Saturday, October 11, 2014

Another Federal Push… What’s the Deal with Trauma Sensitive Schools?

Why Schools Can't Become Trauma-Sensitive Unless They Simultaneously Address Bullying, Exposure to Violence, Persistent Academic Failure, and Other Student Mental Health Issues 

   I hope you are doing well as we move into Fall and the end of the first quarter of the year.

   Today’s message will carry somewhat of a “mixed message.”  I am going to discuss trauma, its impact on students in schools, and the importance of implementing approaches that help these students to succeed in school. 

   At the same time, I am going to emphasize that many of the approaches needed for these students are no different than other (or the same) students who have experienced significant, negative home or life events; teasing or bullying; persistent academic failure and frustration; social rejection, aggression, or isolation; or acute or chronic exposure to violence.

   Finally, I am issuing a warning that an increased emphasis on “Trauma-Sensitive Schools” and “Trauma-Informed Practices” by the federal government and some of its funded national Technical Assistance centers has already created yet another “cottage industry” of companies, consultants, and “specialized trainings” in this area. 

   My concerns are rooted in my attendance at the National School-Based Mental Health Conference last month in Pittsburgh.  I have attended (and presented at) these conferences for at least a decade, and it was notable that- - at the 2013 Conference- - there were virtually no conference sessions on trauma-sensitive or –informed practices.  And yet, suddenly, at last month’s Conference, there were ten or more sessions discussing this topic.

   Again, I am not saying that this is not an important topic and/or mental health/behavioral concern.  However, I am cautioning that many of these sessions were recommending “trauma-specific” treatments or programs that have not been field-tested or validated in schools or with large numbers of students.  And yet, here they are being advocated for at a major national conference.

Critically, virtually all of these “trauma-sensitive or -informed” trainings:

   *  Are not needed at the Tier 1/Prevention or even Tier 2/Strategic Intervention levels of social, emotional, and behavioral support if a school has a sound school-wide program in this area- - one that focuses on students’ social competency and self-management skills.

   *  Have not (once again) been field-tested nor demonstrated their short- or long-term success or their unique need in actually helping students to cope with significant levels of trauma (especially in the absence of other mental health supports).

   *  Add yet another specialized responsibility to our teachers’ “plates” that they are unprepared to fully address, and that they should not need to address- - once again, if the school had sound Tier I/Positive Behavioral Support System approaches in place.
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The Bottom Line is that:

   *  We need to prepare and support all teachers in how to create positive, differentiated, and success-oriented classrooms that teach students the academic and social, emotional, and behavioral skills that they need to be successful. 

   *  These latter skills need to focus on teaching students to demonstrate and apply interpersonal, social problem-solving, conflict prevention and resolution, and emotional coping skills.  As taught, these skills need to be embedded into the academic activities where students need to collaborate and work together, and into students’ social and interpersonal individual and group activities and interactions.

   *  These skills need to be explicitly applied to the areas of behavioral health, bullying prevention, truancy and dropout prevention and reduction, PBIS and positive approaches to discipline, and social and emotional learning.

   *  Schools and districts need to have skilled mental health specialists (typically school psychologists and clinical social workers) who know the cognitive-behavioral and emotional coping interventions to help those students who need more intensive social-behavioral services and supports.
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How Did this All Start ?

   The most-recent focus on trauma began when a series of studies were published in the late 2000s that related to the Adverse Childhood Experiences (ACE) Study, research that originated with the Centers for Disease Control and Prevention (CDC;, and Kaiser Permanente's Health Appraisal Clinic in San Diego.  In one of the largest investigations ever conducted to assess the relationship between ten specific childhood experiences and their later-life health and well-being, information was collected from patients who were undergoing comprehensive physical examinations at more than 17,000 health maintenance organizations.

   The ten home or family experiences covered the first 18 years of the respondents’ lives (the survey does not discriminate when the events occurred), and the experiences were rated “Yes” or “No” relative to whether they ever occurred- - even once.  The experiences involved (a) parental or adult emotional abuse or physical threats, physical aggression, sexual touching, sexual penetration; (b) parental drug abuse, separation or divorce, mental illness, or incarceration; and (c) times where the respondent did not feel loved or supported or protected, did not have clean clothes or supervision, or did not have medical care when needed.

   According to the CDC’s website, “the ACE Study suggests that certain experiences are major risk factors for the leading causes of illness and death as well as poor quality of life in the United States. It is critical to understand how some of the worst health and social problems in our nation can arise as a consequence of adverse childhood experiences.  Realizing these connections is likely to improve efforts towards prevention and recovery.”

