UNDERSTANDING AND ADDRESSING
CHILDHOOD TRAUMA: THE ROLE OF
INFORMED CARE
1
Gordon R. Hodas MD
2012 Conference on the State of Education
in Pennsylvania – Calling for a TraumaInformed Educational System
Cheyney University, Friday, 5/25/12
INTRODUCTION
GORDON R. HODAS MD
 Statewide Child Psychiatric Consultant to PA Office
of Mental Health and Substance Abuse Services
(OMHSAS), 19+ years.
 Child and Adolescent Policy Consultant to Bucks
County Behavioral Health System (BHS), 7 years
 Consultant Psychiatrist & Associate Medical
Director, Wordsworth Academy, Fort Washington PA
 No financial disclosures or conflicts of interest
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INTRODUCTION
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TRAUMA-RELATED EXPERIENCE/EXPERTISE
 1999 – OMHSAS presentation, S/R reduction.
 2003 – Consultant to CWLA Workgroup
 2004 – Faculty member for NETI/NASMHPD training
 2004 – Involvement in DPW S/R, TIC initiative
 2005 – Publication by NASMHPD of paper on TIC.
 2005 on – Additional articles, T/A documents.
 2007 on – Regional SAC (Stakeholders Advisory
Committee) for youth in RTFs, initiated by BC.
 1992 on – Clinical consultation in Special Ed
CREATING THE FRAMEWORK
SAMHSA’S TEN STRATEGIC INITIATIVES (2010)
 Priority #2 = Violence and Trauma
Reduce the behavioral health impacts of violence
and trauma, and integrate trauma-informed services
in prevention and treatment programs in States and
communities and throughout the health service
delivery system, to address root causes of
pervasive, harmful, and costly public health
problems (my underlining).
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CREATING THE FRAMEWORK
THREE KEY ISSUES
 What are the potential outcomes of significant
childhood trauma and adversity, during childhood
and over the lifespan?
 What can be done to decrease the impact, and the
frequency, of childhood trauma, and how is this
related to trauma informed care?
 What additional steps can be taken, in the
community and in the educational system?
 Bottom line: TIC an attitude and mind-set about
youth, which leads to positive practices.
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HEALTHY DEVELOPMENT
Healthy Development
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HEALTHY DEVELOPMENT
BRAZELTON AND GREENSPAN: THE
IRREDUCIBLE NEEDS OF CHILDREN (1)
 Focus: “What every child must have to grow, learn,
and flourish” – 7 irreducible needs
 Ongoing nurturing relationships.
 Physical protection, safety, and regulation.
 Experiences tailored to individual differences.
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HEALTHY DEVELOPMENT
IRREDUCIBLE NEEDS OF CHILDREN (2)
 Developmentally appropriate experiences.
 Limit setting, structure, and expectations.
 Stable, supportive communities & cultural continuity.
 Protecting the future, at national & international
levels.
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HEALTHY DEVELOPMENT
BRAZELTON/GREENSPAN – IMPACT OF SAFETY
& ONGOING, NURTURANT RELATIONSHIPS
 Appropriate development of central nervous system.
 Foundation for development of human emotions.
 Self-regulation & sense of predictability & security.
 Thinking, problem-solving, learning.
 Communication with others.
 Warmth, intimacy, pleasure.
 Trust, empathy, compassion, morality.
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CLASSIFICATION OF TRAUMA
Disruption of healthy development – trauma
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CLASSIFICATION OF TRAUMA
CHARACTERISTICS OF TRAUMA
 Traumatic event (per DSM IV) involves experiencing,
witnessing, or being confronted by event or events
that involved “actual or threatened death or serious
injury, or a threat to the integrity of self or others.”
 The individual’s response involved “intense fear,
helplessness, or horror” (with children, may have
disorganized or agitated behavior).
 Thus, “trauma” requires a psychological (and often
physical) response to a dangerous event.
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CLASSIFICATION OF TRAUMA
TYPES OF TRAUMA – INDIVIDUAL, CHILDHOOD
 Neglect and abuse – physical, sexual, emotional.
 Witnessing of domestic abuse.
 Multiple placements and rejection.
 Traumatic loss.
 All of above involve unstable caregiving and
disruption of primary attachments.
