Trauma-Informed Schools Part 2:Trauma Sensitive Practices

Dr. Briana Woods-Jaeger

Assistant Professor

Rollins School of Public Health

Licensed Clinical Psychologist

Briana Woods-Jaeger, PhD, MS

Rollins School of Public Health, Emory University

Southeast Region MHTTC

Disclaimer: The opinions expressed herein are the views of the presenters and do not reflect the official

position of the Department of Health and Human Services (DHHS), SAMHSA. No official support or

endorsement of DHHS, SAMHSA, for the opinions described in this document is intended or should be

inferred.

ObjectivesDescribe approaches to implement

trauma-informed practices in schools

Provide examples of trauma-informed programs and practices

Discuss staff wellness as a foundation for trauma-informed

schools

Describe staff wellness tools and resources

1

2

3

4

School Mental Health Interventions

4

Multi-Tiered Approach

Universal: target whole

school or classrooms

• Least intrusive, lowest cost

• Greatest chance of adoption

• Can be easier than other approaches

• Need buy in from administrative leaders and

all school staff

Fazel et al., 2014

School Mental Health Interventions

5

Multi-Tiered Approach

Selective: targeted to

population subgroups,

address risk factors

within higher risk

groups

• Promote awareness of alternative coping

strategies

• Reduce development of some problem

behaviors

• Can be delivered in classrooms or small

groups for students at high risk

• Strong evidence for students with risk factors

and for students with anxiety or depressive

disorders

Fazel et al., 2014

School Mental Health Interventions

6

Multi-Tiered Approach

Indicated: overlap

conceptually with

mental health

treatments; can

include services

delivered by staff

employed by

community-based

agencies

• Generally show stronger outcomes for clinical

impairment than universal or selective

interventions

• Community-partnered mental health services

• Consultation in mainstream schools by mental

health specialists

• Some schools provide onsite individual, family

and group treatment

• Intensive treatment can take place during the

school day – more efficient for students and

parents

Fazel et al., 2014

Core Areas of a Trauma-Informed School

1. Identifying and Assessing Traumatic Stress

2. Addressing and Treating Traumatic Stress

3. Trauma Education and Awareness

4. Partnerships with Students and Families

5. Creating a Trauma-Informed Learning Environment

6. Cultural Responsiveness

7. Emergency Management/Crisis Response

8. Staff Self-Care and Secondary Traumatic Stress

9. School Discipline Policies and Practices

10. Cross System Collaboration and Community Partnerships

NCTSN, 2017

Barriers to Becoming and Sustaining a Trauma-Informed School

• Limited staffing and funding to screen for trauma

• Lack of availability of appropriate tools and resources

• Limited capacity of schools to follow-up with students identified as needing services

• District-level leadership changes

• Workforce instability

• Shifting school and district priorities

Overstreet & Chafouleas, 2016

Poll Question:“What are barriers you have

faced in becoming a trauma-informed school?”

Facilitators to Becoming and Sustaining a Trauma-Informed School

• Use of familiar frameworks (e.g., MTSS) to align trauma-informed

approaches with existing educational practices

• Building from effective school-based mental health models and practices

• Use of naturalistic resources (i.e., teachers, peers) within schools to

implement and sustain supports

• Peer-selected key opinion leader (KOLs) teachers to promote new

strategies

• Inclusion of integrated models

• Strengthening the active involvement of parents

Atkins et al., 2008; Atkins et al., 2010; Overstreet & Chafouleas, 2016

Examples of Trauma-Informed Programs & Practices in Schools

MTSS Approach to TIS

Brymer et al., 2012; CBITS, n.d.

Trauma-Informed Training

• Increase staff knowledge about prevalence and effects of trauma

• Increase staff’s ability to recognize signs and symptoms of trauma

• Improve staff skills in appropriately responding to students exhibiting trauma symptoms

• Effectively address student behavior

• Make appropriate referrals

• Recognize and address secondary traumatic stress and burnout • Staff Wellness*

Maynard et al. 2019

Psychological First Aid for Schools (PFA-S)

• Designed to reduce the initial distress caused by emergencies and to foster short- and long-term adaptive functioning and coping

• Identifies individuals who may need additional services and links them to such services as needed

• Potential to mitigate the development of mental health problems or long-term difficulties in recovery

Brymer et al., 2012

PFA Core ActionsGoal: To initiate contacts or to respond to contacts by students and staff in a non-intrusive, compassionate, and helpful manner

Contact and Engagement

Goal: To enhance immediate and ongoing safety, and provide physical and emotional comfortSafety and Comfort

Goal: To calm and orient emotionally overwhelmed or disoriented students and staffStabilization (if needed)

Goal: To identify immediate needs and concerns, gather additional information, and tailor Psychological First Aid for Schools interventions to meet these needs

Information Gathering:

Current Needs and Concerns

Goal: To offer practical help to students and staff in addressing immediate needs and concernsPractical Assistance

Goal: To help establish brief or ongoing contacts with primary support persons or other sources of support, including family, friends, teachers, and other school and/or community resources

Connection with

Social Supports

Goal: To provide information about stress reactions and coping to reduce distress and promote adaptive functioning

Information on Coping

Goal: To link students and staff with available services needed at the time or in the future

Linkage with

Collaborative Services

Brymer et al., 2012

PFA-S Resources

Schools can find training resources including the PFA-S Field Operations Guide, https://www.nctsn.org/resources/all-nctsn-resources.

• PFA-S Field Operations Guide: provides guidance on responding to

disaster, violence, or terrorism events using the Psychological First Aid

intervention.

• PFA-S Webinar: describes the fundamentals of Psychological First Aid

for Schools. This webinar offers information on how PFA-S helps to

reduce the distress that school communities can experience after a

disaster or violent event.

PFA Example Intervention: Link

Communication Skills

Stress Screener

Referral to Resources

Link in Schools Video

Link in Schools Pilot Data:Depressive & PTSD Symptoms

1 Repeated measures ANOVA model controls for student race, grade and sex, flood versus other disaster and correlation within schools

*P <0.05 from baseline.

**

*

Ramirez et al. 2013

Hospital-based Link Study

Children who received LINK

had significantly improved

child behaviors compared to

children who received

educational materials:

Peer relationships

problems (p=.0240)

Conduct problems (p=

.0368)

UI Children’s Hospital

Blank Children’s Hospital

Children’s Minnesota

Children’s Mercy, Kansas City

Link in Schools Process

summer/early fall summer/early fall fall & spring end of year

Trauma Informed

Care training

delivered to all

school staff

Implement Link Program:

At-risk youth (identified using existing

school systems) receive one-on-one

Link session

End-of-year Link

de-briefing

On-going Link

mentoring

Specialists

receive Link

training

Cognitive Behavioral Intervention for Trauma in Schools (CBITS)

• School-based, group and individual intervention; used with students 5th-12th grade

• Evidence-based intervention program developed for diverse youth exposed to trauma

• Reduce symptoms of post-traumatic stress disorder (PTSD), depression, and behavioral problems

• Improves functioning, grades and attendance, peer and parent support and coping skills

21CBITS, n.d.

Program Components

10 group sessions

1-3 individual sessions

2 parent psychoeducational

sessions

1 teacher educational session

Statewide Implementation of CBITS

20 Clinicians

5 school-based mental health provider organizations

Inputs

73 CBITS groups

350 racially and ethnically diverse students served

Activities Significant reductions in child PTSD symptoms and problem severity

Positive impact on students’ psychosocial and academic functioning

Outcomes

Hoover et al., 2018

CBITS Resources

Schools can find training resources including the CBITS fact sheet and culturally-specific fact sheet, https://www.nctsn.org/interventions/cognitive-behavioral-intervention-trauma-schools.

Schools can access a host of free resources, including everything needed to implement CBITS in a school, at https://cbitsprogram.org/.

