Saturday, October 5, 2024

Breaking Down the Wall Between General and Special Education Teachers in Our Schools

How Organizational Missteps Create Classroom Barriers

[CLICK HERE to read this Blog on the Project ACHIEVE Webpage]

 

Dear Colleagues,

Introduction

   On June 12, 1987. . . over 37 years ago. . . Ronald Reagan, near the Brandenburg Gate in what was then West Berlin, delivered one of his famous foreign policy speeches—part of which was directed to the General Secretary of the Communist Party, Mikhail Gorbachev. He stated:

We welcome change and openness; for we believe that freedom and security go together, that the advance of human liberty can only strengthen the cause of world peace. There is one sign the Soviets can make that would be unmistakable, that would advance dramatically the cause of freedom and peace. General Secretary Gorbachev, if you seek peace, if you seek prosperity for the Soviet Union and Eastern Europe, if you seek liberalization: Come here to this gate! Mr. Gorbachev, open this gate! Mr. Gorbachev, tear down this wall!

   This accelerated a period of détente between the United States and the Soviet Union that eventually retired the “Cold War.”

_ _ _ _ _

   Those of us working in education in our country have endured another less publicized Cold War since 1975 when the Individuals with Disabilities Education Act (IDEA) was first signed.

   Indeed, for almost 50 years, there has been a Cold War between general education and special education. . . especially at the district and school levels. . . that has been waged overtly and covertly, both to the detriment of students with abilities and students with disabilities, as well as their teachers.

   This Cold War has spanned my entire professional career. . . evident as I began my School Psychology graduate training in 1976—just one year before IDEA was formally implemented. . . and evident in 2024, in the thousands of schools I have worked with across the country all the way through last week.

   Indeed, last week, as but one example, I continued a consultation in a mid-Western state focused on completing a Needs Assessment for a District wanting to improve its school discipline (SEL/PBIS) and multi-tiered social, emotional, and behavioral continuum and processes.

   During the many interviews that I conducted with staff and students over the three on-site days, the “Wall” between general education and special education was clearly apparent even as “both sides” expressed their empathy and support for each other.

   The purpose of this Blog is not to discuss the history that “built” the General Education/Special Education wall.

   However, if you are interested in this, please read my previous Blog describing the early (and my personal) history of the special education and disability rights litigation that culminated in IDEA:

March 11, 2023

Judy Heumann, Special Education’s History of Litigation, and the Continuing Fight: Complacency and Defensiveness Still Stand in the Way of Students with Disabilities’ Rights

[CLICK HERE for this Past BLOG]

_ _ _ _ _

   Instead, the purpose here is to identify some of the bricks that need to be dislodged so that the Wall can come down.

_ _ _ _ _ _ _ _ _ _

The Five Columns Holding Up the Wall

   There are five columns holding up the General Education/Special Education wall that need to be eliminated so it can topple down:

·       Organizational Barriers

·       Supervision and Accountability Barriers

·       Professional Development and Consultation/Relationship Barriers

·       Instructional Skill and Collaboration/Teaming Barriers

·       Persistence and Success Barriers

   Critically, while we will make specific change recommendations below, many of the issues embedded in these five areas have been entrenched and institutionalized in many districts and schools for years.

   And, thus, the only effective way to disrupt this institutionalization is to have an independent Needs Assessment completed by an outside Expert who can candidly discuss the essential issues (without fear of recrimination or retribution). . . while presenting a detailed and impactful Action Plan.

   Significantly, this Expert must provide a needed level of respect, objectivity, and confidence, while thoughtfully asking the questions needed to facilitate a safe, but honest discussion of the sensitive issues at-hand.

   While some districts may balk at “the expense,” the real expense is the human capital and loss in a system not serving its students and staff well.

   Indeed. . . knowing the high cost of remedial and special education services—that the state and federal government does not reimburse—it is in a district’s best interests to retain an excellent Expert who provides the functional, meaningful, and cost-saving short- and long-term strategies and supports needed. . . to facilitate the more effective services that emerge when the General Education/Special Education wall is dismantled.

_ _ _ _ _

   Before discussing the recommended changes in each of these areas, it is important to emphasize a few important contexts.

Context #1: There are 13 Different Disability Categories in IDEA

   The first context, arguing for a dismantling of the General Education/Special Education wall, involves the number of Students with Disabilities (SWD) who should be educated in general education classrooms by general education teachers who are supported by special education teachers and related services professionals (e.g., academic interventionists, counselors, school psychologists, social workers, speech pathologists, occupational/physical therapists, others).

