Unmasking the ACEs,
and Helping Students Manage their Emotions in School
[CLICK HERE for the
Full Blog Message]
Dear
Colleagues,
Introduction
The new school year started this week in
many districts across the country. And
many of the administrative and faculty workshops and discussions that I have
led this month, in before-school trainings and institutes, have focused on
school climate and school safety.
And rightly so.
Immediately after the El Paso and Dayton
slaughters just weeks ago, different U.S. news agencies reported the number of
mass shooting so far this year as between 17 (ABC News) and 255
(HuffPost—which defines a mass shooting as one where at least four people are
shot).
Relative to children and adolescents under
the age of 17, the non-profit Gun Violence Archive, which maintains an
incident-specific data-base on its website, reports that so far this year
(a) there have been 261 mass shootings (more occurred after Dayton); (b) 420
children between the ages of 0 and 11 years old have been killed or injured by
gun violence; and (c) 1,923 adolescents between 12 and 17 years of age have additionally
been killed or injured by gun violence.
To put these numbers into context, past
Center for Disease Control and Prevention reports (one published in the journal
Pediatrics in 2017) estimate that approximately 50% of all gun-related deaths
involving children and adolescents each year are homicides, and one-third are
suicides.
The bottom line is: Students and staff across this country
are returning to school this year more concerned about (gun) violence and the threat
of (gun) violence at school and in their communities than ever before.
_ _ _ _ _ _ _ _ _ _
Beyond Anxiety
Over Gun Violence: The Current State of Trauma-Sensitive Programs
As noted above, given all of this
community-based violence (and other incidents of violence that are family- or
peer-based), many students are coming to school this new year especially
impacted by trauma. While many schools are
adopting “trauma-sensitive” strategies, it is important for educators to
understand the important psychological facets of trauma so that they implement
approaches that are timely, effective, and worthwhile.
Critically, if schools are implementing
generic, off-the-rack trauma-sensitive “packages” that are not individualized
to their students, staff, and school community, the packages are unlikely to be
timely, effective, and worthwhile. In
fact, they may counterproductively increase some students’ trauma (think an
active shooter drill in school that always increases some students’ and staff
members’ anticipatory trauma).
One problem is that the trauma-sensitive schools
“movement”—largely initiated by the Adverse Childhood Experiences (ACEs)
study—has created a “cottage industry” of “experts and consultants” who have
created their own (what they call) “research-based trauma programs.”
Unfortunately, many of these programs have never
been fully and objectively field-tested (if at all). . . in multiple settings,
under multiple conditions, and with students who have experienced different
types and intensities of trauma.
Said a different way: While many of these programs cite research
that explains why they have included certain components or activities, they
have not—themselves—been researched.
In fact, even from a research perspective, many
of these programs are not psychologically and neuropsychologically
grounded. That is, they do not use the “deep
science” of trauma—including the clinical, multi-tiered psychoeducational
elements needed for student and staff success.
Moreover, many of these programs are “stand
alone” programs. They do not integrate
their approaches into the school’s existing discipline, behavior management,
and student self-management systems, and they often are seen by staff as a
disconnected thread of information that represents “another thing to do” . . .
in an already impossibly busy day, week, and month.
Finally, too many of these programs recommend
global and generic components and activities that are not strategically-chosen
or sustainable. The programs present a fixed
package. . . rather than presenting sound strategies on how to identify and
then analyze the root causes of students’ trauma— so that the assessment
results can be strategically linked to needed services, supports, and
interventions.
Part of this latter problem exists because
many educators do not fully understand the history and limitations of the
original ACEs research, and they do not have the psychological understanding to
discriminate potentially effective from ineffective trauma-sensitive practices.
Indeed, some educators are focused more on
program or package implementation, rather than effective and
strategically-selected trauma-responsive practices.
