How Safe is Your School? 09/29/2013. Working to ensure the safety, permanency and well being of children by strengthening families.

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1 Presented by Dr. Brenda K Roche The Center for Children and Families Forfamilies.org Working to ensure the safety, permanency and well being of children by strengthening families. How Safe is Your School? What things are you seeing in your school that might be problematic for youth who have experienced trauma? What kinds of things does your school do to promote the safety of all students? What might your school do to enhance the safety of your school? What supports or resources do you need? 1

2 All children are impacted by a traumatic event; however, not all children are traumatized. Children are resilient and they just need the opportunity to strengthen that resilience through the help of people like you. New Paradigm From: What s wrong with you? To: What happened to you? Forfamilies.org ACES Study Built upon a conceptual framework that risk factors for disease and other physical ailments are strongly affected by adverse childhood experiences. The study assesses what might be considered scientific gaps gp about the origins of risk factors. This study takes a whole life perspective. If childhood stressors can be identified, we might be able to provide early intervention or utilize protective factors that would reduce the risk. 2

3 Adverse Childhood Experiences (ACEs) Growing up in a household with: Verbal Abuse Recurrent physical, sexual or emotional abuse Emotional or physical neglect Domestic violence between parents An alcoholic Substance abuser An incarcerated household member Someone who is chronically depressed, suicidal, institutionalized or mentally ill Live with One or no biological parents (2006, Consequences Of Unresolved Trauma (2004, Findings of the Study Over 17,000 people participated in the study Almost 2/3 experienced at least one ACE Over ¼ reported one ACE Over 25% reported 2 or more Over 12% reported td 4 or more. One out of 8 Higher ACES scores = Higher scores = increased risk for health problems Strong relationship to health related behaviors during childhood & adolescence including smoking, early sexual activity, illicit drug use, teen pregnancies, and suicide attempts. 3

4 What is Stress? Stress is defined as a process that exists over time. When is continues, it can often lead to a debilitating outcomes as it accumulates. Stress affects all aspects of ones functioning When a child encounters a perceived threat to their safety, their brains trigger a complex set of chemical and neurological events known as the stress response. Stress and the Body & Brain Stress is the set of changes in the body and the brain that are set into motion when there are overwhelming threats to physical or psychological well being. Under threat, the limbic system engages and the frontal lobes disengage. When safety returns, the limbic chemical reaction stops and the frontal lobes reengage. (van der Kolk, B., 2005) 4

5 Reactions to Stress and Trauma Fight Freeze Flee Under normal circumstances these responses to stress are constructive and help keep a child or adolescent safe. However, when a child is traumatized, and is overwhelmed with stress and fear, these responses can become a regular mode of functioning. Consequently, a youth may react to their world even when the dangers are NOT present because they cannot turn off the survival strategies in their brains. Hierarchy of Brain Function Forfamilies.org Explicit and Implicit Memory CORTEX: higher level thought processes, planning, problem solving Adrenal gland HIPPOCAMPUS: Explicit memory - governs recollection of facts, events or associations AMYGDALA: Implicit memory No conscious awareness (procedural memory e.g., riding a bike and emotional memorye.g., fear) Chronic stress = overstimulation of the Amygdala, resulting in the release of cortisol, possible shrinkage or atrophy of the Hippocampus and Cortex, affecting memory and cognition, and leading to anxiety or depression. (Adapted from: Brunson, Lorang, & Baram, 2002) 5

6 What is Trauma? Trauma is a serious physical or psychological injury that has resulted from a highly threatening, terrifying, or horrifying experience. (Echterling, Presbury & McKee, 2005) Trauma arises from an inescapable stressful event that overwhelms an individuals coping mechanisms. (van der Kolk & Fisler, 1995). 6

7 Terror Fear Alarm Vigilance Calm Dissociation or Resilient Normal with supports Vulnerable few supports Vulnerable with supports Traumatic Event Forfamilies.org Multiple Traumatic Events Terror Fear Alarm Vigilance Calm Event #1 Forfamilies.org Event #2 Event #3 Trauma Can Be.. Characterized as more than simple loss Dependent upon an actual event Dependent upon a child s proximity to the traumatic event Dependent upon the number of risk factors that confront a child Dependent upon a child s age In a study that assess adolescent females who witness or experienced violence, 67 % met the diagnosis for PTSD CIVITAS (2002) 7

8 The Effect of Early Trauma on the Brain Prefrontal cortex is less developed Emotional centers (limbic) without the checks and balances, results in Impulsiveness l Greater sensitivity to rewards Less consequential thinking Poor emotional regulation, extremes in emotion, numbness or hyperarousal Forfamilies.org Most Frequent Difficulties Following Chronic Trauma 75% 60% 61.5% 59.2% 57.9% 53.1% 45.8% 45% 30% 15% 0% Affect Dysregulation Attention/Concentration Negative Self-Image Impulse Control Aggression/Risk-taking (Spinazzola.J, et.al., 2005) 8

