by M McInerney · Cited by 163 — In addition to neurological changes, trauma may impact students’ learning and behavior at school. Children who have experienced trauma may find it more

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1 Unlocking the Door to Learning : Trauma – Informed Classroom s & Transformational School s Maura McInerney , Esq. Senior Staff Attorney Amy McKlindon, M.S.W. Childhood trauma can have a direct, immediate, and potentially overwhelming impact on the ability of a child to learn. Yet, this issue has largely been ignored by our education system. This issue brief discusses how educators can begin to understand the role of trauma, its effect on children and learning, and how ed ucators can change methods of interacting and responding to children impacted by trauma. By adopting a trauma – informed approach, schools undertake a paradigm shift at the staff and organizational level to recognize, understand and address the learning nee ds of children impacted by trauma. This requires a commitment to shaping school culture, practices, and policies to be sensitive to the nee ds of traumatized learners. This effort positively impacts schools and changes the life – trajectory of vulnerable stu dents. The first step is to understand who experiences trauma and why, and how it impact s learning . It is well documented that a to trauma can commonly interfere with brain development, learning , and behavior — all of which have a potential impact on a academic success as well as the overall school environment . By understanding and responding to trauma, school a dministrators, teacher s, and staff can help reduce its negative im pact, support critical learning , and crea te a more positive school environment. QUICK FACTS Trauma is Common: It is estimated that one half to two – thirds of children experience trauma . What is Trauma ? A response to a negative external event or series of events which surpasses the comes in many forms and includes experiences such as maltreatment, witnessing violence, or the loss of a loved one. Traumatic experiences can impact brain development and behavior inside and outside of the classroom. Importance for Schools All schools and educators work with children who have experienced trauma , but you may not know who these students are. Schools have an important role to play in providing stability and a safe space for children and connecting them to caring adults. In addition to serving as a link to supportive services, schools can adapt curricula and behavioral interventions to be tter meet the educational needs of students who have experienced trauma. Trauma – Informed Approaches Evidence – supported, trauma – informed models have been developed in other fields and can be implemented in schools. A list of models, training tools, and ad ditional resources is provided.

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2 Trauma – informed approaches are not new they have been implemented in many fields including the medical profession and our judicial system. The lessons learned from these evidence – based approaches can be direct ly applied to classrooms and schools. At the heart of these approaches is the belief that , the question we should ask is not , rather ? 1 By trauma , prevent re – traumatization , and engage a child in learning and finding success in school . Defining Trauma What happened to this child? Childhood trauma has been conceptualized as a response to a negative external event or series of events which render a child defensive operations . 2 response to these potentially traumatizing events will vary depending on the characteristics of the child ( e.g ., age , stage of development, personality, intelligence and prior histor y of trauma ) environment ( e.g ., school and family supports) , and experience ( e.g ., relationship to perpetrator). 3 The Diagnostic and Statistical Manual of Mental Disorders (DSM – IV – TR ) defines traumatic events as those in which an individual experiences, w itnesses, or is confronted with actual or threatened death or serious injury, or threatened physical integrity of self or others. 4 Importantly, t he event need not be violent and need not be directed at the child who experiences trauma. One well – known stu dy describes traumatic experiences in childhood as Adverse Childhood Experiences (ACEs), which may include members who are mentally ill, suicidal, substance a busers, or were ever incarcerated. This study linked ACEs to many common adult medical and psychological problems. 5 In response to a traumatic event, a person may feel intense fe ar, horror, or helplessness , and in response, a child may display disorganized or agitated behavior. 6 Who Experiences Trauma ? Children from all races and socioeconomic backgrounds experience and are impacted by trauma . R esearch suggests that between half and two – thirds of all school – aged children experience trauma 7 as they are exposed to one or more adverse childhood experience that can be trauma – inducing. 8 T rauma can come in many forms. There are obvious examples of trauma. For example, in 2011, there were 4,566 reports of abuse or neglect in Philadelphia, with 2 .1 substantiated cases of abuse or neglect per 1,000 children. 9 However, there are also other hidden examples of exposure to trauma. Here are some statistical examples: Among 769 students sampled in the LA Unified School District, the average number of v iolent events experience d in the previous year was 2.8, and the average number of witnessed events was 5.9. In this context, 76% of surveyed students experienced or witnessed violence involving a gun or knife. 10 In another study of this cohort by Flannery et al., between 56% and 87% of adolescents had witnessed someone being physically assaulted at school during the past year. 11 In one representative sample of children in western North Carolina , 68% of 16 – year – o lds had experienced trauma and 37% had experienced two or more traumatic events. More specifically: o 25% had been exposed to violence . 15% had experienced the violent death of a sibling or peer . 7% had experienced physical abuse by a relative . o 11% had exper ienced sexual trauma in the form of sexual abuse, rape, or coercion .