   Critically, SWDs are not “special education students.” They are students with specific special education instructional and intervention needs.

   By law (i.e., IDEA), these students have a specific, identified disability that impacts their educational progress, and they have the legal right to a free and appropriate individualized education (FAPE, IEP) in the least restrictive environment (LRE) that addresses the impact of their disability.

   Thus, it is essential—and required—that all school administrators and educators know (a) the specific disability(ies) of each SWD; (b) how the disability impacts their educational progress; (c) what services, supports, and interventions they need so they can learn and be behaviorally successful in a general education setting and curriculum; and (d) what their special education and general education goals and outcomes are.

   Relative to specific disabilities, there are thirteen different disability categories in IDEA. Based on the most current national data (2023), the “top” ones are:

·       Specific Learning Disabilities—35% of all SWDs

·       Speech or Language Impairments—18%

·       Other Health Impaired—17%

·       Autism—12%

·       Intellectual Disabilities—6%

·       Emotional Disturbance—5%

·       Developmental Delays—4%

   The top three categories above add up to 70% of all SWDs, and virtually all of these students (including some students with autism and emotional disturbances) should, as above, be the primary responsibility of general education teachers, educated in general education classrooms, supported by special education teachers and related services professionals.

   For students with Specific Learning Disabilities (SLD), for example, it is essential that all teachers know what specific academic learning areas are impacted by each SWD’s disability (e.g., reading decoding, or mathematical problem-solving). . . and what academic areas are not impacted.

   Indeed, many students with SLD have difficulties in one academic (special education) area, but not in others (general education).

   Moreover, decades of research have demonstrated that students with SLD learn more like general education students than students “with special educational needs.”

_ _ _ _ _

Context #2: The Majority of Students with Disabilities are Already Taught in General Education Classrooms

   The second context is that the majority of SWDs already spend 80% or more of their time in general education classrooms. Said another way, they are general education students.

   In the Fall of 2022, among all school-age students served under IDEA, the percentage of SWDs who were in regular schools spent the following amounts of time in general education classes:

·        67% of students receiving services on an IEP spent 80% or more of their time in general education classes. 

·        16% of students receiving services on an IEP spent 40% to 79% of their time in general education classes.

·        13% of students receiving services on an IEP spent less than 40% of their time in general education classes.

   Once again—all things being equal—the students in the first group should be the responsibility of the general education teachers. . . with support.

_ _ _ _ _

Context #3: A Successful Multi-Tiered System Runs on a “Problem-Solving-Consultation-Intervention” Approach to Service Delivery

   This third context emphasizes the service delivery approach that increases all schools’ probability of multi-tiered system of supports success.

   In contrast to a “wait for the student to fail, then refer, test, and place him or her (in special education),” the most effective school-wide approach is to:

·        Identify struggling students as early as possible (by teachers and using data); 

·        Collect and analyze the relevant information and data to specify and clarify the problem, and identify its root causes; and

·        Link the problem analysis results with evidence-based services, supports, or interventions that are implemented. . . in the general education classroom by general education teachers. . . with the consultative support (once again) of special education teachers, intervention specialists, and related services professionals (as needed).

   When schools use this approach as their core multi-tiered services approach, their staffing, scheduling, and service delivery and support is designed accordingly, and the General Education/Special Education wall blurs. . . and topples.  

_ _ _ _ _ _ _ _ _ _ _

Changing Organizational Barriers

   Many districts have inadvertently created organizational barriers that prop up the General Education/Special Education wall.

   Below is a list of recommended changes to eliminate these barriers and help topple the Wall.

·        Holding regularly-scheduled monthly meetings just between the Superintendent, Assistant Superintendent of Curriculum and Instruction (or the equivalent), and the Assistant Superintendent of Pupil Services (or Special Education).

_ _ _ _ _ 

·        In larger districts, holding regularly-scheduled monthly meetings between the Assistant Superintendent of Curriculum and Instruction (or the equivalent), the Assistant Superintendent of Pupil Services (or Special Education), and the School Principals.

_ _ _ _ _

·        Making sure that the district’s Special Education Director (or the equivalent) is on the Superintendent’s Cabinet.