CBITS Dissemination and Sustainability• Madison, Wisconsin

• Journey Mental Health Center in Dane County,

Wisconsin implemented CBITS in local public

schools since 2004.

• Originally funded by SAMHSA now funded

through the United Way of Dane County.

• Los Angeles, California• School Mental Health, an office of the Los Angeles

Unified School District, used a reflective learning

group model (a weekly training and supervision

process from preimplementation to outcome

evaluation) to implement CBITS during 2008-2010.

• They trained 107 staff, offered 117 groups, and

served more than 700 students in approximately

100 schools.

• Baltimore, Maryland• Since 2004, the University of Maryland has been

implementing CBITS in schools throughout the

state

• The Center for School Mental Health and the

School Mental Health Program, both in the School

of Medicine, initially received funding from the

Maryland Department of Health and Mental

Hygiene

• New Orleans, Louisiana• In response to Hurricane Katrina, Mercy Family

Center created Project Fleur-de-lis, a collaborative

partnership among schools, social service

agencies, and national experts to provide mental

health services within New Orleans-area schools.

• Funded through NCTSN and the Louisiana

Children’s Trust Fund

CBITS, n.d.

Staff Wellness as a Foundation

Teachers working with Trauma

• Teachers may experience secondary traumatic stress from working with student trauma

• Teachers express uncertainty and need for additional training related to childhood trauma

• Exposure to trauma-focused training, involvement with students who have experienced trauma, and teaching experience build trauma-related confidence

Alisic et al., 2012; Berger et al., 2016

Vicarious trauma & Compassion fatigueo Vicarious trauma is change resulting

from continuous empathic engagement with trauma survivors

o The “emotional residue” from working with children and families living with chronic stress and trauma

o May lead to changes in one’s sense of self, world view, and spiritual beliefs

o Compassion fatigue is emotional, physical, and spiritual exhaustion from witnessing and absorbing the problems and suffering of others

o Results from chronic use of empathy plus day-to-day bureaucratic hurdles

Vicarious trauma symptoms include:

Being jumpy or easily startled

Feeling trapped by one’s occupation

Free-floating anxiety or irritation

Hopelessness

Detachment from or avoidance of students and

their issues

Newell & MacNeil, 2010; Hunsaker et al., 2015

Promoting Staff WellnessSelf-assessment

Professional Quality of Life Scale

• Questions about your experiences as a caregiver in the last 30 days

• Compassion Satisfaction – pleasure you derive from being able to do your work well

• Burnout- associated with feelings of hopelessness and difficulties in dealing with work or doing job effectively

• Secondary traumatic stress- if exposed to others traumatic events as a result of the work you do may experience symptoms of traumatic stress (jumpy; images of event pop into your mind; problems with sleep)

Stamm, 2010

Professional Quality of Life Scale: Example Questions Secondary Traumatic Stress

I am preoccupied with more than one person I [help].

Because of my [helping], I have felt "on edge" about various things.

I avoid certain activities or situations because they remind me of frightening experiences of the people

I [help]

Compassion Satisfaction

I believe I can make a difference through my work.

I am proud of what I can do to [help].

I have thoughts that I am a “success” as a [helper].

Burnout

I feel worn out because of my work as a [helper].

I feel "bogged down" by the system.

Stamm, 2010

Professional Quality of Life Scale

• ProQOL administered individually or in groups

• Self-score option

• Part of ongoing self-care plan

• Important to establish what will happen with data because data privacy are important

• Feedback can include general information such as “others who score similarly to you” or may be more specific

• Feedback in group settings should not be about an individual but about things that apply to more than one person

• Be prepared to give clear information and answer questions

Stamm, 2010

Professional Quality of Life Scale

• ProQOL is not diagnostic• May raise issues to address with appropriate diagnostic

procedures

• Can be a guide for an individual or organization in regard to balance of positive and negative experiences at work, self-care or organizational wellness plans

• Can self-administer at regular self-determined intervals as regular check in

Stamm, 2010

Poll Question: What are some ideas for

promoting staff wellness in your school/organization?