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3 o 33% had experienced another injury or trauma ( e.g ., serious accident, natural disaster) . 12 According to the 2008 , 61% of children and ad olescents age 17 and younger have been exposed to violence in the past year. Over one – third of children experienced two or more direct victimizations, and 11% had experienced five or more direct victimizations. 13 Children and adolescents in urban environm ents experience hig h er rates of exposure to violence . 14 In one unnamed urban community, 41% of 6 th , 8 th , and 10 th grade students reported witnessing a shooting or stabbing in the past year. 15 In addition, young children are also exposed to trauma, and by age 4, parents report that 26% of young children have been exposed to violence or a non – interpersonal traumatic event such as a car accident. 16 Recent research has disclosed the devastating i mpact of exposure to trauma on the brain development of very young children . Exposure to Violence: Young Children in Philadelphia In a sample of 119 seven – year – old children in Philadelphia, frequent exposure to violence was reported: o 75% had heard gun shots. o 60% had seen drug deals. o 18% had seen a dead body outside. o 10% witnessed a stabbing or shooting in their homes. 17 Notably, in an older study c omparing middle school students in the Philadelphia metropolitan area attending an urban middle school and a suburban middle school, researchers found a strikingly high prevalence of exposure to violence and victimization in both groups: o 89% of suburban and 96% of urban middle school students knew someone who had been robbed, assaulted, or murdered. o 57% of s uburban and 88% of urban middle school students had witnessed someone being robbed, assaulted, or murdered. o 40% of suburban and 67% of urban middle school students had been a victim of violence. 18 Impact of Trauma on Brain Development and Learning Children and adolescents are contin ually developing, and life experiences influence their development in both positive and negative ways. behavioral responses to trauma have the potential learning, school engagement , and academic success . in the early years, such as abuse and ne glect and exposure to violence , can profoundly impact and limit brain development, resulting in cognitive losses, physical, emotional and social delays, all of which undermine learning. 19 Brain imaging shows that the brain continues to develop into ea rly adulthood , with peak times of development in early childhood and adolescence. 20 More specifically, areas such as the hippocampus which is involved in learning and memory develop rapidly in early childhood, while the prefrontal cortex which regulates th oughts and attention matures more rapidly during adolescence. 21 As a result, t rauma experienced during these sensitive periods ha s the potential to be particularly harmful to brain

