1. Susan Jones
San Juan Unified School District
Behavior Specialist
Yolo County ACES
Sacramento County ACES
Adverse Childhood Experiences (ACEs) & Trauma Informed Care for Educators

2. Definition of Trauma

3. What is Child Traumatic Stress?
Child traumatic stress is when children and adolescents are exposed to traumatic events or traumatic situations, and when this exposure overwhelms their ability to cope.
When children have been exposed to situations where they feared for their lives, believed they could have been injured, witnessed violence, or tragically lost a loved one, they may show signs of traumatic stress. The impact on any given child depends partly on the objective danger, partly on his or her subjective reaction to the events, and partly on his or her age and developmental level.

4. Situations that can be traumatic:
Physical or sexual abuse
Abandonment, betrayal of trust (such as abuse by a caregiver)
Neglect
The death or loss of a loved one
Life-threatening illness in a caregiver
Witnessing domestic violence
Automobile accidents or other serious accidents
Bullying
Life-threatening health situations and/or painful medical procedures
Witnessing or experiencing community violence (e.g. shootings, stabbings, robbery, or fighting at home, fights at school, in the neighborhood, or at school)
Witnessing police activity or having a close relative incarcerated
Life-threatening natural disasters
Acts or threats of terrorism (viewed in person or on television)
Living in chronically chaotic environments in which housing and financial resources are not consistently available

5. Acute, Chronic and Complex Trauma
Acute Trauma
Chronic Trauma
Single Incident
Crime Victim
Serious Accident
Natural Disaster
Repeated
Prolonged Trauma
Domestic Violence
Abuse (Physical or Sexual)
War
Complex Trauma
Chronic, Interpersonal Trauma, Varied and Multiple Traumas, Early Onset, Often by Trusted Caregivers

6. Prevalence

7. Trauma Facts for Educators
FACT: One out of every 4 children attending school has been exposed to a traumatic event that can affect learning and/or behavior.
FACT: Trauma can impair learning.
Single exposure to traumatic events may cause jumpiness, intrusive thoughts, interrupted sleep and nightmares, anger and moodiness, and/or social withdrawal- any of which can interfere with concentration and memory.
Chronic exposure to traumatic events, especially in a child’s early years, can:
Adversely affect attention, memory and cognition
Reduce a child’s ability to focus, organize, and process information
Interfere with effective problem solving and/or planning
Result in overwhelming feelings of frustration and anxiety
FACT: Trauma can impact school performance.
Lower GPA
Higher rate of school absences
Increased drop-out
More suspensions and expulsions
Decreased reading ability

8. General Statistics
60% of adults report experiencing abuse or other difficult family circumstances during childhood.
26% of children in the United States will witness or experience a traumatic event before they turn four.
Four of every 10 children in American say they experienced a physical assault during the past year, with one in 10 receiving an assault-related injury.
Nearly 14% of children repeatedly experienced maltreatment by a caregiver, including nearly 4% who experienced physical abuse.
More than 13% of children reported being physically bullied, while more than 1 in 3 said they had been emotionally bullied.
1 in 5 children witnessed violence in their family or the neighborhood during the previous year.
In one year, 39% of children between the ages of 12 and 17 reported witnessing violence, 17%reported being a victim of physical assault and 8% reported being the victim of sexual assault.
1 in 3 girls and 1 in 6 boys are victims of sexual abuse

9. Adverse Childhood Experiences (ACEs) Study
Kaiser Permanente and Center for Disease Control, 1998 The Study:
17,000, mostly white, college-educated, employed adults were screened for 10 prominent childhood traumatic experiences as a part of their routine health care at Kaiser. Participants received one point for each type of trauma.
The Results:
70% of the 17,000 people experienced at least one type of trauma resulting in an “ACE score” of one; 87% of those had more than one.
ACE scores of 4 or more resulted in four times the likelihood of depression, 12 times the risk of suicide.
ACE scores were also directly correlated with early initiation of smoking and sexual activity, adolescent pregnancy, and risk for intimate partner violence.
Eighteen States have since conducted ACE surveys with similar results.
A person with an ACE score of 4 is 260% more likely to have COPD, 240% more likely to have Hepatitis, and 250% more likely to have a sexually transmitted disease than a person with an ACE score of 0.
A male child with an ACE score of 6 has a 4600% increase in the likelihood of becoming an IV drug user when compared to a child with an ACE score of 0.