 Community violence – bullying, rape, witnessing
violence.
 Medical trauma.
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CLASSIFICATION OF TRAUMA
TYPES OF TRAUMA – GLOBAL TRAUMA
(CHILDREN AND ADULTS)
 Natural disasters.
 War.
 Terrorism.
 Refugee trauma.
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CLASSIFICATION OF TRAUMA
OFTEN OVERLOOKED TRAUMA – “THE SYSTEM”
 Iatrogenic, resulting from contact with mental health
and other public systems.
 People report re-traumatization in both institutional
and community service settings.
 Inpatient psychiatric hospitals are most frightening,
but can occur in any level of care.
 Insensitive staff actions may involve dismissing of
concerns, bias and stereotyping, coercion,
 Inappropriate staff actions can include various forms
of abuse.
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CLASSIFICATION OF TRAUMA
DSM IV DIAGNOSIS RELATED TO TRAUMA
 Acute Stress Disorder – within 4 weeks of traumatic
event.
 Posttraumatic Stress Disorder (PTSD):
– Re-experiencing
– Avoidance/numbing
– Hyperarousal
 Dissociation Disorders.
 Conversion Disorder.
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CLASSIFICATION OF TRAUMA
PTSD AS THE “ORPHAN” TRAUMA DIAGNOSIS
 Re-experiencing
 Avoidance/numbing
 Hyperarousal
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CLASSIFICATION OF TRAUMA
HUMAN SERVICE SYSTEMS ALSO EXPERIENCE
TRAUMA (1)
 Repetitive mandate – do more with less.
 Service rates not on par with actual needs.
 Rate adjustments infrequent.
 Policy changes may be sudden and unexpected.
 Recent economic downturn.
 Adversarial relationships with funders & regulators.
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CLASSIFICATION OF TRAUMA
TRAUMA EXPERIENCED BY HUMAN SERVICE
SYSTEMS (2)
 Organizations and agencies become reactive
(Bloom).
 Work difficult, supervision limited.
 Organizations may become autocratic.
 Result:
–
–
–
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Trauma for agencies and workforce.
Diminished morale, and staff turnover.
Focus on survival.
DETERMINANTS OF OUTCOME
DETERMINANTS OF CHILD’S RESPONSE TO
TRAUMA – RESULT OF 3 SETS OF VARIABLES:
 Characteristics of the traumatic event(s)
 Characteristics of the environment
 Characteristics of the individual child
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DETERMINANTS OF OUTCOME
CHARACTERISTICS OF THE TRAUMATIC
EVENT(S)
 Frequency, severity, & duration of event(s)
 Degree of physical violence and bodily violation
 Level of terror and humiliation experienced
 Persistence of threat
 Physical and psychological proximity to event and
perpetrator
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DETERMINANTS OF OUTCOME
CHARACTERISTICS OF THE ENVIRONMENT
 Attitudes and behaviors of first responders.
 Immediate reaction of caregivers or those close to
child.
 Type, quality of, & access to, constructive supports.
 Degree of safety following the event.
 Prevailing community/cultural attitudes and values.
 Other protective & risk factors in environment.
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DETERMINANTS OF OUTCOME
CHARACTERISTICS OF THE INDIVIDUAL CHILD
 Age and stage of development
 Prior trauma history
 Intellectual capacity
 Strengths, coping, and resiliency skills
 Vulnerabilities (psychiatric or physical disorders).
 Child’s culturally based understanding of the trauma
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TRAUMA PREVALENCE
Just how common is childhood trauma in
society”? Unfortunately, very common.
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TRAUMA PREVALENCE
ESTIMATED PREVALENCE IN SOCIETY
 General population: 34-53% report childhood abuse
or sexual abuse.
 Public mental health clients: 90% with trauma, most
multiple experiences.
 People in treatment for substance abuse: 30-59% of
females with PTSD, & 11-38% of males (Najavits).
 Youth in general: 20-50% have experienced trauma.
 Youth in inner cities: Up to 80-90% with history of
trauma.
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TRAUMA PREVALENCE
ESTIMATED TRAUMA PREVALENCE AMONG
YOUTH IN JUVENILE JUSTICE
 One or more traumatic event:
– 93% of males.
– 84% of females.
