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INTEGRATING TRAUMA-INFORMED APPROACHES

WITH PBIS WITHIN AN MTSS FRAMEWORK

Lynne DeSousa - Colorado PBIS Statewide CoordinatorHailey Uphaus - Thompson School District Behavioral Health Specialist

OBJECTIVES OF THE SESSION

• Gain a foundational understanding of trauma and toxic stress

• Review the latest research on how trauma causes instructional/coaching challenges in students/staff

• Guidance on how to integrate trauma informed approaches into and existing SW-PBS system and MTSS framework

• Gain practical strategies for supporting students/staff 2

“It we teach today’s students as we

taught yesterday’s, we rob them of

tomorrow.”

- John Dewey, 1915

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TAKE CARE OF YOURSELF

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What are you currently doing in your

district/school to support students/staff who have experienced trauma, toxic stress or

behaviors ?5

Definition from Monroe County ACCESS Research to Practice Subcommittee, 2011

What is trauma?Trauma is a response to a perceived threat to survival or emotional well- being of an individual or large group, such as a community or a culture.

Trauma leads to adverse brain, bodily and psychological changes that damage self, relational and spiritual development and impair living, learning and working.

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SAMHSA’S THREE E’S OF TRAUMA

Experience

Effects

Event(s)

TYPES OF STRESS NATIONAL SCIENTIFIC COUNCIL ON THE

DEVELOPING CHILD (2005)

PositiveBrief increases in heart rate, mild elevations in stress

hormone levels.

TolerableSerious, temporary stress responses, buffered

by supportive relationships.

ToxicProlonged activation of stress response systems

in the absence of protective relationships

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MOST COMMON ADVERSE CHILDHOOD EXPERIENCES (ACES)

• Recurrent physical abuse

• Emotional abuse• Sexual abuse• Alcohol/drug abuser

in household• Incarcerated house-

hold member

• Household member with chronic mental illness

• Violence betweenadults in the home

• Parental separation or divorce

It is estimated that 66% of the population has at least 1 ACE and 25% have 2 or more ACEs before age 18.

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National Child Traumatic Stress Network

LINKING ACES & SCHOOL PERFORMANCE:

•Are 2 ½ times more likely to fail a grade•Score lower on standardized assessments•Have more receptive & expressive language difficulties•Are suspended or expelled more often•Found eligible for special education more frequently

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3 R’S OF BEING TRUAMA INFORMED

• and understanding traumaRealizing

• how trauma impacts students/staffRecognizing

• by implimenting trauma informed approaches within and exisitng PBIS system & MTSS framework

Responding

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A traumatic stress response

occurs when our ability to

respond to the threat is

overwhelmed.13

Traumatic Event/Events

Traumatic Impact

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IMPACT OF TRAUMA•I am not safe•I cannot trust others•I cannot trust myself•I cannot depend upon others•I am not worthy of care•I deserve the bad things that happen to me•It’s my fault16

IMPACT OF SECONDARY TRAUMA (COMPASSION FATIGUE)

Cognitive effects

• Negative bias, pessimism

• All-or-nothing thinking

• Loss of perspective and critical thinking skills

• Threat focus –see parents, colleagues, supervisor, community members as enemy

• Decreased self-monitoring

• Freezing –unable to think straight or remember information

Social impact

• Reduction in collaboration

• Minimizing the work

• Withdrawal and loss of social support

• Factionalism• Stop hanging

out with friends and loved ones

Emotional impact

• Anxiety • Feelings of

helplessness and hopelessness

• Feelings of restlessness

• Lack of motivation or focus for interests or hobbies

• Feeling overwhelmed

• Irritability or anger

• Sadness or depression

Physical impact

• Headache• Muscle tension

or pain • Chest pain • Fatigue• Stomach upset • Fatigue/sleep

difficulty• Depression• Weight gain• Increased use of

tobacco, alcohol, drugs

(Mayo Clinic)

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PARALLEL PROCESS I can't trust administration. They are

waitingfor me to do something wrong.

