transforming trauma: hearts has been in partnership with ... › departments ›...

HEARTS Trauma Basics August 9, 2018

Copyright © 2017 UCSF HEARTS. All rights reserved.

HEARTS has been in partnership with SFUSD since Dec 2008. Our aim is to promote school success and resilience for trauma-impacted students by creating more safe, supportive, and engaging learning and teaching environments.

Chronic stress and trauma can affect our health, our relationships, and our work.

These people made it through and changed the world What helped them be resilient in the face of adversity? When you look back at their histories, more often than not you will find a caring adult who loved them “warts and all,” and who believed in them. This is consistent with the research around what is most highly associated with resilience.

Trauma-Informed Principles for Promoting School and Community Success: Understanding Trauma & Stress Cultural Humility & Responsiveness Establish Safety & Predictability Compassion & Dependability Empowerment & Collaboration Resilience & Social Emotional Learning

Understand Trauma and Stress:

Without understanding trauma, we are more likely to misinterpret trauma-related behaviors as willful, “sick,” or “crazy,” which can lead to ineffective, stigmatizing and/or punitive reactions to trauma-impacted people. Understanding how trauma and stress can affect individuals, relationships, organizations, health, and work, can help to reframe otherwise confusing, aggravating, or fear-producing behavior. This reframing can help us to recognize these effects more accurately, which can then lead to more compassionate and strength-based, effective responses to trauma-impacted people that can promote healing as opposed to reacting in a way that inadvertently re-traumatizes and causes harm.

UCSF Healthy Environments and Response to Trauma in Schools (HEARTS)

Joyce Dorado, PhDDirector, UCSF HEARTS

Martha Merchant, PsyDHEARTS Consultant

Department of PsychiatryUCSF-San Francisco General Hospital

Copyright © pending: Please do not use or distribute this curriculum without express permission from the authors

Transforming Trauma: Strategies for Promoting Success

Why Is a Trauma-Informed Approach Important to Me?

J. Dorado (2015), UCSF HEARTS, Child & Adolescent Services, UCSF/SFGH

J. Dorado (2015), UCSF HEARTS, UCSF-ZSFG

Modified from SFDPH Trauma Informed Systems Initiative, 2015

Safety& Predictability

Students&

Families

Resilience & Social Emotional

Learning

Cultural Humility& Responsiveness

Trauma-Informed Principles for Promoting School and Community Success

Staff &Caregivers

System & Leadership

Students

Compassion& Dependability

Empowerment & Collaboration

UnderstandingTrauma & Stress



UnderstandTrauma & Stress




“Learning about the psychobiology of stress, toxic stress, and trauma is liberating for people. It gives us explanatory reasons for some of the puzzling behaviors we engage in and the feelings that can come to dominate us.” Cite: Bloom, 2013, p. 48

If you’re feeling stressed out and watching this happen, you might ask yourself “What is wrong with the student?” This will lead to a certain kind of a feeling, which lead to a certain kind of reaction.

Similarly, if you’re feeling stressed out and watching this happen, you might ask yourself “What is wrong with the teacher?” This will lead to a certain kind of a feeling, which lead to a certain kind of reaction.

When someone is behaving in an aggravating, possibly scary way, instead of asking yourself about this person “What is WRONG with you?” can we ask the question “What has HAPPENED to you?” When we asked the question, “What has happened to you?” it gives us a context for the behavior, fosters connection and compassion, and helps us to see the strengths that people are bringing to bear in the face of adversity. Note: we are suggesting you ask these questions to yourself, not necessarily out loud to the person in front of you (we all do this kind of internal talking to ourselves, and these thoughts lead to feelings, which leads to behavior).

Understanding Trauma and StressJ. Dorado (2015), M. Merchant (2015) UCSF HEARTS, Child & Adolescent Services, UCSF/SFGH

Vignette



M. Merchant (2015), J. Dorado (2015), UCSF HEARTS, Child & Adolescent Services, UCSF/SFGH

Shift Your Perspective


Provides context, fosters compassion, helps us to see strengths in face of adversity



Exhale activates “brakes” in body (parasympathetic nervous system) Re-sets brain and body Allows body to metabolize stress arousal

Too little stress arousal = less-than-optimum performance Optimal level of stress arousal = most efficient and effective performance If our stress arousal is too high, we become overwhelmed and lose access to the skills and knowledge that we normally have and performance plummets Reflect upon: Where do you tend to spend most of your time on this curve?