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4 development. 22 T raumatic experiences can actually change the structure and functioning of a brains through the activation of stress response systems. When exposed to a stressor, the body , response that activates several systems in the body and releases stress hormones that are designed to be protective for survival. 23 However, t his response becomes dangerous to the brain, rather than protective, when repeated traumatic experiences lead to a n over – reactive stress system. As described by one pediatrician, these children are living in a 24 and it has very real implications for their brain development and social functioning. Toxic stress has been defined response systems in th e absence of the buffering protection of a supportive, adult relationship . 25 T he American Academy of Pediatrics cautions that extended exposure to toxic stress can lead to functional changes in several regions of the brain involved in learning and behavior including the amygdala, hippocampus, and prefrontal cortex. 26 Further, n eurological imaging indicates that several regions of the brain may actually reduce in size as a result of childhood maltreatment . 27 In addition to neurological changes, trauma may impact at school . Children who have experienced trauma may find it more challenging than their peers to pay attention and process new information, and evidence suggests that some of these children develop sensory processing difficulties which can contribute to problems with writing and reading . 28 In a sample of high – risk children at a pediatric clinic in California, children who were exposed to four or more adverse experiences were 32 times more likely to have lea rning/behavioral problems than their peers w ith no adverse experiences . 29 Another study found that six and seven year – old children who have been exposed to violence and have suffered from trauma – related distress score significantly lower on IQ and reading ability tests. 30 Researchers have also found that maltreated children are more likely than their peers to be retained a grade, have irregular attendance, and be placed in special education classes. 31 Children with higher exposure to violence also had lowe r grade point averages and more absences than those children with less exposure to violence. Trauma Changes the Way Children Interact with Others Children who have experienced trauma may be distrustful or suspicious of others, leading them to question the reliability and predictability of their relationships with classmates and teachers. Research indicates that children who have been exposed to v iolence often have difficulty responding to social cues and may withdraw from social situations or bully others . 32 For example, when compared to their classmates, c hildren w ho have been physically abused have been found to engage in less intimate peer rela tionships and tend to be more aggressive and negative in peer interactions . 33 Further, students who have experienced trauma may feel that authority figures have failed to provide safety for them in the past and may therefore be distrustful of teachers . Te consequences may be viewed as punishment by children who have experienced trauma , increasing the potential for re – traumatization , 34 while at the same time increasing the likelihood that these children will be subject to school discipline and exclusionary practices on a repeated basis. Long – Term Impacts of Childhood Trauma The consequences of traumatic experiences have the potential to be long lasting and devastating to individuals and society. Children who have experienced trauma and adverse experiences may be at elevated risk for mental and physical health problems , 35 substance abuse, 36 and criminal justice involvement 37 in adolescence and adulthood . However, this does not need to be the long – term impact .

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5 Breaking the Cycle of Trauma When trauma causes emotional or psychological damage to children, they may adopt a set of behaviors or patterns of thinking that put them on a path for further trauma. Either directly through their own repeated actions ( e.g ., they are quicker to re sort to violence) or as a result of consequences for their actions that do not fit within societal rules and norms ( e.g ., punitive measures after violation of rules/laws), children may become re – traumatized and their problems are only compounded . We nee which is particularly important to keep in mind in the school environment, where students may display problem behaviors related to past trauma and then become re – traumatized through punishment for those behaviors embedding the trauma further and continuing the cycle of behavioral problems rather than lessening them . Cycle of Trauma Breaking the Cycle: Evidence – Supported and Evidence – Based Approaches Given the high prevalence of childhood trauma, many systems working with children have had to confront this issue. From medical centers to courts to child welfare systems , several evidence – supported and evidence – based approaches to address trauma have b ee n developed and have proven to be effective . These approaches can be broken into two categories: trauma – informed systems approaches that aim to shape organizations to be more trauma – sensitive in their work with children and families and trauma – specific treatment interventions that can be implemented at the individual – level to address trauma and its symptoms. Both types of approaches are explained in more detail and applied to school settings below. Trauma Emotional/Psychological Damage Behavioral Problems Punishment

