Practical Intervention Strategies to
Address Impact of Trauma in Schools
May 22, 2013
Co-sponsored by:
 The Qualitative and Evidence Based Practice Group of the
National Community of Practice on Collaborative School
Behavioral Health and the IDEA Partnership at NASDSE
The National Community of Practice (CoP)
on Collaborative School Behavioral Health
 Co-led by the IDEA Partnership at NASDSE and the
Center for School Mental Health at the University of
Maryland
 The focus of the CoP is to collaboratively work to
create a shared agenda across education, mental
health and families.
The National Community of Practice (CoP)
on Collaborative School Behavioral Health
 The CoP affiliates with cross-stakeholder teams that
have created 16 state CoPs modeled on the national
exemplar.
 The CoP affiliates with 22 national organizations and 9
technical assistance centers and coalesces them around
the issues they share.
 Together the states, organizations and TA centers lead
12 issue-based Practice Groups that develop the content
and design the interaction for of the Annual
Conference on Advancing School Mental Health
 18th Annual Conference – October 3-5, 2013 in Crystal City-
Arlington, Virgina
QEBP Practice Group Mission and Priorities
 Co-facilitators:
Nicole Evangelista Brandt, PhD, Center for School Mental Health
Mark Sander, PsyD, LP, Hennepin County/Minneapolis Public Schools
Sharon Stephan, PhD, Center for School Mental Health



 Mission:
To provide resources and promote sharing of information across
individuals/groups interested in improving the quality of school
mental health (SMH)
To discuss, promote, and disseminate evidence based practices in
SMH


 Priority areas include:




Improving dissemination and sharing of evidence-based practices in
SMH
Bridging the research-practice and practice-research gaps in the field
Understanding and promoting the use of the best student-, program-,
and school-level evaluation strategies.
http://www.sharedwork.org/
Follow up …
 Archived recording of webinar and PowerPoint slides

http://www.sharedwork.org/web/school-behavioralhealth/home
 Center for School Mental Health

http://csmh.umaryland.edu/Resources/ArchivedWebinars/in
dex.html
PSYCHOLOGICAL FIRST AID:
Listen Protect Connect/Model and Teach
Copyright M. Schreiber, R.H. Gurwitch, & M. Wong, 2006
Adapted, M. Wong, 2012
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Presented by Marleen Wong, Ph.D.,
Associate Dean and Clinical Professor
University of Southern California, School of Social Work
REMS TA Center http://rems.ed.gov
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• Technical
Assistance
• Website
Resources
• Online Training
Courses
• On-Site Trainings
by Request
Prevention
-Mitigation
Recovery
Preparedness
Response
U.S. Department of Education (ED)
Office of Safe and Healthy
Students (OSHS)
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What is Psychological First Aid?
• Psychological First Aid
is a set of supportive
actions that help
people cope more
effectively
during times of stress.
• American Red Cross
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With Psychological First Aid
Every adult who interacts with
a child plays an important role
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Why is PFA Important?
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• Knowing how to provide Psychological First Aid
can help you to:
• Create a compassionate environment for
everyone in the school.
• Assess what someone may need at the
moment.
• Provide immediate support to those in
stressful situations.
• Help others cope in the face of stressful
events.
Guidelines for PFA
• Keep boundaries
• Be tolerant of differences
• Respect people’s privacy
• Take care of yourself
• Know when to ask for help
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The Goals of PFA
• Establish safety
• Stabilize the emotions and behaviors
• Return your colleague to an improved
mental and emotional state to the
family - ready to resume education
and re-engage in their family
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Adjustment Over Time in Crisis
A = baseline functioning
B = event
C = vulnerable state
D = usual coping mechanisms fail
E = helplessness, hopelessness
F = improved functioning
G = continued impairment (PTS)
H = return to baseline
I = post-traumatic growth
I
A
B
H
C
G
F
D
E
How Does an Adult
Begin to Recover?
It begins with the
the acknowledgement
that there is a problem
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For Survivors Directly Affected
•
•
•
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Parents and students turn to schools for help
after a community tragedy.
