1. Trauma-Informed Care and Practices in School-Based Settings
Mark R. Groner, MSSA, LISW-S
Joan Blackburn, MSSA, LISW-S
Carol Hoffstetter, MSW, LISW-S
Dominic Ferrante 1

2. Learning Objectives
1: Convey the importance of a trauma-informed care approach when screening, assessing, treating trauma
II. Impart knowledge about the use of trauma- informed care evidence-based practices in school settings in order to advance resiliency as a buffer to adversity and trauma, as well as to address trauma and complex trauma
III. Impart knowledge about the benefits and challenges of school-based service provision when treating trauma and complex trauma in school- based settings 2

3. Beech Brook, providing 163 years of hope to children and families.

4. A word about our history of being an early adopter of trauma-informed care.4

5. Our approach has included:
Use of an internal Trauma-Informed Care Team with ongoing self-study and continuous performance improvement activities
Use of state and national learning communities
Development of internal experts
Use of evidence-based trauma-informed care practice models 5

6. Why is a trauma-informed care approach so essential?6

7. Let’s define “trauma,” “complex trauma,” and “secondary traumatic stress.”7

8. What kinds of experiences result in trauma
What kinds of experiences result in trauma? What aspects of child development get derailed? 8

9. Psychological Trauma Impacts the Brain
Part of Brain
Role
Impact
Amygdala (becomes over-reactive)
Management of emotions
Emotional dysregulation
Hippocampus (shrinks)
Memory and memory consolidation
Impaired memory
Broca (gets smaller and deactivated)
Speech
Shuts down speech
Prefrontal Cortex
Executive functioning
Impaired thinking, judgment, and processing
Cortisol (gets over-produced)
Hormone (chemical secreted by an endocrine gland)
Triggers amygdala resulting in fight, flight, freeze responses
Norepinephrine (gets released)
Neurochemical (chemical released from a nerve cell)
Hypervigilence
Research is increasingly showing that psychological trauma impacts such brain areas as the amygdala (involved in emotion management), and the hippocampus (involved in memory and memory consolidation). If trauma occurs repeatedly or over a prolonged period, cortisol (a hormone released during times of stress) is released too much, subsequently activating the amygdala and causing even more cortisol to be released. It is a self-perpetuating cycle that leaves the individual with heightened sympathetic arousal (“fight” or “flight” response). Research has shown that the hippocampus shrinks in volume in individuals with Post Traumatic Stress Disorder (PTSD), which can have negative effects on memory. 9

10. Definition of Trauma-Informed Screening and Assessment
Trauma-informed screening: a brief, focused inquiry, often in the form of a tool, to determine whether or not an individual has experienced specific traumatic events.
Trauma assessment: a more in-depth exploration of the nature and severity of the traumatic events, the sequelae of those events, and current trauma-related symptoms. 10

11. Our general approaches to trauma treatment
Provide & ensure safety.
Fix a broken system.
Maintain a positive and consistent therapeutic relationship.
Tailor the therapy, taking into consideration client realities.
Take gender and sociocultural issues into account.
Practice ethically, within sound standards of care, and with appropriate boundaries to prevent “counteractivation” (unwittingly becoming unduly assertive or passive).
Take care of yourself and your team. 11

12. Models of trauma treatment
Over 500 documented treatments available for children and adolescents (Kazdin, 2000).
NCTSN lists over 40 evidence informed treatments that focus specifically on trauma and new ones are constantly being developed (NCTSN at practices 12

13. PATHS
Promoting Alternative THinking Strategies 13

14. PATHS What is PATHS? Why Promote it?
-Evidenced Based Curriculum for promoting social and emotional awareness in children
Research findings:
- 23% improvement in social and emotional skills
- 9% improvement in attitudes about self, others school
- 9% improvement in classroom behavior
- 9% decrease in aggression
- 10% decrease in emotional distress such as anxiety and depression
- 11 percentile point gain in achievement test scores 14

15. Compliments PATHS Kid of the Day Impulse Control
Key Components
Compliments PATHS Kid of the Day
Impulse Control
Do the Turtle!
Feelings and Behaviors
Comfortable and Uncomfortable
OK and Not OK 15

16. Key SEL Competencies 16

17. Evidenced Based Models
Trauma Focused Cognitive Behavioral Therapy (TFCBT)
A structured, evidence based model of therapy that addresses the unique biopsychosocial needs of children with PTSD or other problems related to traumatic life experiences
Children and parents are provided knowledge and skills related to processing the trauma
-Psycho Education
Normalize the response of the trauma
-Relaxation/Stress Management
Breathing exercises
progressive muscles relaxation
Thought stopping
-Affect Regulation
“Emotions Color Wheel” good resource
All feelings are OK 17