10. ACEs Conceptual Framework
Early Death
Retaliation and Imprisonment
Weapon Possession and Self-Medication
Hospitalization and Discharge to the Street
Physical Assault (Shot/Stabbed)
Early Death
Diabetes
Overeating
Depression
Sexual Abuse
Early Death
Disease, Disability and Social Problems
Adoption of Health-Risk Behaviors
Social, Emotional and Cognitive Impairment
Disrupted Neurodevelopment
Adverse Childhood Experiences

11. Toxic Stress
The process of exposure to ACEs and the process of adjustment.
Toxic stress- persistent, unpredictable, inescapable.
The ‘complex’ in complex trauma risk:
Early exposure at times of critical development
Multiple risks
Unpredictable and persistent.
Who you love is who you may not be able to count on.
Natural responses to extraordinary circumstances.
Complex trauma involves common challenges and responses that can be understood and guide our actions.
The research that explains the ACE Study is the neurobiology of toxic stress -- what happens to your brain and body when you experience trauma or chronic adversity.
Here’s a short explanation from the Harvard Center on the Developing Child.
Link:

12. ACES Questionnaire for Youth

14. Impact of Adverse Childhood Experiences (ACEs)

15. Adverse Childhood Experiences….
….are very common. ...occur together -- if you have one ACE, there’s an 87% chance you have more. ...the more you have, the higher your risk of physical, mental and social problems.
So, the ACE Study revealed four important findings.
-- Childhood adversity is very common – 64 percent experienced at least one type of childhood trauma.
-- If there's one type of childhood trauma, there’s an 87% chance that there are others. In other words, traumas such as child sex abuse rarely happen alone.
-- -- The more types of adverse childhood experiences, the higher the likelihood of long-term effects,

16. Important Things to Remember
Not “what’s wrong with you” but “what happened to you”
Symptoms are adaptations
Violence causes trauma and… trauma causes violence.
SAMHSA, 2013

17. There are students in your school who have experienced trauma
What you might observe in students:
Anxiety, fear and worry about safety of self and others (Elementary aged students may be more clingy with teacher or parent)
Worry about the recurrence of violence
Increased distress (unusually whiny, irritable, moody)
Changes in behavior:
Increase in activity level
Decreased attention and/or concentration
Change in academic/school performance
Withdrawal from others or activities
Irritability with friends, teachers, events (Middle School students)
Angry outbursts and/or aggression
Absenteeism
Increase in impulsivity, risk-taking behavior (High School students)

18. Increased somatic complaints
Distrust of others, affecting how children interact with both adults and peers (Elementary School students)
A change in ability to interpret and respond appropriately to social cues (Elementary School students)
Increased somatic complaints
headaches, stomachaches, chest pains
overreaction to minor bumps and bruises (Elementary School students)
Discomfort with feelings (such as troubling thoughts of revenge)-Middle School students
Increased risk for substance abuse (High School students)
Recreating the even (e.g. repeatedly talking about, “playing” out, or drawing the event)
Over- or under-reacting to bells, physical contact, doors slamming, sirens, lighting, sudden movements

19. Statements and questions about death and dying
In High School students- repetitive thoughts and comments about death and dying (including suicidal thoughts, writing, art, or notebook covers about violent or morbid topics, internet searches)
Difficulty with authority, redirection or criticism
Re-experiencing the trauma (e.g. nightmares, or disturbing memories during the day)
Hyperarousal (e.g. sleep disturbances, tendency to be easily startled)
Avoidance behaviors (e.g. resisting going to places that remind them of the event)
Emotional numbing (e.g. seeming to have no feeling about the event)

