WHY TRAUMA-INFORMED SCHOOLS?

In the United States, two out of three children experience a traumatic event by the time they reach age 16 (Jackson & Peck, 2019). Trauma has a significant impact on brain development, which in turn affects learning, memory, attitudes, behaviors, perception, relationships, and self-regulation. People who experience childhood trauma may develop or be at increased risk for: school problems, including lower grades and more disciplinary incidents; mental health issues; involvement with child welfare and juvenile justice; and developing substance use disorders (Perrello, 2019). Although trauma continues to affect students, up to 80% of youth in need of mental health services do not receive services in their communities. Students are 21 times more likely to visit school-based centers for mental health (Taylor, 2019), indicating that school-based mental health supports may be more accessible and effective at helping students who are impacted by trauma.

Trauma is unique to each individual, and it is not something that is obvious to outside observers. It can impact development at different stages, shaping the perceptions that students have about themselves and the world around them (Perrello, 2019). Symptoms of trauma can be emotional, physical, physiological, psychological, and behavioral in nature. With an increase in traumatic events for students, including school shootings and weather-related disasters, it is natural that schools are looking to expand safety efforts and school-based mental health services. Although national media attention has focused in on traumatic events, there are children who attend school every day who are affected by toxic stress and trauma, related to many different adverse childhood experiences (Walkley & Cox, 2013).

Trauma-informed care is an organized framework that incorporates understanding, recognition, and responding to different types of trauma (Paccione-Dyszlewski, 2016). While there have been and will continue to be students in schools who have experienced trauma, it is important for educators to understand that prolonged exposure to toxic stress can have permanent, detrimental effects on children. The following literature review highlights the definition and impact of toxic stress and trauma, discusses the PA Model Trauma-Informed Approach Plan guidelines and requirements, builds support for integrating a trauma-informed culture with the use of PBIS, illustrates trauma-focused school counseling and mental health practices, examines how to apply the Trauma-Informed Approach in school systems, and reviews best practices for providing trauma-informed professional development to educators.

Defining Toxic Stress & Trauma

All people have the ability to experience developmentally appropriate stress, which is thought to help build coping skills and resiliency. Stress can be described using a continuum, with normative stress on one end and traumatic stress on the other end. Traumatic stress can be defined by its unpredictability and accompanying feelings of horror and helplessness (Walkley & Cox, 2013), and incidents that potentially threaten a person’s life, safety, or personal integrity (Wiest-Stevenson & Lee, 2016). Trauma can be defined in the school setting as “any adverse experience that affect’s a child’s ability to function,” (Paccione-Dyszlewski, 2016, p. 8). Examples of traumatic experiences include natural disasters, terrorism, mass shootings, physical and/or sexual abuse, domestic and community violence, vehicle accidents, and chronic painful medical procedures. Closely related to traumatic stress is toxic stress, which occurs when a child experiences strong, repeated, and sustained adversity, i.e. children raised in a home with parents experiencing addiction or serious mental health problems, incarcerated family members, poverty, or suffering from emotional or physical neglect. In addition, people who have indirectly experienced a traumatic event either by experiencing a survivor’s response to the trauma or by trying to help the survivor can experience what is known as secondary traumatic stress (Weist-Stevenson & Lee, 2016).

Impact of Trauma & Toxic Stress

Traumatic experiences can lead to lasting physical, mental, and emotional harm (Rumsey & Milsom, 2019) and have the ability to alter the brain’s neurological structure (Rhoton, 2019). When the brain is repeatedly activated by traumatic events or toxic stress, the body’s neurological system that distinguishes relevant and important information known as the Anterior Cingulate of the Cortex (ACC) can become distorted, affecting reaction time and judgement, and resulting in rigid thinking. Neuropathways are developed based on experiences, so the more often they are activated, the faster the response is triggered (Rhoton, 2019). People who are exposed to trauma may be quick to react, where others are able to pause before reacting, because the space between the stimulus and response becomes shorter each time the brain becomes “activated.” The ACC system controls physical, emotional, and physiological responses, making it difficult for children triggered by traumatic events or toxic stress to focus on anything other than “survival,” because the trauma response in the brain will continue to have the same reaction, regardless of whether or not the event is actually life threatening (Rhoton, 2019).

While trauma is personal and experienced differently by each individual person, young children exposed to trauma are particularly vulnerable to “developmental delays in language and cognitive functioning, difficulty in maintaining attention and concentration, and difficulty in regulating emotions and functioning appropriately in a classroom setting,” (Paccione-Dyszlewski, 2019, p. 8). Traumatic responses in children can result in fight, flight, or freeze responses, which can be observed in the school setting if students engage in externalizing and overt behaviors. Students who display aggressive and violent behaviors may receive disciplinary action which can further escalate behavior.

Untreated trauma from childhood can have significant long-term impacts on brain development, emotional wellbeing, and behavioral stability (Naik, 2019). There is also a connection between trauma exposure and substance use for adolescents. Research suggests that teens who have experienced physical or sexual abuse are three times more likely to report current or past substance abuse than peers who do not have a history of trauma (PCCD, 2020). Children who have increased rates of Adverse Childhood Experiences (ACEs) face greater rates of depression, drug use, physiological disease, risk for domestic violence, financial instability, and poor academic achievement (Naik, 2019). Experiencing prolonged traumatic events or toxic stress in childhood is linked with impaired cognitive and physical development, and it is thought that “the more adversity a child faces, the greater the odds for long-term developmental consequences” (Walkley & Cox, 2013, p. 123).