_ _ _ _ _

·        Making the district’s Multi-Tiered System of Supports a shared responsibility of the Assistant Superintendent of Curriculum and Instruction (or the equivalent), and the Assistant Superintendent of Pupil Services (or Special Education).

_ _ _ _ _

·        Organizing all Counselors, School Psychologists, Social Workers, and other relevant Related Services Professionals so that they meet regularly (at district and school levels), and work collaboratively within the district’s integrated Multi-Tiered System of Supports.

_ _ _ _ _

·        Having shared (or, at least, collaborative) supervision between district and school administrators for all Counselors, School Psychologists, Social Workers, and other relevant Related Services Professionals.

_ _ _ _ _

·        Ensuring that the Tier I system and alignment of curriculum and instruction, and social-emotional learning is clear, organized, well-resourced, and implemented and supervised by the School Principals with intensity and integrity.

_ _ _ _ _

·        Holding regularly-scheduled cross-school special education and related services staff meetings (and training) at the district level that involves School Principals as appropriate.

_ _ _ _ _ 

·        Interviewing General Education teacher applicants to determine their “individual differences and special education” philosophy and skills, and hiring only those who are comfortable with and commited to the Problem Solving-Consultation-Intervention service delivery orientation.

_ _ _ _ _ _ _ _ _ _

Changing Supervision and Accountability Barriers

   Many schools have inadvertently created supervision and accountability barriers that prop up the General Education/Special Education wall.

   Below is a list of recommended changes to eliminate these barriers and help topple the Wall.

·        School Principals must have a sound, working knowledge—with ongoing training and/or updates provided—on the philosophy, requirements, and integration of the Elementary and Secondary Education Act, the Individuals with Disabilities Education Act, and Section 504 of the Rehabilitation Act.

_ _ _ _ _

·        Schools should do an initial analysis of their special education and related services staffing and other resource needs every May—relative to the next school year—and School Principals should collaborate with District Administrators to address these needs over the summer.

_ _ _ _ _

·        The special education and related services analysis above should also be used to organize the school’s instructional schedule such that the service delivery needs of the students drive the schedule, rather than the schedule determining the delivery of the services.

_ _ _ _ _

·        Certified Special Education teachers who want to move into General Education teaching openings the next school year need to be identified early on, and the reasons for these requests should be discussed with School, if not District, administrators. . . so that any corrective or remedial steps, to keep these teachers in their current positions, can occur.

_ _ _ _ _

·        The School Principal (or his/her administrative designee) must be on and consistently attend the school’s Multi-Tiered System of Support multi-disciplinary team, helping to ensure that the district’s system—relative to designing and implementing successful early interventions for struggling students—is implemented with integrity.

_ _ _ _ _

·        School Principals must communicate, support, model, reinforce, and hold teachers accountable for the school’s Problem Solving-Consultation-Intervention service delivery system, and the effective Tier 1 instruction for all students. They must hold feedback conferences with individual teachers not adhering to the model, and put unresponsive staff on “Professional Development Plans” as needed.

_ _ _ _ _ _ _ _ _ _

Changing Professional Development and Consultation/Relationship Barriers

   Many districts and schools have inadvertently created professional development and consultation/relationship barriers that prop up the General Education/Special Education wall.

   Below is a list of recommended changes to eliminate these barriers and help topple the Wall.

·        Ensure that all relevant professional development and in-service programs/presentations provide knowledge and skills related to general education, struggling learners, and the students with disabilities who are being taught in general education classrooms. 

For example, training in the science of reading should include—for all staff—instructional approaches for (as above) struggling learners as well as students with disabilities (including dyslexia).

In-services on classroom management should include strategies for addressing the needs of students with disabilities who, once again, are largely educated in their general education classrooms.

         _ _ _ _ _

·        The multidisciplinary members on the school’s Multi-Tiered System of Supports team should have the responsibility of overseeing the building’s 504 process, as well as the implementation and evaluation (at least on a quarterly basis) of the 504 Plans for all involved students and teachers.

_ _ _ _ _

·        Special education teachers and related services professionals should maintain a dedicated amount of time each week in their schools for general education classroom-based consultation.

Said differently, schools should not under-staff these professions nor “force” these professionals to be fully loaded with direct service responsibilities. That is, special education teachers should not be spending their entire days in special education direct instruction, and school psychologists should not be spending their entire days doing special education eligibility or re-evaluation assessments.