 Witnessed violence or death:
– 59% males.
– 47% females.
 Sexual abuse among adjudicated females: more
than 75%.
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ACE STUDY
ACE Study: Adversity, not just trauma, matters
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ACE STUDY
ADVERSE CHILD EXPERIENCES (ACE) STUDY
 Kaiser Permanente, California, starting in 1995.
 An ongoing longitudinal study, most significant public
health study of natural history of trauma/adversities.
 Middle class population, able to afford private
insurance.
 Goal: to determine relationship between adverse
child experiences (“exposures”) – childhood
maltreatment & family stress – and later outcomes.
 Outcomes tracked for adults and youth.
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ACE STUDY
ACE STUDY – CATEGORIES OF ADVERSITIES (1)
 Physical abuse
Did a parent or other adult in the household often or very often
push, grab, slap, or throw something at you?

Sexual abuse
Did an adult or person at least 5 years older than you ever touch
or fondle you, or have you touch their body in a sexual way?

Neglect
Did you often or very often feel that you didn’t have enough to
eat, had to wear dirty clothes, or had no one to protect you?
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ACE STUDY
ACE STUDY – ADVERSITIES (2)
 Emotional abuse
Did a parent or other adult in the household often or very often
swear at you, insult you, put you down, or humiliate you?

Feeling unloved
Did you often or very often feel that no one in your family loved
you or thought you were important or special?

Domestic abuse
Was your mother or stepmother ever repeatedly hit a few minutes
or threatened with a gun or knife?
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ACE STUDY
ACE STUDY – ADVERSITIES (3)
 Parental separation or divorce
Were your parents ever separated or divorced?

Parental mental illness
Was a household member depressed or mentally ill,
suicide?

or attempt
Substance abuse in the family
Did you live with anyone who was a problem drinker or
alcoholic, or who used street drugs?

Incarceration of parent
Did a household member go to prison?
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ACE STUDY
KEY FINDINGS OF THE ACE STUDY (1)
 Range of ACE scores = 0-10.
 ACE scores based only on categories of exposure,
not frequency within categories.
 50% of respondents reported at least 1 exposure
(ACE score of 1).
 25% had ACE score of 2 or more.
 Adversities found to be additive, graded relationship:
Higher ACE score = more severe outcomes.
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ACE STUDY
KEY FINDINGS OF THE ACE STUDY (2)
 Outcomes involve both mental & physical health
impairment.
 Adult outcomes (prospective): poor health status
with medical disorders, psychiatric disorders, &
substance abuse disorders.
 Adolescent outcomes (retrospective): high risk
behaviors, including smoking, substance use,
frequent & unprotected sex, suicide attempts.
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ACE STUDY
SPECIFIC EXAMPLES: ACE STUDY & DEPRESSION
AND SUICIDALITY
 ACE score of 0: less than 2% adults made suicide
attempt.
 ACE score of 4+ (compared with score of 0): 460%
more likely to have depression.
 ACE score of 4+: nearly 20% made a SA (e.g., 12x
more likely to attempt suicide than person with 0).
 ACE score of 7+: SA is 51x more likely, as youth.
 ACE score of 7+: SA is 30x more likely, as adult.
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ACE STUDY
ACE STUDY & VICTIMIZATION
 ACE score of 4+ (compared with score of 0): over 8
times more likely to be victimized by rape.
 ACE score of 4+ (compared with score of 0): 5 times
more likely to be victimized by domestic abuse.
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ACE STUDY
ACE STUDY & SUBSTANCE ABUSE
 ACE score of 4+ (compared with score of 0): 5-7
times more likely to struggle with alcohol abuse.
 ACE score of 6+ (compared with score of 0): 46 x
more likely to engage in IV drug use.
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ACE STUDY
ACE STUDY & PHYSICAL HEALTH: SCORE OF 4+
 Smoking: twice as likely as those with ACE of 0.
 Heart disease: twice as likely.
 Cancer: twice as likely.
 Emphysema & chronic bronchitis: Four times as
likely.
 Early death common.
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The ACE Study (Anda & Filetti)
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OTHER CONSEQUENCES
ACE STUDY – NOT FULLY REFLECT REAL
CHALLENGES IN COMMUNITIES
 Middle class population with resources & ability to
afford private insurance – 74% attended college.