_ _ _ _ _ _ _ _ _ _
What the ACE
Research Is and Isn’t
The original ACE
Study was conducted by the Kaiser Permanente Health Maintenance Organization
(HMO) in Southern California from 1995 to 1997 with two waves of data
collection. As they were receiving physical
exams, over 17,000 HMO members completed confidential surveys regarding their
childhood experiences and their current health status and behaviors. Significantly, beyond the fact that the
sample was from a limited geographic area, the participants were primarily
white and from the middle class.
It is important to
read and understand the actual ACE Study Questions as there is a difference
between their how they were contextualized in the 1990s, and their contexts now
in 2019. Indeed, there are even potential
differences in the number of students with four or more traumatic events in the
1990s and now in 2019.
[CLICK HERE for the
Full Blog Message with the Ten Specific ACE Questions]
Briefly, the
results of the original ACEs study indicated that:
- About two-thirds of participants reported at least one adverse childhood experience;
- The number of ACE points were strongly associated with high-risk health behaviors during adulthood such as smoking, alcohol and drug abuse, promiscuity, and severe obesity;
- The number of ACE points also correlated with depression, heart disease, cancer, chronic lung disease, and a shortened lifespan.
- Compared to an ACE score of zero, having four adverse childhood experiences (i.e., Four or more ACE points) was associated with a seven-fold (700%) increase in alcoholism, a doubling of risk of being diagnosed with cancer, and a four-fold increase in emphysema; and
- An ACE score above six was associated with a 30-fold (3,000%) increase in attempted suicide.
More than 50
ACE-related studies have followed the original.
These studies have (a) used more diverse and different participant
samples— including children and adolescents as respondents; (b) looked at
different physical, behavioral, mental health, and life outcomes; (c) adapted
the original ACE survey and methodology; and (d) replicated many of the correlational
(not causal) results from the original study.
In addition, the
concerns highlighted by these studies resulted—beginning in 2011 in Florida—in
communities beginning trauma-awareness programs; and—about 10 years ago in Massachusetts,
Washington, and California—in schools beginning similar trauma-related
initiatives.
Relative to
prevention, a 2016 Center for Disease Control and Prevention Monograph
made a number of recommendations.
[CLICK HERE for the
Full Blog Message with these Important Recommendations]
But there still is
not a well-established and validated science-to-practice foundation that connects
the ACEs study with an effective approach to trauma awareness and programming
in the schools. The closest we get is an
October, 2018 report by the American Institutes for Research (AIR; more on this
report below), Trauma and Learning Policy Initiative (TLPI): Trauma-Sensitive
Schools Descriptive Study.
_ _ _ _ _ _ _ _ _ _
A Science-to-Practice Foundation to Trauma Programming
in Schools
Quite honestly, as discussed in the
Introduction to this Blog message, we do not need—in 2019—the ACEs study to
tell us that some students come to school having experienced significant
emotional traumas in their lives, or that all schools need to create and
sustain safe school climates and positive, supportive classrooms. Moreover, to a large degree, the neurophysiological
and neuropsychological pathways and impact of trauma have been known for many
years.
But, to their credit, what the ACEs and
follow-up research studies have done is to crystallize the discussion
and information, and put it directly in the hands of different educators—helping
them to better understand some of the social, emotional, and behavioral
interactions of our children and adolescents.
But we may have gone too far, too fast in specializing
our quest to create “Trauma-Sensitive Schools.”
Indeed, in the first paragraph of the
Executive Summary of AIR’s Trauma-Sensitive Schools Descriptive Study,
the authors state:
Background and Introduction:
School Climate and Culture and School Improvement
For decades, educators and policymakers have grappled
with the issue of school improvement—or how to create systemic changes that
lead to better and sustained student academic outcomes. A growing body of
evidence suggests that school improvement efforts cannot happen without
considering the impact of school climate and culture. Research demonstrates
that a positive school climate (which includes factors such as safety, a sense
of connectedness and belonging, social and emotional competencies, and the
physical environment) is associated with positive student outcomes (Kraft,
Marinell, & Yee, 2016; Kwong & Davis, 2015). Specifically, a positive school
climate is associated with higher student achievement, improved psychological
well-being, decreased absenteeism, and lower rates of suspension.
It also has been found that improving safety and
school climate can help reduce bullying and aggression (Bradshaw, Mitchell,
& Leaf, 2010; MacNeil, Prater, & Busch, 2009; Ross & Horner, 2009;
Thapa, Cohen, Guffey, & Higgins-D’Alessandro, 2013). In addition, research
indicates that the perception of a positive school climate, though beneficial
for all students, may be even more useful for students at risk for negative
outcomes (Loukas, 2007). The latter finding is particularly important given the
prevalence of trauma among students in schools.
While the remainder of the 118-page report
focused on the impact of trauma— because AIR was being paid to produce this
report for a trauma-focused educational organization—the paragraph above
reflects the appropriate mindset that all educators must have when even considering
a trauma-sensitive program.
That mindset should be:
Focus on establishing and
sustaining prosocial and safe school climates, and positive and supportive
classrooms interactions.
As part of this school
discipline, classroom management, and student self-management process, identify
how trauma—and other critical factors—are affecting students’ social,
emotional, and behavioral readiness for and interactions in school, and
integrate prevention and early-response services, supports, and strategies to
address high-hit circumstances or needs.
For students with significant social,
emotional, behavioral, or mental health needs (whether trauma-based or not),
schools need a multi-disciplinary team of diverse experts who can analyze the
root causes of the problems, and link the assessment results to effective,
research-based multi-tiered services, supports, strategies, and interventions.
In other words, the
mindset should be one where educators are establishing comprehensive,
evidence-based, multi-tiered school discipline (or positive behavioral support/social-emotional
learning) systems that integrate trauma as but one factor affecting
students’ behavior, interactions, and academic readiness and engagement.
Moreover, this
suggests that schools should not implement a dedicated Trauma-Sensitive Program
as its core (or even secondary) system relative to school safety and
discipline, classroom climate and management, and student self-management and
academic engagement.
This is because:
- A Trauma-Sensitive Program may be too specialized for the typical school, and it may miss many of the non-trauma factors that contribute to school safety and climate;
- The Trauma-Sensitive Program may not be needed (thus, saving time, training, money, and motivation) if trauma-related information and practices are integrated into the core system;
- Most Trauma-Sensitive Programs are not even close to addressing the (Tier II and Tier III) strategic or intensive multi-tiered needs to specific students; and
- We still do not have a sound research-to-practice foundation (as discussed above) to know which trauma-sensitive practices and interventions provide the best services and supports to students, and the best return-on-investment to schools.
_ _ _ _ _
Understand, however,
that this Report is a qualitative (not quantitative) study, and that it focused
on the experiences of only five schools.
Moreover, the purpose of the AIR study was to understand how an
inquiry-based process was useful in supporting the educators in the five participating
schools to transform their school’s culture to become more trauma sensitive. More specifically, they studied how a
systems-level process helped educators to shift their thinking, deepen their
understanding, and change their practices relative to the impact of trauma on
learning.
Critically: The AIR Report was not about what
multi-tiered services, supports, strategies, and interventions had the greatest
impact on helping students to minimize the impact of trauma on their social,
emotional, or behavioral interactions.
The Report focused on how to build a systemic infrastructure for change.
And while it
provides some sound advice, professionals should use that advice to strengthen
the organizational development and buy-in to their core school
discipline, classroom management, and student self-management system.
And so, in the context
of the mindset recommendation above, professionals who decide to read the AIR
Report should substitute the words, “School Safety, Climate, and Discipline”
for “trauma” or “trauma-sensitive” as they read the Report.
And, educators
who are interested in the evidence-based components and specific multi-tiered services,
support, strategies, and programs needed for your core system:
Feel free to download
our free monograph, Project ACHIEVE’s School Improvement and Positive Behavioral
Support System/Social-Emotional Learning Overview
[CLICK
HERE and Find at the Bottom of the Page]
and consider its
companion resource, A Multi-Tiered Service and Support Implementation
Guidebook for Schools: Closing
the Achievement Gap
[CLICK HERE and Find at the
Top of the Page]
At this point, however,
let’s discuss one of the critical elements in helping students to manage their
emotions—whether they are trauma-related or triggered in other ways.
_ _ _ _ _ _ _ _ _ _
The Science-to-Practice Components of Emotional
Self-Management
Last month (July 16,
2019), Education Week reported on a teacher survey that its Research
Center conducted with classroom teachers relative to how prepared and supported
they felt in addressing their students’ significant social-emotional needs.
[CLICK
HERE for the Education Week article]
Relative to our
discussion here, the critical “take-aways” were:
- While most of the teachers responding to the survey said it's important to teach social-emotional skills, many still don't feel equipped to help students manage their emotions—especially when it comes to the children who are demonstrating the greatest needs.
- Indeed, 43% of the teachers said they had difficulty "finding ways to help students who appear to be struggling with problems outside of school."
- 23% of the teachers said that their most challenging task was "finding ways to help students who appear to be experiencing emotional or psychological distress."
- Less than 40% of the surveyed teachers said they received training in conflict de-escalation, a similar number reported training in child trauma, and only 29% reported receiving mental health training.
- Some teachers above said that their training did not cover practical, classroom-based strategies for the more complicated, emotional, severe, or dangerous student situations they might experience.
- When faced with these significant problems, most of the teachers turned to school-based professionals like psychologists or counselors. But almost 50% of all the surveyed teachers reported that they could not call on these staff members when they needed them.
- Indeed, 46% of respondents said they "somewhat" or "completely" disagreed that “their school had adequate support services from counselors, school psychologists, or other professionals to assist students experiencing emotional or psychological distress.”
- Thus, 70% of the teachers said they addressed their students' mental-health challenges by talking with them themselves.
_ _ _ _ _
The Emotional Self-Management
Components: Teachers, Support Staff, and Students
One of the ultimate
goals of a comprehensive school discipline (Positive Behavioral
Support/Social-Emotional Learning, PBSS/SEL) system is to teach and motivate students
to learn, master, and independently apply social, emotional, and behavioral self-management
skills. Emotional self-management
skills, which some call “emotional self-regulation” or even “emotional intelligence,”
involves instruction in emotional awareness, emotional control,
and emotional coping skills.
In the Full Blog Message,
we describe these three components and their characteristics from a
psychological and neuropsychological science-to-practice perspective—a perspective
that often is missing in many “trauma-sensitive” programs.
[CLICK HERE for the
Full Blog Message]
When schools implement
effective approaches within these three components—from preschool through high
school—their students are more able to handle the emotional triggers in their lives. Critically, the anchor to the entire process
is an evidence-based social, emotional, and behavioral skills program that is
taught in the general education classroom by students’ classroom teachers. The social skills program literally teaches
students—at their specific developmental level—emotional control, attributional
and attitude control, and behavioral execution skills.
For students who
need small group or individual instruction—due to their social, emotional,
behavioral, or mental health challenges, the school’s mental health and related
service professionals (e.g., school psychologists, counselors, and social
workers) need to be directly involved.
This is because some of these students need more clinical intervention,
and these mental health professionals are the best-trained and skilled people
to deliver them.
Indeed, some of the
clinical interventions that may needed at this deeper multi-tiered level
include:
·
Progressive Muscle Relaxation Therapy and Stress
Management
·
Emotional Self-Management (Self-awareness,
Self-instruction, Self-
monitoring, Self-evaluation, and Self-reinforcement) Training
·
Emotional/Anger Control and Management Therapy
·
Self-Talk and Attribution (Re)Training
·
Thought Stopping approaches
·
Systematic Desensitization
·
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
·
Cognitive-Behavioral Intervention for Trauma in
Schools (CBITS)
·
Structured Psychotherapy for Adolescents
Responding to Chronic
Stress (SPARCS)
·
Trauma Systems Therapy (TST)
The Question is: Do your related service professionals have
the skills to clinically deliver (as needed—based on student-centered assessments)
some or all of these strategies or therapies. . . or, are they available from
mental health professionals who are practicing in your community?