18. Evidenced Based Models
Trauma Focused Cognitive Behavioral Therapy (TFCBT)
-Cognitive Coping
Goal: practice the skill of developing many ways to thing about a given situation
Positive self talk, challenge thinking errors
Cognitive triangle
Recognize how one is coping well
-Trauma Narrative
Gradually desensitize the traumatic event
Use words, pictures, poems, song- get them to tell their story
-In-Vivo
Gradual exposure, dealing with remaining avoidant behaviors
Conjoint Parent Child Sessions
-Prepare parent for narrative sharing, sharing and praise for progress
Enhancing Future Safety and Development 18

19. Evidenced Based Models
Alternatives for Families Cognitive Behavioral Therapy (AFCBT)
An approach for working with families that experience frequent conflicts that may result in excessive arguments or use of physical force or discipline.
Appropriate for use with physically coercive/abusive parents and their school aged children
Adopts a comprehensive approach to treatment targeting the contributors of the angry and aggressive behaviors and the impact of these behavior's on a child’s development
The model is designed to help parents take responsibility for what has occurred and learn new ways of problem solving, conflict resolution and parenting skills. 19

20. Evidenced Based Models
Outcomes of AFCBT
Caregiver/child verbal and physical aggression
Family conflict
Recidivism (caregiver)
Child safety
Child social competence
Parental nurturing
Family cohesion
Kolko, 1966, Kolko et al., 2011, 2012, 2014 20

21. Trauma and Grief Component Therapy for Adolescents
Assessment-driven manualized individual and group treatment model for trauma-exposed or traumatically bereaved older children and adolescents.
Designed for youth and transitional youth between the ages of 12 and 20 years, including those impacted by community violence, traumatic bereavement, natural and man-made disasters, war/ethnic cleansing, domestic violence, witnessing interpersonal violence, medical trauma, serious accidents, physical assaults, gang violence, and terrorist events 21

22. Trauma and Grief Component Therapy for Adolescents
The intervention is assessment-driven, with specific treatment modules selected based on clients' problems, needs, and strengths.
Model contains a variety of components.:
An initial assessment, case conceptualization, and treatment planning
Psychoeducation
Emotional regulation skills
Addressing youths' and families' traumatic stress experiences and reactions
Promoting adaptive coping (e.g., social support, problem-solving, contending with trauma and loss reminders),
Addressing maladaptive beliefs relating to trauma and loss,
Promoting adaptive developmental progression
Addressing grief and loss,
Maintaining adaptive routines,
Relapse prevention, and (k) ongoing monitoring, surveillance, and evaluation of treatment response.
Family/parent sessions are offered at key points in treatment.
Assessment tools are available to measure all major targeted therapeutic outcomes. 22

23. Cognitive Behavioral Interventions for Trauma in Schools - CBITS
“CBITS is a school-based, group and individual intervention. Designed to reduce symptoms of post- traumatic stress disorder (PTSD), depression, and behavioral problems, and to improve functioning, grades and attendance, peer and parent support, and coping skills.”
CBITS uses cognitive-behavioral techniques to help youth, grades 5-12, who may have experienced a variety of stressful and traumatic life events. The model incorporates psycho-education, relaxation, social problem-solving, cognitive restructuring, and exposure. 23

24. Outcome Data 2013 & & 24

25. Actively Caring For People
May 5th, 2012
Creating a more compassionate community through intentional acts of kindness 25

26. AC4P Actively Caring For People
Founded by E. Scott Geller, Ph.D., Director of the Center for Applied Behavior Systems, Virginal Tech University initially focusing on workplace safety, psychology of safety, behavioral safety interventions.
In 2007, the AC4P movement at Virginia Tech began to develop a kinder, more compassionate and interdependent culture.
In 2009, Shane McCarty, Ph.D. candidate, Department of Organizational Psychology, Virginia Tech University, expanded AC4P to focus on enhancing school climate. 26

27. Foundations of AC4P
AC4P is about “intentional acts of kindness. Random implies chance.
Requires personal interaction with others.
Takes moral courage.
Behavior based feedback to support desired behavior.
Emphasizes a youth led, peer-to-peer model.
Research done on the Elementary and Middle School approaches show promising outcomes (McCarty & Geller, 2013) and (McCarty, Teie, Langerman & Geller, 2014). 27

28. 28

29. McCarty, 2014 29

30. There are advantages of providing trauma treatment in schools.30

31. There are disadvantages of providing trauma treatment in schools.31

32. This is a plug for attention to secondary traumatic stress and burnout.32

33. 33