New Orleans, Louisiana, February 10–13
Presenters in Focus: Bringing Trauma-Informed Schools to Life
Volume 44 Issue 1
By Stacy Overstreet
A national survey estimates that one in four children ages 0-17 years old have experienced one childhood adversity, with 23% having two or more adverse family experiences (National Survey of Children's Health, 2011/2012). Adverse childhood experiences (ACEs) are associated with trauma that can contribute to behavioral, social, mental health, and academic problems in school. As awareness of the pervasiveness of childhood trauma grows, the need for trauma informed schools has become increasingly apparent. In this "Presenters in Focus" Q&A, convention presenter Stacy Overstreet discusses the key issues related to understanding, advocating for, and implementing strategies to support traumatized students in schools (NASP Practice Model Domains: 2, 4, & 6). She will explore these issues in more depth during both her featured session FS04: Building Partnerships to Create Trauma-Informed Schools, Thursday, February 11, 2:30-3:50 p.m. and her related documented session, DS05: Trauma 101: Preparing Your School for Trauma-Informed Service Delivery, Friday, February 12, 10:00-11:20 a.m. at the 2016 national convention in New Orleans.
What are some of the key points school psychologists should know about addressing the needs of students experiencing toxic stress and trauma? Finding an inclusive frame for terminology is important to begin the conversation. I suggest the frame of adverse childhood experiences (ACEs), which is a generic term used to refer to overlapping sets of traumatic and adverse childhood experiences and home environment factors that substantially increase a child's risk for serious, lifelong medical and mental illnesses. I also would reinforce the importance of the four central findings from the original ACEs study (Felitti et al., 1998):
- Exposure to adverse events is common; about two thirds of youth experience one adverse event.
- Exposure to adverse events is chronic; youth exposed to one ACE have an 87% chance of being exposed to another type. In addition, ACE exposure tends to be prolonged, with duration of exposure ranging from months to years (Pynoos et al., 2014).
- The greater the exposure, the more likely a child will experience negative long-term effects. Adults who experienced four or more ACEs during their childhood were 4 times as likely to develop depression, 3.9 times more like to develop chronic obstructive pulmonary disease, 2.4 times more likely to have a stroke, and 2.2 times more likely to have ischemic heart disease.
- ACEs contribute to major chronic health, mental health, and economic and social problems.
What advice do you have for school psychologists working in schools or communities where students are regularly exposed to adverse experiences? Focus first on building your own knowledge base. The U.S. Attorney General's Task Force on Children Exposed to Violence noted that the greatest challenge to trauma-informed service delivery models is the lack of professionals who have the expertise to provide trauma-specific treatment services to children exposed to trauma (U.S. Attorney General, 2013). Layne and colleagues (2011) noted that standard graduate preparation in mental health disciplines does not prepare students to work effectively with youth experiencing complex trauma reactions. School mental health professionals, in particular, often lack expertise in evidence-based trauma treatments (Splett, Fowler, Weist, McDaniel, & Dvorsky, 2013). There are several online training options available, including the National Child Traumatic Stress Network's Core Curriculum on Childhood Trauma (CCCT), designed to "promote the development of a trauma-informed mental health workforce by providing a sound foundational understanding of psychological trauma" (Layne et al., 2011, p. 244).
Focus second on building a workforce that is knowledgeable about trauma and its effect on development and can employ skills and strategies that prevent, reduce, and ameliorate its effects on children. Without such knowledge and training, school personnel may not accurately identify or understand the connection between a child's presentation, behaviors, and symptoms and exposure to adversity and trauma. For example, school staff may misunderstand trauma-related behavioral reactions as oppositional or defiant behavior, inadvertently use discipline strategies that can serve as triggers for traumatized students, and miss opportunities to support social, emotional, and academic growth.
