Trauma Informed Approach in Schools

Trauma is defined as any experience that leaves a person feeling hopeless, helpless, fearing for their life/survival, or their safety. This experience can be real or perceived. Trauma Informed Resilience Schools

The National Child Traumatic Stress Network (NCTSN) lists possible sources of traumatic events or trauma types, including: bullying, community violence, complex trauma, disasters, early childhood trauma, intimate partner violence, medical trauma, physical abuse, refugee trauma, sexual abuse, terrorism and violence, and traumatic grief (difficulty adjusting after experiencing someone’s death).

According to Call and Mercado (2019), there is no one profile that describes a typical reaction to childhood traumatic events. Each child experiences trauma in their own subjective manner which can be influenced by developmental and cultural factors. A child’s interpretation of trauma can lead to various internal triggers (experienced inside a student’s body and mind) and external triggers (happen outside the body - people,situations, places) that elicit strong reactions. These reactions are actually a survival response, often called fight, flight, freeze. This video helps explain the biology behind this response.

The signs and symptoms of trauma can vary greatly from one child to the next, making it challenging for school personnel to identify a child who has been impacted by trauma. Many of the common symptoms can be organized using the fight, flight, freeze model:

Fight might look like:

• hitting, kicking, yelling

Flight might look like:

• running away, changing the subject, distracting

Freeze might look like:

• whining, clinging, zoning out

The NCTSN has created a toolkit which provides a more extensive list of signs/symptoms you might observe in elementary, middle, and high school students who have experienced trauma. It is important to understand that a student living in a state of flight, fright, freeze is not learning, is unable to make generalizations, is unable to critically think, problem solve, plan ahead, and/or organize, and takes longer to process (may need visual cues). Traumatized children may experience physical and emotional distress and have difficulty regulating their emotions and behaviors. Trauma can impact a child’s ability to form relationships and cause them to have low self-esteem. Here is a list of common trauma triggers:

The Traumatic stress response cycle is the process by which an event occurs, triggering the individual, which can lead to agitation, acceleration, and a peak phase. Students in a peak phase, may engage in unsafe behavior. The goal in schools is to help de-escalate the student and lead them to recovery, and eventually back to a state of calm. This link includes a 6 part webinar which describes this cycle in detail, and provides guidance on best responses during each phase of this cycle and ways to foster trauma sensitive practices in schools.

This video provides an overview of Trust Based Relationships Intervention (TBRI) and why it can be used by all adults who care for children. The developers of TBRI (Purvis & Cross, 2018) provide an overview of the neuropsychology of trauma, which is summarized here.
We are all born with the basics, which includes the spinal cord, brain stem, deep (inner) brain, and amygdala. The deep brain acts like a sensory brain that regulates sensations, affect/stress, and memory. The amygdala is the part of the brain that senses danger, like a smoke detector. For example, if a bear surprises you, this part of your brain tells you what to do. That is, to run away, fight back, or freeze. It does not involve conscious thought, but rather is purely reactive, focusing on survival.

After birth, we develop our outer brain, which includes abilities such as thinking, language, processing, problem solving, and learning. All of these are necessary for school success. Trauma can impact a child’s education, making it more difficult to learn or leading to school avoidance. Trauma Aware Schools provides resources for parents, educators, and mental health professionals to help support students who have experienced trauma in their lives. Our outer brain is more difficult to access when stressful moments occur.

During times of stress, when mental energy is being used by the inner part of the brain, children do not have access to the thinking/learning part of the brain, which includes language. Practically, what this means is that when a child is in a reactive state, and you ask them what they are upset about, they may not be able to access the words to tell you “what happened.” Children who have experienced trauma will move into the fear state more quickly and more often because their amygdala is bigger and more active. Stressed brains can’t learn because learning, language, and thinking are all outer brain processes. They first need to calm down, and then they will be able to speak with you.

In order to be able to self-regulate when agitated, a student needs to have practiced the skills when calm. Remember, an agitated child cannot access their learning brain, so the skill needs to be automatic. Dr. Bruce Perry, an expert in the field of neuroscience suggests the following strategy: regulate, relate and reason. Children will often need an adult’s assistance to calm when they are in an agitated state, which is where calming strategies come in. If they don’t have the skill to do it independently, they can do it along with you, called co-regulation.

Things that work well when working with a dysregulated child include speaking calmly and helping them to regulate their breathing. Students may not know how to regulate their breathing, and it can be helpful to provide a variety of strategies and tools.

Calming corners in a classroom can be helpful in providing a place for a dysregulated child to regain control. There are also virtual calming corners where students can access strategies via computer. On-line activities are also available, such as Rainbow Breathing on Go Noodle (good whole class activity).