I can't trust adults. They will eventually hurt me.

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PARALLEL PROCESS I have no power or control over my work.

It doesn't matter what I do someone

will always take it away.

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PARALLEL PROCESS It is much easier to do it myself than

having to collaborate.

It is me against the world. I am the only one that has my back.

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PARALLEL PROCESS I can't concentrate on one thing

because I have so many responsibilities and expectations in this job.

There is no way I can pay attention in school. I keep thinking about

all that hashappened to me.

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PARALLEL PROCESS If I had done my job better, this

wouldn’t have happened.

It’s all my fault that I’m in foster care.

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3 R’S OF BEING TRUAMA INFORMED

• and understanding traumaRealizing

• how trauma impacts students/staffRecognizing

• by implimenting trauma informed approaches within and exisitng PBIS system & MTSS framework

Responding

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InstinctiveBrain

Emotional Brain

Thinking Brain

Dr. James Henry

A substitute

Change in schedule

Not having the snack/lunch that was anticipated

“Jimmy”

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Dr. James Henry

• Increased anxiety and/or depression

• Increased aggression• Increased impulsivity• Decreased social ability• Reduced ability to regulate • Difficulty with attachment

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BUT…WHEN THE TIGER LIVES IN YOUR SCHOOL, HOME, COMMUNITY, OR LIFE…

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Our interpretation guides our own reactions.

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Struggle with self-regulation

Not having the snack/lunch

that was anticipated

Or

Change in schedule

Or

A Substitute

Feelings of worthlessness

Not feeling safe

HomelessFoster care

Violence in the homeDeath of a loved one

Divorce

“Skippy”Can’t predict

change

SURVIVAL RESPONSEFight

• Individual struggles to regain or hold on to power, especially when feeling coerced

• Mislabeled as: Non-compliant or combative Flight

• Individual disengages, “no shows”, or “check outs” emotionally

• Mislabeled as: Uncooperative or resistantFreeze

• Individual gives in to those in positions of power, does not or is unable to speak up

• Mislabeled as: Passive or unmotivated

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Think of the ‘learning brain’ as the rider, and the ‘survival brain’ as the horse. When a student is triggered, the ‘learning brain’ largely goes offline. The rider’s off the horse, and you’re just dealing with a really terrified horse.”

(Joyce Dorado, director of HEARTS)34

EMOTIONAL REACTIVITYThe primary impact of exposure to trauma is “emotional dysregulation.” (Van der Kolk, 2009)

An inability of the left side of the brain to talk to the right side of the brain.

•Ability to calm•Ability to regulate•Ability to contain affect

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When students are in fight, flight, or freeze their ‘rider’ has been

thrown off.

Fight, flight, or freeze causes a breakdown in the capacity to think

clearly, causing the child to become overwhelmed

and irrational.

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Current problematic behaviors and symptoms may have originated as

legitimate and even courageous attempts to cope with or defend

against trauma.

SEEKING TO COPE

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What are some things you would like to change in your district/schools to

better support students/staff who have

experienced trauma, toxic stress or behaviors ?

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3 R’S OF BEING TRUAMA INFORMED

• and understanding traumaRealizing

• how trauma impacts students/staffRecognizing

Responding• by implimenting trauma

informed approaches within and exisitng PBIS system & MTSS framework

How can PBIS schools become more Trauma Informed?

1. Raise staff awareness of the prevalence and impact of trauma.

2. Pay attention to students emotional responses in addition to behavioral ones.

3. Recognize that problem behaviors might be a response/adaptation trauma.

4. For students impacted by trauma, work with them to identify and reduce school triggers.

5. Establish a discipline policy that is sensitive, predictable and respectful.

6. Infuse youth development and cultural humility into curricula, student activities, schools-wide events, staff professional development and family/community events.

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What exactly IS a trauma-sensitive school?