To accomplish this, IEPs should be written in every school so that all special education teachers have dedicated blocks of time for general education teacher consultation. Not every “resource student” needs five days of resource room support for 45 to 60 hours per day (a “special education tradition”), and resource room time should not be dictated, at the secondary level, by a school’s block or period-related schedule.

_ _ _ _ _ _ _ _ _ _

Changing Instructional Skill and Collaboration/Team Barriers

   Many districts and schools have inadvertently created instructional skill and collaboration/team barriers that prop up the General Education/Special Education wall.

   Below is a list of recommended changes to eliminate these barriers and help topple the Wall.

·        Ensure that general education teachers have expertise (at least, content knowledge and implementation/application skills)—at the Tier I level—in instructional differentiation, remediation, the implementation of accommodations, curricular modification, classroom-based intervention, and the use of assistive technology.

_ _ _ _ _

·        As appropriate, general education teachers should be written into SWDs’ IEPs.

Hence, general education teachers should consistently participate as full members on specific SWD’s IEP Teams, the IEP should describe how each special education goal should be evaluated (and by whom), and the IEP should identify who will be responsible for assigning what Report Card grades for each student—the general education teacher, the special education teacher, or both.

Similarly, every school’s Multi-Tiered System of Support (i.e., early intervention/multi-disciplinary) Team should have special education teacher representation.

_ _ _ _ _

·        When co-teaching is used in a general education classroom, the SWDs should be instructionally and interactively shared by both general and special education teachers, respectively.

Said a different way, during co-teaching, the general education teacher should not be teaching only general education students, and the special education teacher should not be working only with SWDs.

_ _ _ _ _

·        Students’ IEP progress should be evaluated on a quarterly basis with the full participation of the general education teachers who have been written into the IEPs of specific students.

All SWDs should be viewed as “whole children” who are learning and growing both academically and behaviorally. . . not as children who are “dissected” into general education and special education “parts.”

_ _ _ _ _

·        When students are not succeeding (for example, as identified during a quarterly review), the IEP team—involving both general and special education teachers—should meet to analyze why, making mid-course corrections as needed. Parents should be involved—especially if the changes involve formal, substantive changes to the IEP.

_ _ _ _ _

·        SWDs should, as much as possible, be actively involved in their own learning, instructional and intervention planning, and evaluation and feedback.

_ _ _ _ _ _ _ _ _ _

Changing Persistence and Success Barriers

   Many districts and schools have inadvertently created barriers that undermine their general education and special education teachers’ persistence and success, serving to prop up the General Education/Special Education wall.

   Below is a list of recommended changes to eliminate these barriers and help topple the Wall.

·        IEP Teams need to make sure that the evaluation approaches used to track SWDs progress and success are sensitive enough to pick up meaningful student growth. Sometimes, evaluation tools are not sensitive enough, they do not pick up student success, and general and special education (and others) become frustrated because they believe their hard work is not paying off.

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·        During quarterly (and other) IEP reviews, the Team involved should focus on both student and staff successes, as well as gaps or areas that need improvement or change. The specific reasons for the identified successes should be determined so that the successes can be maintained or extended.

_ _ _ _ _

·        SWDs do not always make consistent progress or succeed “in a straight line.” Instead, they often take “two steps forward and one step back.” Given this, general and special education teachers (and others) need to maintain a mindset that accommodates for a SWD’s “uneven,” yet progressive growth.

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   The “bottom line” here is that when general and special education teachers are successful with their shared students, the General Education and Special Education Wall blurs and, over time, disappears. This success occurs because of the barrier-busting suggestions—discussed above—in the other four wall-supporting columns.

   In the end, when integrated, blended, collaborative, and conjoint general education and special education services result in a student’s academic and social, emotional, and behavioral learning and progress, the wall has been toppled.

   The next question is, “How do we succeed with all SWDs such that the wall is toppled—permanently— for all?”

_ _ _ _ _ _ _ _ _ _

Summary

   This Blog discussed the wall that has existed between General Education and Special Education Teachers since Students with Disabilities (SWDs) were fully included in our nation’s public schools in the mid-1970s.

   The goal of the discussion was to identify some of the bricks that need to be dislodged so that the Wall can come down.

   This was down by making specific change recommendations in the five areas—the “columns”—that have long supported and even institutionalized the Wall. Many of these recommendations focused on changing staff and administrative beliefs, policies, procedures, or practices.