Promoting Staff WellnessSelf-Care Tools & Techniques

Self-Care Strategies Worksheet

Belonging to positive social networks; maintaining relationships with friends; attending social activities or events.

Social

Self-Care

Appropriate exercise; proper eating habits; proper amount of sleep; joining gyms or exercise clubs.

Physical

Self-Care

Reading books; attending work-shops or seminars; learning a new craft or developing a new hobby.

Intellectual

Self-Care

Itemizing bills; monitoring expenses; incorporating expenses for leisure activities; talking with a financial consultant.

Financial

Self-care

Taking steps to reconnect with your Higher Power; attending religious services; participating in study groups; daily reflection on your purpose in life.

Spiritual

Self-Care

Taking a walk outdoors; creating a specific space in your home that is reserved only for healthy activities or rest; camping or contributing to an environmentally sound cause.

Environmental

Self-Care

Hydon et al. 2015

Professional Self-Care Card

36

Get Ready/Get Set In the Moment After-care

Coffee Name my emotion Take a walk

Exercise Consultation with

colleague

Play with dog

Prioritize my daily tasks Deep breathing

exercises

Romantic comedies

Poll Question:What comes to mind when you

hear the word mindfulness?

Mindfulness Definitions

• Intentionally living with awareness in the present moment

• Without judging or rejecting

• Without attaching or holding on to

• Mindfulness can be practiced at any time, anywhere, while

doing anything

Mindfulness Benefits

• Mindfulness may not reduce stressors, but it can help you manage stress by providing you with additional ways of coping with stress.

• Practicing mindfulness can be used to:

• Develop a broader perspective of life and a sense of connectedness with others

• Sharpen concentration, allowing greater focus in the activities we undertake in our lives

• Help to cope with stress, anger, and other forms of emotion

• Engage in the present and experience life in a richer, fuller way

International Society for Traumatic Studies

Mindfulness Benefits

Flook et al., 2013; Roeser et al., 2012

• Teaching can be uncertain, emotional, and attentionally demanding

• Requires mental flexibility, emotion regulation and relationship management skills

• Teachers have to problem solve on the fly while also expressing a range of emotions

• Pilot randomized controlled trial of modified Mindfulness-Based Stress Reduction course for teachers showed:

• Significant reductions in psychological symptoms and burnout • Improvements in observer-rated classroom organization • Increases in self-compassion

Ideas for Quick Mindfulness Practice

Possible Next Steps…

“The Flexible Framework,” n.d.

LEADERSHIP: SCHOOL ADMINISTRATORS CREATE

INFRASTRUCTURE AND CULTURE THAT PROMOTES TRAUMA

SENSITIVITY

PROFESSIONAL DEVELOPMENT: BUILD SKILLS THAT ENHANCE

CAPACITY TO CREATE A TRAUMA SENSITIVE LEARNING

ENVIRONMENT

ACCESS TO RESOURCES AND SERVICES: COORDINATE WITH MENTAL HEALTH AND OTHER

SERVICES OUTSIDE THE SCHOOL; SUPPORT STAFF TO REFLECT HOW WORK AFFECTS THEIR OWN LIVES

Possible Next Steps…

ACADEMIC AND NONACADEMIC STRATEGIES: IDENTIFY AND BUILD ON STUDENTS’ STRENGTHS AND ENSURE A SAFE ENVIRONMENT

POLICIES AND PROTOCOLS: REVIEW POLICIES AND

PROTOCOLS FOR DAY TO DAY ACTIVITIES AND LOGISTICS TO ENSURE TRAUMA SENSITIVE

ENVIRONMENT

COLLABORATION WITH FAMILIES: ENGAGE FAMILIES IN ALL ASPECTS

OF THEIR CHILD’S EDUCATION

“The Flexible Framework,” n.d.

References• Atkins, M. S., Frazier, S. L., Leathers, S. J., Graczyk, P. A., Talbott, E., Jakobsons, L., ... & Bell, C. C. (2008). Teacher

key opinion leaders and mental health consultation in low-income urban schools. Journal of Consulting and Clinical Psychology, 76(5), 905.