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6 B ecoming trauma – informed requires a paradigm shift at the staff and organizational level to re – focus on understanding what happened to a child , rather than focusing on the conduct alone. 38 Trauma – informed approaches represent a holistic approach to shaping organizational culture , practices, and policies to be sensitive to the experiences and needs of traumatized individuals . Several models have been developed to guide the design and implementation of trauma – informed systems that take these key elements into consideration. One well – known approach is the Sanctuary Model ® , developed by Dr. Sandra Bloom, Associate Professor at Drexel University in Philadelphia. This model engages organizational leaders and staff to develop an organizational culture where staff model and clients build skills in key areas such as safety, emotional management, self – control, and conflict resolution. At the same time, open communication, healthy boundaries, healthy social relationships, and growth and change are promoted. The model also utilizes the S.E.L.F. curriculum to gu ide individual 39 The Sanctuary Model has been used across a variety of settings including residential facilities, juvenile justice facilities, mental health programs and schools. 40 Links to information about the Sanctuary Model and other trauma – informed systems approaches are included in the resources at the end of this publication. Evidence Supporting Trauma – Informed Approaches at the Organizational Level The use of trauma – informed systems and methods in other fields , including medicine and child welfare, has had very promising results – engagement and retention, staff and client safety, s taff development, and increased supportive environments. Here are some examples of measurable positive outcomes: When staff in a child and adolescent inpatient psychiatric facility were trained on trauma – informed care, the facility experienced a 67% redu ction in the number of times children were placed in seclusion and/or in restraints . 41 In a study that compared units at a residential treatment facility that implemented the Sanctuary Model® with units that provided services as usual, staff in the Sanctua ry Model® units were more likely to report community environments that promoted support, autonomy, safety, open expression of feelings, and personal problem – solving. 42 Women receiving substance abuse treatment that was trauma – enhanced ( i.e. , promoted physic al and psychological safety, provided culturally competent and individualized services, and involved staff training on trauma) were less likely to leave treatment early, compared to women receiving services as usual. 43 Child welfare supervisors in Arkansas who attended a two – day training on trauma – informed services reported a significant increase in their knowledge of trauma – informed practices, as well as a significant increase in their active support of trauma – informed assessment and trauma – informed care a mong the staff they supervise. 44 Researchers and practitioners in the field agree that trauma – informed approaches at the system level make intuitive sense, and a growing body of research supports their implementation as evidence – supported approaches. Ho wever, rigorous evaluations are still needed to build on this evidence and further establish the efficacy of these approaches. 45 SEVEN ELEMENTS OF TRAUMA – INFORMED SYSTEMS 46

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8 Links to Mental Health Professionals Schools should create links to mental health cons ultation and services for staff, students, and families. For staff, clinical supports include the opportunity to participate in sessions with their peers and a clinician to confidentially discuss specific cases, reflect on experiences of secondary trauma, and learn and practice strategies for working with children and families. For students and families, school staff should ref er families to appropriate mental health resources and following up on referrals. Trusting relationships between parents/caregivers, school staff, and mental health providers can help to ensure success. Be sure to secure the necessary authorization for r elease of information between parties to facilitate communication and collaboration. A cademic Instruction for Students who have Experienced Trauma Specific strategies can be used to support the learning needs of students who have experienced trauma, inclu individual interests and competencies ; maintaining predictable routines and expectations; maintaining expectations for the student that are consistent with those of his/her peers; and providing positive behavi oral supports . Language – based teaching approaches can help students process information and alleviate their fears. Students who have experienced trauma often pay more attention to nonverbal cues than verbal communication, so using multiple forms of commun icating information and helping students identify and verbally express their feelings are important strategies to support learning. School evaluations, including psychological, speech and language, functional behavioral, and occupational therapy evaluation s, should assess the role of trauma and identify needed supports. Nonacademic Strategies Build nonacademic relationships with students . Support and facilitate participation in extracurricular activities . School Policies, Procedures, and Protocols School discipline policies are trauma – informed when they: Balance accountability with an understanding of traumatic behavior ; Teach students the school and classroom rules while reinforcing that school is not a violent place and abusive discipline (which student s who have experienced trauma may be accustomed to) is not allowed at school ; Minimize disruptions to education with an emphasis on positive behavioral supports and behavioral intervention plans ; Create consistent rules and consequences ; Model respectful, nonviolent relationships . Communication procedures and protocols are trauma – informed when they: Respect confidentiality ; Involve open communication and rela tionship – building with families ; Ensure ongoing monitoring of new policies, practices and training. Source: Helping Traumatized Children Learn 48