22. Protective Factors for Post Trauma Adjustment
A reliable support system (family, friends)
Access to safe and stable housing
Timely and appropriate care from first responders
Self care practices (sleeping, nutrition)
Using positive coping mechanisms verses negative coping mechanisms
Parental resilience
Knowledge of parenting and child development
Nurturing and attachment

23. Trauma Informed Care

24. But with all this bad news about how trauma hurts us, there’s good news. Our brains are plastic. Our bodies are plastic. Resilience research has identified many ways that individuals can implement ways to prevent childhood adversity and stop further traumatizing already traumatized people. Those include meditation -- which one researcher calls dental hygiene for the brain -- exercise, sleep, good nutrition, and social interaction. There’s emerging research on what makes families resilient. The frontier of resilience research lies in communities and systems.

25. What is “Trauma Informed”?
A program, organization or system that is trauma informed realizes the widespread impact of trauma and understands the potential paths for healing; recognizes the signs and symptoms of trauma in staff, clients, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, practices, and settings.
SAMHSA, 2013

26. Goals of Trauma Informed Care
Provide the foundation for a basic understanding of the psychological, neurological, biological and social impact that trauma and violence have on many of the individuals we serve by:
Avoiding unintentional re-traumatization through agency policies, practices and staff interactions with youth and their families
Recognizing the impact of trauma on your students, your staff and YOU
Incorporating Trauma Informed Practices in policies and procedures
Educating and empowering staff and youth
Encouraging self care practices and identifying vicarious trauma

28. Trauma Informed System of Care
Non-Trauma Informed
Recognition of high prevalence of trauma
Lack of education on trauma prevalence and “universal” precautions
Recognition of primary and co-occurring trauma diagnoses
Over diagnosis of Schizophrenia, Bipolar Disorder, Conduct Disorder, and singular addictions
Assess for traumatic histories and symptoms
Cursory or no trauma assessment
Recognition of culture and practices that are re-traumatizing
“Tradition of Toughness” valued as best care approach
Power/control minimized- constant attention to culture
Keys, security uniforms, staff demeanor, tone of voice

29. Trauma Informed System of Care
Non-Trauma Informed
Caregivers/supporters-collaboration
Rule enforcers-compliance
Address training needs of staff to improve knowledge and sensitivity
“Youth blaming” as fallback position without training
Staff understand function of behavior (rage, repetition-compulsion, self-injury)
Behavior is seen as intentionally provocative
Objective, neutral language
Labeling language: “manipulative”, “needy”, “attention-seeking”
Transparent systems open to outside parties
Closed system- advocates discouraged

