3/1/2017
1
INTEGRATING TRAUMA-INFORMED APPROACHES
WITH PBIS WITHIN AN MTSS FRAMEWORK
Lynne DeSousa - Colorado PBIS Statewide CoordinatorHailey Uphaus - Thompson School District Behavioral Health Specialist
OBJECTIVES OF THE SESSION
• Gain a foundational understanding of trauma and toxic stress
• Review the latest research on how trauma causes instructional/coaching challenges in students/staff
• Guidance on how to integrate trauma informed approaches into and existing SW-PBS system and MTSS framework
• Gain practical strategies for supporting students/staff 2
“It we teach today’s students as we
taught yesterday’s, we rob them of
tomorrow.”
- John Dewey, 1915
3
3/1/2017
2
TAKE CARE OF YOURSELF
4
What are you currently doing in your
district/school to support students/staff who have experienced trauma, toxic stress or
behaviors ?5
Definition from Monroe County ACCESS Research to Practice Subcommittee, 2011
What is trauma?Trauma is a response to a perceived threat to survival or emotional well- being of an individual or large group, such as a community or a culture.
Trauma leads to adverse brain, bodily and psychological changes that damage self, relational and spiritual development and impair living, learning and working.
3/1/2017
3
SAMHSA’S THREE E’S OF TRAUMA
Experience
Effects
Event(s)
TYPES OF STRESS NATIONAL SCIENTIFIC COUNCIL ON THE
DEVELOPING CHILD (2005)
PositiveBrief increases in heart rate, mild elevations in stress
hormone levels.
TolerableSerious, temporary stress responses, buffered
by supportive relationships.
ToxicProlonged activation of stress response systems
in the absence of protective relationships
7
MOST COMMON ADVERSE CHILDHOOD EXPERIENCES (ACES)
• Recurrent physical abuse
• Emotional abuse• Sexual abuse• Alcohol/drug abuser
in household• Incarcerated house-
hold member
• Household member with chronic mental illness
• Violence betweenadults in the home
• Parental separation or divorce
It is estimated that 66% of the population has at least 1 ACE and 25% have 2 or more ACEs before age 18.
3/1/2017
4
National Child Traumatic Stress Network
LINKING ACES & SCHOOL PERFORMANCE:
•Are 2 ½ times more likely to fail a grade•Score lower on standardized assessments•Have more receptive & expressive language difficulties•Are suspended or expelled more often•Found eligible for special education more frequently
10
3 R’S OF BEING TRUAMA INFORMED
• and understanding traumaRealizing
• how trauma impacts students/staffRecognizing
• by implimenting trauma informed approaches within and exisitng PBIS system & MTSS framework
Responding
3/1/2017
5
A traumatic stress response
occurs when our ability to
respond to the threat is
overwhelmed.13
Traumatic Event/Events
Traumatic Impact
15
3/1/2017
6
IMPACT OF TRAUMA•I am not safe•I cannot trust others•I cannot trust myself•I cannot depend upon others•I am not worthy of care•I deserve the bad things that happen to me•It’s my fault16
IMPACT OF SECONDARY TRAUMA (COMPASSION FATIGUE)
Cognitive effects
• Negative bias, pessimism
• All-or-nothing thinking
• Loss of perspective and critical thinking skills
• Threat focus –see parents, colleagues, supervisor, community members as enemy
• Decreased self-monitoring
• Freezing –unable to think straight or remember information
Social impact
• Reduction in collaboration
• Minimizing the work
• Withdrawal and loss of social support
• Factionalism• Stop hanging
out with friends and loved ones
Emotional impact
• Anxiety • Feelings of
helplessness and hopelessness
• Feelings of restlessness
• Lack of motivation or focus for interests or hobbies
• Feeling overwhelmed
• Irritability or anger
• Sadness or depression
Physical impact
• Headache• Muscle tension
or pain • Chest pain • Fatigue• Stomach upset • Fatigue/sleep
difficulty• Depression• Weight gain• Increased use of
tobacco, alcohol, drugs
(Mayo Clinic)
3/1/2017
7
PARALLEL PROCESS I can't trust administration. They are
waitingfor me to do something wrong.
I can't trust adults. They will eventually hurt me.
19
PARALLEL PROCESS I have no power or control over my work.
It doesn't matter what I do someone
will always take it away.
20
PARALLEL PROCESS It is much easier to do it myself than
having to collaborate.
It is me against the world. I am the only one that has my back.
21
3/1/2017
8
PARALLEL PROCESS I can't concentrate on one thing
because I have so many responsibilities and expectations in this job.
There is no way I can pay attention in school. I keep thinking about
all that hashappened to me.
22
PARALLEL PROCESS If I had done my job better, this
wouldn’t have happened.
It’s all my fault that I’m in foster care.
23
3 R’S OF BEING TRUAMA INFORMED
• and understanding traumaRealizing
• how trauma impacts students/staffRecognizing
• by implimenting trauma informed approaches within and exisitng PBIS system & MTSS framework
Responding
3/1/2017
9
InstinctiveBrain
Emotional Brain
Thinking Brain
Dr. James Henry
A substitute
Change in schedule
Not having the snack/lunch that was anticipated
“Jimmy”
27
3/1/2017
10
Dr. James Henry
• Increased anxiety and/or depression
• Increased aggression• Increased impulsivity• Decreased social ability• Reduced ability to regulate • Difficulty with attachment
29
BUT…WHEN THE TIGER LIVES IN YOUR SCHOOL, HOME, COMMUNITY, OR LIFE…
31
3/1/2017
11
Our interpretation guides our own reactions.
30
Struggle with self-regulation
Not having the snack/lunch
that was anticipated
Or
Change in schedule
Or
A Substitute
Feelings of worthlessness
Not feeling safe
HomelessFoster care
Violence in the homeDeath of a loved one
Divorce
“Skippy”Can’t predict
change
SURVIVAL RESPONSEFight
• Individual struggles to regain or hold on to power, especially when feeling coerced
• Mislabeled as: Non-compliant or combative Flight
• Individual disengages, “no shows”, or “check outs” emotionally
• Mislabeled as: Uncooperative or resistantFreeze
• Individual gives in to those in positions of power, does not or is unable to speak up
• Mislabeled as: Passive or unmotivated
3/1/2017
12
Think of the ‘learning brain’ as the rider, and the ‘survival brain’ as the horse. When a student is triggered, the ‘learning brain’ largely goes offline. The rider’s off the horse, and you’re just dealing with a really terrified horse.”
(Joyce Dorado, director of HEARTS)34
EMOTIONAL REACTIVITYThe primary impact of exposure to trauma is “emotional dysregulation.” (Van der Kolk, 2009)
An inability of the left side of the brain to talk to the right side of the brain.
•Ability to calm•Ability to regulate•Ability to contain affect
35
When students are in fight, flight, or freeze their ‘rider’ has been
thrown off.
Fight, flight, or freeze causes a breakdown in the capacity to think
clearly, causing the child to become overwhelmed
and irrational.
36
3/1/2017
13
Current problematic behaviors and symptoms may have originated as
legitimate and even courageous attempts to cope with or defend
against trauma.
SEEKING TO COPE
37
What are some things you would like to change in your district/schools to
better support students/staff who have
experienced trauma, toxic stress or behaviors ?
3/1/2017
14
3 R’S OF BEING TRUAMA INFORMED
• and understanding traumaRealizing
• how trauma impacts students/staffRecognizing
Responding• by implimenting trauma
informed approaches within and exisitng PBIS system & MTSS framework
How can PBIS schools become more Trauma Informed?
1. Raise staff awareness of the prevalence and impact of trauma.
2. Pay attention to students emotional responses in addition to behavioral ones.
3. Recognize that problem behaviors might be a response/adaptation trauma.
4. For students impacted by trauma, work with them to identify and reduce school triggers.
5. Establish a discipline policy that is sensitive, predictable and respectful.
6. Infuse youth development and cultural humility into curricula, student activities, schools-wide events, staff professional development and family/community events.
3/1/2017
15
43
What exactly IS a trauma-sensitive school?
1. All staff understand the prevalence and impact of trauma of their students and themselves.
2. School strives for physical, emotional, social, academic safety for all.
3. The school addresses holistic student needs.4. The school is inclusive and connects students to the
community instead of excluding them.5. The school staff work collaboratively to support
students.6. School leaders adapt services and supports based on
contemporary needs of students.
ProactiveReactive
TIME AWAY
CORRECTION
PRAISE
PRO-ACTIVEPROACTIVE
PRAISE
CORRECTION
TIME AWAY
Boys Town WMS41
Trauma Sensitive Checklist
Wisconsin Department of Public Instruction, Trauma Toolkithttps://dpi.wi.gov/sspw/mental-health/trauma
3/1/2017
16
Key Principles of Trauma Informed Approaches (SAMHSA)
Principle1. Safety2. Trustworthy and
Transparency3. Peer Support4. Collaboration and
Mutuality5. Empowerment, Voice
and Choice 6. Cultural, Historical
and Gender Issues
Application In Schools1. Safe School Environment, immediate
response to bullying incidents2. Positive adult relationships, clear
room policies around behavior, grading, etc.
3. Group services and mentoring programs
4. Clear discipline policies that emphasis restoration over punishment
5. Youth developmental practices, student fishbowls, and partners in decision-making
6. Culturally relevant curriculum, implicit bias training for staff
RESILIENCY
RESILIENCY CONTEXTUALIZES A PERSON’S STRENGTHS (INDIVIDUAL, FAMILIAL, COMMUNITY)
AGAINST HER/HIS ADVERSE EXPERIENCES.(Z O LK O SK I & B U LLO CK , 20 1 2)
48
Positive Family Communication
Caring School Climate
Parent Involvement in Schooling
Roles for Youth within the
Community
Peaceful Conflict Resolution
Positive Self-Image
Student cares about
school
Increased Achievement and
Motivation
Student feels connected to the school
Optimistic about future
49
3/1/2017
17
“We learned in therapy that some of the most therapeutic experiences do
not take place in ‘therapy’ but in naturally occurring healthy relationships.” (Perry, 2011)
“What works best is anything that increases the quality and number of
relationships in a child’s life.” (Perry, 2011)
It only takes one caring adult!50
SENSE OF RELATEDNESS
AFFECT & REGULATION
MASTERY & EFFICACY SELF- ESTEEM
SENSE OF RELATEDNESS
Relationships with others and sense of relatedness serves as a
protective factor against stress.
• Home Involvement Activities• Peace Keepers• Grade level team competition• Student Council or “Voice and Choice”• Phone Calls home• Postcards sent home• Cross grade buddies• Lunch bunch• Student/Class recognition • Family Night• Class/school jobs• 2 x 10 Rapport building• Mentorship opportunities
Linking to PBIS & MTSS:
Collaborative partnerships between school, home, and community is viewed as essential for creating culturally relevant outcomes and sustained benefits for students.
52
3/1/2017
18
RULES “THE WHAT”
State behaviorally and positivelyLimited to 3 – 5 general behaviorsManageable and enforceableConsistent with your schools policies, mission, and visionPosted and frequently reviewed
53
PROCEDURES “THE HOW”
Decide what you want students to accomplishDetermine behaviors needed in various routines and locationsIdentify stepsPost when necessary and near the area students will need the procedureTeach and review
54
55
3/1/2017
19
55%
7%
Para Verbal
Verbal
Non Verbal
38%
58
3/1/2017
20
AFFECT & REGULATION
• Zones of Regulation• Check and Connect• In Focus• Mind-Up• Yoga• Mindfulness• Sensory Toolkits
• Check-In Check-Out• Social Skills Instruction • Social skill stories
Affect & Self-Regulation are significantly correlated with “success” in life – whether it is financial success,
happiness, or adjustment or other various positive psychological factors
Linking to PBIS and MTSS:
• Emphasize the recognition, understanding, and responsiveness to student needs using a preventive, positive, and instructional lens.
• Recognize the necessity of building the collective capacity of school personal to create safe, predictable, and engaging learning environments for all students.
