October 29, 2016
FCPS Mental Wellness Conference
Marcie Cohen, LCSW (VA), LCSW-C (MD)
Developed in partnership with the Trauma Informed Community Network (TICN) of Fairfax County
Agenda
Presentation and exercises
Questions
Trauma Defined Trauma refers to experiences that cause intense physical and
psychological stress reactions.
It can refer to a single event, multiple events, or a set of circumstances that is experienced by an individual as physically and emotionally harmful or threatening and that has lasting adverse effects on the individual's physical, social, emotional, or spiritual well-being.
A Normal Reaction to a Horrific Situation
SAMHSA 2014 SUBSTANCE ABUSE & MENTAL HEALTH SERVICES ADMINISTRATION
Forms of Trauma
Violence
Witness/exposure to violence
Abuse
Neglect
War zone & Refugee experiences
Traumatic Grief
Terrorism
Immigration Experiences
Medical Trauma
Natural Disasters
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Systemic Trauma
Complex
Acute
Homophobia
Racism Poverty
Sexism
Discrimination Ableism
Single incident
Multiple exposures of violence and trauma
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Trauma and Immigration
(NCTSN)
Trauma Reactions Reactions to trauma (or responses to triggers) can be Short or Long Term, and may
include:
Emotional Identification, Expression, Regulation (overwhelmed)
Physical Physiological response,
Survival Mode—Freeze, Fight, or Flight (can’t sit still) Somatic complaints (stomach aches)
Relational/Social Attachment, ability to connect, trust, friendships
Spiritual Hopeless
Behavioral Hyper, aggressive, impulsive (risk taking, “defiant,” or acting out behavior), withdrawn
(“compliant”) Cognitive
Brain development, memory loss, confusion, inability to concentrate Self-Concept
Sense of self, self-worth, self-esteem, self in the world
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Trauma reactions may lead to:
Strong or unexpected emotional or behavioral responses:
Difficulty modulating emotional responses to the situation
Avoidance of people, places, situations
Over/under-estimation of danger
Difficulty coping with change or the unexpected
Feeling unsafe and reacting using unhealthy coping skills
Ongoing emotional concerns:
Intense anger, hostility
Anxiety, irritability
Low self-esteem, helplessness
Feeling that they are weak, “crazy” or alone in their suffering
Embarrassment regarding emotions and physical responses
Difficulty with interpersonal relationships
Difficulty trusting others
Expectations of maltreatment or abandonment
Feelings of loneliness
Negative influences on health
Sleep disturbances (masked by late-night studying, television watching, partying)
Drug and alcohol use (possible coping mechanism to address stress)
Self-harm
Foreshortened future
Negative influences on cognitive functioning
Increased risk of revictimization
Especially if the adolescent has lived with chronic or complex trauma
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Trauma Reactions
Trauma Reactions Emotional and behavioral responses are influenced by:
Physical fight/flight/freeze responses
Trauma’s influence on students’ beliefs and expectations about: Self (not worthy, not lovable)
Adults who care for them (not trustworthy or helpful, may not stick around)
The world not feeling safe
Taken together, these reactions interfere with key developmental tasks, such as an adolescent’s ability to: Think abstractly
Anticipate and consider the consequences of behavior
Accurately judge danger and safety
Modify and control behavior to meet long-term goals
These “beliefs” can be unlearned – there is hope!
May feel helpless
May possess an uncertainty about whether there is continued danger
May have a general fear that extends beyond the traumatic event into other parts of their lives
May have difficulty describing in words what is bothering them or what they are experiencing emotionally
This feeling of helplessness and anxiety is often expressed as a loss of previously acquired developmental skills
(e.g., unable to separate from their parents at school, loss of speech, toileting skills, inability to fall asleep on their own)
Engaging in traumatic play —a repetitive and less imaginative form of play that may represent children’s continued focus on the traumatic event or an attempt to change a negative outcome of a traumatic event
Trauma Reactions in Younger Children
Age-Related Reactions to a Traumatic Event National Child Traumatic Stress Network; www.nctsn.org
Traumatic experiences may elicit feelings of persistent worry over their own safety and the safety of others in their school or family
Children may be consumed with their own actions during the event and may feel guilt or shame over what they did/did not do during a traumatic event.
This may compromise the developmental tasks of school-age children as well. Children of this age may display sleep disturbances, which might include difficulty falling asleep, fear of sleeping alone, or frequent nightmares.