1. All staff understand the prevalence and impact of trauma of their students and themselves.

2. School strives for physical, emotional, social, academic safety for all.

3. The school addresses holistic student needs.4. The school is inclusive and connects students to the

community instead of excluding them.5. The school staff work collaboratively to support

students.6. School leaders adapt services and supports based on

contemporary needs of students.

ProactiveReactive

TIME AWAY

CORRECTION

PRAISE

PRO-ACTIVEPROACTIVE

PRAISE

CORRECTION

TIME AWAY

Boys Town WMS41

Trauma Sensitive Checklist

Wisconsin Department of Public Instruction, Trauma Toolkithttps://dpi.wi.gov/sspw/mental-health/trauma

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Key Principles of Trauma Informed Approaches (SAMHSA)

Principle1. Safety2. Trustworthy and

Transparency3. Peer Support4. Collaboration and

Mutuality5. Empowerment, Voice

and Choice 6. Cultural, Historical

and Gender Issues

Application In Schools1. Safe School Environment, immediate

response to bullying incidents2. Positive adult relationships, clear

room policies around behavior, grading, etc.

3. Group services and mentoring programs

4. Clear discipline policies that emphasis restoration over punishment

5. Youth developmental practices, student fishbowls, and partners in decision-making

6. Culturally relevant curriculum, implicit bias training for staff

RESILIENCY

RESILIENCY CONTEXTUALIZES A PERSON’S STRENGTHS (INDIVIDUAL, FAMILIAL, COMMUNITY)

AGAINST HER/HIS ADVERSE EXPERIENCES.(Z O LK O SK I & B U LLO CK , 20 1 2)

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Positive Family Communication

Caring School Climate

Parent Involvement in Schooling

Roles for Youth within the

Community

Peaceful Conflict Resolution

Positive Self-Image

Student cares about

school

Increased Achievement and

Motivation

Student feels connected to the school

Optimistic about future

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“We learned in therapy that some of the most therapeutic experiences do

not take place in ‘therapy’ but in naturally occurring healthy relationships.” (Perry, 2011)

“What works best is anything that increases the quality and number of

relationships in a child’s life.” (Perry, 2011)

It only takes one caring adult!50

SENSE OF RELATEDNESS

AFFECT & REGULATION

MASTERY & EFFICACY SELF- ESTEEM

SENSE OF RELATEDNESS

Relationships with others and sense of relatedness serves as a

protective factor against stress.

• Home Involvement Activities• Peace Keepers• Grade level team competition• Student Council or “Voice and Choice”• Phone Calls home• Postcards sent home• Cross grade buddies• Lunch bunch• Student/Class recognition • Family Night• Class/school jobs• 2 x 10 Rapport building• Mentorship opportunities

Linking to PBIS & MTSS:

Collaborative partnerships between school, home, and community is viewed as essential for creating culturally relevant outcomes and sustained benefits for students.

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RULES “THE WHAT”

State behaviorally and positivelyLimited to 3 – 5 general behaviorsManageable and enforceableConsistent with your schools policies, mission, and visionPosted and frequently reviewed

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PROCEDURES “THE HOW”

Decide what you want students to accomplishDetermine behaviors needed in various routines and locationsIdentify stepsPost when necessary and near the area students will need the procedureTeach and review

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55%

7%

Para Verbal

Verbal

Non Verbal

38%

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AFFECT & REGULATION

• Zones of Regulation• Check and Connect• In Focus• Mind-Up• Yoga• Mindfulness• Sensory Toolkits

• Check-In Check-Out• Social Skills Instruction • Social skill stories

Affect & Self-Regulation are significantly correlated with “success” in life – whether it is financial success,

happiness, or adjustment or other various positive psychological factors

Linking to PBIS and MTSS:

• Emphasize the recognition, understanding, and responsiveness to student needs using a preventive, positive, and instructional lens.

• Recognize the necessity of building the collective capacity of school personal to create safe, predictable, and engaging learning environments for all students.