   The five columns that are holding up the General Education/Special Education Wall, and that need to be addressed. . . so it can topple down are:

·       Organizational Barriers

·       Supervision and Accountability Barriers

·       Professional Development and Consultation/Relationship Barriers

·       Instructional Skill and Collaboration/Teaming Barriers

·       Persistence and Success Barriers

   We encourage educators in district, school, and agency settings to read and discuss the recommendations above, complete a Needs Assessment, and work to consciously change the most-persistent or most-dominant “bricks” in their walls. . . on behalf of all of their students.

   As a special bonus, we want to share a recent Education Talk Radio interview on this topic (October 2, 2024) between me and host Larry Jacobs. We directed addressed the General Education and Special Education Wall, and provide additional thoughts on why it exists and how it can be dismantled:

_ _ _ _ _

   The integration of general education and special education services goes to the root of student, staff, and school success.

   As noted above, many times, the only effective way to disrupt an institutionalization General Education and Special Education Wall is to have an independent Needs Assessment completed by an outside Expert who can candidly discuss the essential issues (without fear of recrimination or retribution). . . while presenting a detailed and impactful Action Plan.

   Significantly, this Expert must provide a needed level of respect, objectivity, and confidence, while thoughtfully asking the questions needed to facilitate a safe, but honest discussion of the sensitive issues at-hand.

   There are a lot of Experts out there. . . but please also know how I differ from others who do similar work:

1. Everything that I do is focused on YOUR success. . . .and the success of your students, staff, schools, colleagues, and community.

 

2. I "do my homework" and personalize all of my work--using data-driven and research-based approaches-- to look at YOUR history, trends, strengths, resources, gaps, and needs.

 

3. I am uniquely interested in YOU. I want to know you and your colleagues on a personal and professional level, and I want to be a member of "your team" during our time together.

 

4. You can depend on my honesty, integrity, compassion, passion, and dependability. I will not avoid the "challenging conversations" with you, and I will not ignore the "seven-ton elephant in the room."

 

5. I will over-deliver. I do not "work" as a consultant. I live to be a consultant.

   If these "mission statements" resonate with you, and you believe that a partnership together can help you and your colleagues move from "great to greater," please feel free to contact me. Let's begin your journey to your next level of excellence together.

   Thank you for your dedication to education, and the students and families that you serve. Know that I am always available to discuss these issues with you and your team.

   I hope to hear from you soon.

Best,

Howie

 

[CLICK HERE to read this Blog on the Project ACHIEVE Webpage]

Saturday, September 21, 2024

Research Teases Out the Impact of Adverse Childhood Experiences

But Many Educators Still Don’t Understand Social-Emotional Screeners, and the Limitations of ACEs-Only Assessments

[CLICK HERE to read this Blog on the Project ACHIEVE Webpage]

 

Dear Colleagues,

Introduction

   In my July 27, 2024 Blog a few months ago, I discussed the results of a recent School Pulse Panel survey organized by the National Center for Education Statistics (NCES). Completed between May 14 and May 28, 2024, the survey involved 1,714 public school K-12 leaders from every state in the country and Washington, D.C. focusing on their perspectives of the most compelling social, emotional, behavioral, and mental health concerns in their schools.

   The article reported that the survey’s respondents identified a significant and wide variety of challenges in these areas. . . results echoed this past year in other research and national reports.

   For example:

·        83% reported that the pandemic and its lingering eects continue to negatively influence the social-emotional development of students;

·    76% of the public school leaders said they need “more support for student and/or staff mental health”; 

·      75% reported that students’ lack of focus or inattention had either a “moderate” or “severe” negative impact on learning during the 2023-24 school year;

·        71% need “more training on supporting students’ socioemotional development;”

 

·        45% reported having confiscated a weapon from students during the year;


·     36% reported that student acts of disrespect toward teachers or staff members, other than verbal abuse, occurred at least once a week;


·     30% reported instances of cyberbullying that happened at and outside of school at least once a week; and


·      20% reported that threats of physical attacks or fights between students occurred at least once a week.

   From a screening perspective, some schools use specific assessments or tools to identify students with possible social, emotional, or behavioral challenges that need follow-up.