Event is an actual danger or extreme threat of harm (can be experienced directly or indirectly) When we are under threat, our brains and bodies mobilize into a “fight, flight, or freeze” response. Despite our efforts, we are helpless to escape the traumatic event. This overwhelms our brain and body. This leads to a dis-integration of the parts of our brain and body that normally work well together, which leads to a dysregulation, which is a loss in capacity to modulate internal states—stress arousal and emotional states. This can have lasting adverse effects.

J. Dorado (2015), M. Merchant (2015) UCSF HEARTS, Child & Adolescent Services, UCSF/SFGH


B r a in B r e a k : B e lly B r e a t h in g

Slow breath out through mouthEmpty chest, then belly (empty belly air all the way out)

Slow breath in through noseFill belly, then chest with air


Let’s Talk aboutStress and Trauma

Stress Affects Our Performance


RachelBritton.com

Trauma = Event, Experience, & Effect


Overwhelms brain and body

Helpless to escape

Dis-integration

(Herman, 1997; Van der Kolk, 2005; DSM-IV-TR; SAMHSA; Siegel, 2012; Bloom, 2013)

Actual or extreme threat of harm

“Fight, flight or freeze”

Lasting adverse effects

Dysregulation

Event

Experience

Effect



Toxic stress is caused by strong, prolonged, and/or frequent adversity without adequate support for caring others that causes prolonged activation of the stress response system. Adverse Childhood Experiences, including physical, emotional, or sexual abuse and witnessing domestic violence, as well as other adversities such as having divorced parents that may or may not be experienced as traumatic. Research shows that the more ACES we have experienced in childhood, the more at risk we are for a number of serious medical illness, including heart disease, in adulthood.

Chronic, repetitive harm, neglect, or abandonment either perpetrated by people who we depend upon, or that impairs the ability of people who we depend upon to support and take care of us. This can compromise development. Post-Traumatic Stress Disorder (PTSD) does not capture the range of effects that complex trauma can have on functioning

While we may experience and react to stress and trauma differently than each other, we all share the same underlying neurobiology. Knowing this helps us not take trauma reactions personally.

Autonomic Nervous System The sympathetic nervous system is the Accelerator in our system. It gives us energy when we need to move quickly. When this is activated, our airways open up, heart rate speeds up, our digestion gets inhibited. The parasympathetic nervous system is the Brakes in our system. This slows our body back down after it’s gotten amped up so that we can “rest and digest.” When healthy, these two systems work together to balance each other out.

Our brain and the rest of our nervous system is made up of networks of neurons connected to each other. Each time a connection is made, the connection becomes stronger. This is how any of what we do becomes automatic. It’s how we form habits. This is an important fundamental concept, as it helps to explain what happens to us when we are exposed to chronic trauma, and also helps to explain how we can help to “rewire” the brains/nervous systems of children/youth who have been exposed to chronic trauma.

When “fight, flight, or freeze” is what is firing over and over again, this response is what gets wired up strongly into a habitual response Metaphor of vinyl record album – trauma wears a groove in our brain/record album Can be doing fine, then a trauma trigger can knock us into the deep groove (trauma groove, fear song), and then we can get stuck in that groove (skipping back into groove instead of moving onto next song)



Multiple traumatic events that often occur in the home

We Share the SameNeurobiology

Accelerator


•Mariëlle Coppes•www.magicaldaydream.com

Brakes

Neurons that fire together wire together (Hebb’s Rule):

J. Dorado (2015), UCSF HEARTS

Practice Habits/Automatic

Trauma “Wears a Groove” in the Brain

“The Fear Song”J. Dorado (2015), UCSF HEARTS



Research demonstrates that when triggered, Thinking Brain largely goes off line, Survival brain takes over and brain/body behave like past trauma is happening right now

Here’s a metaphor to remember what can happen to a person who has been knocked into survival brain: It’s of a rider on a horse (first heard this from Bessel Van der Kolk). The Thinking Brain is the Rider The Rider sits up high, makes informed, rational decisions, can use verbal language to communicate

