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  • Children and Trauma: How Schools Can Help With Healing

  • A significant number of school-age children are impacted by trauma. In community samples, more than two thirds of children report having experienced a traumatic event before age 16 (APA, 2008). The National Child Traumatic Stress Network (NCTSN, 2008) estimates that as many as one out of every 4 children attending US schools have been exposed to a traumatic event that can affect learning and/or behavior. Trauma is defined as an experience that threatens the life or physical integrity of oneself or others and that overwhelms an individual’s capacity to cope. Trauma occurs when children have been in situations where they have feared for their own lives or the lives of close loved ones, believed they could have been seriously injured, or tragically lost a loved one

    November 2013 Vol. 29, No. 11CABL logo

    This article was published in the Brown University Child and Adolescent Behavior Letter in cooperation with Bradley Hospital.  

    Traumatic events can be acute, sudden events that are limited to a particular time and place. Examples of acute traumatic events include serious accidents, natural or man-made disasters, terrorist attacks, school shootings, gang related incidents, sudden or violent loss of a loved one, physical or sexual assault, and life-threatening or painful medical procedures

    Traumatic situations can also be chronic with multiple instances across time. Chronic traumatic situations may include wars or political violence, chronic violence in the community, exposure to drugs, witnessing domestic violence, emotional or physical neglect, and repeated physical or sexual abuse. When trauma is associated with the failure of caretakers who should be protecting and nurturing the child and is perceived as intentional rather than unintentional, it is more likely to be associated with particularly adverse outcomes for the child (NCTSN, 2008; Trickey et al., 2012)

    Child Traumatic Stress

    Child traumatic stress is an overarching term to describe the physical and emotional responses that a child has in response to a traumatic event or to witnessing a trauma occur to another person. In the aftermath of traumatic experiences, nearly all children experience short-term distress. The majority of children, however, prove to be resilient, especially in event of a single-incident traumatic exposure. That is, when exposure to trauma is limited, most children return over time to their prior levels of functioning

    It is far more common, however, for children to be exposed to more than one trauma. Children are at a higher risk of showing symptoms for post-traumatic stress disorder when they’ve been exposed to multiple traumas, when they have had previous anxiety problems or comorbid psychological problems, or when they have perceived life threat

    Children are also at higher risk when they exhibit greater distraction and thought suppression after a traumatic event, and when they experience low social support and poor family functioning after the event (Trickey et al., 2012). An individual child’s reaction and the duration of reaction are related to both the objective nature of the event and the child’s subjective interpretation and response to the event (APA, 2008)

    Traumatic stress may result in enduring patterns of emotional and behavioral difficulties. Children’s reaction to trauma is often described in terms of the “fight, flight, or freeze” survival responses in the face of a threat. When a trauma is unprocessed or unresolved, these survival strategies may generalize and become maladaptive coping strategies that are used in a variety of situations, including at school, where they are perceived by others as inappropriate. School-age children with traumatic stress may exhibit increased anxiety and worry about safety of self and others, negative thoughts and feelings, discomfort with emotions, increased somatic complaints, rumination or re-experiencing aspects of the trauma, avoidance behaviors, emotional numbing, over- or under-reacting to loud or unexpected sounds and sudden movements, and heightened arousal marked by aggressive, reckless, or self-destructive behavior

    Help and Hope at School

    trauma in schoolAt school, a child may have difficulty with authority figures or show resistance to transition or change. Some changes in behavior that may be observed at school include: decreased attention, increased activity level, lower grades, greater absenteeism, irritability, angry outbursts, impulsive behavior, and withdrawal (NCTSN, 2008)

    When school personnel understand the potential behaviors associated with traumatic stress, they are less likely to interpret the child’s behavior as intentionally defiant and are more equipped to intervene in ways that reassure rather than escalate the child’s behaviors. Schools can be instrumental in providing help and hope for children’s recovery from traumatic stress. When educators understand the risk and impact of childhood trauma and recognize and understand the signs and symptoms of traumatic stress, they can partner with parents and other caregivers as well as medical and mental health providers to provide preventive education and effective interventions for trauma recovery (NCTSN, 2008)