Schools are often shelters after a disaster and
become the primary source of community
support.
K-12 schools are one of the first “service
agencies” to resume operations after
community crisis or disaster.
Psychological First Aid after Traumatic Crises:
The Responsibility of Caring Adults
• Listen
• Protect
• Connect
• Model
• Teach
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Listen
• Encourage to share experiences and express
feelings of fear or concern.
• Be willing to listen and respond to verbal and
nonverbal cues.
• Give extra reassurance, support, and
encouragement.
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Listen: You want to convey your interest
and empathy
• Where were you when this crisis happened?
• What was your first thought?
• What do you remember about that day?
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Protect
• Maintain structure, stability, and predictability.
Have predictable routines, clear expectations,
consistent rules, and immediate feedback.
• Keep your ears open and eyes watchful,
especially for aggression toward students,
parents, teachers, or administrators.
• Keep environment free of anything that could
re-traumatize.
• Validate the person’s life experience.
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Protect (cont.)
• What’s the most difficult thing for you to deal
with right now?
• Are you worried about how you are reacting?
• Are you worried about your safety?...
• Around students?
• Around adults at school or outside of school?
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Connect
• Check in with colleagues on a regular basis.
• Encourage interaction, activities, team projects,
trusted family members, teachers.
• Refer or talk to counselors.
• Keep track of and comment on what's going on
in their lives.
• Share positive feedback from students, parents,
teachers, and other adults.
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Connect (cont.)
• What would make things easier to cope with?
• What can I do to help you right now?
• What can your family members do?
• What can your peers or administrators do to
help?
• What can your friends do to help?
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Model Calm and Optimistic Behavior
• Maintain level emotions and reactions – Stay in
the middle – no highs or lows – to help them
achieve balance.
• Take constructive actions to assure school safety.
• Express positive thoughts for the future.
• Help colleagues to cope with day to day
problems.
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Teach About Normal Stress Symptoms
and How to Cope
Acknowledge the normal changes that can occur in
people who are traumatized or grieve:
• Physical Changes
• Emotional Changes
• Cognitive Changes
• Changes in Spiritual Beliefs
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Help to problem solve:
• How to come to work/school everyday.
• How to stay at school everyday.
• How to get along and enjoy friends and family.
• How to manage planning and professional
development.
Adults’ Issues That Affect Students
• Adults may not recognize distress in students or
others.
• Adults may be preoccupied with their own issues.
• Adults may not validate student’s reactions to
trauma.
• Communication between adults may be poor.
• Adults may be compliant in the aftermath of an
event, while silently suffering.
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PFA/LPC in Practice
• LISTEN, PROTECT, CONNECT
• Empathetic, active listening
• Taking steps to protect
• Connect with them
• MODEL, TEACH
• Map their own supports
• Build a basic self-care plan with follow through
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Evaluating Efforts
Desirable Outcomes
• Returns to average educator and student attendance
• Resumes peer and student relationships
• Maintains academic achievement of class(es)
• Look at grades and standardized tests scores
Undesirable Outcomes
• Increased discipline referrals
• Educators absenteeism
• Resignation
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Extra Understanding and Patience BUT…
• Educators, administrators, and school staff
should maintain their expectations for behavior
and performance and should maintain discipline.
• At the same time, however, they can be
prepared to provide extra support,
encouragement, and crisis counseling, if needed,
to help other educators return to the school, and
help students succeed in school.
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Additional Resources
• Listen, Protect, Connect, Model, and Teach: Psychological First
Aid for Students and Teachers
http://www.ready.gov/sites/default/files/documents/files/PFA
_SchoolCrisis.pdf
• REMS Helpful Hints, “Psychological First Aid (PFA) for Students
and Teachers: Listen, Protect, Connect - Model & Teach”
http://rems.ed.gov/docs/HH_Vol3Issue3.pdf
Additional resources, worksheets and exercises will be posted
with the archived webinar on the REMS TA Center website
http://rems.ed.gov
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Contacting the REMS TA Center
TA requests can be made via telephone Monday through Friday.