   It is critical to note—right from the beginning—that Educators:

·       Read the technical manuals for social-emotional screening tools they are considering to determine if they are well-normed, reliable and valid, and applicable to the students in their specific schools; 

·       Recognize that screening tools are not diagnostic tools that are sensitive enough to differentially determine the specific social-emotional concerns or interventions needed by a student; 

·       Reflect that screening tools result in False-Positive and False-Negative results—where students are incorrectly identified as having a “problem” (that does not exist), or as not having a “problem” (where one actually exists), respectively; and 

·       Remember that screening tools must be followed up by diagnostic assessments that both validate the screening tool’s results, and determine the specific clinical concerns presented by a student.

_ _ _ _ _

The ACEs  

   One screening tool area that has received a fair amount of attention over the recent years measures students’ Adverse Childhood Experiences (ACEs).

   There are serious concerns with these scales in that some believe that: (a) the ACEs areas reliably, validly, and diagnostically assess “traumatic” events in students’ lives; (b) a high number of ACEs events or scores predicts individuals who will exhibit current or eventual social, emotional, behavioral, and mental health challenges; and that (for the very uninformed) (c) this relationship is causal, as opposed to correlational (and what that means).

   Through this Blog, we want to make sure that every educator understands what an ACEs scale is really measuring, and we report on a recent study that begins the process of helping us understand what an ACEs screening survey score may actually correlate with in our classrooms and schools.

   As we try to “cut through the talk,” we hope to solidify educators’ understanding that an ACEs screening has more limitations than strengths relative to their applicability to classrooms and schools.

_ _ _ _ _ _ _ _ _ _

What the ACEs Research Is and Isn’t

   The original ACEs 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.

   Below are the actual ACEs Study Questions. Each “Yes” response received one point toward the “final score.” As educators, please read these items relative to today’s students. Think about how many of your students have experienced four or more of these events so far in their lives (more on that below).

While you were growing up, during your first 18 years of life:

 

1. Emotional Abuse. Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you?

or Act in a way that made you afraid that you might be physically hurt?

 

2. Physical Abuse. Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you?

or Ever hit you so hard that you had marks or were injured?

 

3. Sexual Abuse. Did an adult or person at least 5 years older than you ever…

Touch or fondle you or have you touch their body in a sexual way?

or Attempt or actually have oral, anal, or vaginal intercourse with you?

 

4. Emotional Neglect. Did you often or very often feel that … No one in your family loved you or thought you were important or special?

or Your family didn’t look out for each other, feel close to each other, or support each other?

 

5. Physical Neglect. Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you?

or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?

 

6. Parental Separation or Divorce. Were your parents ever separated or divorced?

 

7. Mother Treated Violently. Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her?

or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard?

or Ever repeatedly hit at least a few minutes or threatened with a gun or knife?

 

8. Household Substance Abuse. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?

 

9. Household Mental Illness. Was a household member depressed or mentally ill, or did a household member attempt suicide?

 

10. Incarcerated Household Member. Did a household member go to prison?

_ _ _ _ _

   Initially, it is paramount to remind educators that “Trauma” is clinically defined—from a psychological/psychiatric perspective—and it is diagnostically differentiated from related mental health challenges like stress, anxiety, and fear.

   We have discussed this in a previous Blog, showing that the clinical definition and criteria for a diagnosis of “trauma” is far more narrow than the way it is represented in the popular press.

   Indeed, given the criteria, there are far fewer children, adolescents, and adults who are clinically traumatized than reported in the popular press, and when contrasted with individuals clinically affected by stress, anxiety, or fear.

   To read more about this, go to:

August 8, 2020 

Why Stress-Informed Schools Must Precede Trauma-Informed Schools: When We Address Student Stress First, We Begin to Impact Trauma. . . If It Exists

[CLICK HERE for this BLOG]

_ _ _ _ _

   Continuing the ACEs discussion begun above:

  The most critical concerns with the ACEs Questions are:

·       They do not discriminate between “finite” events (e.g., having a household member incarcerated) and events that can occur over time or in a repeated way; 

·       Thus, they do not quantify many of the events (e.g., how long was the separation, how many times was your mother physically threatened); 

·       They do not identify the age (or age range) when the child or adolescent experienced each event;

·       They do not ask for a rating of the intensity of each event (e.g., along a Mild-Moderate-Severe continuum);

·       They do not get a rating of the emotional impact of each event at the time that it occurred (e.g., along a None-Low-Mild-Moderate-Significant-Life Changing continuum); and

·       They do not get a rating of the current (assuming an event occurred in the past) and/or continuing emotional impact of each event.

   This leads to a critical conclusion:

Given the absence of this critical contextual information, educators (and others) do not really know the cumulative depth, breadth, intensity, or impact of an individual’s projected traumatic history from an ACEs screening.