    Schools can be helpful in the identification and treatment of trauma in several ways. First, children with trauma histories that have not been previously disclosed may be first identified for mental health intervention by school personnel. Referrals of individual children may be initially based on a child’s emotional or behavioral problems that interfere with or impede learning in the classroom, given the fact that children do not always reveal the traumatic events that happen to them, particularly in the case of child abuse and domestic violence. They may not disclose these traumas in school for a variety of reasons including fear of being removed from their homes and concerns about disappointing their parents or caregivers. Secondly, schools are often the sensible place for screening for traumatic stress reactions after traumatic events impacting whole communities. With proper referral and adequate screening for trauma history, children with severe acute or ongoing psychological symptoms related to trauma exposure can be identified, referred, and offered treatment with evidenced-based interventions for persistent trauma reactions. Finally, in some cases, evidence-based clinical treatment interventions are being offered in school settings, thus making mental health care more accessible

    School-Based Interventions

    In terms of school-based interventions, many schools have implemented a “response to intervention” approach that provides positive behavior supports to students in tandem with evidenced-based teaching for academics. These approaches focus on proactive and preventive school-wide initiatives for positive behaviors as well as targeted and individualized services for at-risk students, including those with trauma histories. Data collection and progress monitoring are essential for this type of program, enabling educators and support personnel to predict and potentially prevent problem behaviors at school. In cases where the behaviors are not easily prevented, school personnel can at least respond in a planned, effective teaching manner rather than simply in a reactive mode. For children with known traumatic stress symptoms and those who experience greater challenges coping at school, Individual Education Plans (IEPs) and/or 504 plans can incorporate appropriate accommodations in the school setting (e.g., extended time to complete assignments, opportunities to leave class to speak to a supportive adult) to help the child to succeed in the short-term and achieve greater self-efficacy and competence in the long-term

    Trauma-Informed Practices

    Some schools have also begun to identify trauma-informed practices to be implemented on a school-wide basis. Trauma-informed principles focus on:

    • Creating a school culture and climate where safety is the priority
    • Educating and supporting all staff regarding the impact of trauma on learning and school behaviors
    • Adhering to a strengths-based approach in working with students
    • Ensuring that discipline is logical and restorative rather than punitive and rejecting of children
    • Providing flexible accommodations for diverse learners
    • Using data to identify vulnerable students and to determine outcomes and strategies for continuous quality improvement.

    The primary goal is to create a stable, safe, and supportive environment where learning can take place. To this end, teachers are encouraged to use creative strategies to promote and support the wellbeing of the whole child. Massachusetts and Washington states have led the move towards trauma-informed compassionate schools.

    For more information about these practices, two handbooks are available for free via download from the web

    In a fundamental way, as teaching institutions, schools can be particularly helpful in teaching adaptive coping skills and creating safe and supported opportunities for children to practice effective coping skills, not only for trauma-related memories or trauma-triggers, but also for other life challenges. After a traumatic event, there is a benefit in returning to predictable routines that help children to return to a sense of normalcy, and the school setting provides many of these routines for children. In this role, schools can provide reassurance and a sense of safety for the child impacted by trauma. That sense of normalcy and safety provided by the school setting, along with appropriate intervention for traumatic stress, allow children to work towards restoring their sense of well-being and towards gaining a sense of optimism for the future


    Laura Deihl, PhD, is a a staff psychologist at The Bradley School in Portsmouth, Rhode Island and a clinical assistant professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University.


    References

    American Academy of Child and Adolescent Psychiatry. Practice parameter for the assessment and treatment of children and adolescents with posttraumatic stress disorder. J Am Acad Child Adolesc Psychiatry 2010; 49(4):414–430

    American Psychological Association Presidential Task Force on Posttraumatic Stress Disorder and Trauma in Children and Adolescents. Children and Trauma: Update for Mental Health Professionals; 2008. http://www.apa.org/pi/families/resources/children-trauma-update.aspx 

    Cole SF, O’Brien J G, Gadd MG, Ristuccia J, Wallace DL, Gregory M. Helping traumatized children learn: Supportive school environments for children traumatized by family violence; 2005. http://www.massadvocates.org/download-book.php 

    The National Child Traumatic Stress Network. Child Trauma Toolkit for Educators; 2008. http://rems.ed.gov/docs/NCTSN_ChildTraumaToolkitForEducators.pdf  

    Trickey D, Siddaway AP, Meiser-Stedman R, Serpell L, Field AP. A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents. Clin Psychol Rev 2012; 32(2):122–138

    Wolpow R, Johnson MM, Hertel R, Kincaid S. The heart of learning and teaching: compassion, resilience, and academic success; 2009. http://www.k12.wa.us/CompassionateSchools/pubdocs/TheHeartofLearningandTeaching.pdf