E-mail requests are responded to during business hours of
operation. Whatever you need, we're willing to help! Requests
for assistance can be made:
• Telephone: 1-866-540-7367 (REMS)
• When you have a quick question, follow-up (e.g., training events).
• Website: http://rems.ed.gov/
• When you need information or resources, or would like to
request TA through the online request form.
• E-mail: tasupport@remstacenter.org
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• When you have a question or need assistance.
Building a Collaborative System for
Educating Traumatized Students
Eric Rossen, PhD, NCSP
National Association of School Psychologists (NASP)
Today’s topics
• Creating trauma sensitive classrooms and
schools
• Integrating learning supports in schools to help
students with trauma histories
• Utilizing existing school-based mental health
supports
• Empowering all educators
Learning Objectives
• At the conclusion of today’s presentation,
attendees should be able to:
▫ Recognize the drawbacks of relying solely on
traditional models of treatment
▫ Understand the importance of developing trauma
sensitive classrooms
▫ Support practices that supplement direct clinical
intervention services for students with trauma
histories
What We Know
• Virtually every classroom has one or multiple
children with adverse experiences
• For many students these experiences begin at an
early age and are chronic
• Adverse events can impact behavioral and
academic performance
• These data suggest the need for a new paradigm
to support these students.
▫ Especially in schools with a high population of
students living in poverty
Poll Question
• Should students with documented trauma
histories that exhibit symptoms of a disability
that overlap with symptoms of trauma receive
special education services?
• Yes
• No
• Depends
Drawbacks of Traditional Models
• Higher likelihood of:
▫
▫
▫
▫
▫
False positives (identification)
Misidentification and application of interventions
Potential for a binary system
Perpetuating mistrust
Ineffective use of resources
NY Times Op-Ed (July, 2012), referring to a high
poverty public school in NYC
• “The traditional therapist’s response, of course,
is to recommend therapy for traumatized
children. But that’s an impossible solution in a
big-city school of 1,000 or more students.”
http://www.nytimes.com/2012/07/28/opinion/noceraaddressing-poverty-in-schools.html
Limitations of Tier III Evidence
Based Treatments
•
•
•
•
Time/Difficult to complete entire EBT protocols
Resources/Cost Efficiency
Hard to build school ownership
Potential for disconnect between mental health
providers and other adults that spend every day
with the student
• Students that may need support not always
identified
• Clinical services not always implicated
• Wait to Fail Model
What do we suggest?
• Supplementing (NOT supplanting) EBT with
classroom-based support by building TraumaSensitive Classrooms and Schools
▫
▫
▫
▫
▫
Raising awareness
Empowering Educators
Providing support throughout the day to all students
Consultation
Increasing effective use of time and knowledge
Supplementing Clinical
Interventions
• Teachers have a stake in responding to trauma
due to its impact on behavior and learning
• Giving teachers the ability to address interfering
factors is essential for enabling learning
• Unify mental health and learning
• Provides support for all students throughout the
day
• May help prevent need for intensive services
Poll Question
• Are classroom teachers equipped to provide
critical supports to traumatized students?
• Yes
• No
Same Op-Ed from NY Times
(7/27/2012)
• “The most disruptive children dominated the
schools. Teachers didn’t have control of their
classrooms — in part because nothing in their
training had taught them how to deal with
traumatized children.”
• “…there are few, if any, pre-service teacher
preparation programs that help educators to
develop skills and coping strategies to detect and
teach traumatized, depressed, or anxious
students.”
Wong, M. (2008). Interventions to reduce psychological harm from traumatic events
among children and adolescents: A commentary on the application of findings to the
real world of schools. American Journal of Preventive Medicine, 35, 398–400.
Empowering All Educators to Play a
Role In Supporting Traumatized
Students
• Provides a different paradigm for why children are
not achieving
• Improves:
• IEP development
• behavior intervention development
• support for therapeutic recommendations
• discipline practices
Ahmed: True Story *Name Changed
• You receive a referral for a Muslim student, age
11 years, because he often seems frustrated and
angry, and sometimes gets into fights with other
students. The teacher reports that while he is
often teased, he loses his temper easily and can
get aggressive.
• How would you typically respond?
Ahmed continued
• Ahmed is originally from Somalia, where he saw his
father and older brother murdered. He fled with his
mother and two younger sisters, leaving behind other
family members he was close with. After spending time
in a refugee camp in Kenya, the family was admitted to
the US with refugee status. Although successfully
resettled in the Midwest, Ahmed’s mother is having
difficulty making ends meet, and they live in a lowincome, high-crime neighborhood. Kids at school call
him “Osama” and tease him for not knowing much
English and being so thin.
Examples For All Educators
• Immigrant Students
▫ Incorporate information about country of origin
into classroom activities
▫ Identify local immigrant community organizations
▫ Focus on student strengths
▫ Support maintenance of home culture
▫ Engage immigrant families as part of school
community
▫ Recruit mentors
▫ Promote tolerance
Examples For All Educators
• Student Experiencing Sexual Abuse
▫ Understand cultural differences
▫ Respond to disclosure with empathy and without
judgment
▫ Help locate and identify needed supports
▫ Be observant
▫ Know the law
Examples For All Educators
• Students with Parents Involved in Substance
Abuse or Dependence
▫
▫
▫
▫
▫
▫
Think practically
Don’t keep it a secret/know the law
Meet basic needs
Know what to say
Become a source of information
Connect with caregivers (even substance abusing
parent)
Creating Trauma Sensitive
Classrooms and Schools
A Three-Legged Stool
Major content areas: Learning Supports
Instructional
Component
Learning
Supports
Component
• Building teacher capacity to re-engage
disconnected students
• Providing support for the full range of
experiences that students and families
encounter
• Responding to and preventing academic,
behavioral, social–emotional problems
and crises
Management
Component
• Increasing community and family
involvement and support
• Facilitating student and family access to
effective services and special assistance
as needed
Utilize School-Employed Mental Health
Professionals/Learning Supports
• Consultation
▫ Individual or classroom level
•
•
•
•
Staff training
Identifying resources
Participation in team/committee meetings
Improve assessment
▫ Routinely include questions about childhood events,
stressors, problems at home or community, etc.
• Data collection
Benefits of Trauma-Sensitive
Schools and Classrooms
• Supportive of primary mission of schools
• Provides supports to all students (prevention)
• Provides tools to school staff and students to
respond to distress
• Supports teachers and reduces burnout
• Improves the “presence” of mental health
providers in schools
• Improves student outcomes
Benefits of Trauma-Sensitive
Schools and Classrooms
• Increasing students’ sense of safety and
connectedness:
▫ Reduces stress response
▫ Increases availability to learn
▫ Increases adoption of prosocial norms
Common themes
•
•
•
•
School-wide focus
Building safe environments
Building student capacities
Building staff capacities
Takeaways From This Series
• Trauma impacts the learning, behavior, and mental
health of many students
• Knowledge of these factors continues to evolve
• Trauma has traditionally been difficult to identify
and distinguish from psychological disorders or
educational disabilities
• The traditional “wait to fail” disorder model is
insufficient to support and educate students
impacted by trauma (you can’t do it alone)
• Mental health providers are key players in creating
trauma-sensitive systems
By the way…
• Don’t forget to take care of yourself!
• Secondary traumatic stress is real
▫
▫
▫
▫
▫
Working with vulnerable students
Empathy
Insufficient recovery time
Unresolved personal trauma
Lack of resources
• Taking care of yourself is not selfish – it helps
you help others.
Resources
▫ RAND: How You Can Help Students Recover from
Traumatic Experiences (Free)
▫ Creating Trauma Sensitive Schools to Improve
Learning: WI Dept. of Public Instruction (Free)
▫ Helping Traumatized Children Learn [Trauma
and Learning Policy Initiative (Free)
▫ Child Trauma Toolkit for Educators: NCTSN
(Free)
▫ Massachusetts Trauma Sensitive Schools website
(www.doe.mass.edu/tss/)
▫ Supporting and Educating Traumatized Students:
A Guide for School-based Professionals
(DISCLAIMER)
THANK YOU
Eric Rossen
erossen@naspweb.org
www.nasponline.org