• Atkins, M. S., Hoagwood, K. E., Kutash, K., & Seidman, E. (2010). Toward the integration of education and mental health in schools. Administration and Policy in Mental Health and Mental Health Services Research, 37(1-2), 40-47

• Alisic, E., Bus, M., Dulack, W., Pennings, L., & Splinter, J. (2012). Teachers experiences supporting children after traumatic exposure. Journal of Traumatic Stress, 25, 98-101.

• Berger, R., Abu-Raiya, H., & Benatov, J. (2016). Reducing primary and secondary traumatic stress symptoms among educators by training them to deliver a resiliency program (ERASE-Stress) following the Christchurch earthquake in New Zealand. American Journal of Orthopsychatiry, 86, 236-251.

• Brymer M., Taylor M., Escudero P., Jacobs A., Kronenberg M., Macy R., Mock L., Payne L., Pynoos R., & Vogel J. Psychological first aid for schools: Field operations guide, 2nd Edition. (2012). Los Angeles: National Child Traumatic Stress Network.

• Cognitive Behavioral Intervention for Trauma in Schools (CBITS). (n.d.). Retrieved from https://cbitsprogram.org/

• Fazel, M., Hoagwood, K., Stephan, S., & Ford, T. (2014). Mental health interventions in schools in high-income countries. The Lancet Psychiatry, 1(5), 377-387.

• Flook, L., Goldberg, S. B., Pinger, L., Bonus, K., & Davidson, R. J. (2013). Mindfulness for teachers: A pilot study to assess effects on stress, burnout, and teaching efficacy. Mind, Brain, and Education, 7(3), 182-195.

• Hoover, S. A., Sapere, H., Lang, J. M., Nadeem, E., Dean, K. L., & Vona, P. (2018). Statewide implementation of an evidence-based trauma intervention in schools. School Psychology Quarterly, 33(1), 44.

• Hunsaker, S., Chen, H. C., Maughan, D., & Heaston, S. (2015). Factors that influence the development of compassion fatigue, burnout, and compassion satisfaction in emergency department nurses. Journal of Nursing Scholarship, 47(2), 186-194.

References

• Hydon, S., Wong, M., Langley, A.K., Stein, B.D., Kataoka, S.H. (2015). Preventing secondary traumatic stress in educators. Child & Adolescent Psychiatric Clinics of North America 24, 319–333.

• International Society for Traumatic Studies: https://www.istss.org/education research/online learning

• Maynard, B. R., Farina, A., & Dell, N. A. (2017). Effects of trauma-informed approaches in schools. Downloaded October, 6, 2018.

• National Child Traumatic Stress Network (NCTSN), Schools Committee. (2017). Creating, supporting, and sustaining trauma-informed schools: A system framework. Los Angeles, CA and Durham, NC: National Center for Child Traumatic Stress.

• Newell, J. M., & MacNeil, G. A. (2010). Professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue. Best Practices in Mental Health, 6(2), 57-68.

• Overstreet, S. & Chafouleas, S.M. (2016). Trauma-informed schools: Introduction to the special issue. School Mental Health, 8, 1-6.

• Ramirez, M., Harland, K., Frederick, M., Shepherd, R., Wong, M., & Cavanaugh, J. E. (2013). Listen protect connect for traumatized schoolchildren: a pilot study of psychological first aid. BMC psychology, 1(1), 26.

• Roeser, R. W., Skinner, E., Beers, J., & Jennings, P. A. (2012). Mindfulness training and teachers' professional development: An emerging area of research and practice. Child Development Perspectives, 6(2), 167-173.

• Stamm, B.H. (2010). The Concise ProQOL Manual, 2nd Ed. Pocatello, ID: ProQOL.org.

• The Flexible Framework: Six Elements of School Operations Involved in Creating a Trauma-Sensitive School. (n.d.). Retrieved from https://traumasensitiveschools.org/trauma-and-learning/the-flexible-framework/