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Trauma-Informed Care and Trauma-Informed Care and Practices in School-Based Practices in School-Based SettingsSettings

Mark R. Groner, MSSA, LISW-SJoan Blackburn, MSSA, LISW-SCarol Hoffstetter, MSW, LISW-SDominic Ferrante

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Learning ObjectivesLearning Objectives1: Convey the importance of a trauma-

informed care approach when screening, assessing, treating trauma

II. Impart knowledge about the use of trauma-informed care evidence-based practices in school settings in order to advance resiliency as a buffer to adversity and trauma, as well as to address trauma and complex trauma

III. Impart knowledge about the benefits and challenges of school-based service provision when treating trauma and complex trauma in school-based settings

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Beech Brook, providing 163 Beech Brook, providing 163 years of hope to children and years of hope to children and families.families.

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A word about our history of A word about our history of being an early adopter of being an early adopter of trauma-informed care.trauma-informed care.

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Our approach has Our approach has included:included:Use of an internal Trauma-Informed Care

Team with ongoing self-study and continuous performance improvement activities

Use of state and national learning communities

Development of internal experts

Use of evidence-based trauma-informed care practice models

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Why is a trauma-informed Why is a trauma-informed care approach so essential?care approach so essential?

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Let’s define “trauma,” Let’s define “trauma,” “complex trauma,” and “complex trauma,” and “secondary traumatic stress.”“secondary traumatic stress.”

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What kinds of experiences What kinds of experiences result in trauma? What result in trauma? What aspects of child development aspects of child development get derailed?get derailed?

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Psychological Trauma Impacts Psychological Trauma Impacts the Brainthe Brain

Part of Brain Role Impact

Amygdala (becomes over-reactive)

Management of emotions

Emotional dysregulation

Hippocampus (shrinks)

Memory and memory consolidation

Impaired memory

Broca (gets smaller and deactivated)

Speech Shuts down speech

Prefrontal Cortex Executive functioning

Impaired thinking, judgment, and processing

Cortisol (gets over-produced)

Hormone (chemical secreted by an endocrine gland)

Triggers amygdala resulting in fight, flight, freeze responses

Norepinephrine (gets released)

Neurochemical (chemical released from a nerve cell)

Hypervigilence

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Definition of Trauma-Definition of Trauma-Informed Screening and Informed Screening and AssessmentAssessment

Trauma-informed screening: a brief, focused inquiry, often in the form of a tool, to determine whether or not an individual has experienced specific traumatic events.

Trauma assessment: a more in-depth exploration of the nature and severity of the traumatic events, the sequelae of those events, and current trauma-related symptoms.

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Our general approaches to Our general approaches to trauma treatment trauma treatment 1. Provide & ensure safety.2. Fix a broken system.3. Maintain a positive and consistent therapeutic

relationship.4. Tailor the therapy, taking into consideration

client realities.5. Take gender and sociocultural issues into

account.6. Practice ethically, within sound standards of

care, and with appropriate boundaries to prevent “counteractivation” (unwittingly becoming unduly assertive or passive).

7. Take care of yourself and your team.

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Models of trauma Models of trauma treatmenttreatmentOver 500 documented treatments

available for children and adolescents (Kazdin, 2000).

NCTSN lists over 40 evidence informed treatments that focus specifically on trauma and new ones are constantly being developed (NCTSN at http://www.nctsn.org/resources/topics/treatments-that-work/promising-practices

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PATHS PATHS

Promoting Alternative THinking Strategies

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PATHSPATHS ◦What is PATHS? Why Promote it? ◦ -Evidenced Based Curriculum for promoting social and emotional awareness in children

◦Research findings:◦ - 23% improvement in social and emotional skills◦ - 9% improvement in attitudes about self, others school◦ - 9% improvement in classroom behavior◦ - 9% decrease in aggression◦ - 10% decrease in emotional distress such as

anxiety and depression◦ - 11 percentile point gain in achievement test scores

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Key Components Key Components

◦ComplimentsComplimentsPATHS Kid of the DayPATHS Kid of the Day

◦Impulse ControlImpulse Control◦ Do the Do the TurtleTurtle! !

◦Feelings and Behaviors Feelings and Behaviors ◦ Comfortable and Uncomfortable Comfortable and Uncomfortable ◦ OK and Not OK OK and Not OK

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Key SEL CompetenciesKey SEL Competencies

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Evidenced Based Evidenced Based ModelsModelsTrauma Focused Cognitive Behavioral

Therapy (TFCBT)◦ A structured, evidence based model of therapy that addresses the

unique biopsychosocial needs of children with PTSD or other problems related to traumatic life experiences

◦ Children and parents are provided knowledge and skills related to processing the trauma

-Psycho Education Normalize the response of the trauma

-Relaxation/Stress Management Breathing exercisesprogressive muscles relaxationThought stopping

-Affect Regulation“Emotions Color Wheel” good resourceAll feelings are OK

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Evidenced Based Evidenced Based ModelsModelsTrauma Focused Cognitive Behavioral Therapy