The Centers for Disease Control and Prevention (CDC) has compiled information about the impact of Adverse Childhood Experiences, or ACEs. ACEs are potentially traumatic events that occur in childhood (0-17 years) such as experiencing violence, abuse, or neglect; witnessing violence in the home; and having a family member attempt or die by suicide. Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding such as growing up in a household with substance misuse, mental health problems, or instability due to parental separation or incarceration of a parent, sibling or other member of the household. The Robert Wood Johnson Foundation has created this infographic to increase awareness and understanding of the impact of ACEs and the need to develop effective innovative interventions.

Children growing up with toxic stress may have difficulty forming healthy and stable relationships. They may also have unstable work histories as adults and struggle with finances, jobs, and depression throughout life. These effects can also be passed on to their own children. Some children may face further exposure to toxic stress from historical and ongoing traumas due to systemic racism or the impacts of poverty resulting from limited educational and economic opportunities. ACEs are preventable. Creating and sustaining safe, stable, nurturing relationships and environments for all children and families can prevent ACEs and help all children reach their full potential. The CDC has produced this resource to help states and communities take advantage of the best available evidence to prevent ACEs. Important findings from the ACEs survey in this resource were:

• Almost 2/3 (61%) of adults surveyed had at least one Adverse Childhood Experience, as defined on the survey. The majority who reported at least one ACE, reported more than one.

• ACEs are linked to health problems, mental illness, and substance misuse in adulthood. They can also lead to negatively impacted education and job opportunities.

• Women and several racial/ethnic minority groups are at higher risk of experiencing 4 or more aces.

Some of the major findings from the ACE survey about how ACEs affect our lives and society can be found here that also includes an interactive tool. These findings include:

• Dramatic links between ACEs and risky behavior, psychological issues, serious illness, and the leading causes of death.
• ACE scores of 4 or more were 4.6 times more likely to report feeling depressed and 12.2 times as likely to have ever attempted suicide
• ACE scores of 6 or more died nearly 20 years earlier on average

Resilience is defined as the capacity to recover quickly from difficulties. The Resilience documentary delves into the science of ACEs and a new movement to treat and prevent toxic stress. You can view the trailer here.

An important element of a Trauma Informed Approach is a focus on building resilience. Researchers in this field agree that it is a mindset shift away from identifying what is wrong with a student, to being curious about what has happened or is happening to a student. STARR Commonwealth has identified 10 steps to being trauma informed. In its Concept of Trauma and Guidance for a Trauma Informed Approach document, Substance Abuse and Mental Health Service Administration (SAMHSA; 2014) emphasizes the importance of realizing how widespread experiences of trauma are, recognizing the signs and symptoms, and responding by integrating this knowledge into daily practices and policies, thereby resisting re-traumatization. The CDC and SAMHSA created this visual of the 6 Key Principles of a trauma informed systems approach.

Dr. Eric Rossen (Rossen, 2020) has presented 6 Principles of Trauma Informed Schools to consider in the context of the pandemic. These principles emphasize viewing the child with unconditional positive regard while keeping expectations high, empowering the child through offering choice, and teaching students how to interact with others. His original presentation is not available for publication. However, Dr. Rossen was interviewed for a podcast discussing 10 principles of a trauma informed approach which can be found here.

COVID-19 can surely be considered a collective traumatic experience. Fears and worries related to physical and emotional health are prevalent and many people feel overwhelmed. It is important to acknowledge that not every individual will have long term traumatic reactions upon re-entry due to COVID-19. However, SAMSHA discusses a system that employs a universal precautions approach in which one expects the presence of trauma in the lives of individuals being served. Thus, all can benefit from a trauma informed approach whether they have been traumatized by an event or not.

Applying a trauma informed approach is also critical now due to a different type of trauma experienced by many individuals within our community and country. As noted in the Child Welfare Trauma Training Toolkit, Historical Trauma is defined as a personal or historic event, or prolonged experience that continues to have impact over generations. These events and experiences may include massacres, slavery, and cultural and racial oppression.

The Administration for Children and Families states that “People coming into systems of services and support from communities who have been subjected to historical trauma may believe the systems do not support them. They may experience triggers that are re-traumatizing.”

The recent, as well as numerous previous deaths of unarmed Black people, and the continued systemic barriers and inequities that have been present for generations has resulted in continued re-traumatizing of many Black people in this country. It has prevented an experience of felt safety for many, which is so critical in addressing the impact of trauma.