_ _ _ _ _
Developmental Differences and Students’ Emotional
Triggers
Part of the
emotional control training also involves a recognition of the developmental
differences of students from preschool through high school. Another part involves an understanding of students’
shared and individual emotional triggers.
Relative to the
former area, there are significant developmental and emotional differences
between students at the preschool to Grade 2, Grades 3 to 5, and Grades 6 and
above levels. Teachers need to factor
these differences into their classroom self-management discussions and
instruction—both as they plan and as they implement the social skills
curriculum.
At the preschool to
Grade 2 level, students are concrete, sequential, and egocentric in their
thinking. Early on, they don’t even have
an emotional vocabulary to help them identify or express their feelings. Later on, they are egocentrically focused more
on their own—than others’—feelings, and their insight is limited relative to
the social complexities of many interpersonal situations. Given all of this, then, teachers at these
grade levels will need to be both their students’ social, emotional, and
behavioral guides, as well as their emotional control prompters and compasses.
At the Grade 3 to 5
level, students are beginning to develop higher-ordered thinking skills (both
academically and behaviorally), they have more self-insight, and they are more
able to predict and understand how others are feeling. . . and why they are
reacting in different social situations.
At these grade levels, however, teachers still need to teach their
students about their own and others’ feelings, and how to analyze and solve
common social situations. In other
words, while students here are more developmentally ready to solve more complex
social situations and dilemmas, they still need the instruction.
An academic parallel
here is when Grade 4 students are more cognitively ready to handle abstract and
multi-level comprehension questions in literacy or science, but they still need
the instruction in how to do this.
At the Grade 6 and above
level, students’ emotional situations are compounded by their desire for more
independence, physiological and sexual changes, enhanced academic and
organizational demands, the impact and influence of different peer groups, and their
less restricted exposure to social media, internet-driven, and news or entertainment
broadcasts and events that touch on sensitive issues or ones they have yet to
experience.
Here, teachers need to recognize
that, while they often “sound” mature, these students still need training and
guidance in (a) how to handle these complex or sensitive social situations; (b)
how to communicate in or respond to highly emotional personal, peer, or adult
situations; (c) how to understand and navigate their virtual, social
media-driven worlds; and (d) how to integrate moral and ethical decision-making
into these social dilemmas and deliberations.
Critically, this
requires a blend of advanced skill instruction, group discussion and processing,
social problem-solving simulations, and personal reflection and self-evaluation.
_ _ _ _ _
Relative to the
latter area, students’ emotions are triggered in many different ways.
While they are a good
start, the issues embedded in the ACEs questions (revisit them above) need to
be expanded, as relevant, to community, school, and peer experiences and
interactions. To reflect this, the Full
Blog Message provides a table with the original ten ACEs areas, with X’s in the
boxes where these traumas could also occur in non-familial settings or with
individuals who are not family members.
[CLICK HERE for the
Full Blog Message and this Table]
The point here is
that: These events or issues are no
longer limited to our students’ familial experiences, and our trauma-related
assessments need to include these multiple settings. Said a different way: “Trauma is not
setting-specific. It is event-dependent.” Traumas obviously can be experienced outside
of the “family home,” and be just as emotionally debilitating.
But beyond the trauma areas
in the ACEs research, other areas that trigger students’ emotionality include:
·
Academic Frustration
·
Test/Homework/Work Completion Anxiety
·
Peer (including Girlfriend/Boyfriend) Conflicts/Rejection
·
Teasing and Bullying—Direct, Indirect, Social,
and Social Media
·
Gender Status or Discrimination
·
Racial or Multi-Cultural Status or Discrimination
·
Sexual Identification or Orientation
Discrimination
·
Socio-economic Status or Discrimination
·
Circumstances Related to Poverty/Parental Income
·
Family Moves/Housing Mobility/Homelessness
·
Competition/Losing
·
Physical or Other Limitations or Disabilities
On a situational level,
these triggers can product emotional reactions that are just as quick and
intense as those that are trauma-related, and these need to be consciously
factored into a school climate, discipline, and classroom management system.