30. Utilizing a Trauma Informed Approach to Teach Students
Teaching and learning play an important role in diminishing trauma symptoms and enabling traumatized children to reach their potential despite their difficult circumstances.
Helping children regulate emotions in order to master social and academic skills.
Maintaining high academic standards.
Helping children feel safe.
Managing behavior and setting limits.
Reducing bullying and harassment.
Helping children have a sense of agency.
Building on strengths.
Understanding the connection between behavior and emotion.
Avoiding labels.
Helping children regulate emotions in order to master social and academic skills
School provides an important opportunity to teach children how to calm their anxieties and modulate their behaviors. Traumatized children operate at a high level of arousal and fear, making it difficult for them to process information. Anything that reminds a child of the trauma (a facial expression, the color of someone’s hair) can trigger behaviors that may not be appropriate in the classroom. Training can start by helping staff recognize when children might be experiencing intense emotions and then move on to a discussion of appropriate supports and responses. Physical activities such as martial arts, yoga, and theater are becoming
54 Helping Traumatized Children Learn
recognized as important activities that can help traumatized children reduce hyperarousal and can be enlisted in the classroom to help children focus and learn. Also, simple accommodations such as creating a safe space, or “peace corner,” in the classroom; alerting children to any loud noises (e.g., bells, fire alarms) before they occur; and giving children goal-directed tasks that involve movement (e.g., passing out papers) can help children who are aroused regulate their emotions.147
Maintaining high academic standards:
One of the most effective ways for children to overcome the impact of trauma is to master the academic and social goals set by the school. Upon learning that a child has been subjected to trauma, it is natural to assume that the curricula should be lightened or expectations diminished. Often adults will say, “She needs time away from academics for a while.” It is understandable to want to make things easier on a stressed child, and sometimes this
is appropriate. However, careful attention should be paid to the message conveyed by lowering standards. Children often interpret lowered standards as validation of a sense of themselves as worthless, a self-image created by the trauma. Ideally, it is best to let the student know that, despite the travails of his or her life, your expectation is that the student will continue to meet the high standards set for all the children, and that the school will help to make that possible.
Helping Children feel safe:
Many of the academic and behavioral difficulties experienced by traumatized children are consequences of the persistent state of fear in which they live. For them to be educated effectively, it is essential that they feel physically and emotionally safe at school. Training should include discussion of how the school can ensure that abusive parents do not enter the building, how to make the classroom safe from teasing and bullying, ways to help children perceive adults as safe and positive, how to reinforce predictability in the classroom, and how to help traumatized children react to the unexpected (e.g., a schedule change).
Managing behavior and setting limits:
Traumatized students must be held accountable for their behavior. However, a behavior-management system should be based on an understanding of why a particular child might respond inappropriately in the classroom and on the relational and academic needs of that child. (For more detail, see section VI of the Framework, “School Policies, Procedures, and Protocols.”) Traumatized children may need to learn that obeying rules will make a positive difference in their lives; the experience of many children growing up in households plagued by family violence is that rules are arbitrary. It is essential to put in place a school- wide coordinated behavior-management system that emphasizes positive behavioral supports. In addition, traumatized children may benefit from social-skills groups that teach children what behaviors are socially acceptable at school, discuss ways to make friends, and help them learn to trust adults.
Reducing bullying and harassment.
Traumatized students will particularly benefit from a predictable environment that is bully and harassment free. To create such an environment, schoolwide policies concerning bullying and harassment should be established and all staff and students should be trained in how to recognize and respond appropriately. The Newton, Massachusetts, Public Schools curriculum “Creating a Peaceable School: Confronting Intolerance and Bullying” emphasizes a school environment where students feel connected as a community and where older students model positive alternatives to negative peer group behavior. This curriculum also provides “opportunities for students to deal with feelings of exclusion, anger, prejudice, and disempowerment, and conversely with feelings of community, speaking one’s voice and empowerment.”148
Helping children have a sense of agency.
Teachers can help traumatized children cultivate a sense that they can control their environment by creating structures within which children can make choices. Making choices strengthens one’s sense of empowerment; having structured opportunities to make choices helps traumatized children overcome the chronic feeling of powerlessness that family violence induces. Learning to accept school boundaries and make appropriate choices within these boundaries can foster a much-needed sense of self- control in traumatized children who chronically seek to be in control of others.
Building on strengths.
Every child has an area of strength in which he or she excels, whether it is in academics, art, music, or sports. When educators can identify and focus on a child’s strength, they afford the child the opportunity to experience success, with all the emotional implications of doing something well. This is an important starting point in mastering academic content and social relations, which in turn can serve as a basis for success at school.
Understanding the connection between behavior and emotion.
Traumatized children are often unable to express their experiences in ways adults can readily understand. Lacking the words to communicate their pain, they may express feelings
of vulnerability by becoming aggressive or feigning disinterest in academic success because they believe they cannot succeed. Moreover, they themselves may not understand why they are upset or acting out, creating a disconnect between experience, emotion, and actions. When teachers don’t understand why
a child is acting out, they are likely to focus on the behavior, not on the emotion behind it. Training should help staff understand that a traumatized child’s disruptive behavior often is not a matter of willful defiance, but originates in feelings of vulnerability. Once teachers grasp this critical insight, they will be able to work toward responding to what the child may be feeling, rather than solely on the problematic behavior.
Avoiding Labels.
Training needs to emphasize the negative consequences of publicly labeling children “traumatized” or “abused.” Labeling carries the risk of making trauma into a prominent feature of the child’s identity.