Comment.  Without minimizing the real impacts of these individual and cumulative life events, and acknowledging the burgeoning research in this area, it is important to recognize that:

   *  Most of the research in this area is correlational- - these ten home and family life events during childhood or adolescent do not necessarily cause adults to have health and/or social problems.  All we know is that adults with these problems, retrospectively, had a higher number of the ACE events.

Moreover, we cannot generalize the results of data from thousands of adults to predict the impact of these events on a single adult- - or even a single child or adolescent.

   *  For an individual student, the intensity of the ten events may be more predictive of the cited adult problems than the number of the events.  Study participants did not rate the intensity of the events- - they only reported, from their perspectives, whether the events occurred or did not occur. 

   *  For an individual student, the age when the one or more events occurred, and their emotional coping skills and/or the presence of external support systems may be more predictive of the impact of the events than their actual number.

   *  As noted above, there are other home, community, and school events (e.g., bullying, exposure to violence, the impact of a disability) that were not on the ACE that may be as predictive to adults’ (and students’) health and social status.
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The Bottom Line is that schools need to:

   *  Routinely screen all students for social, emotional, and/or behavioral concerns.  However, we need to recognize that the best screeners are classroom teachers who have positive relationships with their students, are tuned in to them as individuals, and are able to recognize when they are struggling in these areas.

   *  Have early intervention teams (e.g., Student Assistance Teams, Student Services Teams) who include the best academic and behavioral professionals in or available to the school- - who then work with the school staff, parents/guardians, and the student him/herself to determine the “root causes” underlying the social, emotional, and/or behavioral concerns.

   *  Have professionals skilled in social, emotional, and behavioral interventions, and (when needed) additional mental health response systems so that the services, supports, strategies, and/or programs needed to address the underlying causes of a student’s challenges can be successfully addressed. 

Significantly, this “system” may involve school-based or school-linked community mental health professionals- - especially when the school does not have the depth of expertise needed, or when the student needs intensive supports at that level.
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Where Has This Gone ?

   Somewhat parallel to the ACE research has been work published in 2005 and then 2013 by the Massachusetts Advocates for Children (MAC).  Focusing first on the policies needed to “Help Traumatized Children Learn,” and then to create “Trauma-Sensitive Schools,” the MAC’s work has become embedded in legislative action in Massachusetts that established (FY2014) a Safe and Supportive Schools Grant Program.  The grant money is to help schools to create and implement plans to help establish “Safe and Supportive School Environments.”

   Significantly, the legislative act defined a “Safe and Supportive School Environment” as:

“A safe, positive, healthy and inclusive whole-school learning environment that (i) enables students to develop positive relationships with adults and peers, regulate their emotions and behavior, achieve academic and non-academic success in school and maintain physical and psychological health and well-being; and (ii) integrates services and aligns initiatives that promote students’ behavioral health, including social and emotional learning, bullying prevention, trauma sensitivity, dropout prevention, truancy reduction, children’s mental health, the education of foster care and homeless youth, the inclusion of students with disabilities, positive behavioral approaches that reduce suspensions and expulsions and other similar initiatives.”

   In the 2013 document, the MAC emphasized the importance of aligning all of the initiatives above together because “the same legal and policy conditions necessary for trauma sensitivity are also necessary for a wide range of other important education reform initiatives.”
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Summary and Conclusions

   Many of the social, emotional, and behavioral reactions, responses, and needs that students have when they experience significant, negative home or life events; teasing or bullying; persistent academic failure and frustration; social rejection, aggression, or isolation; or acute or chronic exposure to violence coexist.  Significantly, then, it makes no sense (nor is it realistic relative to teachers, time, and training) to implement separate, discrete prevention and early response programs for what appear to be somewhat different situations.

   We know that there are five components needed in a (Tier I) prevention and early intervention approach to supporting all students- - especially those students experiencing the life and social circumstances above.  These are:

   *  Positive school and classroom climates and relationships
   *  Identifying and teaching core, needed interpersonal, conflict prevention and resolution, social problem-solving, and emotional coping skills
   *  Establishing a behavioral accountability system and holding students accountable to using their social, emotional, and behavioral skills
   *  Maintaining consistency throughout the process
   *  Applying the process to all settings, while encouraging the different student peer groups in a school to become full partners in supporting the process

   Beyond this, schools and districts need a continuum of services, supports, strategies, and programs that provide interventions and mental health supports to students (and families) in greater need.

   We have got to work together- - effectively and efficiently- - in order to establish these system, school, staff, and student approaches.  We should not be swayed by companies, consultants, or
specialized training approaches that have not been field-tested or validated in schools or with large numbers of students, and that take our attention away from the “common core” of components that help create truly safe and support school environments.

   I hope that some of the ideas above resonate with you.  Please accept my best wishes as you continue to provide the services and supports that all of your students need. Have a GREAT week !!!