 Public sector children, families, and adults often lack
basic resources.
 Study not ask about poverty.
 Poverty associated with abuse & negative outcomes.
 Study not ask about bullying or community violence.
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OTHER CONSEQUENCES OF TRAUMA
Many other negative consequences of trauma
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OTHER CONSEQUENCES
ADULT PSYCHIATRIC DISORDERS AFTER
TRAUMA (SEPARATE FROM PTSD)
 Affective disorder: almost 3 times more likely.
 Anxiety disorder: almost 3 times more likely.
 Phobia: almost 2½ times more likely.
 Panic disorder: more than 10 times more likely.
 Antisocial personality disorder: 4 times more likely.
 Self-harm: suicide attempts, cutting, self-starving.
 Auditory hallucinations. – Increased likelihood, if
exposed to trauma during childhood.
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OTHER CONSEQUENCES
CRITICAL LINK: TRAUMA AFFECTS ATTACHMENT
 The earlier the maltreatment, the greater the impact
on attachment. Cannot consider one without other.
 Attachment is the basis for child’s safety, emotions,
learning, identity, coping, etc.
 Insecure attachments create significant risk for child,
and likelihood of multiple disabilities across lifespan.
 Conversely, if trauma or adversity occurs after child
has attached well to primary caregivers, less impact.
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OTHER CONSEQUENCES
JAMES GILLIGAN: SHAME AND VIOLENCE
(2001: Preventing Violence. New York: Thames and
Hudson)
 Central role of shame & disrespect in violence:
The purpose of violence is to force respect from
other people.
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OTHER CONSEQUENCES
INCREASE IN ARREST & VIOLENCE, WITH
TRAUMA
 Increased arrest, as consequence of childhood
abuse or neglect:
– Arrest as juvenile, 53% more likely, with trauma.
– Arrest as young adult, 38% more likely.
 Increased violent crime leading to arrest: Those with
trauma history 38% more likely to be arrested for
violence than those without trauma history.
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OTHER CONSEQUENCES
IF YOUTH COULD VERBALIZE & SPOKE FREELY
 “The world is unsafe, threatening, and bewildering.”
 “The world is punitive, judgmental, and blaming.”
 “People are unpredictable.”
 “Very few are to be trusted.”
 “I don’t have control over my life.”
 “My survival is uncertain.”
 “If I admit a mistake, things will be worse.”
 When challenged, I must defend my honor & selfrespect.”
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OTHER CONSEQUENCES
PRACTICAL IMPACT: IMPAIRED SELFREGULATION
 Internal discomfort.
 Impaired daily functioning.
 Impaired learning & problem solving.
 Impaired ability to form relationships.
 Impaired ability to experience & display empathy.
 Youth may not present as “likable,” and elicit
negative feelings within involved adults.
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OTHER CONSEQUENCES
RELATED SOCIAL AND OTHER CONSEQUENCES
 Homelessness.
 Criminal behavior.
 Unemployment and under-employment.
 Physical health problems.
 Lower intelligence (Putnam; Koenen et al).
 High-end needs and greater cost, re services.
 Ineffectiveness of usual interventions.
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BRAIN CHANGES DUE TO TRAUMA
Chronic, severe trauma gives rise to significant
brain changes – structural, neurobiological,
and functional.
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BRAIN CHANGES DUE TO TRAUMA
SUMMARY OF SPECIFIC BRAIN CHANGES
 Structural – smaller overall brain size, plus specific
areas affected (pre-frontal cortex, corpus callosum).
 Neurobiological:
–
–

Functional:
–
–
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Over-activity of catecholamines, leading to emotional and
behavioral dysregulation: hyperarousal, impaired judgment,
and limited capacity for self-regulation.
Increase in vagal tone, leading to dissociation.
Interruption of usual brain circuitry/patterns.
Progressive shut-down of higher brain structures, in
response to severe stress.
BRAIN CHANGES DUE TO TRAUMA
BRAIN CHANGES: NEW RESEARCH
 Violence and trauma damage the integrity of the
individual’s chromosomes, which contain DNA.
 This damage is to the telomeres, found on the tips of
chromosomes in cells. Telomeres protect DNA.