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Keys to Setting LimitsSimple/Clear

• If…Then…. or First…Then…• Start with

positive, end with consequence (do what works for the student)

• Limit steps, words, complex vocabulary

Reasonable• Offer choices that

are obtainable• Consequences fit

behavior (natural, logical, artificial)

• Allow for a “fix” –correction vs. perfection

Enforceable• Know what you can

and can’t do• If you are unsure

ask• Willing and able to

follow through

“If you can predict it, you can plan for it.”(Jim Fay, Founder of Love and Logic)

Detour Strategies:• Cool down time/space set a timer, alternative seat,

space, environment, etc.)

• Empathy “It does feel like a long time until lunch!”“How can I help you?”

• DIB/DAB Statements “right now you are yelling you need to be quiet”

• Reality Statements “the sooner you get calm the sooner we can talk about what you need.”

• Praise – “Doing a good job getting calm.”

Your choice of strategies should be driven by the frequency, duration, and intensity of the behavior(s),

as well as by what strategies are most effective with the student.

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VERBAL TRICKS & TIPS• Refrain from using “I need you to…” “I want you to…” “I’m telling you to…”• Don’t use opened questions, unless it really is a choice -

“Would you like do your work now?” “How about we go back to class?”• Use manners, but don’t beg! –

“Please tuck in you chair.” v.s. “Tuck in you chair pleeese.”• Reframe “Yes” and “No” questions

Student: “Can I go to the bathroom?”Teacher: “You are asking when you can use the restroom…”

• Use behaviorally specific language when describing behaviors“You are being respectful.” (Good)“You are being respectful by putting your eyes are on the speaker.” (Great)

• “You said something like…” v.s. “You said…”• “You will earn…” v.s. “You will get…” or “You have lost”• “You’re more likely to get…” v.s. “You will get…”• Use clarifying statements

“What I think you are saying is…”“What I am hearing you say is.”

Interrupt & Redirect

“You are shouting. Please lower your

voice.”

If & Then

“If you finish your math then you may

earn computer time.”

Approaches to Setting Limits

When & Then

“When you are showing a calm body & calm

voice then I will be able to talk to you.”66

MASTERY & EFFICACY

• Corrective teaching • Teachable moments• “Correction vs. Perfection” • Common Language

• 4:1 ratio of reinforcement• “Teach-To’s”• Increased rate of reinforcement• General, Specific, and Effective

Praise

Linking to PBIS & MTSS:

• Make explicit efforts to build healthy, trusting relationships, emphasize choice and empowerment through skill building.

• Intentionally create positive opportunities where students can practice self-regulation strategies and prosocial skills.

Students with a strong sense of efficacy are more likely to challenge themselves with difficult tasks and be intrinsically motivates. These students will put forth a high degree of effort in order to meet their commitments, and attributes failure to things which are in their control, rather than blaming external factors.

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PLANNED TEACHING• “Hook” • Ask questions related to the skill Introduce the skill

• Label the skill• Describe the skill steps

Describe appropriate behavior

• Meaningful to the student• BriefGive a reason

• Set up clearly• Have student practice to criteriaPractice

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Peace 4 Kids69

PREVENTIVE PROMPTS

Brief Verbal or Nonverbalreminder to students

• before the skill you want students demonstrate

• before the rule you want students to follow

• before using a procedure

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GUIDED SELF-CORRECTION1. Let’s talk about what just

happened.2. What should have happened

instead?3. Why would that have been a better

choice?4. Remember to try it like that next

time.71

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Corrective Teaching• “Thanks for staying in your seat, Devon.”Use praise or empathy

• “When you wanted my attention, you called out my name and yelled something like, ‘I need some help!’”

Describe inappropriate behavior

• “A better way to get my attention is to raise your hand, wait for me to call on you or come over, and then ask your question or make your comment.”

Describe appropriate behavior

• “When you get my attention by raising your hand, it lets me know you need some help.”Give a reason

• “I am going to go answer another question. Show me you can get my attention by raising your hand and waiting quietly until I can get back to you.”

