Trauma-Informed Care in PK-12

Patricia A. Markos, Ph.D., CRC

Institute for Professional Studies in Education, UW-La Crosse
Perhaps you have one, or maybe two, or even more children in your classroom who are exhibiting behaviors that are disrupting your classroom, negatively impacting the learning of other students. If you do, I’m not surprised. These behaviors may be due to mental health issues and/or past trauma. According to research from the National Traumatic Stress Network, one in four children experience a traumatic event before they reach the age of 16 (National Traumatic Stress Network, 2003). 

The incidence of mental health and trauma in children continues to increase (National Institute of Mental Health [NIMH], 2015). It’s important to note that children react differently to trauma and some may not react immediately. A child may be more reactive to trauma if they already have a mental health issue, if they have experienced previous traumas, or have little support from home (NIMH, 2015).

We know that trauma impacts children’s ability to learn, develop relationships, and act appropriately in class (Cole, Greenwald O’Brien, Gadd, Ristuccia, Wallace, Michael Gregory, 2014). Teachers and school staff then, play a critical role in helping children deal with mental health and trauma since they see children every day during the school year and are on the front line.

According to the American Academy of Pediatrics (2014), some stress is normal and expected. It’s when stress becomes toxic due to Adverse Childhood Experiences (ACEs) that happen frequently, are strong, and occur over a long period of time that there is increased concern. There are three categories of Adverse Childhood Experiences: abuse, neglect, and household dysfunction (Robert Wood Johnson Foundation, 2017). 

Abuse includes physical abuse, emotional abuse, and sexual abuse (Robert Wood Johnson Foundation, 2017). Neglect is defined as physical neglect and emotional neglect. Household dysfunction encompasses mental illness, incarcerated relative, mother treated violently, substance abuse, and divorce. In an ACE study of 17,000 participants, 28.3% experienced physical abuse, 20,7% experienced sexual abuse, and 10.6% experienced emotional abuse. In the area of neglect 14.8% experienced emotional neglect and 9.9% experienced physical neglect. Household dysfunction showed 26.9% of participants experienced household substance abuse, 23.3% experienced parental divorce, 19.4% experienced household mental illness, 12.7% of mothers were treated violently, and 4.7% had an incarcerated family member.  

Here are the behavioral characteristics you may see if a child has experienced trauma. A child may exhibit cognitive behaviors such as poor verbal skills, memory problems, difficulties focusing or learning in school, development of learning disabilities, and poor skill development (The National Child Traumatic Stress Network, 2017). There may also be behavioral characteristics such as excessive temper, demanding attention, regressive behaviors, aggressive behaviors, acting out, verbal abuse, startling easily, inability to trust others or make friends, belief they are to blame for the traumatic experience, show sadness, or are anxious, avoidant, fearful, act withdrawn and lack self-confidence. Last are physiological symptoms including poor appetite, and digestive problems, stomachaches and headaches, poor sleeping, nightmares or sleep problems, or wetting the bed or self.

So what is being done to help children who have experienced Adverse Childhood Experiences? The answer is Trauma-informed Care. According to the Crisis Prevention Institute (CPI) in Milwaukee, Trauma-informed Care is “a framework of thinking and interventions that are directed by a thorough understanding of the profound neurological, biological, psychological, and social effects trauma has on an individual (p. 3, 2017).”  We also know that an individual is constantly striving for safety, relationships, and the ability to cope with reactions that interfere with daily living skills. 

Trauma-informed refers to the impact of trauma on a child’s life (Trauma-Informed Schools, 2015). SAMHSA (Substance Abuse and Mental Health Services Administration, 2015) describes the 4 R’s of trauma-informed: 

1. Realizes the widespread impact of trauma and understands potential paths for recovery; 

2. Recognizes the signs and symptoms of trauma in clients, families staff, and others involved with the system; 

3. Responds by fully integrating knowledge about trauma into policies, procedures and practices; and 

4. Seeks to actively resist re-traumatization (p. 3).

Walkley and Cox (2013, p. 124) describe several ways to help schools to develop a trauma-responsive system: 

Calm – Educators should strive to keep themselves and their students in a calm state. 

Attuned – Educators should be aware of students’ non-verbal cues. 

Present – Educators should be in the moment with their students, focusing their attention on them. 

Predictable – Educators should provide structured, repeated and consistent positive experiences for students. 

Don’t let children’s emotions escalate your own – Educators should remain in control of their own emotions and expression. 

Schools can effectively work with students feeling the effects of trauma in the school environment by being mindful when using trauma-specific interventions to 

1. recognize students’ needs to be respected, informed, connected, and hopeful regarding their recovery, 

2. recognize the relationship between trauma and mental health symptoms of trauma, and 

3. work collaboratively with students, their families, and other agencies in an empowering way (SAMHSA, 2015, p. 3). 

The WI Department of Public Instruction (DPI) has a website dedicated to Mental Health – Trauma (2017). The site includes 14 training modules on Trauma-Informed Schools, Trauma Strategies, Incorporating Trauma Sensitive Practices, Trauma and PBIS, Professional Development, Presentation Materials, Childhood, Evaluation, and E-Resources. The link for this information is: https://dpi.wi.gov/sspw/mental-health/trauma 

In conclusion, trauma and mental health issues continue to be a growing concern in schools. To address these issues the Institute for Professional Studies in Education at UW-La Crosse is sponsoring the Fall for Education Conference with the theme of Mental Health and Trauma in PK-12.  The conference is November 4-5, 2017 at UW-La Crosse and is free and open to WI teachers. We have room for 250 more teachers and administrators. If interested, please register at: https://www.eventbrite.com/e/2017-fall-for-education-conference-tickets-35819232288 
References

American Academy of Pediatrics (2014). https://www.aap.org/en-us/Documents/ttb_aces_consequences.pdf 

Cole, S. F., Greenwald O’Brien, J., Gadd, G., Ristuccia, J., Wallace, L., Gregory, M. (2014). Helping traumatized children learn, Massachusetts Advocates for Children Trauma and Learning Policy Initiative. https://traumasensitiveschools.org/wp-content/uploads/2013/06/Helping-Traumatized-Children-Learn.pdf 

Crisis Prevention Institute (2017). Trauma-Informed Care Resources Guide.  https://www.crisisprevention.com/Blog/July-2011/Trauma-Informed-Care 

WI Department of Public Instruction (2017). https://dpi.wi.gov/sspw/mental-health/trauma

GoodTherapy.org (2016). https://www.goodtherapy.org/blog/psychpedia/ace-questionnaire 

National Institute of Mental Health. What Community Members Can Do (2015). https://www.nimh.nih.gov/health/publications/helping-children-and-adolescents-cope-with-violence-and-disasters-community-members/index.shtml 

Robert Wood Johnson Foundation (2017). http://www.rwjf.org/en/library/infographics/the-truth-about-aces.html#/download 

SAMHSA. (2015). Trauma-informed approach and trauma-specific interventions. Retrieved from: http://www.samhsa.gov/nctic/traumainterventions 

Trauma Informed Schools (2015). Ohio Project AWARE Brief, NO. 4. https://education.ohio.gov/getattachment/Topics/Other-Resources/School-Safety/Building-Better-Learning-Environments/PBIS-Resources/Project-AWARE-Ohio/Project-AWARE-Ohio-Statewide-Resources/Trauma-Informed-Schools.pdf.aspx 

Walkley, M., & Cox, T. L. (2013). Building trauma-informed schools and communities. Children Schools, 35 (2), 123-126. doi:10.l093/cs/cdt007  

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