 Damage to telomeres – shrinking in size – can cause
cell death, premature aging, even premature death.
 Impact may not be evident early on, but may
become more significant later in lifespan.
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“ADVERSITIES” VS. “TOXIC STRESS”
“ADVERSITY” NEED NOT LEAD TO “TOXIC
STRESS”
 Toxic stress = “the excessive or prolonged activation
of the physiologic stress response systems, in the
absence of buffering protection afforded by stable,
responsive relationships” (my italics) (AAP, 2012).
 Implication: Stable, caring relationships can mitigate
the physiologic and emotional impact of adversities.
 This is a key way that trauma can be addressed, and
re-traumatization prevented.
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TRAUMA INFORMED CARE
Making a difference – trauma informed care
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TRAUMA INTERVENTIONS
TRAUMA INFORMED CARE
 TIC = set of beliefs & practices implemented within
an organization, applicable to all individuals served.
 TIC attempts to create a culture of safety and
empowerment.
 TIC is an approach rather than a specific treatment.
 TIC is distinguished from trauma specific services –
specific, clinical trauma treatments for those who
need it.
 Without a trauma informed setting, clinically-based
trauma treatment unlikely to be helpful.
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TRAUMA INFORMED CARE
TRAUMA INFORMED CARE (1)
Trauma informed care involves a commitment to
relationships, programs, and interventions that seek
to mitigate the effects of past traumatic experiences,
and to prevent new trauma and re-traumatizing
experiences, for the person and others. Trauma
informed care thus involves both individual
interactions with the person and a public health
approach that supports safe, non-violent
relationships and settings.
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TRAUMA INFORMED CARE
TRAUMA INFORMED CARE (2)
When used in treatment and care settings, TIC
involves the provision of interventions and
relationships informed by an understanding of the
pervasiveness of trauma and its consequences,
including the loss of safety, trust, sense of control,
and self-efficacy. In so doing, TIC also promotes the
person’s resilience and recovery.
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TRAUMA INFORMED CARE
ELABORATION OF “TRAUMA INFORMED
SERVICES” (Ann Jennings, 2004)
“Trauma informed” services are not specifically
designed to treat symptoms or syndromes related to
sexual or physical abuse or other trauma, but they
are informed about, and sensitive to, trauma-related
issues present in survivors….
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TRAUMA INFORMED CARE
WHAT TIC ENTAILS (1)
 Universal precautions: TIC applicable for everyone.
 Safety is primary – physical and emotional.
 Focus on the person, not just the behavior.
 Understanding how the person “got there” – e.g.,
“what happened to you,” rather than “what’s wrong
with you.” Presumption: Behavior is adaptive.
 Focus on person’s strengths.
 Empathy, caring, and support from adults.
 Avoidance of power struggles.
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TRAUMA INFORMED CARE
WHAT TIC ENTAILS (2)
 Supporting self-expression and self-advocacy.
 Development of interpersonal skills.
 Development of constructive coping skills.
 Development of healthy, reciprocal relationships.
 Development of prosocial life goals.
 Maintaining accountability and personal
responsibility, in a mentoring, non-punitive manner.
 Ensuring that shaming and humiliation do not occur.
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TRAUMA INFORMED CARE
WHAT TIC DOES NOT ENTAIL AND AVOIDS
 Blaming the victim.
 Stigmatizing and disqualifying the person (e.g.,
student is “manipulative” and “attention-seeking”).
 Minimizing person’s concerns.
 Threats and coercion.
 Use of seclusion and restraint, “laying on of hands.”
 Punitive practices.
 Psychotropic medication for staff convenience.
 Expectation of “compliance” and “obedience.”
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TRAUMA INFORMED CARE
FORMULATIONS OF TRAUMA INFORMED CARE
 Roger Fallot, Community Connections: 5 core
principles for trauma informed care
 Sandra Bloom, Andrus Center, NY and Center for
Non-violence and Social Justice, Drexel University
School of Public Health: Sanctuary
–
–
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S.E.L.F. (safety, emotions, loss, future).
Seven Sanctuary Commitments (non-violence, emotional
intelligence, social learning, open communication, social
responsibility, democracy, growth and change).