Practice

• “Because you didn’t get my attention appropriately, you’ve had to wait a little longer to get your question answered.”

Negative consequence (optional)

Boys Town WMS73

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SELF- ESTEEM

• Classroom/school jobs• Peer buddies• Mentorships• 4:1 ratio of reinforcement (or higher)• General, Specific, and Effective Praise• De-escalation with dignity• goal setting• Restorative Justice• Student of the month• School Store, assemblies

Linking to PBIS & MTSS:

• Make explicit efforts to build healthy, trusting relationships, emphasize choice and empowerment through skill building.

• Intentionally create positive opportunities where students can practice self-regulation strategies and prosocial skills.

Self-esteem is an essential human need that is vital for survival and normal, healthy developments. It can arise automatically from within based on a person’s beliefs and consciousness or occurs in conjunction with a person’s thoughts, behaviors, feelings, and actions.

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General Praise/Non-

Contingent

Behavioral Specific Praise

Effective Praise

4:1Boys Town WMS76

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“Why do I need to praise for things students should be doing?”

Think about all the things we do because we get reinforced…

King Soopers Card Starbucks RewardsPosting on Facebook Frequent Flyer MilesWear an outfit/tie or style your hair a certain way Pay Check

WHY PRAISE?

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Effective Praise

Specific Praise

THE SHAPING PROCESS

General Praise

Self-Reinforcing

High

Low

Skill

Mas

tery

External

Internal

Boys Town SCM78

SHIFTING THE MINDSET FROM VICTIM TO SELF-EMPOWERMENT

MusicArtSportsIntelligence Recognized or noticed

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THREE PRACTICAL ACTS TO BUILD POSITIVE RELATIONSHIPS

WITH CHILDREN • Instead of thinking “what is wrong with you” think “what

has happened to you?”

• Recognize and honor a student’s inability to trust and feel safe despite how it feels for you. “Of course you can’t trust me.”

• Know you cannot change a student’s perception because you tell them what your reality is. “I know you can’t believe me”

• Start where the student is at not where you want them to be. Safety is always the first step. “How can I help you feel safer?”

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Traumatic Event/Events

Resiliency Factors

Traumatic Impact

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PBIS

Mindfulness

Yoga & Self Regulation

Sensory CenterOpportunity Zone

Restorative Center

Social Skill Instruction

What if…?

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“Jimmy” “Skippy”

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What ideas/strategies are you going to take back to

your district/ school to better support

students/staff that have experienced trauma, toxic

stress or behaviors ?85

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REFERENCES & RESOURCESResources & References:Boys Town Well Managed SchoolsDr. James Henry - The Children’s Trauma Assessment Center of MichiganCrisis Prevention Institute Trauma & Learning Policy Initiative of Massachusetts Advocates for Children & the Legal Services of Harvard Law School & Lesley University

Books: The Body Remembers by Babette RothschildHelp for Billy by Heather T. Forbes, LCSWThe Body Keeps the Score by Van Der Kolk, M.D.Lost At School by Ross W. Greene, PH.DThe Boy Who Was Raised as a Dog by Bruce Perry and Supporting and Educating Traumatized Students: A Guide for School –Based ProfessionalsCoaching Classroom Management; Strategies & Tools for Administrators & Coaches By Sprick and Knight

Documentary: Paper Tigers by James Redford

Websites: Wisconsin Department of Public Instruction https://dpi.wi.gov/sspw/mental-health/traumaColorado State University – Child Trauma Resilience Assessment Center http://www.ctrac.chhs.colostate.edu/We Teach Peace -The Center for Anti-bullying & Non-Violence (CAN) has taken leadership in developing the Peace4Kids model that is highly effective with aggressive youth http://wecanco.org/Trauma Transformed http://www.t2bayarea.orgSAMHSA Trauma Resources http://www.samhsa.gov/nctic/