9 Social Emotional Learning SEL is the process of acquiring the skills to recognize and manage emotions, develop caring and concern for others, establish positive relationships, make responsible decisions, and handle challenging tasks effectively. Collaborative for Academic, Social, and Emotional Learning (2005). Safe and Sound, IL Edition What are the Core SEL Competencies? Managing emotions and behaviors to achieve one s goals Recognizing one s emotions and values as well as one s strengths and limitations Selfmanagement Selfawareness Responsible decisionmaking SEL Making ethical, constructive choices about personal and social behavior Showing understanding and empathy for others Social awareness Graphic: CASEL Relationship Skills Forming positive relationships, working in teams, and dealing effectively with conflict 9

10 Physiological Effects Perpetual extreme levels of stress arousal may lead to: hypervigilance and loss of ability to concentrate altered vision and hearing hyperactivity or dissociation avoidance of potential triggers to trauma altered sleep patterns altered eating patterns compulsive self harm attempts to self medicate with substances (Cairns, K. & Stanway, S., 2004.) Physical Effects Continued stress arousal may lead to: headaches digestive disorders respiratory disorders other psychosomatic illnesses muscle tension aching joints clumsiness altered spatial awareness (Cairns, K. & Stanway, S., 2004.) Emotional Effects Inability to process emotions through language Diminished capacity for empathy Hypersensitivity to trauma in others Diminished range of emotions: terror or rage Depression or sadness Feelings of worthlessness and shame Bad memories Recurring outbreaks Dissociation (Cairns, K. & Stanway, S., 2004; CIVITAS, 2002) 10

11 Social Effects May become socially isolated or member of deviant peer group due to: Extreme reactions of terror or rage Diminished empathy limits social connectedness Survival mode restricts motivation to be sociable Avoidance restricts capacity to connect to others Diminished language restricts social accountability Traumatic identity leads to persistent victim or aggressor behavior (Cairns, K. & Stanway, S., 2004.) Cognitive Effects Negative cognitive reactions affect how a youth processes information and performs advanced thinking. Inability to remember details Memory impairment Poor attention Unable to concentrate Lack of goals Poor problem solving Sense of shortened future CIVITAS ( 2002) Response to Trauma Infants (Birth 2 ½ year) Eating disturbances Irritable, difficult to soothe Developmental regression Language delay Attachment disorder Failure to thrive Sleep disturbance 11

12 Response to Trauma Young Children (2 ½ 6 years) Helplessness and Passivity Generalized Fear Confusion, difficulty planning Difficulty identifying what is bothering them Attributing i magical qualities i to traumatic reminders Fighting or threatening behavior Attention Problems Sadness/Depression Separation Anxiety Specific Fears Response to Trauma School age Children (6 11year) Physical complaints Bedwetting School failure/absenteeism Behavioral problems Attention problems Fighting or threatening behaviors Guilt feelings Acting like a parent to siblings Depression Response to Trauma Adolescents (12 to 18 years) Antisocial behavior Runaway Depression/Suicidal thought Sleep Disorders Absenteeism Acting like a parent to siblings Eating Disorders Dating violence Substance abuse School failure Relationship problems 12

13 Why is This Important? Trauma Facts for Educators One out of every 4 children attending school has been exposed to a traumatic event that can affect learning and/or behavior. Trauma can impact school performance. (Lower GPA, higher absence rate, decreased reading ability, increased behavior problems). Trauma can impair learning. (Chronic exposure can adversely affect attention, ti memory, and cognition, interfere with problem solving, li result in overwhelming feelings of frustration and anxiety). Traumatized children may experience physical and emotional distress. You can help a child who has been traumatized. Source: National Child Traumatic Stress Network, 2008 Relationship Between Diagnoses & Eligibilities Special Education Eligibility: Emotional Disturbance Inability to learn not explained by health, intellectual, or sensory disability; Inability to build/maintain relationships; Inappropriate behavior or feelings under normal circumstances; Pervasive anxiety or depression; Physical symptoms or fears. Psychological/Neurobiological Diagnosis: Traumatic Stress Rarely in attentive state Defiant, aggressive, oppositional Hyperarousal Internalizing disorders Fear, somatic disorders Special Education Eligibility: Specific Learning Disability Disorder in basic psychological processes involved in understanding/using language, spoken or written, may manifest in an imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations. Rarely in attentive state; Lack of concentration; Misperceptions; Avoidance; Dissociation; Repeated intrusive memories (Shumow & Perry, 2006) Trauma s Impact on Learning Inability to process social cues and to convey feelings in an appropriate manner. ACADEMIC PERFORMANCE DIFFICULTIES CLASSROOM BEHAVIORS Language & communication skills Learning and retrieving new verbal information Problem solving Goal setting Lack capacity for self regulation Distorted world view Reactivity and impulsivity Aggression Defiance Withdrawal Perfectionism 13