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9 In addition to the systemic approach outlined above, Massachusetts has taken its interest in promoting trauma – informed sch ool environments to the legislative level. In 2004, the legislature established a grant program administered through the Massachusetts Department of Elementary and Secondary Education to support school – based efforts to address the educational and psychosocial needs of students whose behavior interferes with learning, with a particular emphasis on those students who have witnessed violence and experienced trauma. 49 Schools have implemented innovative trauma – in formed practices utilizing these funds 50 For example, Framingham School District offered a 12 – hour course for credit for teachers and school staff on the impact of trauma on Strategic Learning Charter School instit uted bi – weekly meetings for staff to discuss implementation of trauma – sensitive school practices, provide training, and conduct case consultations with a psychologist. 51 Trauma committees have also been formed to better meet the needs of students experienc ing trauma in some schools, as highlighted in the adjacent textbox. Washington State has taken steps at the state – level to bring special attention to the needs of students who have experienced trauma. The Washington State Office of the Superintendent of Public Instruction Compassionate Schools Initiative released the second edition of its handbook The Heart of Learning and Teaching: Compassion, Resiliency, and Academic Success in 2011 . In addition to providing ba ckground information on trauma and the importance of self – care for school staff, this handbook outlines six principles which should guide interactions with students who have experienced trauma: 1. Always Empower, Never Disempower : Avoid battles for power with students. Students who have experienced trauma often seek to control their environment to protect themselves, and their behavior will generally deteriorate when they feel more helpless. Classroom discipline is necessary, but should be done in a way that is respectful, consistent, an d non – violent. 2. Provide Unconditional Positive Regard : As consistently caring adults, school staff have the opportunity to help students build trust and form relationships. For example, if a student tells 3. Maintain High Expectations : Set and enforce limits in a consistent way. Maintain the same high expectations of a student who h as experie nced trauma as you do for his/her peers. 4. Check Assumptions, Observe, and Question : Trauma can affect any student and can manifest in many different ways. Realize when you are making assumptions , and instead, talk with the Trauma – Informed Student Engagement: Ford Elementary School, Lynn, MA After receiving a state grant to focus on youth traumatized by violence, Ford Elementary School trained staff and established a whose behaviors may be impacted by trauma at home. These staff members then identify the strengths, interests, and talents of those students experiencing trauma, and use this information to help engage st udents in school. For example, in one case, a teacher recognized a arrangement where this student, who was struggling academically and experiencing domestic violence at home, was able to join the team prov ided he improved his grades. strengths led to improved behavior, grades, and self – esteem.

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10 student and ask questions. Make engaged in listening to his/her response. 5. Be a Relationship Coach : Help students from preschool through high school develop social skills and support positive relationships between children and their caregivers. 6. Provide Guided Opportunities for Helpful Participation : Model, foster, and support ongoing peer e.g ., peer tutoring, support groups). 52 The Washington State Compassionate Schools Initiative recommends applying these principles to three curriculum domains safety, connection, and assurance ; emotional and behavioral self – regulation; and competencies of personal agency, social skills, and academic skills and provides specific strategies to do so. To create a feeling of safety in the classroom, teachers may implement strategies to create co nsistency and routine. 53 Examples from the handbook include posting the Monday schedule on the board (students experiencing trauma may be returning to school from a weekend of chaos at home) and creating spaces where students can go to calm down. To prom ote emotional and behavioral self – regulation, the handbook emphasizes the importance of helping students learn to recognize and identify their emotions. Example exercises include discussing the emotions of characters in books and engaging in relaxation exe rcises. Finally, in the domain of competencies and skills, students who have experienced trauma may need additional opportunities to build their sense of personal agency, social skills, academic skills, and executive functions (e.g., setting goals, antici pating consequences). Sample exercises are provided including journal writing and training on non – violent communication. Actions Taken in Other States . In addition to the systematic frameworks developed in Massachusetts and Washington, other states have promoted education on trauma – informed practices. For example, states such as Illinois , 54 Wisconsin, 55 and Massachusetts 56 have included resources on trauma on their State Department/Board of Education websites. Information on trauma can also be incorporated into mental health training received by school staff . I n Idaho, Idaho State University and includes education on trauma. 57 [ Links to the resources from Massachusetts and Washington highlighted here are included in the resources at the end of this publication. ] Trauma – Informed Discipline Policies: Lincol n High School, Walla Walla, WA Jim S porleder, p rincipal of Lincoln High School, recently implemented an approach to school discipline that looks to the underlying factors prompting student behaviors. Rather than automatically suspending students for behavioral problems, school leaders sit down Students still receive consequences for their actions, including in school suspensions where they have access to a teacher and a comforting environment . Sporleder reports that students are very re ceptive to this approach and open up to staff about underlying trauma and stress that are contributing to their behavior. Suspensions and expulsions have also dropped dramatically, from 798 suspensions and 50 expulsions in the 2009 – 2010 school year (prior to implementing this trauma – informed approach) , to 135 suspensions and 30 expulsions in 2010 – 2011.