Teachers often comment that these children are having greater difficulties concentrating and learning at school
Students may engage in constant retelling of the traumatic event
They may describe being overwhelmed by their feelings of fear or sadness
After a traumatic event, children may complain of headaches and/or stomach aches without obvious cause
Some may engage in unusually aggressive or reckless behaviors
Trauma Reactions in School-Age Children www.NCTSN.org
Age-Related Reactions to a Traumatic Event National Child Traumatic Stress Network; www.nctsn.org
Trauma versus Grief
Trauma Reactions Impact on Education:
Exposure to traumatic experiences is correlated with
Decreased IQ and reading ability (Delaney-Black et al. 2003) Distractibility (jittery, fidgety, difficulty focusing for expected periods of time
Decreased graduation rates (Grogger, 1997) Increased rates of suspension and expulsion (LAUSD Survey)
Exposure to violence is correlated with: Lower GPA’s More negative remarks in cumulative folders More absences from school than other students (NCTSN)
Children with two or more “adverse childhood experiences”: 2.67 times more likely to repeat a grade (Bethell et al., 2014)
Adults with four or more “adverse childhood experiences”: 4.4 fold increase in impaired memory of childhood (Anda et al., 2006)
https://www.cdc.gov/violenceprevention/acestudy/about_ace.html
Trauma Reactions
Impact of Trauma on Student- Adult Relationships
Behaviors related to trauma symptoms are often interpreted as deliberate misbehavior by adults, and can lead to increased conflict in the home.
Relationships and connectedness can be greatly affected by the lack of trust and confidence trauma can cause, inhibiting an adult’s ability to work effectively with their student.
Lack of understanding can be compounded when adults have their own unaddressed trauma history, depending on what beliefs they have about their traumatic experiences.
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Trauma Informed Strategies for Educators
McInerney & McKildon
Trauma Informed Strategies People who have experienced trauma need the following in order to recover:
Sense of safety (physical and emotional)
Information
Healthy coping skills
Hope and optimism
Sense of connection, supportive relationships
People need to feel safe, capable, and lovable.
Trauma-informed strategies benefit all students, though they are especially necessary to support students who have experienced trauma.
It is important to “know our role.”
How can I support this child as a classroom teacher? What strategies are appropriate for me to use? What are the limits of my expertise?
Who can I reach out to for consultation and collaboration when a child needs more support?
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Responding to Disclosure
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Trauma Informed Strategies for Educators If a Student Discloses their Experience:
Use key phrases to validate and normalize their experience.
“I care about you. How can I help?” “This can be really hard. You might want to talk with someone.” “It makes sense that you are feeling this way.” “I can help you find help.” “I am here for you when you are ready for help.”
Do not ask for details Do not investigate or assume the worst Stay in your role and reach out to others for help! Initiate a referral to the school psychologist, school social worker, or counselor. Facilitate this
referral by offering to introduce your student to this staff member.
KNOW WHEN A MENTAL HEALTH REFERRAL IS REQUIRED!! If the student discusses:
Suicide or desire to harm themselves a desire to harm others abuse/neglect OR they cannot calm
DO NOT LEAVE THEM ALONE!! Request that your psychologist, social worker, or counselor come to the room
immediately.
Intervention and Prevention Services of Northern Virginia Family Service
Connect & SUPPORT
Implement your school’s PBIS program consistently.
Develop routines and be consistent in using
them.
Use gentle, affirming language and gestures. Use an even tone, low to moderate volume, and
open posture. Stand shoulder to shoulder, sit or squat at eye
level, and avoid sudden gestures. Avoid touch.
Maintain clear behavioral expectations. Praise publicly, correct privately.
Know what “safe places” are available to students who need a place to calm down.
Think of ways you can gently encourage students to use these spaces when needed.
Focus on problem-solving, not punishment. Help students develop ways to manage their own behavior.
Build opportunities for success into various settings, academic and social.
Ensure that transitions to new spaces or activities are calm and predictable.
Help your students set and achieve personal goals. Create short and long-term goals, methods for completion, and acknowledgements for success.
Avoid power struggles. Create and offer choices that are acceptable to both you and your students.
Devote time to teach students skills to identify and manage their emotions. Students need to learn coping skills to manage situations that become overwhelming.
Trauma Informed Strategies for Educators: Connect & Support
Intervention and Prevention Services of Northern Virginia Family Service
BE INFORMED
Remain aware of important events such as anniversaries (e.g. of a death). Proactively consider how these events may influence a student’s feelings or behaviors and develop thoughtful plans that are flexible and attentive to their needs.