The National Association of School Psychologists provides information and resources on Social Justice, including issues of race and implicit bias. It also provides social justice lesson plans.

Again it is important to recognize that not all individuals within any particular group will have the same response to traumatic events. Many are resilient and will recover. However, it is important to acknowledge and identify individuals who may be at higher risk; as well as those vulnerable to re-traumatization. Triage is important in order to identify students and staff needing support.

The NCTSN notes students who may be at increased risk during this time of COVID-19. It also provides strategies for educators, school staff, and administrators during COVID-19. Included are ways to create a trauma informed learning environment and ways to support staff, as well as crisis response and discipline practices.

Dr. Eric Rossen adds that individuals who have experienced racism and discrimination related to COVID-19, those who have had disruptions in their lifestyle including food and financial insecurity, and those who have lost family members and loved ones without an opportunity to process their grief are all at greater risk.

Additional factors to consider for those who may be at higher risk for increased traumatic responses during this time include individuals with health/medical conditions who are particularly vulnerable to COVID-19, those who are impacted by historical trauma, and those who have had a history of being systematically oppressed.

Please note that this list is not exhaustive. According to Dr Eric Rossen, we must be responsive to the needs individuals have and not just the needs we think they should have. The significance of an experienced loss is subjective. So a student who missed a very important milestone during COVID-19 may have feelings and responses which warrant acknowledgement and support.

According to an article in Psychology Today, pandemics can impact the mental health of the general population in many ways, including increases in stress and traumatic stress, depression, feelings of hopelessness, anxiety, panic, and grief (Douglas et. al., 2009; Kamara et al., 2017, as cited in Render Turmaud 2020).

The Administration for Children and Families notes that Historical Trauma can impact psychological and physical health and lead to problems including low self esteem, depression, and cardiovascular disease.

Upon re-entry, it is crucial to prioritize the social/emotional and mental health needs in order to help students be ready for learning. According to Dr. Bruce Perry, we have to promote regulation and relationships, in order to get to reasoning. In this video clip, Dr. Perry discusses brain functioning and the importance of self-regulation and social emotional development prior to learning.

Relationship building is a key component to building resilience in children. It is also important that teachers and staff practice self-compassion and self-care to remediate the impact of secondary traumatic stress.

This link includes various strategies and resources on trauma which includes universal strategies, teacher/caregiver support, and COVID-19 specific resources.

Administration for Children and Families. (n.d.). Trauma. U.S. Department of Health and Human Services. https://www.acf.hhs.gov/trauma-toolkit/trauma-concept#:~:text=Historical%20trauma%20is%20cumulative%20and,%2C%20and%20self%2Ddestructive%20behavior.

Call, C. & Mercado, S. (2019). TBRI & trauma-informed classrooms [Online Course]. Karyn Purvis Institute of Child Development. https://child.tcu.edu/tbritic/#sthash.btP4VYY6.j25bCGbn.dpbs

Centers for Disease Control and Prevention. (n.d.). Preventing adverse childhood experiences. U.S. Department of Health and Human Services. https://www.cdc.gov/violenceprevention/childabuseandneglect/aces/fastfact.html

Cox, S., Morgan, K., Smith, A., & Locklear, L. (2018, October) Presented at the Child Welfare Trauma Training Toolkit. From the National Child Traumatic Stress Network. Winston Salem, N.C.

Hart, K. (2019). Trauma informed resilient schools [Online Course]. STARR Commonwealth. https://starr.org/course/trauma-informed-resilient-schools/

National Child Traumatic Stress Network. (n.d.). Retrieved June 2, 2020, from https://www.nctsn.org/

Purvis, K. & Cross, D. (2018). TBRI 101: A self-guided course in trust-based relationships [Online Course]. Karyn Purvis Institute of Child Development. https://child.tcu.edu/tbri101/

Render Turmaud, D. (2020, March 14). Trauma of pandemic proportions: Mental health consequences of the COVID-19 pandemic and tools for coping. Psychology Today. https://www.psychologytoday.com/us/blog/lifting-the-veil-trauma/202003/trauma-pandemic-proportions

Rossen, E. (2020). Applying trauma informed practices in a post-pandemic world [Online Course]. https://nyasp.wildapricot.org/event-3828699

Santodenato, M. (2018, November 7). Trauma-informed considerations and strategies for adults working with young children [PowerPoint slides]. SlideShare https://www.slideshare.net/schoolhealthcenters/traumainformed-considerations-and-strategies-for-adults-working-with-young-children

Substance Abuse and Mental Health Services Administration. (2014, July). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. U.S. Department of Health and Human Services.https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf