Trauma Sensitive Schools
Karen Yost, MA, LSW, LPC,NCC, ALPS, MAC,
CCDVC, CSOTS
Prestera Center
Learning Objectives
As a result of this training, participants will:
 Understand the prevalence & impact of traumatic
experiences on the health & well-being of students,
including the impact on the ability to learn
 Be able to define & promote the principles &
components of trauma-sensitive care
 Be able to identify evidence-based practices for students
who have experienced trauma in the school setting.
2
Have you ever had a student who was…
irritable or hostile?
avoidant of school?
chronically poor in self-care health habits?
exhibiting confusion or poor memory when being
questioned?
 stoic and reluctant to admit to problems, or
extremely needy and/or demanding?
 presenting with a history of alcohol/substance
abuse, depressive symptoms, chronic
relationship difficulties and/or intermittent
employment history?
 problems with learning?




2
You Are Not Alone!
 Youth with histories of trauma are likely to
present to schools with some (or many) of these
characteristics.
 Their behavior can interfere with learning,
student-teacher communication, impede
compliance with instructions/rules, and
generally, frustrate the school staff.
 More importantly, these youth are at high risk for
academic failure and deteriorating health.
Most youth who have experienced traumas do
not seek mental health services.
4
Take Home Message
 Trauma is pervasive
 Trauma’s impact is broad, diverse and often life-
shaping
 School personnel can prevent retraumatization:
Do No Harm
 Educators and providers can have a healing effect:
Healing Happens in Relationships
5
Trauma Defined…
 “an emotional shock that creates significant and lasting
damage to a person’s mental, physical and emotional
growth.”
 Traumatic experiences can significantly alter a person’s
perception of themselves, their environment, and the people
around them. In effect, trauma changes the way people view
themselves, others and their world.
 Can impact safety, well-being, permanence.
Trauma occurs in layers, with each layer affecting
every other layer. Current trauma is one layer.
Former traumas in one’s life are more fundamental
layers. Underlying one’s own individual trauma
history is one’s group identity or identities and the
historical trauma with which they are associated.
Bonnie Burs
7
Prevalence
 70‐80% of mental health clients have severe trauma histories
 In state hospitals, estimates range up to 95%
 90% or more of women in jails and prisons are victims of
physical or sexual abuse
 Up to 2/3 of men and women in substance abuse treatment
report childhood abuse or neglect
 Similar statistics exist for foster care, juvenile justice, homeless
shelters, welfare programs, etc
 Boys who experience or witness violence are 1000 times more
likely to commit violence
Vulnerable Populations
 Children & women
 American Indian/Alaska Native
 Veterans
 Refugees and immigrants
 People who are homeless
 People who are institutionalized in mental health or criminal
justice systems
Staggering Financial Burden of
Childhood Abuse & Trauma
 Annual Direct Costs: Hospitalization, Mental Health Care
System, Child Welfare Service System, Law Enforcement =
$33,101,302,133.
 Annual Indirect Costs: Special Ed, Juvenile Justice, Mental
Health & Health Care, Criminal Justice System, Lost
Productivity = $70,652,715,359.
 Total Annual Cost: $103,754,017,492 (over $184 million
dollars a day).
Economic Impact Study. (September, 2007). Prevent Child Abuse America
Trauma is…
 NOT a diagnostic category
 A series of experiences that elicits feelings of terror,
powerlessness, & out-of-control psychological arousal; result
in survival driven behaviors, thoughts, emotions, & needs.
 Often misinterpreted & assigned as symptoms of disorders
(depression, Bipolar Disorder, ADHD, Oppositional Defiant
Disorder, Conduct Disorder, Attachment Disorder, etc.).
 These diagnoses generally do not capture full extent of
developmental impact of trauma.
Exposure to Trauma
Trauma can be:
•A single event
•A connected series of events
•Chronic lasting stress
Trauma is under-reported and under-diagnosed.
(NTAC, 2004)
Types of Traumatic Experiences
 Loss of a loved one
 Serious medical Illness
 Abandonment
 Physical abuse
 Accidents
 Sexual abuse
 Homelessness
 Emotional/verbal abuse
 Community/school
 Man-made or natural




violence
Bullying, including cyberbullying
Domestic violence
Neglect
Frequent moves
disasters
 Witnessing violence
 Terrorism
 Refugee and War Zone
trauma
Types of Trauma
A single traumatic event
that is limited in time.
The experience of multiple
traumatic events.
Acute
Trauma
Chronic
Trauma
Vicarious
Trauma
Complex
Trauma
Both exposure to chronic trauma, and the
impact such exposure has on an
individual.
System
Induced
Trauma
The traumatic removal from home,
admission to a detention or residential
facility or multiple placements within a
short time.
Trauma can occur at any age.
Trauma can impact
anyone.
Impact of Trauma Over the Life Span
ACE Study - effects are neurological,
biological, psychological and social
in nature, including:
 Changes in neurobiology
 Social, emotional and cognitive
impairment
 Adoption of health-risk behaviors
as coping mechanisms
 Severe and persistent behavioral
health, physical health, social
problems, and early death
(Felitti)
16
Adverse childhood experiences
increase the risk of:
Heart
Disease
4 or more
traumatic
experiences
shorten life
expectancy by 20
years
Immune
Diseases
Chronic
Lung Disease
Adverse
Childhood
Experiences
Liver
Disease
Cancer
Diabetes
Adverse childhood experiences
increase the risk of:
Mental
Illness
4 or more
traumatic
experiences
shorten life
expectancy by 20
years
Relationship
Problems
Suicide
Adverse
Childhood
Experiences
Substance
Abuse
Behavior
Problems
Poor SelfEsteem
Impact of Exposure to Trauma
Can cause impairments in many areas of development &
functioning, including:
 Attachment – Difficulty relating to & empathizing with
others; believe the world to be uncertain & unpredictable
 Biology – problems with sensation & movement, including
hypersensitivity to physical contact & insensitivity to pain;
physical symptoms & increased medical problems
Impact of Trauma, cont.
 Mood Regulation – difficulty identifying & controlling
emotions & internal states
 Behavioral Control - poor impulse control, self-
destructive behavior, aggression, risk taking
behavior
 Dissociation – feeling detached, as if observing
something happening to them that is not real
Impact of Trauma, cont.
 Cognition – difficult focusing & completing tasks or
anticipating future events; learning difficulties & problems
with language development
 Self-concept – feeling shame/guilt; low self-esteem,
disturbed body image
 Loss & Betrayal - loss of part(s) of their life; distrust of
others
 Powerlessness – perceive self as victim; have no say in
what happens to them; unable to control their lives, etc.
Impact on Learning & School Behavior
 Loss of pleasure in learning & displays inconsistent or






little effort
Belief that they are not smart - especially LD students
Re-live the painful, burning memories of shaming
experiences
Exhibit chronic, habitual anger toward teachers and
those in authority
Inconsistent attendance/truancy
Low appetite for risk-taking academically and in other
areas (“I don’t care”)
Behavior problems
A Vignette
Robert, Ben, and Sam were walking home from high school. A car drove by playing loud music.
Ben recognized a gang member in the car who had earlier threatened him. "Let's get out of
here!" he said. Before the boys could get away, the car stopped and four gang members
surrounded them. All three boys were beaten. Ben's nose was broken, Robert's front teeth were
knocked out, and Raul received a black eye and a fractured rib. In the weeks that followed, each
had a very different reaction in school.
Robert became reluctant to attend school. When he went to school, he did not participate in
discussions as much as before and was more irritable with his friends and teachers. Previously a
conscientious student, Robert began giving excuses for not completing his homework and did
poorly on his most recent exam.
Ben seemed to enjoy the notoriety given him from being jumped, and tended to become more
aggressive and outspoken with his peers. In class, Ben expanded his role as class clown, now
including the teacher in his sarcastic remarks, for which he was repeatedly sent to the office.
Sam showed no obvious signs at school following the experience. He continued in the same
manner with his friends and in the classroom. According to Robert, however, each day Raul
insisted on taking a different route home from school from the one they took when they were
23 beaten.
School-Related Impact
 Frequently moved from school to school with poor




transitions for new students
Labeled as “less than” academically – high referrals for
Special Education
Have experienced humiliation in a variety of ways and for
many reasons-academics, physical characteristics,
popularity, social class-in the school setting
Considered to be “less than,” “wrong,” or “not capable”
– lowered expectations by school staff
Staff interventions may be counterproductive or
retraumatizing
Trauma and the Brain
 Has serious consequences for normal development of
children’s brains, brain chemistry & nervous system.
 Trauma-induced alterations in biological stress symptoms can
adversely effect brain development, cognitive & academic
skills, & language development.
 Result in increased levels of stress hormones (impacts
response to future stress)
Trauma and the Brain, cont.
Affects “cross-talk” between brain’s hemispheres, including
parts that:
 regulate emotions
 manage fears, anxieties & aggression
 sustain attention for learning & problem solving
 control impulses & manage physical responses to danger
 allow realistic appraisal of danger & safety
 promote consideration of consequences of behavior
 allow ability to govern behavior & meet longer term goals
The Influence of Culture
 People of different cultural, national, linguistic, spiritual &
ethnic backgrounds may define & describe “trauma”
differently
 Assessment of trauma history should always take into
account cultural background & modes of communication of
assessor and family
 Strong cultural identify & community/family connections can
contribute to strength & resilience or can increase risk for &
experience of trauma.
The Influence of Development
 Child traumatic stress reactions vary by developmental
stage.
 Children with traumatic experiences may spend much
energy responding to, coping with, & coming to terms with
the experience – results in delays in mastering ageappropriate developmental tasks – delayed development
 The longer traumatic stress goes untreated, the farther
children tend to stray from appropriate developmental
pathways.
The Influence of Developmental Stage
 Child traumatic stress reactions vary by developmental stage.
 Children who have been exposed to trauma expend a great deal
of energy responding to, coping with, and coming to terms with
the event.
 This may reduce children’s capacity to explore the environment
and to master age-appropriate developmental tasks.
 The longer traumatic stress goes untreated, the farther children
tend to stray from appropriate developmental pathways.
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The Influence of Developmental Stage:
Young Children
 Young children who have experienced trauma may:
 Become passive, quiet, and easily alarmed
 Become fearful, especially regarding separations
and new situations
 Experience confusion about assessing threat and
finding protection, especially in cases where a
parent or caretaker is the aggressor
 Regress to recent behaviors (e.g., baby talk, bed-
wetting, crying)
 Experience strong startle reactions, night terrors, or
aggressive outbursts
30
The Influence of Developmental Stage:
School-Age Children
 School-age children with
a history of trauma may:
 Experience unwanted and intrusive thoughts and
images
 Become preoccupied with frightening moments
from the traumatic experience
 Replay the traumatic event in their minds in order
to figure out what could have been prevented or
how it could have been different
 Develop intense, specific new fears linking back to
the original danger
31
The Influence of Developmental Stage:
School-Age Children, cont.
School-age children may also:
 Alternate between shy/withdrawn behavior and
unusually aggressive behavior
 Become so fearful of recurrence that they avoid
previously enjoyable activities
 Have thoughts of revenge
 Experience sleep disturbances that may
interfere with daytime concentration and
attention
32
The Influence of Developmental Stage:
Adolescents
In response to trauma, adolescents may feel:
 That they are weak, strange, childish, or “going
crazy”
 Embarrassed by their bouts of fear or exaggerated
physical responses
 That they are unique and alone in their pain and
suffering
 Anxiety and depression
 Intense anger
 Low self-esteem and helplessness
33
The Influence of Developmental Stage:
Adolescents, cont.
These trauma reactions may in turn lead to:
 Aggressive or disruptive behavior
 Sleep disturbances masked by late-night studying,
television watching, or partying
 Drug and alcohol use as a coping mechanism to deal
with stress
 Over- or under-estimation of danger
 Expectations of maltreatment or abandonment
 Difficulties with trust
 Increased risk of revictimization, especially if the
adolescent has lived with chronic or complex trauma
34
The Influence of Developmental Stage
Adolescents, Trauma, & Substance Abuse
 Adolescents who have experienced trauma may use
alcohol or drugs in an attempt to avoid overwhelming
emotional and physical responses. In these teens:
 Reminders of past trauma may elicit cravings for drugs or
alcohol.
 Substance abuse further impairs their ability to cope with
distressing and traumatic events.
 Substance abuse increases the risk of engaging in risky activities
that could lead to additional trauma.
 Counselors must consider the link between trauma and
substance abuse and consider referrals for relevant
treatment(s).
35
The Influence of Developmental Stage:
Specific Adolescent Groups
 Homeless youth are at greater risk for experiencing trauma
than other adolescents.
 Many have run away to escape recurrent physical, sexual, and/or
emotional abuse
 Female homeless teens are particularly at risk for sexual trauma
 Special needs adolescents are 2 to 10 times more likely to
be abused than their typically developing counterparts.
 Lesbian, gay, bisexual, transgender or questioning (LGBTQ)
adolescents contend with violence directed at them in
response to suspicion about or declaration of their sexual
orientation and gender identity
36
Variability in Responses to Traumatic Events
The impact of a potentially traumatic event depends
on:
 Individual’s age & developmental level
 Individual’s perception of the danger faced
 Whether the individual was victim or perpetrator
 Individual’s relationship to victim or perpetrator
 Individual’s past experience with trauma
 Adversities the individual faces following the
trauma
 Presence/availability of others who can offer
help/support/protection
TRIGGERS
For trauma survivors, it is different…
What is a Trigger?
This
A conditioned response
that happens
automatically when faced
with a stimuli associated
with traumatic
experiences
Not This
Triggers
Seeing, feeling, hearing, smelling something that reminds us of
past trauma
Activates the alarm system…
The response is as if there is current danger.
Thinking brain automatically shuts off in the face of triggers.
Past and present danger become confused.
Our experience.
A trauma survivor’s
experience.
We all have buttons that can be pushed…
Your response is keyNonTrauma
Informed
Response
Trigger
Trigger
Negative
Outcome
Trauma
Informed
Response
Positive
Outcome
Protective Factors
• Parental/caregiver resilience
• Social connections
• Knowledge of parenting and child development
• Concrete support in times of need
• Nurturing and attachment/social and emotional
competence of children
“It’s about the right to have a
present and a future that are not
completely dominated and
dictated by the past.”
Karen Saakvitne
TRAUMA–SENSITIVE PRACTICE
Trauma Informed
Non-Trauma Informed
Recognition of high prevalence of
trauma
Lack of education on trauma
prevalence & “universal”
precautions
Recognition of primary and cooccurring trauma diagnoses
Over-diagnosis of Schizophrenia &
Bipolar D/O, Conduct D/O &
singular addictions
Assess for traumatic histories &
symptoms
Cursory or no trauma assessment
Recognition of culture and practices
that are re-traumatizing; emphasis
on learning more than correctness
“Tradition of Toughness” valued as
best care approach
TRAUMA-SENSITIVE PRACTICE
Trauma Informed
Non-Trauma Informed
Power/control minimized - constant
attention to culture; help kids regain
belief that they can learn;
consequences not punishment
Staff demeanor, tone of voice;
engage in power struggles;
punishment oriented
Caregivers/supporters –
collaboration
Judgment of parents/caregivers;
discounting of perspective; failure to
engage in partnership
Address training needs of staff to
improve knowledge & sensitivity
“Student-blaming” as fallback
position without training
Staff understand function of
behavior as an attempt to cope
Behavior seen as intentionally
provocative
TRAUMA-SENSITIVE PRACTICE
Trauma Informed
Non-Trauma Informed
Objective, neutral language – avoid
labeling
Labeling language: manipulative,
needy, “attention-seeking”; slow;
lazy; trouble-maker; problem-child
Transparent systems open to
outside parties
Closed system – advocates
discouraged
(Fallot & Harris, 2002; Cook et al., 2002, Ford, 2003, Cusack et al., Jennings, 1998, Prescott, 2000)
Trauma Informed Systems
UNIVERSAL PRECAUTIONS
Presume that every person in a treatment setting has been
exposed to abuse, violence, neglect, or other traumatic
event(s).
“What has
happened to you?”
Though no one can go back
and make a brand new start,
anyone can start from now
and make a brand new
ending.
Carl Bard
Trauma is when
people live with
more fear than
hope.
Trauma
Recovery
is when
people live
with more
hope than
fear…
What matters most…
How people cope with trauma determined by:
 How they experience what they are exposed to
 Who they were exposed to in their traumatic past
 What they are exposed to in the present
environment
Trauma-Sensitive Care
Trauma-Sensitive Care provides a new paradigm
under which the basic premise for organizing
services is transformed from
“What’s wrong with you?”
“What happened to you?”
54
TRAUMA-SENSITIVE CARE
Provides the foundation for a basic
understanding of the psychological,
neurological, biological, and social
impact that trauma and violence have
on many people.
55
Incorporates proven practices into
current operations to deliver services that
acknowledge the role that violence and
victimization play in the lives of most of
the individuals entering our systems.
Trauma-Sensitive Paradigm
 Understanding of Trauma
 Understanding of the Student/Survivor
 Understanding of Services
 Understanding of the Service Relationship
Understanding of Trauma
 Traumatic events are not rare; experiences of life disruption are
pervasive and common
 The impact of trauma is seen in multiple, apparently unrelated
life domains
 Repeated trauma is viewed as a core life event around which
subsequent development organizes
 Trauma begins a complex pattern of actions and reactions
which have a continuing impact over the course of one’s life
Understanding Student/Survivor

An integrated, whole person view of individuals and their
problems and resources

“Symptoms” are understood not as pathology but primarily
as attempts to cope and survive; what seem to be symptoms
may more accurately be solutions

A contextual, relational view of both problems and solutions

Appropriate and collaborative responsibility allocation
Understanding of Services
 Primary goals are empowerment and recovery
 Survivors are survivors; their strengths need to
be recognized
 Intervention priorities are prevention driven
 Risk to the student is considered along with risk
to the system and the school
Understanding of Service Relationship
 A collaborative relationship between the student and the
school staff, particularly teacher
 Both the student and the staff are assumed to have valid and
valuable knowledge bases
 The student is an active planner and participant in the
education process
 The student’s safety must be guaranteed and trust must be
developed over time
A Culture Shift: Core Principles of a TraumaSensitive System
 Safety: Ensuring physical and emotional safety
 Trustworthiness: Maximizing trustworthiness,
making tasks clear, and maintaining appropriate
boundaries
 Choice: Prioritizing choice and control
 Collaboration: Maximizing collaboration and sharing
of power with students
 Empowerment: Prioritizing student empowerment
and skill-building
Essential Elements of TSC
 Maximize one’s sense of security
 Assist individual in reducing overwhelming emotion.
 Help individual make new meaning of trauma history
& current experiences.
 Address impact of trauma & subsequent changes in
one’s behavior, development & relationships.
 Coordinate services with other agencies/systems.
Essential Elements, cont.
 Utilize comprehensive assessment of trauma experiences &
their impact on development & behavior to guide services
 Support & promote positive & stable relationships in the life
of the individual.
 Provide support & guidance to the school staff and
family/caregivers.
 Manage professional & personal stress.
“Don't
ever take a fence
down until you know why
it was put up.”
-Robert Frost
What Can a School Counselor Do?
 Recognize that exposure to trauma is the rule, not the