59
60
61
3/1/2017
21
62
Keys to Setting LimitsSimple/Clear
• If…Then…. or First…Then…• Start with
positive, end with consequence (do what works for the student)
• Limit steps, words, complex vocabulary
Reasonable• Offer choices that
are obtainable• Consequences fit
behavior (natural, logical, artificial)
• Allow for a “fix” –correction vs. perfection
Enforceable• Know what you can
and can’t do• If you are unsure
ask• Willing and able to
follow through
“If you can predict it, you can plan for it.”(Jim Fay, Founder of Love and Logic)
Detour Strategies:• Cool down time/space set a timer, alternative seat,
space, environment, etc.)
• Empathy “It does feel like a long time until lunch!”“How can I help you?”
• DIB/DAB Statements “right now you are yelling you need to be quiet”
• Reality Statements “the sooner you get calm the sooner we can talk about what you need.”
• Praise – “Doing a good job getting calm.”
Your choice of strategies should be driven by the frequency, duration, and intensity of the behavior(s),
as well as by what strategies are most effective with the student.
3/1/2017
22
VERBAL TRICKS & TIPS• Refrain from using “I need you to…” “I want you to…” “I’m telling you to…”• Don’t use opened questions, unless it really is a choice -
“Would you like do your work now?” “How about we go back to class?”• Use manners, but don’t beg! –
“Please tuck in you chair.” v.s. “Tuck in you chair pleeese.”• Reframe “Yes” and “No” questions
Student: “Can I go to the bathroom?”Teacher: “You are asking when you can use the restroom…”
• Use behaviorally specific language when describing behaviors“You are being respectful.” (Good)“You are being respectful by putting your eyes are on the speaker.” (Great)
• “You said something like…” v.s. “You said…”• “You will earn…” v.s. “You will get…” or “You have lost”• “You’re more likely to get…” v.s. “You will get…”• Use clarifying statements
“What I think you are saying is…”“What I am hearing you say is.”
Interrupt & Redirect
“You are shouting. Please lower your
voice.”
If & Then
“If you finish your math then you may
earn computer time.”
Approaches to Setting Limits
When & Then
“When you are showing a calm body & calm
voice then I will be able to talk to you.”66
MASTERY & EFFICACY
• Corrective teaching • Teachable moments• “Correction vs. Perfection” • Common Language
• 4:1 ratio of reinforcement• “Teach-To’s”• Increased rate of reinforcement• General, Specific, and Effective
Praise
Linking to PBIS & MTSS:
• Make explicit efforts to build healthy, trusting relationships, emphasize choice and empowerment through skill building.
• Intentionally create positive opportunities where students can practice self-regulation strategies and prosocial skills.
Students with a strong sense of efficacy are more likely to challenge themselves with difficult tasks and be intrinsically motivates. These students will put forth a high degree of effort in order to meet their commitments, and attributes failure to things which are in their control, rather than blaming external factors.
67
3/1/2017
23
PLANNED TEACHING• “Hook” • Ask questions related to the skill Introduce the skill
• Label the skill• Describe the skill steps
Describe appropriate behavior
• Meaningful to the student• BriefGive a reason
• Set up clearly• Have student practice to criteriaPractice
68
Peace 4 Kids69
PREVENTIVE PROMPTS
Brief Verbal or Nonverbalreminder to students
• before the skill you want students demonstrate
• before the rule you want students to follow
• before using a procedure
70
3/1/2017
24
GUIDED SELF-CORRECTION1. Let’s talk about what just
happened.2. What should have happened
instead?3. Why would that have been a better
choice?4. Remember to try it like that next
time.71
72
Corrective Teaching• “Thanks for staying in your seat, Devon.”Use praise or empathy
• “When you wanted my attention, you called out my name and yelled something like, ‘I need some help!’”
Describe inappropriate behavior
• “A better way to get my attention is to raise your hand, wait for me to call on you or come over, and then ask your question or make your comment.”
Describe appropriate behavior
• “When you get my attention by raising your hand, it lets me know you need some help.”Give a reason
• “I am going to go answer another question. Show me you can get my attention by raising your hand and waiting quietly until I can get back to you.”