The Survival Brain is the Horse The Horse is very strong, acts on protective instincts, based on feelings

When the rider and horse are working together, can get pretty far, do lots of productive work

But when triggered by a trauma reminder, the Rider falls off the Horse. Once we recognize what’s happening as a Fear response, we instinctively know to lower the register of our voice, talk slowly and calmly (they’re not necessarily hearing the words, but they may be processing our non-verbal communication and body language) move slowly and predictably, don’t approach suddenly, do whatever we can to help the person in front of us feel safe, not trapped, in a little bit more control, and ultimately to help them calm down so that they’re Rider can get back on their Horse.

Survival Mode: Fight/Flight/Freeze

Learning/Thinking Brain

Survival/ Emotion

Brain

(Ford, 2009, Van der Kolk)


M. Merchant (2015) UCSF HEARTS, Child & Adolescent Services, UCSF/SFGH

Orlando StuweLearning Brain

M. Merchant (2015), UCSF HEARTS, Child & Adolescent Services, UCSF/SFGHmoril

Survival Brain

M. Merchant (2015), UCSF HEARTS, Child & Adolescent Services, UCSF/SFGH

charroup.com

Integrated Brain

M. Merchant (2015), UCSF HEARTS, Child & Adolescent Services, UCSF/SFGH

John Riggs

Rider Off the Horse



Systems, organizations like schools, school districts, departments, are all made up of living beings, people like you and me. So they act as though they are living organisms. In healthy circumstances, they are organized, integrated. You don’t need to see what is on this organizational chart, but you can see that it is organized, predictable, people can see what their role is, everyone’s jobs and functions work together. But what can happen in an organization that is experiencing chronic stress and trauma is that there is a gravitational pull towards dis-organization and dis-integration. Then what you might get is Difficulty Maintaining Structure, Lack of Cohesiveness, Blurred Roles, Boundary Difficulties, Scapegoating, Finger-Pointing, Hypervigilance, and even an Over-focus on Threat Reduction, where it is all about control, order, at the expense of creativity, growth, thinking outside the box—which we need to be able to do if we are trying to address complex problems like trauma!

Understanding the effects of chronic stress and trauma on their interaction can help us to respond more effectively. Again, we’re not saying that people get to lose their tempers and raise their voices at each other. Rather, we’re suggesting that trauma understanding can help head these escalations off, and/or help to respond to them more effectively by addressing the underlying stress and trauma.

This came from a colleague of ours at San Francisco Unified School District: If someone is behaving in an aggravating, even scary manner in front of you, this is “a cause for pause.” Can you pause, take a breath, and instead of asking yourself “what is wrong with you?” ask yourself “what has happened to you?” and “What is happening here?” The moment you do this, you are kicking your brain into a higher level of functioning, moving you out of emotional/survival brain and into thinking brain.

The bottom line is that a Trauma-Informed System takes care of its caregivers. We need to attend to stress, burnout, and secondary trauma through self-care and Organizational Strategies. This is crucial for creating more safe and supportive care and work environments within our schools.

At Systemic Level: Chronic Stress and Trauma Can Lead to Dis-organization


Address stress & secondary trauma on organizational level

M. Merchant (20150 J. Dorado (2014), UCSF HEARTS, Child & Adolescent Services, UCSF/SFGH

What is happening here?

Keep your rider on the horse

M. Merchant (2015), UCSF HEARTS, Child & Adolescent Services, UCSF/SFGHc

Get your rider back on the horse

A Trauma-Informed System Takes Care of the

Whole Team

Brain Break





We come from diverse social and cultural groups that may experience and react to trauma and stress trauma differently. When we are open to understanding these differences and respond to them sensitively, we make each other feel understood and equity and social justice are enhanced.

