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Behavioral Hyper, aggressive, impulsive (risk taking, “defiant,” or acting out behavior), withdrawn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

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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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