Finally, school psychologists and all educators working with traumatized students must make a commitment to self-care. The nature of the work is taxing and places us at risk for vicarious traumatization. We must prioritize self-care for ourselves and provide education to school staff on the importance of and strategies for self-care.
What are some of the common misconceptions people have about addressing trauma within the school setting? One response to the staggering number of trauma-exposed students in need of treatment has been the provision of school-based trauma-specific treatments. When delivered in schools, these treatments, such as Cognitive Behavioral Intervention for Trauma in Schools (CBITS), increase accessibility to treatment (Jaycox et al., 2010) and have demonstrated medium to large effects in the reduction of traumatic stress reactions (Rolfsnes & Idsoe, 2011). However, despite their promise, isolated interventions and programs are difficult to sustain in resource-strapped community settings, even when they are high-quality, evidence-based programs (Cole et al., 2013; Domitrovich et al., 2010; Flay et al., 2005). Interventions delivered in isolation may lack sufficient buy-in and, without a shared understanding of the problem being targeted by specific interventions, tension can arise when schools attempt to integrate mental health programs into the educational environment (Cole et al., 2013; Evans, Stephan, & Sugai, 2014). In fact, addressing the mental health and behavioral needs of students often is seen as being in direct conflict with the academic mission of the school (Ristuccia, 2013), even though the exact opposite is true.
Trauma-informed schools attempt to resolve this conflict by adopting a universal approach to meet the needs of trauma-exposed youth-and to create safe and supportive schools for all students. Much like universal positive behavioral interventions and supports (PBIS), trauma-informed schools provide a framework for effective practices, interventions, and systems-change strategies focused on building a school culture and learning environment that is responsive to the needs of trauma-exposed students while at the same time benefiting all students (Cole et al., 2013).
Importantly, trauma-informed schools are not "a program" but rather a framework for how to understand and respond to students experiencing trauma. These approaches can and should be integrated into ongoing prevention-intervention programming in the school, such as PBIS, to be both effective and sustainable.
What are some of the biggest challenges in supporting students with trauma histories? Changing the lens through which their behavior is viewed by others. We are too ready to ask, "What is wrong with this student?" instead of the more responsive question, "What has happened to this student?" and how can we help.
What are some cultural differences that school psychologists should be mindful of when planning interventions?Children from all walks of life, cultural backgrounds, and socioeconomic classes experience ACEs, but there may be important differences in the nature of those experiences, reactions to those experiences, and preferences for helping students adapt to those experiences. School psychologists and school administrators must understand and respect the communities in which they are embedded and make efforts to respond in culturally sensitive ways. For example, there is increased interest in universal screening for trauma exposure. However, because of the sensitive nature of trauma screening, it is critical to engage all stakeholders, including parents and community members, in the creation of a screening process that is socially acceptable and ecologically valid. Issues to be considered in this work include determining the best informant (or combination of informants), defining the nature of the violence-related events that will be screened for (school bullying, community violence, etc.), identifying the best measure for symptom identification, determining the best time for the screening, developing procedures for managing the information and maintaining confidentiality, and other considerations.
What suggestions do you have for school psychologists to advocate for and improve collaborative work related to meeting the needs of traumatized students? Successful advocacy requires presenting the problem within a framework to which schools can relate, which is usually in terms of academic functioning. We need to educate powerbrokers about the biological mechanisms through which trauma shapes brain development and illustrate how changes in brain structure and function drive student learning and behavior in the classroom. Similarly, with appropriate strategies, the effects of trauma on brain development can be mitigated, whereas more traditional disciplinary approaches may exacerbate trauma reactions. Emerging literature documents the negative impact of specific types of ACEs on academic functioning, and suggests entry points for prevention and intervention efforts.
Stacy Overstreet, is a professor in the Department of Psychology at Tulane University. She serves as codirector of Tulane's trauma-focused school psychology training specialization within the doctoral-level school psychology program. Dr. Overstreet's current work focuses on the implementation and evaluation of trauma-informed approaches in schools