 

Indeed, the screening may simply tell us how many challenging events an individual may have experienced. It does not tell us if one or more of the events were traumatic for an individual, or if they continue to be traumatic.

_ _ _ _ _

   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 ACEs 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 ACEs points also correlated with depression, heart disease, cancer, chronic lung disease, and a shortened lifespan.

 

·      Compared to an ACEs score of zero, having four adverse childhood experiences (i.e., Four or more ACEs 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 ACEs score above six was associated with a 30-fold (3,000%) increase in attempted suicide.

   More than 50 ACEs-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—starting 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 the following recommendations:


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   Critically, as noted, the ACEs surveys or scales reviewed are screening tools that are not very sensitive and may, in fact, be biased in their attempts to correlate a number of challenging events in students’ lives with their current social, emotional, behavioral, or mental health status.

   In point of fact, an ACEs scale:

·        Is not a reliable or valid diagnostic instrument;

·        It cannot draw causal connections between any number of challenging life events and a student’s current social, emotional, or behavioral status; and

·        If used as the only social-emotional screener by a school, it has a high potential of both over-identifying some students, while under-identifying others.

   If a district or school wants to use a social, emotional, behavioral screening tool (which is not necessarily recommended in all cases), there are a number of far more effective, psychometrically-sound tools available. . . that provide information and context well beyond the current ACEs screeners.

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Kindergarten Readiness Not Impacted by a High Number of ACEs

   Earlier this month (September 11, 2024), an article was published in K12 Dive reviewing a study published in the Journal of Child and Family Studies involving 115 preschoolers attending a comprehensive school readiness summer program in Miami in 2017, 2018, and 2019. The children were transitioning between preschool and kindergarten, and they were enrolled because they were exhibiting disruptive behavior problems at home and in school.

   After completing an ACEs survey with the children’s parents or caregivers, the study reported that nearly all of the children had experienced poverty, about 94% had experienced at least one ACE, and 49% had experienced four or more ACEs. Only 6% of the children in the study had experienced no ACEs.

   The K12 Dive article summarized the study’s results and implications as follows:

·       The study found a correlation between the number of adverse childhood experiences faced by rising kindergartners and the severity of their disruptive behaviors, anxiety, and depression.

 

·       But, the correlation between the ACEs and the students’ performance did not hold for the students’ academic and social readiness, with those skills being comparable with peers experiencing fewer harmful events.

   During an interview with the study’s lead author, she noted that the ACEs’ correlation with students’ internalizing and disruptive behavior was expected, but she was surprised that there was no association between a student’s ACEs score and his or her academic functioning, for example, in early math and reading skills.

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ACEs Implications and Practical Next Steps

   This study provides educators both good news and bad news.

   The good news is that research is starting (continuing) to investigate the functional relationship between the number of ACEs experienced by a student and a variety of academic and social, emotional, behavioral, and mental health outcomes.

   The bad news (for some believing that ACEs screenings portend important school outcomes) is that—while this study focused only on a relatively small number of very young students in one geographic area—it, as above, (a) confirmed a logical and expected correlation between the ACEs and participating students’ emotional and behavioral status, but (b) rejected what many educators assumed would be a similar ACEs correlation with their academic status.

   As noted earlier, we cannot conclude from even the one confirmed correlation above that a high ACEs score means that a student is “traumatized,” or that any of the ACEs events were the reasons behind a student’s current social, emotional, behavioral, or mental health status.

   Indeed, to really understand the results of this study, every student considered “at-risk” by the ACEs screener would need to be diagnostically assessed to determine exactly what appropriate and challenging behaviors they were demonstrating and when during the school day, as well as why the challenging behaviors were occurring (i.e., the root causes) and how they were being triggered.

   Critically, students’ social, emotional, and behavioral challenges are triggered in many different ways— often well beyond any of the events described in an ACEs screener. Indeed, if you re-read the ACEs screening questions above, you will note that the vast majority of the items focus on home and family-related events.

   Below is a table with the original ten ACEs areas, and X’s in boxes indicating that many of the ACEs events could occur in Community or School settings, as well as with or due to Peers.

   The point here is that:  The ACEs events or issues are not limited to our students’ familial experiences. Moreover, social, emotional, behavioral, and mental health assessments need to include multiple student settings, sources, and events.