TRAUMA INFORMED CARE
FALLOT’S 5 CORE PRINCIPLES OF A TI SYSTEM
 Safety – physical and emotional, the sine qua non.
 Trustworthiness – built on honesty, transparency,
and consistency.
 Choice – creating opportunities for daily decisionmaking & experiencing an internal locus of control.
 Collaboration – working together and sharing power,
as a corrective to prior abuse of power.
 Empowerment – prioritizing validation, competency,
and skill-building.
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TRAUMA INFORMED CARE
SOME POSITIVE OUTCOMES OF TIC
 Increased sense of safety and mastery.
 Decrease need for vigilance.
 Calmer, more regulated internal state conducive to
learning, planning, other executive functioning.
 Decrease in impulsivity.
 Decreased likelihood of violence.
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TRAUMA INFORMED CARE
PA’s INITIATIVES FOR RESIDENTIAL PROGRAMS
 Funding of Sanctuary Program for 29 facilities.
 Certification after 3 years & necessary changes (23
funded programs in PA have gained certification).
 Trainings in TF-CBT (trauma-specific Rx), to support
expansion of trauma-competent workforce (13 RTFs
with TF-CBT training).
 Collaboration among state agencies re TIC –
OMHSAS, OCYF (Office of Children, Youth &
Families), ODP (Office of Developmental Programs).
 County and BH-MCO-based initiatives.
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TRAUMA INFORMED CARE
TIC IS IN “THE EYE OF THE BEHOLDER”
 The individual needs to experience the 5 core
principles, continuously.
 Interruption of core elements disrupts sense of
safety and trust.
 Thus, staff efforts to implement core principles are
insufficient, if the person is not asked about them.
 Essential: a “trauma lens,” and trying to understand
the individual’s subjective needs and experience.
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TRAUMA INFORMED CARE
FALLOT’S EXAMPLE: TRAUMA INCOMPETENCE
AND ITS TRANSFORMATION
 Sign upon entering D&A provider agency: “Denial
stops here.”
 What is the likely impact of this on an anxious
individual reluctantly looking for help and support?
 How could the provider’s sign be more trauma
informed and strengths-based?
 “Optimism starts here.”
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TIC IN COMMUNITY SETTINGS
TIC is applicable beyond residential care
settings
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TIC IN THE COMMUNITY
CORE PRINCIPLES ARE TRANSPORTABLE
 Core principles (safety, trustworthiness, choice,
collaboration, empowerment) promote child’s
psychosocial development.
 Applicable to education, child welfare, juvenile
justice, D&A, primary care.
 Applicable to parenting and the community.
 Synergy between TIC, gender resocialization, and
commitment to non-violence.
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TIC IN THE COMMUNITY
ROLE OF CARING ADULTS IN THE COMMUNITY
 Core values can be modeled by adults, who offer:
respect, trustworthiness, collaboration, support.
 All involved adults can provide TIC to youth:
–
–
–
–
–
–
–
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Teachers, principals, guidance counselors
Mental health professionals and paraprofessionals
Child welfare workers and/or juvenile probation officers
Pediatricians
Coaches
Ministers and other spiritual leaders.
Parents and guardians
TIC IN THE COMMUNITY
GENDER RESOCIALIZATION
 Masculinity redefined – what it means to be “a man”:
–
–
–

Female empowerment:
–
–
–
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Focus on altruism (Ehrmann: “a man built for others”).
Focus on non-violence – using words, not fists or weapons.
Promoting emotional expression, nurturance, & compassion
(Canada).
Continued support for commitment to family and to others.
Support for personal dignity & self-determination.
Moving beyond boyfriends and sexuality as primary sources
of validation.
TIC IN THE COMMUNITY
PRIMARY CARE AND THE MEDICAL HOME
 Recognition that primary care physicians and others
in the medical home see many more children than
mental health professionals.
 Increased interest in coordinating and integrating
behavioral health and medical care. National
mandate, and part of healthcare reform.
 AAP (2012): “The reduction of toxic stress in young
children ought to be a high priority for medicine as a
whole and for pediatrics in particular.”
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TIC IN THE COMMUNITY
TRAUMA INFORMED PARENTING
 Principles of TIC are readily applied to parenting,
whether by bio parent, kinship caregiver, or other.