Cultural humility: process of reflecting together as a community to examine how societal oppressions, e.g., individual and institutionalized racism, cause suffering to develop individual and institutional accountability to counteract these harms Life long process – today focus on intersection between societal oppression (e.g., racism) and trauma, and create common understanding and language in order to promote dialogue so we can address these issues

Insidious trauma (Root, 1992): also known as “micro-aggressions” (Sue, 2003, 2007) like drops of acid falling on stone: (Brown, 2008) “Another component of culturally competent trauma practice requires psychotherapists to consider how insidious trauma and microaggression may have been present in a client’s life even when the particular client does not identify this kind of experience. Everyday racism, sexism, heterosexism, ableism, and other forms of institutionalized oppressions may seem so familiar to people as the background noise of their lives that they may have no cognitive construct into which to place these encounters; they simply have the post trauma distress and dysfunction arising from doing battle every day against an army of small toxic agents.” Laura Brown, 2008, p.106

The contexts in this outer circle (forms of insidious trauma), plus the experiences that many traditionally think of as trauma (e.g., child abuse, domestic violence) together form Synergistic Trauma—a particularly toxic brew. These forms of oppression happen on an institutional and individual level define institutional: Biased practices that get systematically embedded in institutional structures and policies, resulting in negative treatment of people within a social identity group (including inequity, exclusion, devaluing, and injustice) When we are addressing trauma, we MUST also address these societal oppressions, or we are missing the boat.






Staff

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Learning

Cultural Humility& Responsivness



Staff &Caregivers

System & Leadership

Students




Cultural Humility & Responsiveness

Cultural Humility

• Lifelong learning and critical self-reflection• Recognizing and changing power imbalances• Developing institutional accountability

(Tervalon & Murray-Garcia, 1998)

“More than a concept, Cultural Humility is a process of communal reflectionto analyze the root causes of suffering and create a broader, moreinclusive view of the world.”

Insidious Trauma“like drops of acid falling on a stone”

(Root, 1992)

J. Dorado (2016), UCSF HEARTS, UCSF-Zuckerberg San Francisco General Hospital

Racism

Oppression

Inequity

Sexism

Classism

Xenophobia

TraumaSynergistic

Trauma

Homophobia

Context MattersFrom SFDPH Trauma Informed Systems Workgroup



Age Disability (developmental) Disability (acquired) Religion & spirituality Ethnicity/culture Social class Sexual orientation Indigenous heritage/colonization, Immigration/refugee status, National origin Gender and sex

Anne Fadiman calls the process of working towards cultural congruence “Moving towards the Lune.” (moving towards the moon)

When we are stressed out, we go straight to our cultural center, and suddenly if someone else is, for example, expressing emotion in a way that is different than I express emotion, then that person is not simply different from me, but wrong or rude. Stress exacerbates the effects of implicit bias. Anger exacerbates the use of stereotyped thinking towards other people.

Joy De Gruy: Grocery Store video

ADDRESSING Model(Hays, 2001, 2008)

Age Disability (developmental)Disability (acquired)Religion & spiritualityEthnicity/cultureSocial classSexual orientationIndigenous heritage/colonization, Immigration/refugee status, National origin, Gender and sex


Anne Fadiman, 2008

Create a Shared CultureJ. Dorado & L. Dolce (2012), UCSF HEARTS, Child & Adolescent Services, UCSF/SFGH

Stress Often Interferes with Creating Shared Culture

(adapted from presentation by Ghosh-Ippen, 2012)

J. Dorado & L. Dolce (2012), UCSF HEARTS, Child & Adolescent Services, UCSF/SFGH

M. Merchant (2016), UCSF HEARTS

Brain Break





Trauma unpredictably violates our physical, social, and emotional safety resulting in a sense of threat and need to focus resources on managing risks. Establishing physical, social, and emotional safety, as well as predictability in the environment can help us to focus resources on healthy development, wellness, learning, and teaching.

A key approach in promoting safety and stability is understanding and addressing all of the different domains of safety. Ultimately, none of us can upshift into “thinking brain” if we do not feel safe.

Physical safety - Protection from harm and danger - Includes clearly communicated safety procedures - safe physical environment - Reduction of unnecessary triggers Emotional safety - Social or Relationship safety We are social creatures. Since we don’t have claws and fur and fangs, we are evolutionarily hard-wired to seek safety in numbers and in connections with each other. So it is important that we all build positive working relationships with each other so that we can provide each other with support in times of stress Stability - Predictable environment - Routines and consistency Explicit preparation for changes and transitions Tools in our toolbox can help us build a safe and stable shared culture






Staff

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Staff &Caregivers

System & Leadership

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Students cannot upshift from“Survival Brain” to “Learning Brain”

if they do not feel safe

(true for all of us)


Establish Safety and Predictability

Andy Dean Photography

Tier 1: Schoolwide Supports

Ongoing Staff Training/Consultation

on RP and Trauma Informed Practices

16 Proactive Classroom Management Strategies

Thunderbolt Middle School, Arizona

El Dorado ElementaryM. Merchant (2015) UCSF HEARTS, Child & Adolescent Services, UCSF/SFGH



To enhance internal safety and promote wellness, here are tools for stress relief. Keys to wellness break: give your brain and body a break (don’t dwell on or talk about bothersome things while doing wellness activity) Sleep, healthy eating, and exercise can mitigate adverse physical effects of major stress on a cellular level

Do one thing at a time – so you are not going for a walk in the garden WHILE at the same time talking on your cell phone about the super stressful things that have been happening It should be enjoyable, pleasurable to you It should involve some sort of physical activity It should involve breathing – making sure you’re not just breathing in a shallow way One more thing: taking good care of yourself physically can help ameliorate health effects of stress. Recent research indicates that a healthy lifestyle (eating well, sleeping well, and exercise) reduces stress-related cell aging (less telomere shortening) (Puterman et al., 2014)

CALM: Student is cooperative. Accepts corrective feedback. Follows directives. Sets personal goals. Ignores distractions. Accepts praise. Intervention is focused on prevention. TRIGGER: Student experiences a series of unresolved conflicts. Repeated failures. Frequent corrections. Interpersonal conflicts. Timelines. Low rates of positive reinforcement Intervention is focused on prevention & redirection. AGITATION Student exhibits increase in unfocused behavior. Off-task; Frequent start/stop on tasks. Out of seat. Talking with others. Social withdrawal Intervention is focused on reducing anxiety DE-ESCALATION Student displays confusion but with decreases in severe behavior. Social withdrawal. Denial. Blaming others. Minimization of problem Intervention is focused on removing excess attention RECOVERY Student displays eagerness to engage in non-engagement activities. Attempts to correct problem. Unwillingness to participate in group activities. Social withdrawal & sleep. Follow through with consequences for problem behavior. Positively reinforce any displays of appropriate behavior. Intervention is focused on re-establishing routines activities.

When people get extremely dysregulated, their behavior can sometimes escalate to the point where intervention is needed. Note that these curves are parallel, but off phase from each other. Notice now just as the “student’s” stress arousal level is coming down, the responder’s stress-arousal level is coming up. The intersection of these two curves is where there is a high risk for the responder to inadvertently re-escalate the client. Also notice that everyone’s cognitive abilities to think clearly are lowest when their stress arousal level is highest.


Classroom Strategy: Brain Breaks for Stress Relief


Tools for Stress Relief During the Day

Getty Images

Inclusion paradox

Iha.com


Escalation: Prevention and Intervention

Calm

Trigger

Agitation

Acting-Out Person

De-escalation

Recovery

Peak

Re-escalation still possible

Acceleration

(CPI (2005); Kaplan & Wheeler (1983); Colvin & Sugai (1989))

Avoid Re-escalation:Where Are You in the Cycle?

Student’s Cycle

(Adapted from SFGH Safety Management and Response Techniques (SMART) Training)




Compassion & Dependability Trauma is overwhelming and can leave us feeling isolated or betrayed, which may make it difficult to trust others and receive support. However, when we experience compassionate (attuned), and dependable (trustworthy) relationships, we reestablish trusting connections with others that help us calm down when we are stressed out, and can foster health and well-being.

Caregiver’s ability to help regulate bodily and affective responses of developing infant/child provides “co-regulation” that contributes to the development of self-regulatory capacities in the child. (NCTSN, 2003)

Brain Break







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Co-RegulationJ. Dorado (2015), UCSF HEARTS, Child & Adolescent Services, UCSF/SFGH



We all need co-regulation for our whole lives because we are hard wired for attuned, caring interactions/relationships to help us when we are stressed out When we work with people, it is part of our jobs to provide co-regulation to those we serve and to each other.