(TFCBT)-Cognitive Coping

Goal: practice the skill of developing many ways to thing about a given situationPositive self talk, challenge thinking errors Cognitive triangle Recognize how one is coping well

-Trauma Narrative Gradually desensitize the traumatic event Use words, pictures, poems, song- get them to tell their story

-In-VivoGradual exposure, dealing with remaining avoidant behaviors

Conjoint Parent Child Sessions-Prepare parent for narrative sharing, sharing and praise for progress

Enhancing Future Safety and Development

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Evidenced Based ModelsEvidenced Based ModelsAlternatives for Families Cognitive

Behavioral Therapy (AFCBT)◦ An approach for working with families that experience

frequent conflicts that may result in excessive arguments or use of physical force or discipline.

◦ Appropriate for use with physically coercive/abusive parents and their school aged children Adopts a comprehensive approach to treatment

targeting the contributors of the angry and aggressive behaviors and the impact of these behavior's on a child’s development

The model is designed to help parents take responsibility for what has occurred and learn new ways of problem solving, conflict resolution and parenting skills.

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Evidenced Based ModelsEvidenced Based ModelsOutcomes of AFCBT

Caregiver/child verbal and physical aggression Family conflict Recidivism (caregiver)

Child safety Child social competence Parental nurturing Family cohesion Kolko, 1966, Kolko et al., 2011, 2012, 2014

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Trauma and Grief Component Trauma and Grief Component Therapy for AdolescentsTherapy for AdolescentsAssessment-driven manualized individual and

group treatment model for trauma-exposed or traumatically bereaved older children and adolescents.

Designed for youth and transitional youth between the ages of 12 and 20 years, including those impacted by community violence, traumatic bereavement, natural and man-made disasters, war/ethnic cleansing, domestic violence, witnessing interpersonal violence, medical trauma, serious accidents, physical assaults, gang violence, and terrorist events

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Trauma and Grief Component Trauma and Grief Component Therapy for AdolescentsTherapy for Adolescents

The intervention is assessment-driven, with specific treatment modules selected based on clients' problems, needs, and strengths.

Model contains a variety of components.:◦ An initial assessment, case conceptualization, and treatment planning◦ Psychoeducation◦ Emotional regulation skills◦ Addressing youths' and families' traumatic stress experiences and reactions◦ Promoting adaptive coping (e.g., social support, problem-solving, contending with trauma and

loss reminders),◦ Addressing maladaptive beliefs relating to trauma and loss,◦ Promoting adaptive developmental progression◦ Addressing grief and loss,◦ Maintaining adaptive routines,◦ Relapse prevention, and (k) ongoing monitoring, surveillance, and evaluation of treatment

response.

Family/parent sessions are offered at key points in treatment.

Assessment tools are available to measure all major targeted therapeutic outcomes.

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Cognitive Behavioral Interventions Cognitive Behavioral Interventions for Trauma in Schools - CBITSfor Trauma in Schools - CBITS

“CBITS is a school-based, group and individual intervention. Designed to reduce symptoms of post-traumatic stress disorder (PTSD), depression, and behavioral problems, and to improve functioning,

grades and attendance, peer and parent support, and coping skills.”

CBITS uses cognitive-behavioral techniques to help youth, grades 5-12, who may have experienced a

variety of stressful and traumatic life events. The model incorporates psycho-education, relaxation, social

problem-solving, cognitive restructuring, and exposure.http://cbitsprogram.org

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Outcome Data 2013 & 2014 Outcome Data 2013 & 2014

2013 & 20142013 & 20142012012013220132

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Actively Caring For PeopleActively Caring For People

Creating a more compassionate community through intentional acts of kindness

May 5th, 2012

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AC4PAC4PAActively ctively CCaring aring FFor or PPeopleeople

Founded by E. Scott Geller, Ph.D., Director of the Center for Applied Behavior Systems, Virginal Tech University initially focusing on workplace safety, psychology of safety, behavioral safety interventions.

In 2007, the AC4P movement at Virginia Tech began to develop a kinder, more compassionate and interdependent culture.

In 2009, Shane McCarty, Ph.D. candidate, Department of Organizational Psychology, Virginia Tech University, expanded AC4P to focus on enhancing school climate.

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Foundations of Foundations of AC4PAC4P

AC4P is about “intentional acts of kindness. Random implies chance.

Requires personal interaction with others. Takes moral courage. Behavior based feedback to support desired

behavior. Emphasizes a youth led, peer-to-peer model. Research done on the Elementary and Middle

School approaches show promising outcomes (McCarty & Geller, 2013) and (McCarty, Teie, Langerman & Geller, 2014).

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McCarty, 2014

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There are advantages of There are advantages of providing trauma treatment in providing trauma treatment in schools.schools.

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There are disadvantages of There are disadvantages of providing trauma treatment in providing trauma treatment in schools.schools.

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This is a plug for attention to This is a plug for attention to secondary traumatic stress and secondary traumatic stress and burnout.burnout.

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