 Avoiding responses that trigger or exacerbate child’s
dysregulation and disrupt his/her sense of safety.
 Serving as role model for emotional regulation.
 Foster care: Need to promote attachment & provide
nurturance, not just “room and board” (Zeanah et al).
 Serving as strengths-based, supportive mentor/
coach, with awareness that child is work-in-progress.
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TIC IN THE COMMUNITY
TRAUMA INFORMED EDUCATION (1)
 Awareness of potential impact of trauma on student
performance, expectations, and social interactions.
 Promoting safety, within school setting & community.
 Use of trauma screening & safety plans.
 Recognizing practical issues – hunger/basic needs.
 Valuing student relationships.
 Taking student concerns seriously.
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TIC IN THE COMMUNITY
EDUCATION (2)
 Abandoning dismissive labels of “manipulative” and
“attention-seeking,” in favor of deeper understanding
 Recognizing the empowering impact of positive staff
interactions & relationships with student.
 Adults as mentors & facilitators, not enforcers.
 Adults as “carriers of hope,” when necessary.
 Making “TIC” an explicit part of the philosophy of
“School-Wide Positive Behavior Support” in PA.
 Building TIC into primary prevention.
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TIC IN THE COMMUNITY
EDUCATION (3)
 Addressing bullying, at all three prevention levels.
 Engaging students in classroom & in activities.
 Teaching to student strengths & interests.
 Developing alternatives to out-of-school suspension.
 Ensuring that the student voice is heard, & that the
student’s experience guides teacher responses.
 Reinforcing kindness and prosocial behavior.
 Creating a trauma informed culture within education.
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SUMMARY
TIC IS NOT ROCKET SCIENCE: BASIC NEEDS
 Safety
 Respect
 Support (Hodas’ “Cardinal Rule”)
 Nurturance, attachment, and love
 Understanding of student life experiences to date
 Patience/compassion
 Non-punitive limits
 Joyfulness
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REFERENCES
OVERVIEW, CHILDHOOD TRAUMA & TIC
 Hodas, G (2006): “Responding to childhood trauma:
The promise and practice of trauma informed care.”
National Association of State Mental Health Program
Directors (NASMHPD).
Easy access via web search: “Hodas” with
“NASMHPD”
-Multiple additional references at end.
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REFERENCES
SOME KEY WEBSITES
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National Child Traumatic Stress Network Center (NCTSN)
www.nctsnet.org
Substance Abuse and Mental Health Services Administration
(SAMHSA) www.samhsma.gov/
ACE Study www.acestudy.org
Community Connections (Fallot and Harris)
www.communityconnectionsdc.org
The Anna Institute www.theannainstitute.org
National Center for Trauma Informed Care (NCTIC)
www.samhsa.gov/nctic
REFERENCES
BOOKS OF INTEREST (1)
 Anderson, E. (1999): Code of the Street: Decency, Violence,
and the Moral Life of the Inner City. New York: Norton.
 Bloom, S (1997): Creating Sanctuary: Toward the Evolution of
Sane Societies. New York: Routledge.
 Brazelton, T and Greenspan, S (2000): The Irreducible Needs
of Children: What Every Child Must Have to Grow, Learn,
and Flourish. Cambridge, MA: Perseus.
 Canada, G (1998): Reaching Up for Manhood: Transforming
the Lives of Boys in America. Boston: Beacon Press.
 Garbarino, J. (1999): Lost Boys: Why Our Sons Turn Violent
and How We Can Save Them. New York: Free Press.
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REFERENCES
BOOKS OF INTEREST (2)
 Gilligan, J. (2001): Preventing Violence. New York. Thames
and Hudson Inc.
 Groves, B (2002): Children Who See Too Much: Lessons
form the Child Witness to Violence Project. Boston: Beacon.
 Hughes, D (2009): Attachment Focused Parenting: Effective
Strategies to Care for Children. New York: Norton.
 Marx, J (2003): Season of Life: A Football Star, a Boy, a
Journey to Manhood. NY: Simon & Shuster.
 Mollica, R: Healing Invisible Wounds: Paths to Hope and
Recovery in a Violent World. New York: Harcourt.
 Tough, P (article): “The Poverty Clinic,” New Yorker, March 21,
2011.
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