Vagal nervous system runs from our brains down to our gut. It involves the vocal chords: when we are feeling compassion/connection, it changes the tone and timbre of our voice It slows our breathing and our heart rate We can recognize the feeling of connection and compassion in our gut One essential ingredient in positive, healthy relationships is “attunement”: Being sensitive, responsive, in harmony with the feelings and needs of others. In other words: “I see you, I understand you, I care about you and can sensitively respond to your needs”

Rita Pierson – Every Kid Needs A Champion

If caregiver is source of trauma/pain/terror or is unavailable during trauma (e.g., child exposed to caregivers’ intimate partner violence), there is no one to provide co-regulation during child’s terror. Child develops unhealthy ways to self-regulate (e.g., dissociation, self harm, aggression), which can derail development of healthy self-regulation skills and affect child and relationships into adulthood

When connection (a basic need) is source of terror/pain, humans are put in an impossible dilemma. Rather than negatively judging people with these behaviors (“What is wrong with you?”), know that these behaviors are often adaptations: ways people have figured out how to get rid of unbearable feelings of extreme dysregulation in the absence of healthy co-regulation growing up (“What has happened to you?”). Compassionate stance of “there but for the grace of good fortune go I” helps us contribute towards healing rather than harm/marginalization.

Resiliency research: strong relationship with a parent or surrogate caregiving figure in mentoring role (Masten & Coatsworth, 1998) One of the strongest predictors of academic success is the students’ perception of “Does the teacher like me?” (Stutzman Amstutz & Mullet, 2005, citing Nelson, Lott, & Glenn) Emotionally warm, sensitive teachers had students w/greater growth in math and reading ability (Pianta et al. 2008)


Humans are Hard-wired for Connection


TEDTalks

Relationship Difficulties


Reframing “Risk Behaviors”J. Dorado (2015), UCSF HEARTS, Child & Adolescent Services, UCSF/SFGH

Strong Relationships: A Fundamental Cornerstone to School Success




Positive teacher-student relationship particularly important for students with self-regulation difficulties on tasks requiring fine motor skills, accuracy, and attention-related skills (Liew et al., 2010).

Build school community, 5:1, public acknowledgement Predictability, build skills in social emotional learning, relationship Convey hope and empowerment by highlighting strengths and acknowledging progress

“Big I” interventions, such as Trauma Informed Systems, are important But all “Big I” interventions are made up of hundreds of everyday “little i” interactions. Calm, attuned, present, predictable, non-escalating interactions can help to rewire brains towards health. We can all make a difference through our everyday interactions – don’t need to be a therapist to do this.

Trauma-Informed Principles for Promoting School and Community Success: Understand Trauma & Stress Practice Cultural Humility & Responsiveness Establish Safety & Predictability Foster Compassionate & Dependable Relationships Promote Resilience & Social Emotional Learning Facilitate Empowerment & Collaboration

Trauma involves a loss of power and control that can make us feel helpless and hopeless. So every time we unnecessarily disempower someone, take away a person’s voice and choice, we may be inadvertently be retraumatizing them. Being given meaningful opportunities to have voice and choice can be an important component of healing – we know this from research literature around recovering from trauma – the ability to DO SOMETHING, and have a sense of agency helps with healing.


You Can Make a Difference“Big I” = Interventions“Little i” = interactions

(Ghosh-Ippen, 2013)

P a t ter n ed , r ep et it ive

st im u li h elp

r ewir e th e b r a in

(Perry, 2008, 2009)


Brain Break







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Trauma makes us feel helpless and powerless because it overwhelms us. Insidious trauma also causes disempowerment Disempowering someone by taking away their voice and choice could potentially re-traumatize them

When potentially traumatic event happens, our bodies mobilize into “fight or flight” to DO something about our plight. Being able to DO SOMETHING (have some agency) in the face of trauma or extreme stress (either during or afterward) can help with the recovery and healing process.

