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Trauma-Informed Care and Practices in School-Based Settings

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Title: Trauma-Informed Care and Practices in School-Based Settings


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

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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

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Beech Brook, providing 163 years of hope to
children and families.
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A word about our history of being an early
adopter of trauma-informed care.
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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

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Why is a trauma-informed care approach so
essential?
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Lets define trauma, complex trauma, and
secondary traumatic stress.
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What kinds of experiences result in trauma? What
aspects of child development get derailed?
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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
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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.

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

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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
    http//www.nctsn.org/resources/topics/treatments-t
    hat-work/promising-practices

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PATHS
  • Promoting Alternative THinking Strategies

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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

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

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Key SEL Competencies
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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

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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

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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 childs 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.

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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

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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

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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.

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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.
  • http//cbitsprogram.org

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Outcome Data 2013 2014 2013 2014 201 20132
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Actively Caring For People
May 5th, 2012
Creating a more compassionate community through
intentional acts of kindness
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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.

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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).

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McCarty, 2014
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There are advantages of providing trauma
treatment in schools.
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There are disadvantages of providing trauma
treatment in schools.
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This is a plug for attention to secondary
traumatic stress and burnout.
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