65
exception, among children in the child welfare system.
Recognize the signs, symptoms & cumulative effect of child
traumatic stress and how they vary in different age groups.
Recognize that children’s “bad” behavior is sometimes an
adaptation to trauma.
Understand the impact of trauma on different
developmental domains.
Help teachers understand how their own communication
style brings on behavior that hinders learning (disruption,
passivity, anxiety).
What Can a School Counselor Do?
 Recognize that education system responses/interventions have
the potential to either exacerbate or decrease the impact of
previous traumas.
 Lessen the risk of system-induced secondary trauma by serving
as a protective and stress-reducing buffer for children:
 Develop trust with children through listening, frequent
contacts, and honesty in order to mitigate previous traumatic
stress.
 Avoid repeated interviews, especially about experiences of
sexual abuse.
 Avoid making professional promises that, if unfulfilled, are
likely to increase traumatization.
66
Approaches to Assessment of Trauma
Three basic approaches to assessment of trauma
and post-traumatic sequelae through tools and
instruments:
 Instruments that directly measure traumatic experiences
or reactions
 Broadly based diagnostic instruments that include PTSD
subscales
 Instruments that assess symptoms not trauma specific
but commonly associated symptoms of trauma
Wolpaw & Ford 2004
Screening/Diagnosis Issues
 Identification of PTSD or sub-threshold PTSD symptoms is
complicated by the fact that these symptoms mimic
symptoms of anxiety and depression
 Many individuals with PTSD also abuse alcohol and drugs
 If trauma screening isn’t conducted, these individuals are
usually treated as people with just depression, or just
anxiety, or just AOD
Hallmark PTSD Symptoms
 Reexperiencing the traumatic event (nightmares, intrusive




memories, flashbacks, etc.)
Intense psychological or physiological reactions to internal
or external cues that symbolize or resemble some aspect of
the original trauma
Avoidance of thoughts, feelings, places, &/or people
associated with the trauma
Emotional numbing (detachment, estrangement, loss of
interest in activities, etc.)
Increased arousal (heightened startle response, sleep
disturbance, irritability, etc.)
Universal Screener for Mental Health,
Substance Abuse & Trauma
Screening Questions for Mental Health
 Have you ever been worried about how you are thinking, feeling, or acting?
 Has anyone ever expressed concerns about how you were thinking, feeling, or acting?
 Have you ever harmed yourself or thought about harming yourself?
Screening Questions for Substance Abuse



Have you ever had any problem related to your use of alcohol or other drugs?
Has a relative, friend, physician, counselor, or other person been concerned about your drinking or
other drug use or suggested that you cut down or stop drinking/using?
Have you ever said to another person, “No, I don’t have an alcohol or drug problem,” when you
questioned yourself and felt, maybe I do have a problem?
Screening Questions for Trauma
 Have you ever been hit, kicked, choked, or received a more serious punishment from a parent or other
adult?
 Has anyone ever touched you in a sexual way or made you touch them when you did not want to?
 Have you had an experience that was so frightening, horrible, or upsetting that you have nightmares,
upsetting thoughts or memories that come to your mind against your will or have bodily reactions (felt
numb or detached from others/surroundings, been constantly on guard/watchful or easily startled, fast
heartbeat, stomach churning, sweatiness, dizziness, etc.) when you are reminded of the event?
Guiding Values of Trauma-Informed Care
“Healing Happens in Relationship”
71
Thoughts from Helen Keller
 The extraordinary Helen Keller, despite being blind and
deaf, achieved so much in her life. She once said:
“The world is moved not only by the mighty shoves of the
heroes, but also by the aggregate of the tiny pushes of each
honest worker.”
Each of you is a “honest worker” caring and giving so much of
yourselves to help others. If you all push a little you can move
mountains and yourselves. You are so intertwined, you
caregivers and care recipients, that rules and regulations that
are aimed at helping them also help you, and rules and
regulations that are designed to help you also help them.
72