Moreover, as in the
trauma research, please remember that student emotionality can be manifested
along a “fight, flight, or freeze” continuum.
The Take-Aways here,
once again, include the following:
- There are multiple circumstances or events that trigger students’ emotionality in school. Many of them are not specifically (or by definition) traumatic events and, thus, schools that are using trauma-sensitive programs may easily miss them.
- Schools need to assess and identify the emotional triggers that are most prevalent across their student bodies, and the emotional triggers (if different) that are most often present for the students presenting with the most frequent, significant, or severe social, emotional, and behavioral challenges.
For the former group, these triggers
need to be integrated into the social skills curriculum at the prevention and
early response levels.
For the latter group, these triggers
need to frame the strategic or intensive interventions or therapies that
related services personnel need to be prepared to deliver.
- Finally, schools and districts need to be prepared to deliver the full multi-tiered continuum of services, supports, strategies, and interventions. This includes the necessary training, resources, and personnel both in general, and as needed on a year-to-year basis.
_ _ _ _ _ _ _ _ _ _
Summary
We started this Blog “journey” by discussing
how students and staff across the country are returning to school this year more
concerned about (gun) violence and the threat of (gun) violence at
school and in their communities than ever before.
The discussion then moved to a recognition
that “trauma sensitive school programs” are still in their infancy, that most
of them have not been field-tested nor independently proven to be effective in
multiple settings and under multiple conditions, and that—if implemented—these programs
will not address the comprehensive emotional needs of most students as there
are many emotional triggers that are not trauma-related.
Next, we addressed the reality and
limitations of the original late-1970s ACEs research, and concluded that:
Schools need to focus on establishing and sustaining prosocial
and safe school climates, and positive and supportive classrooms interactions.
As part of this school discipline, classroom management,
and student self-management process, they need to identify how trauma—and other
critical factors—are affecting students’ social, emotional, and behavioral readiness
for and interactions in school, and integrate prevention and early-response
services, supports, and strategies to address high-hit circumstances or needs.
For students with significant social, emotional, behavioral,
or mental health needs (whether trauma-based or not), schools need a
multi-disciplinary team of diverse experts who can analyze the root causes of
the problems, and link the assessment results to effective, research-based multi-tiered
services, supports, strategies, and interventions.
And so, all of this suggests that schools should not
implement a dedicated Trauma-Sensitive Program as its core (or even
secondary) system relative to school safety and discipline, classroom climate
and management, and student self-management and academic engagement.
We concluded the discussion by outlining the
components needed in the recommended multi-tiered system that integrates
trauma-relevant incidents and issues, and specifying what teachers need to do,
and what related services professionals should be prepared to do.
All of this is focused on helping schools to
most effectively address the social, emotional, and behavioral needs of all
students—with a focus on their emotional self-management. When students have emotional self-management
skills, and the support around them to facilitate emotional control and coping,
issues related to trauma and emotional triggers become less evident, because
most everyone is “handling” them.
Our schools still have a ways to go. We need to be mindful of the recent Education
Week survey. If teachers don’t have
the (right) training, professional development, and support; and if they don’t
have the trained and available mental health and related service colleagues
available, these gaps will (continue to) undermine all of the best intentions,
plans, and initial steps.
_ _ _ _ _
As always, I look forward to your thoughts
and comments.
With the new school year beginning, I am
always available to provide a free hour of telephone consultation to those who
want to discuss their own students, school, or district needs. Feel free to contact me at any time if there
is anything that I can do to support your work. . . now, and as you enter this
new school year.
Best,
Howie
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