   Said a different way:

Trauma, stress, anxiety, and other social-emotional issues are not setting-specific. They are event-dependent. Events obviously can be experienced outside of the family or home, and they can be just as emotionally debilitating as those measured by an ACEs screening.


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   But even beyond the ACEs events above, there are many other life experiences that trigger students’ social, emotional, and interpersonal challenges.

   These may 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 family- or trauma-related, and these events need to be consciously factored into a social, emotional, or behavioral screening.

   The Take-Aways here 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 too focused on trauma may easily miss them.

·       Schools need to assess and identify the emotional triggers that are most prevalent across their students, and they should target these emotional triggers with their preventative services, supports, and interventions.

At the Tier 1 level, these triggers need to be integrated into the schools’ social skills curricula at the prevention and early response levels.

At the Tier 2 and 3 levels, these triggers need to frame the strategic or intensive interventions or therapies that related services personnel prepare to deliver.

·       Finally, schools and districts need to be prepared to deliver the full multi-tiered continuum of services, supports, strategies, and interventions for students with social, emotional, behavioral, and mental health challenges.  This includes the necessary training, resources, and personnel both in general, and as needed on a year-to-year basis.

   Some of the Tier 2 or 3 clinical interventions that may be needed at the deeper levels of the multi-tiered continuum 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)

   Ultimately, districts and schools need to ask themselves: 

Do your related service professionals have the skills to clinically deliver (as needed, and based on student-centered diagnostic assessments) some or all of the strategies or therapies above. . . and/or, are they available from the mental health professionals who are practicing in your community?

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Summary

   We started this Blog journey by revisiting the many social, emotional, behavioral, and mental health concerns this past school year as documented by the National Center for Education Statistics. While many of these concerns have existed for years, the striking outcome is their elevation especially due to the pandemic.

   To analyze these concerns on a local level, many districts use a social-emotional screening process with their entire student populations. Critically, the Blog discussed the limitations of these screening instruments, emphasizing that they make errors, and that all screening results must be validated through individual student diagnostic assessments.

   The Blog then focused on screeners that assess for students’ Adverse Childhood Experiences (ACEs). We detailed the history, psychometric properties, and research with ACEs assessments, noting serious limitations with their validity and ability to causally explain students’ social-emotional difficulties. We concluded that ACEs screeners are not good assessments for root cause analyses or to ecologically measure traumatic life events.

   We reviewed a recently published study analyzing preschool to first grade students that found the ACEs correlated with social-emotional but not academic performance. We identified the many reasons (beyond traumatic events) that explain students’ social-emotional challenges, and discussed some of the Tier 2 and 3 interventions available to help.

   Our ultimate conclusion was that:

We cannot conclude that a high ACEs score means that a student is “traumatized,” or that any of the ACEs events were the reasons behind a student’s current social, emotional, behavioral, or mental health status.

 

ACEs surveys are screening tools. Given the absence of critical contextual information within the individual events assessed through the ACEs’ items, educators (and others) do not really know the cumulative depth, breadth, intensity, or impact of an individual’s projected traumatic history from an ACEs screening.

 

Indeed, the screening may simply tell us how many challenging events an individual may have experienced. It does not tell us if one or more of the events were traumatic for an individual, or if they continue to be traumatic. This information can only come from an individual diagnostic assessment process that identifies past and present social, emotional, behavioral, and mental health status; the ecologically-based root causes of any significant challenges; and what specific evidence-based services, supports, and/or interventions link to specific root causes.

   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 corresponding self-management. When students have social, emotional, and behavioral self-management skills, and the peer, staff, and school support to facilitate them, issues related to—for example—stress, anxiety, fear, trauma and their emotional triggers become less evident. . . because they are handling, addressing, and coping with them.

   Our schools still have a ways to go. But teachers, support staff, and administrators need the (right) training, professional development, and support; and schools need to have the mental health and related service colleagues.  Otherwise, the gaps will (continue to) undermine all of the best intentions, plans, and actions.

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   Now that everyone across the country has begun their school year, we hope that this Blog is helpful and relevant to your planning and implementation.

   If you would like to discuss these issues (or others) with me as part of a free virtual consultation, please drop me an e-mail (howieknoff1@projectachieve.info) so we can set up a Zoom call to look at your needs and gaps . . . and how to close these gaps and attain the outcomes that you want for students and staff.

   Together, I know that we can make this the school year that you want and that every student deserves.

Best,

Howie

 

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