
smiles. He hugged his two small children, & gave his wife a kiss. Afterward, he
walked me to my car. As we passed the tree, my curiosity got the better of me. I
asked him about what I saw him do earlier. "Oh, that's my trouble tree," he replied.
"I know I can't help having troubles on the job, but one thing is for sure: troubles
don't belong in the house with my wife & the children. So I hang them up on the
tree every night when I come home. In the morning, I pick them up again. Funny
thing is," he smiled, "when I come out in the morning to pick them up, there aren't
nearly as many as I remember hanging up the night before."
RESOURCES ON SECONDARY TRAUMA
Professional Quality of Life Measure
www.proqol.org/ProQol_Test.html
Self-Care Starter Kit (University of Buffalo)
http://socialwork.buffalo.edu/resources/self-care-starter-kit.html
Self Care for Educators
www.nctsn.org/sites/all/modules/pubdlcnt/pubdlcnt.php?file=/sites/de
fault/files/assets/pdfs/CTTE_Educators.pdf&nid=84
Secondary Traumatic Stress Fact Sheet
www.nrccps.org/wp-content/uploads/secondary_traumatic_tress.pdf
RESOURCE ORGANIZATIONS
National Child Traumatic Stress Network
www.nctsn.org/
National Center for Trauma Informed Care (SAMHSA)
www.samhsa.gov/nctic
Treatment and Services Adaptation Center
https://traumaawareschools.org/
Trauma Informed Oregon
http://traumainformedoregon.org/resources
RESOURCE DOCUMENTS
Child Trauma Toolkit for Educators
www.nctsn.org/sites/all/modules/pubdlcnt/pubdlcnt.php?file=/sites
/default/files/assets/pdfs/Child_Trauma_Toolkit_Final.pdf&nid=84
Tip Sheet: Suggestions for Educators
www.nctsn.org/sites/all/modules/pubdlcnt/pubdlcnt.php?file=/sites
/default/files/assets/pdfs/CTTE_Educators.pdf&nid=84
THREE LITTLE FROGS
Question: There were once three frogs on a
log and one of them made a decision to jump
in. How many were left?
Answer: There are still three frogs on a log,
he only made a decision, he took no action!
NEXT STEPS
• Evaluate your district
• sspw.dpi.wi.gov/sites/default/files/imce/sspw/pdf/traumastrategies.pdf
• www.traumainformedcareproject.org/resources/Helping-TraumatizedChildren-Learn.pdf
• Identify your partners
• Those in the trenches with you, those who validate your work, those
that fund your work
NEXT STEPS
• Make your pitch: logical & emotional
• Where does this fit?
• Positive Behavioral Interventions & Supports (PBIS), Response
to Intervention (RtI), Multi-tiered Systems of Support (MTSS)
• School safety academies/School wellness
• Dropout prevention
• Title I programming- Standard interventions & set-aside
Remember: Cultures don’t change in a single day
THE DONKEY IN THE WELL
One day a farmer’s donkey fell down into a well. The animal
cried piteously for hours as the farmer tried to figure out
what to do. Finally, he decided the donkey was old, & the well needed to be
covered up anyway; it just wasn’t worth it to retrieve the donkey. He invited
all his neighbors to come over & help him. They all grabbed a shovel & began
to shovel dirt into the well. At first, the donkey realized what was happening
& cried horribly. Then, to everyone’s amazement he quieted down. A few
shovel loads later, the farmer finally looked down the well. He was
astonished at what he saw. With each shovel of dirt that hit his back, the
donkey did something amazing. He shook it off & took a step up. As the
farmer’s neighbors continued to shovel dirt on top of the animal, he would
shake it off & take a step up. Pretty soon, everyone was amazed as the
donkey stepped up over the edge of the well & happily trotted off!
PRESENTER INFORMATION
Christina Endres
National Center for Homeless Education
[email protected]
(336) 315-7438