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11 Evidence Supporting Trauma – Informed Practices in Schools Evidence supporting trauma – informed approaches is continuing to grow, but few studies have been published to – date on the effectiveness of this approach in schools. As the Lincoln High School case example above illustrates, when this school implemented a t rauma – informed approach , suspensions dropped by 83 percent and expulsions dropped by 40 percent in the year following implementation . 58 It is hypothesized that trauma – informed practices in schools will help to identify and address the impact of trauma on In Pennsylvania , t he Sanctuary Model has been implemented in residential and public schools. The Pace School , an approved private school and partial hospitalization pr ogram in Pittsburgh , reported an increase in student attendance and an increase in the percentage of students meeting or exceeding benchmark targets in math and writing following implementation of the Sanctuary Model. 59 The Sanctuary Model is also utilized by several residential programs with on – site schools, including 60 Highlands School District in Allegheny County, Pennsylvania was the first public school district in the United States to implement the Sanctuary Model in all of its schools. 61 Implementing Trauma – Specific Interventions in Schools In the context of trauma – informed school systems, evidence – based trauma – specific interventions can be implemented to address the trauma needs of individual students. These treatments target individual students affected by trauma to promote recovery. School – based mental health services have grown in recent decades 62 Health in 2003 as an important strategy for early screening and intervention for mental health problems. 63 Trauma – s pecific mental health services may be provided by school – based health centers or community mental health providers co – locate in schools, and schools may also refer students to outside mental health providers for these services. 64 Research indicates that re ceiving trauma – specific treatment can lead to improved school attendance and academic outcomes. 65 A number of trauma – specific treatments have shown promising results for reducing trauma symptoms and behavior problems in children . For example, according to The National Child Traumatic Stress Network, Trauma – Focused Cognitive Behavioral Therapy (TF – CBT) has the strongest research evidence of any treatment program for children who have experienced trauma. 66 Through individual sessions with the child and joint sessions between the parent and child, TF – CBT interventions can be remembered skills, cognitive coping and processing skills, trauma narrative, in viv o exposure, conjoint parent – child sessions, and enhancing safety. 67 Trauma – specific interventions have also been designed specifically for use in schools. For example, Cognitive Behavioral Intervention for Trauma in Schools (CBITS) is an evidence – supporte d intervention designed for use in schools with children who have experienced trauma. It includes group and individual sessions, as well as psychoeducational sessions for parents and training for teachers. CBITS has also been modified to be delivered by t eachers and school counselors to middle school students . The modified program is called Support for Students Exposed to Trauma (SSET) , and preliminary research findings indicate that students and parents are satisfied with the program and students show a small reduction in student – reported symptoms of depression and posttraumatic stress disorder (PTSD) . More research is warranted to evaluate the effectiveness of SSET . 68 When trained clinicians are not available at a school to provide trauma – specific treat ment, school staff should consider implementing programs

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