31. Lincoln High School, Walla Walla, WA
Lincoln High School is an alternative school in Walla Walla, WA. It’s where they put the “throw-away” kids. Almost every city has one of these schools. The first year after principal Jim Sporleder implemented trauma-informed practices, suspensions dropped 85% and expulsions went down 40%.
Lincoln High School, Walla Walla, WA

32. By the 2012 school year, suspensions dropped another 50%, and there were no expulsions. And their academic scores and graduation rates went up. The kids know they’re safe and loved; they say the school is their family. They’ve done their own ACE survey, and found that their average ACE score is 5.
This story has touched a nerve. Since it was published in 2012, it’s gone viral twice, and has had more than 700,000 page views.

33. UCSF HEARTS Program: 
Healthy Environments and Response to Trauma in Schools
A comprehensive, multilevel school-based prevention and intervention program for children who have experienced trauma
Their goal is to create school environments that are more trauma-sensitive and supportive of the needs of traumatized children.
A main objective is to work collaboratively with the school district to promote school success by decreasing trauma-related difficulties and increasing healthy functioning in students who have experienced complex trauma.
Trauma-sensitive school environments will likely benefit not only traumatized children, but also those who are affected by these children, including child peers and school personnel.
The UCSF Healthy Environments and Response to Trauma in Schools (HEARTS) project is a comprehensive, multilevel school-based prevention and intervention program for children who have experienced trauma. The goal of UCSF HEARTS is to create school environments that are more trauma-sensitive and supportive of the needs of traumatized children. A main objective of this project is to work collaboratively with SFUSD to promote school success by decreasing trauma-related difficulties and increasing healthy functioning in students within the San Francisco Unified School District (SFUSD) who have experienced complex trauma. Trauma-sensitive school environments will likely benefit not only traumatized children, but also those who are affected by these children, including child peers and school personnel.

34. UCSF HEARTS Program: What does UCSF Hearts do?
First Area: school-based intervention and prevention work with children and adolescents directly and indirectly affected by trauma
» Tertiary interventions, e.g., trauma-informed therapeutic interventions for youth who are having post-trauma difficulties
» Secondary interventions, e.g., skill-building groups for at-risk youth
» Primary prevention, e.g., classroom presentations on coping with trauma and violence
Second Area: training, consultation and support for adult members of the caregiving system (school personnel and parents/guardians)
» Interventions such as psychoeducational and skill-building workshops for parents/caregivers
» Training and consultation in complex trauma and trauma-sensitive practices for teachers, administrators, paraprofessionals, and school mental health staff
» Aimed at building capacity in SFUSD personnel around more effectively working with traumatized students
» Support for school staff around stress, burnout, and vicarious traumatization
Third Area: working with SFUSD at the school-level and the district-level to help improve school- and district-wide policies and procedures » Trauma-informed consultation around positive behavioral support systems, discipline policies, and alternatives to suspension from school for students with behavioral challenges
The UCSF Healthy Environments and Response to Trauma in Schools (HEARTS) project is a comprehensive, multilevel school-based prevention and intervention program for children who have experienced trauma. The goal of UCSF HEARTS is to create school environments that are more trauma-sensitive and supportive of the needs of traumatized children. A main objective of this project is to work collaboratively with SFUSD to promote school success by decreasing trauma-related difficulties and increasing healthy functioning in students within the San Francisco Unified School District (SFUSD) who have experienced complex trauma. Trauma-sensitive school environments will likely benefit not only traumatized children, but also those who are affected by these children, including child peers and school personnel.