Know your students’ academic and social strengths and weaknesses. Praise their strengths in the moment and give them strategies to address weaknesses. Consult with other staff members about interventions, relying on their different areas of expertise.
Be mindful when developing assignments with themes such as “family” or “memories.” Consider allowing students to choose an alternate assignment or to work collaboratively with you to modify the task.
Remind the student that they can talk with school-based mental health staff (psychologist, social worker, or counselor) and show them how to access these individuals.
Talk to school-based mental health staff (psychologist, social worker, or counselor) about classroom-appropriate techniques that can be taught to students for managing overwhelming emotions (e.g. deep breathing). Encourage your students to use these techniques in the moment.
Trauma Informed Strategies for Educators: Connect & Support
Trauma Informed Strategies for Educators Develop Relationships and Foster Community:
Increase resiliency by providing students the opportunity to build
strong relationships with at least one competent, caring adult who can serve as a positive role model.
Consider pairing the student with supportive peers who model healthy, appropriate coping skills.
Provide opportunities for your student to give back by helping others.
Provide age appropriate opportunities to have fun and “be a kid.”
Remember that all students have strengths. Find them and build upon them.
Trauma Informed Strategies for Educators
If a Student Uses Challenging or Difficult Behaviors:
Do not resort to shaming or isolating punishment.
Be mindful of your physical presence and tone of voice. Adults often react strongly to aggressive, disrespectful, or otherwise challenging behaviors. By remaining calm and neutral in your tone and posture, you remain in control of the situation and model appropriate behavior. (Students who exhibit symptoms of trauma can observe changes in facial expressions or tone of voice before we are even aware. Accurate versus Misperceptions?)
Consider what might have caused the student’s behavior, beyond what is obvious to an observer. Ask the student questions in a compassionate manner.
Listen carefully, without interrupting. Summarize the student’s statements in a supportive manner and ask if you have understood correctly.
Trauma Informed Strategies for Educators (CONTINUED)
If a Student Uses Challenging or Difficult Behaviors:
Avoid passing judgment, offering advice, or becoming overly reassuring.
Offer water and suggest some basic relaxation techniques (e.g. deep breathing) to help the student regain composure and return to the moment. Some ideas: http://kidshealth.org/parent/_cancer_center/feelings/relaxation.html
Validate your student’s thoughts/feelings. Offer choices for appropriate ways to remove themselves from the situation or manage unacceptable behavior. Calmly request that they choose from one of several clear, easy options.
Remember that the behavior in question is not driven by logic. The student is in flight, fight or freeze mode and survival responses are taking over. Try some de-escalation techniques to help them manage their aggression and calm down. Check out this video to see how to pull some of these ideas together. https://www.youtube.com/watch?v=QGn1bx7ZZUY
Trauma Informed Strategies for Educators
Collaborate and Consult:
Work collaboratively with your school-based mental health team (psychologist, social worker, and counselor). Keep one another abreast of important changes in behavior, relationships, academic functioning, or other concerns. Work together to develop and implement classroom appropriate interventions.
Work collaboratively with families, keeping in mind that many students have non-traditional family structures. Communicate with families about students’ current functioning and progress, as well as interventions that have been helpful. Ask families what interventions may have been helpful in other environments.
Four C’s and a VCR
Students may provoke four “C” reactions in adults
Challenging
Confronting
Criticizing
Correcting
Not Helpful; do not correct
Students may tune out adults more concerned with ruling than
relating
Instead, promotes shame and
worthlessness
So instead… the VCR approach
(Hardy & Laszloffy, 2005/2007)
Validation- before all else, youth need to be validated; sends message that “I understand your perspective”
Challenging- AFTER appropriate and adequate validation, its possible to challenge troubling youth thoughts & behaviors
Requesting- make a request- translate feedback received into positive, concrete action
VCR Guiding Principles (Hardy & Laszloffy, 2005/2007)
Validation must PRECEDE any form of challenge or confrontation; goal is replace spontaneous challenge/criticism with spontaneous validation
The youth (recipient of validation) determines when validation is sufficient
Validation, challenge AND request must all be centered around same topic/theme.