14 Structuring the Environment: Structuring is proactive, positive action To prevent problems Insure success. Traumatized children need: A Trusted Adult to Protect Them A Safe Environment A Predictable Environment A Patterned Environment New development occurs only when the child feels safe and secure. Consistency=Predictability=Security (Landreth, 2002) Forfamilies.org The Three R s: A definition of trauma informed incorporates three key elements: 1. Realizing the prevalence of trauma 2. Recognizing how trauma affects all individuals involved with the program, organization, or system, including its own workforce 3. Responding by putting this knowledge into practice Examples of Trauma Informed Approaches Telling people what you are going to do before you do it Recognizing a flashback and managing it with words instead of action Seeing trauma responses as adaptations rather than manipulations 14

15 Main Points There are no bad kids Punitive (aversive) practices do not work Positive practices can be planned for and learned by anyone Positive practices work: Teach appropriate behavior Upgrade school culture Lead to academic future and success Raise staff morale Jerry s Story 7 years old The principal kept recording me and taking pictures of me and I didn t want her to but she wouldn t stop. I crawled under a table to get away from her, but she just kept recording me under the table. I tried to hd hide inside the refrigerator, but she kept coming after me. She thought it was fun. She wanted to show the police. Victoria s Story 19 years old Whenever I had a meltdown (sensory overload induced tantrum common to children with my disorder), I would be restrained, my arms pinned behind my back, and then tossed into one of these horrible seclusion rooms. I would cry for what seemed like and sometimes was hours, wondering when I would be let out. This went on for the 2 ½ years. I attended a school for children with special needs and behavioral issues. 7+ years later, I still can t think about it without shuddering. I was a wreck when I left that place. The worst part I remember was feeling like nobody cared like I was just some freak that nobody knew or cared if I were shut away. 15

16 The Root of Challenging Behaviors Communication of: Pain or discomfort Frustration Anxiety Threat Non understanding Distrust/Fear Root cause may be medical Find out why? Think of an Iceberg. Think about an Invisible Backpack Trauma affects how children feel, behave, and think. The Invisible Backpack Beliefs about self l f b d l h f h Beliefs about adults who care for them Beliefs about the world What is in the student s invisible backpack? 16

17 Repacking the Invisible Backpack How can we repack this backpack with positive experiences and beliefs? How can we promote resilience in the student by making him or her feel: Safe? Capable? Likable/Lovable? What You May See Anxiety, fear, and worry Changes in behavior (anger outbursts, change in academic performance, irritability, absenteeism) Heightened difficulty with authority, redirection, or criticism Emotional numbing Over or under reacting to environmental stimuli (sirens, physical contact, doors slamming, bells) Repetitive thoughts and comments about death or dying (including writing and artwork) Skill Review: Establishing Safety Strategies Clarifying your role with the student Establish yourself as a safe individual. Create an environment of respect. Give the student opportunities to make choices. Talk about safety and what steps you will take to help the student be safe. Connect the student to the appropriate resources/people Message: You are not alone. 17

18 Skill Review: Behavior Management Strategies Use of specific praise You did a great job paying attention in class today. vs Good job today. 10:1 (Ratio of positive to negative statements for traumatized children/adolescents) Active ignoring of negative behavior Consistent expectations and behavior plans Behavior plans based on reward systems, not punishment Skill Review: Stress Management Strategies BREATHE! Provide students with a calm or quiet place to sit or talk. Remain calm quiet, and present. Use LOW and SLOW when needed. Offer suggestions on self calming techniques. Breathing Rapid Relaxation Music, exercise, stretching LOW and SLOW LOW Lower the volume and pitch of your voice Keep a matter of fact tone regardless of the situation Speak in short sentences without a lot of questions Don t preach this is about talking with the student, not at the student SLOW Slow your self down by slowing down your heart rate. Take slow, deep breaths. Slow down your rate of speech and make sure to pause between sentences. Slow down your body movements. Slow down your agenda and take your time. 18

19 Skill Review: Feelings Expression and Coping Strategies Identify and label emotions and feelings. Use of scales and thermometer to rate emotion intensity. Identify coping skills to help decrease emotional intensity. Help youth find positive ways to cope. Connect students to friends, peers, or supportive adults. Participating in creative and positive social activities. Relaxation techniques. Skill Review: Connect with Social Supports Strategies Identify and provide opportunities for peer support. Be a source of support yourself. Identify/Access family and community supports. Skill Review: Enhancing Future Safety Strategies Help students identify internal and external people and places that are safe. Circle of Safety Safety maps/plans Teach students how to ask for help until someone responds. Role play accessing additional supports. Best friend role plays: What would you tell your best friend to do? 19

20 Skill Review: Patience Strategies Recognize that change happens very slowly. You may never see the outcomes of your efforts. Trust that our simple compassionate gestures are important elements of healing and surviving. Consider the bigger picture. Implementing Strategies: Case Examples How could the student s behaviors or symptoms be explained from a trauma perspective? For example: What are the thoughts, feelings, and beliefs that may be the source of the behavior? What s under the tip of the iceberg? What would you do to address the problem in each of the scenarios? How is your response trauma informed? 20