35. Supporting student’s resilience
Encourage social connectedness – developing community
Provide concrete support in times of need
Demonstrate social and emotional competence
Support the use of restorative practices in managing conflict
Be a safe caring adult
Be consistent
Follow through
Be flexible

36. Relationship is the Evidence-Based Practice
Trauma results primarily from disrupted relationships
Relationship is the vehicle for life success
Attachment key to well-being
Critical role of core caregiver-infant relationships
Early learning creates persistent but potentially modifiable responses
Progressive role of extended caregivers and intimate relationships
Christopher Blodgett, Ph.D.
CLEAR Trauma Center
Washington State University
Copyright WSU AHEC CLEAR Center 2013

37. Supporting Resilient Communities
Safe, stable, and nurturing relationships and environments are essential to prevent child maltreatment and to assure children reach their full potential.
Adopt the vision
Raise awareness
Partner with others
Join the Yolo County ACES Connection Group at acesconnection.com

38. Resources

39. AcesTooHigh.com

41. ACEsConnection is the accompanying community of practice social network. Most of its more than 3,000 members are implementing practices based on ACE- and trauma-informed concepts.
ACEsConnection.com

43. Helping Traumatized Children Learn: http://traumasensitiveschools.org

44. National Child Traumatic Stress Network: http://nctsn.org

45. Self Care for Educators
“There is a cost to caring”-Charles Figley
Be aware of the signs
Increased irritability or impatience with students
Difficulty planning classroom activities and lessons
Decreased concentration
Denying that traumatic events impact students or feeling numb or detached
Intense feelings and intrusive thoughts, that don’t lessen over time, about a student’s trauma
Dreams about students’ traumas
Don’t go it alone
Recognize compassion fatigue as an occupational hazard
Seek help with your own traumas
If you see signs in yourself, talk to a professional
Attend to self care
Trauma takes a toll on children, families, schools, and communities. Trauma can also take a toll on school professionals. Any educator who works directly with traumatized children and adolescents is vulnerable to the effects of trauma—referred to as compassion fatigue or secondary traumatic stress—being physically, mentally, or emotionally worn out, or feeling overwhelmed by students’ traumas. The best way to deal with compassion fatigue is early recognition.
TIPS FOR EDUCATORS:
1. Be aware of the signs. Educators with compassion fatigue may exhibit some of the following signs:
• Increased irritability or impatience with students
• Difficulty planning classroom activities and lessons
• Decreased concentration
• Denying that traumatic events impact students or feeling numb or detached
• Intense feelings and intrusive thoughts, that don’t lessen over time, about a student’s trauma
• Dreams about students’ traumas
2. Don’t go it alone. Anyone who knows about stories of trauma needs to guard against isolation. While respecting the confidentiality of your students, get support by working in teams, talking to others in your school, and asking for support from administrators or colleagues.
3. Recognize compassion fatigue as an occupational hazard. When an educator approaches students with an open heart and a listening ear, compassion fatigue can develop. All too often educators judge themselves as weak or incompetent for having strong reactions to a student’s trauma. Compassion fatigue is not a sign of weakness or incompetence; rather, it is the cost of caring.
4. Seek help with your own traumas. Any adult helping children with trauma, who also has his or her own unresolved traumatic experiences, is more at risk for compassion fatigue.
5. If you see signs in yourself, talk to a professional. If you are experiencing signs of compassion fatigue for more than two to three weeks, seek counseling with a professional who is knowledgeable about trauma.
6. Attend to self care. Guard against your work becoming the only activity that defines who you are.
Keep perspective by spending time with children and adolescents who are not experiencing traumatic stress. Take care of yourself by eating well and exercising, engaging in fun activities, taking a break during the workday, finding time to self-reflect, allowing yourself to cry, and finding things to laugh about.

46. Resources www.nctsn.org www.tfcbt.musc.edu www.samhsa.org
content/uploads/2012/05/Trauma_Informed_Care_Powerpoint. pdf
education/upload/TraumaPowerpoint-DrBurrHarris2012.pdf
booklet-web.pdf

47. Resources Substance Abuse and Mental Health Services Administration
- news site
Link to story about Lincoln High:
- professional networking site
CDC Synopsis:
CDC’s Essentials for Childhood Framework: ml
National Child Traumatic Stress Network
Substance Abuse and Mental Health Services Administration

49. Thank you! Susan Jones susan.jones@sanjuan.edu