Communicate with “I..” messages and “And”, not “but”
Avoid asking questions, especially when high levels of rage and anger
What does Student Services do? Engage/educate caregivers
Provides psychological first aid Establishes safety Provides for immediate health and welfare needs Screens for and addresses emergency concerns/provides crisis
intervention Assists student in problem-solving re: identified concerns Encourages use of healthy coping skills, assists in return to calm, well-
regulated emotional state
Consult with teachers regarding academic and social-emotional needs and interventions;
Provides outside referrals
Rational Detachment
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31 www.crisisprevention.com
Rational Detachment
32 www.crisisprevention.com
Rational Detachment
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WHEN STUDENTS ARE TRIGGERED, DO NOT…
WHEN STUDENTS ARE TRIGGERED WHAT CAN WE DO?
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What would being trauma informed look like for you?
What will I start doing? What will I avoid doing?
Looking at situations through a “trauma lens” when addressing acting out behavior or rule violations Trauma Lens = Changing the question from “what's wrong with you?” to “what happened to you?”
Enforcing rules and levying consequences without consideration of the potential impact of trauma on behavior
Providing increased opportunities for youth to build on their strengths and giving them positive recognition when they succeed
Not being thoughtful in the assignment of tasks to youth (the goal should be to present opportunities for mastery and success as opposed to setting youth up for failure that they may not be equipped to cope with)
Considering possible triggers like lights, sounds, crowds, small spaces, etc. when planning activities
Using a raised tone, flickering lights, or other potentially triggering methods to gain the attention of the group
Sticking to the expected schedule and avoiding surprises whenever possible
Letting staffing shortages or other unexpected events result in the loss of anticipated structure
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What is Secondary Traumatic Stress?
Secondary Traumatic Stress: The emotional duress that results when an individual hears about the first-
hand trauma experiences of another. Symptoms can mimic those of Post-Traumatic Stress Disorder (PTSD). Individuals may find themselves re-experiencing personal trauma or notice an
increase in arousal and avoidance reactions related to the indirect trauma exposure.
Individuals may experience changes in their memory and perception; alterations in their sense of self-efficacy; a depletion of their own personal resources; a disruption in their perceptions of safety, trust, and independence.
Since some workers may develop/exhibit some observable reactions that mirror PTSD, Secondary Traumatic Stress can be perceived as:
Helping that HURTS!
(Figley, 2012; NCTSN, 2011)
How can you protect yourself? Regular use of deliberate coping strategies
Self-care
Attract and maintain social support (personal and professional)
Have a personal calling to the field
Personality traits that include emotional competencies
Optimism, Faith, Flexibility, Sense of Meaning, Self-Efficacy, Impulse Control, Empathy, Close Relationships, Spirituality, Effective Problem Solving (Protective Factors that contribute to Resiliency)
Collins-Camargo, 2012
Practicing Self-Care
Get adequate sleep
Prioritize hydration and good nutrition
Exercise
Identify your own triggers, as well as strategies to manage them
Find opportunities to connect with others. Build a support network inside and outside of work
Engage in activities you enjoy
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Practicing Self-Care Focus on the rewards of the job and feelings of career
satisfaction
Create opportunities to “de-brief” after particularly difficult student interactions
Create boundaries between work and home
Acknowledge that the work can be stressful and difficult. Don’t be too hard on yourself!
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Closing Thoughts What strategies can you apply immediately?
What strategies to you have more questions about?
Other comments or questions?
Resources – Service Providers Virginia 211; Dial 211 or http://www.211virginia.org Community Services Boards, find locality at
http://www.dbhds.virginia.gov/individuals-and-families/community-services-boards
Early Intervention (infants and toddlers)- http://infantva.org/ Northern Virginia:
FCPS Office of Psychology Services - 571-423-4250
FCPS Office School Social Work - 571-423-4300
Coordinated Services Planning– family activities and basic needs 703-222-0880
Formed Families Forward, www.formedfamiliesforward.org Northern Virginia Family Services
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Resources – Hotlines
National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
http://suicidepreventionlifeline.org
Crisis Link 24-Hour Suicide Hotline: 703-527-4077 or text 703-940-0888
http://prsinc.org/crisislink/services/
24-Hour Domestic & Sexual Violence Hotline: 703-360-7273
Alternative House Teen Crisis Hotline: 1-800-SAY-TEEN (729-8336)
Fairfax County 24-Hour Emergency Services: 703-573-5679, TTY
711
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Resources - Internet
Childhood Trauma :
http://www.samhsa.gov/trauma/index.aspx#TipsChildren
http://www.nctsn.org/resources
http://www.nctsn.org/sites/default/files/assets/pdfs/childrenanddv_factsheetseries_complete.pdf
When a Child’s Parent has PTSD:
http://www.ptsd.va.gov/professional/treatment/children/pro_child_parent_ptsd.asp
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