Building a Trauma-Informed School Culture

One of the most important elements of building an effective Trauma-Informed School Model (TISM) involves the total commitment by school administration, with school leadership providing clear guidelines for how each position within the school can assist each other in responding to various situations. There must be a plan to outline the procedures, policies, and key roles, with an emphasis on fostering a safe environment (Weist-Stevenson & Lee, 2016). The Substance Abuse and Mental Health Services Administration (SAMHSA) outline the following elements as essential to a trauma-informed systems approach: safety, trust, peer support, collaboration, empowerment, and culture (Kataoka et al., 2018).

A positive learning environment conducive to healing begins with a culture of trust and acceptance. While there first must be an understanding of symptoms of toxic stress and recognition of these symptoms within the school setting, educators must also work to create a kinder, gentler environment where children feel safe enough to reveal their trauma (Paccione-Dyszlewski, 2016). Awareness is a crucial first step, but schools can also utilize existing evidence-based frameworks to further develop their school culture to promote a trauma-informed approach. For example, a Positive Behavior Interventions and Supports (PBIS) framework can be implemented to help provide a safe and therapeutic classroom environment for students.

PBIS. Although a theoretical foundation for the PBIS framework has been present for decades within education, the PBIS approach was formally created as a response to improve school climate and restructure disciplinary systems across the United States. It is considered a public school reform movement, and focuses on adopting evidence-based practices and procedures to promote positive behavioral and academic outcomes for students (Frey, Lingo, & Nelson, 2008). More than 25,000 schools across the country have adopted PBIS programs, but race, social class, and disability continue to impact overrepresentation in special education programs, detention, suspension, and other exclusionary discipline practices (Cramer & Bennett, 2015). As a multi-tiered system of support, PBIS was designed for universal implementation so that all students in a school or educational setting would be able to benefit from the support services. Utilizing a PBIS approach within a school system can promote a positive climate and culture for students who have been impacted by trauma, and this approach also aligns with more intensive supports at the secondary and tertiary levels.

Regulation Skills. In addition to utilizing a PBIS model, teachers should incorporate coping skills and relaxation strategies into everyday curriculum to promote deep breathing, positive imagery, and allow frequent breaks (Weist-Stevenson & Lee, 2016). This allows students to be continuously exposed to positive stress management and coping techniques. Teachers who model these skills also help to mitigate effects of secondary trauma they may be experiencing themselves and can contribute to the trauma-informed culture by offering the resources with a friendly, warm demeanor. It is very important for the environment of the classroom to provide comfort and security.

Integrating the TIA with PBIS

A multi-tiered system of support (MTSS) framework and the PBIS approach both provide universal, targeted, and intensive interventions that can support both the academic and social-emotional needs of students. MTSS and PBIS are both three-tiered, schoolwide approaches that promote early identification and support for students with learning and emotional/behavioral needs (Ramsey & Myers, 2019). Within each tier, strategies and practices can be embedded to create a trauma-informed school. The application of multi-tiered strategies has shown to be effective in facilitating academic, social, emotional, and behavioral growth across a wide range of youth populations (Kumm, Mather, Cassavaugh, & Butts, 2020). The transformative strategies for trauma-informed approaches align well with the stages and principles at the core of the PBIS framework. Appendix B presents the continuum of practices for PBIS, Restorative Practices, and the Trauma-Informed Approach, which can be utilized by districts in designing a program that integrates concepts from each framework.

Implementing a trauma-informed approach within PBIS may help to address negative impacts associated with trauma, i.e. re-traumatization, suicidal ideation or attempts, self-injurious behavior, and increased time spent in mental health placements (Kumm et al., 2020). In order to inform practices, data should be continuously collected and monitored to identify patterns and guide decisions related to selecting and implementing interventions. It is essential that staff utilize data-based decision-making practices, including examining both data collection tools and contextual factors, when making decisions about interventions. Kumm at al. (2020) suggested that the goal of embedding mental health and trauma-informed interventions into PBIS is not to make every staff member a mental health provider, but instead to provide all staff with the skills to recognize the signs and symptoms of trauma so that they can recommend students for appropriate interventions when needed. The use of data helps staff to improve its capacity to create a positive climate and culture conducive to addressing the complex needs of children impacted by trauma.

One of the most challenging aspects of a tiered system is identifying who requires more intensive services, as well as determining how and when they can be provided (Kumm et al., 2020). As districts work to integrate trauma-informed practices within a system of tiered supports, they must consider that the delivery of mental health supports should be consistent with the risk principle, that is, students who are considered high-risk should receive more intensive supports.

Implementing Trauma-Informed Professional Development

Professional development is considered an integral part of school and local educational agency strategies for providing educators with the knowledge and skills necessary to promote student success across multiple domains (Ramsey & Myers, 2019). In order to meet state academic standards, professional development must consider well-rounded educational practices and should be sustained, intensive, collaborative, data-driven, and classroom-focused. These activities, for maximum benefit to be derived, should not be stand alone or 1-day workshops. Kumm et al. (2020) emphasized the need for thorough training of staff on both selecting which evidence-based interventions should be provided, as well as training on how to provide the interventions within a program to support students’ mental health. Staff should be trained to utilize trauma-informed care as a continuum of strategies to make adults aware, sensitive, and responsive to the individualized needs of students impacted by trauma (Kumm et al., 2020).