Practice
• “Because you didn’t get my attention appropriately, you’ve had to wait a little longer to get your question answered.”
Negative consequence (optional)
Boys Town WMS73
3/1/2017
25
74 Boys Town SCM
SELF- ESTEEM
• Classroom/school jobs• Peer buddies• Mentorships• 4:1 ratio of reinforcement (or higher)• General, Specific, and Effective Praise• De-escalation with dignity• goal setting• Restorative Justice• Student of the month• School Store, assemblies
Linking to PBIS & MTSS:
• Make explicit efforts to build healthy, trusting relationships, emphasize choice and empowerment through skill building.
• Intentionally create positive opportunities where students can practice self-regulation strategies and prosocial skills.
Self-esteem is an essential human need that is vital for survival and normal, healthy developments. It can arise automatically from within based on a person’s beliefs and consciousness or occurs in conjunction with a person’s thoughts, behaviors, feelings, and actions.
75
General Praise/Non-
Contingent
Behavioral Specific Praise
Effective Praise
4:1Boys Town WMS76
3/1/2017
26
“Why do I need to praise for things students should be doing?”
Think about all the things we do because we get reinforced…
King Soopers Card Starbucks RewardsPosting on Facebook Frequent Flyer MilesWear an outfit/tie or style your hair a certain way Pay Check
WHY PRAISE?
77
Effective Praise
Specific Praise
THE SHAPING PROCESS
General Praise
Self-Reinforcing
High
Low
Skill
Mas
tery
External
Internal
Boys Town SCM78
SHIFTING THE MINDSET FROM VICTIM TO SELF-EMPOWERMENT
MusicArtSportsIntelligence Recognized or noticed
79
3/1/2017
27
THREE PRACTICAL ACTS TO BUILD POSITIVE RELATIONSHIPS
WITH CHILDREN • Instead of thinking “what is wrong with you” think “what
has happened to you?”
• Recognize and honor a student’s inability to trust and feel safe despite how it feels for you. “Of course you can’t trust me.”
• Know you cannot change a student’s perception because you tell them what your reality is. “I know you can’t believe me”
• Start where the student is at not where you want them to be. Safety is always the first step. “How can I help you feel safer?”
80
Traumatic Event/Events
Resiliency Factors
Traumatic Impact
81
PBIS
Mindfulness
Yoga & Self Regulation
Sensory CenterOpportunity Zone
Restorative Center
Social Skill Instruction
What if…?
82
3/1/2017
28
83
“Jimmy” “Skippy”
84
What ideas/strategies are you going to take back to
your district/ school to better support
students/staff that have experienced trauma, toxic
stress or behaviors ?85
3/1/2017
29
REFERENCES & RESOURCESResources & References:Boys Town Well Managed SchoolsDr. James Henry - The Children’s Trauma Assessment Center of MichiganCrisis Prevention Institute Trauma & Learning Policy Initiative of Massachusetts Advocates for Children & the Legal Services of Harvard Law School & Lesley University
Books: The Body Remembers by Babette RothschildHelp for Billy by Heather T. Forbes, LCSWThe Body Keeps the Score by Van Der Kolk, M.D.Lost At School by Ross W. Greene, PH.DThe Boy Who Was Raised as a Dog by Bruce Perry and Supporting and Educating Traumatized Students: A Guide for School –Based ProfessionalsCoaching Classroom Management; Strategies & Tools for Administrators & Coaches By Sprick and Knight
Documentary: Paper Tigers by James Redford
Websites: Wisconsin Department of Public Instruction https://dpi.wi.gov/sspw/mental-health/traumaColorado State University – Child Trauma Resilience Assessment Center http://www.ctrac.chhs.colostate.edu/We Teach Peace -The Center for Anti-bullying & Non-Violence (CAN) has taken leadership in developing the Peace4Kids model that is highly effective with aggressive youth http://wecanco.org/Trauma Transformed http://www.t2bayarea.orgSAMHSA Trauma Resources http://www.samhsa.gov/nctic/