Having even a perception of some control (sense of agency) can reduce physiological effects of chronic stress. Promoting voice and choice creates more safe and supportive work and care environment and facilitates healing. Learned helplessness can develop in the face of repeatedly thwarted attempts at doing something to change a painful situation. Providing repeated offers of help or opportunities to “do something” about a painful situation, within the context of relational safety, can help people to actually be empowered enough to take action

Trauma-Informed Principles for Promoting School and Community Success: Understand Trauma & Stress Practice Cultural Humility & Responsiveness Establish Safety & Predictability Foster Compassionate & Dependable Relationships Promote Resilience & Social Emotional Learning Facilitate Empowerment & Collaboration

Trauma Helplessness

Disempowerment


Ilona Harezi

Moving Through TraumaM. Merchant (2016) J. Dorado (2015), UCSF HEARTS, Child & Adolescent Services, UCSF/SFGH

Voice and Choice


elm.umaryland.edu

Kevin De Young

Brain Break







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Trauma can derail the development of healthy emotion regulation, social information processing, and problem solving skills, which can then compound trauma’s negative effects. When we build skills in self-management, self-awareness, social awareness, relationships, and responsible decision making, we are more likely to be resilient and achieve our goals in school and at work.

Address the needs underlying the behaviors rather than punishing youth for having a skill deficit or being in “survival brain” •Social Emotional Learning (SEL) curricula •PBIS •Restorative Practices •Scaffolding, skill building, support •Differentiated discipline •Modified behavioral supports

A major educational goal is to get students’ thinking learning brain engaged: learning readiness (and teaching readiness) In order to do this, particularly in context of trauma and chronic stress, needs self-regulation so that survival brain does not take over So dysregulated students may need co-regulation from teacher In order for teacher to provide co-regulation, teacher must have self-regulation In context of chronic stress and/or trauma, teacher may become dysregulated Dysregulated teachers benefit from co-regulation from supervisor/principal In order to provide co-regulation, principal needs to have self-regulation

Social Emotional Learning (SEL) Curriculum Brain breaks Alternate high energy and low energy activities Mindfulness skills Cool Down Kit/Corners Restorative Practices

Resilience & Social Emotional Learning




Build Student Skills to Address Hidden Injuries


Find the “wheelchair ramp”needed for success!

(Greene, 1998)

Creating Conditions for Learning and Teaching

J. Dorado (2016), UCSF HEARTS, UCSF/SFGH

Self-Regulation Co-Regulation

Thinking-Learning Brain Engaged

Self-RegulationCo-Regulation

Self-Regulation

Strategy: Build Self Management Skills for All

•Social Emotional Learning (SEL) Curriculum

•Brain breaks

•Alternate high energy and low energy activities

•Mindfulness skills

•Cool Down Kit/Corners

•Restorative Practices

J. Dorado (2014) UCSF HEARTS, Child and Adolescent Services, UCSF-SFGHJ. Dorado (2014) UCSF HEARTS, Child and Adolescent Services, UCSF-SFGH

Changing the World




National Child Traumatic Stress Network - www.nctsn.org For Educators: Resources for School Personnel Massachusetts Advocates for Children: Trauma and Learning Policy Initiative Helping Traumatized Children Learn (Cole et al.) Freely downloadable at traumasensitiveschools.org/ Reaching and Teaching Children Who Hurt: Strategies for Your Classroom (Susan Craig) Fostering Resilient Learners (Kristin Souers & Peter A. Hall) Culturally Responsive Teaching and the Brain (Zaretta Hammond)

The Restorative Practices Handbook for Teachers, Disciplinarians and Administrators (Costello, Wachtel, & Wachtel) The Heart of Learning: Compassion, Resiliency, and Academic Success (Ray Wolpow, et al.) Freely downloadable at the website below http://www.k12.wa.us/CompassionateSchools/HeartofLearning.aspx Lost at School (Ross Greene) (Collaborative Problem Solving) www.livesinthebalance.org Mindfulness in Education www.mindfuleducation.org/resources.html


Resources• National Child Traumatic Stress Network

• www.nctsn.org• For Educators: Resources for School Personnel

• Massachusetts Advocates for Children: Trauma and Learning Policy Initiative• Helping Traumatized Children Learn (Cole et al.)

• Freely downloadable at traumasensitiveschools.org/

• Reaching and Teaching Children Who Hurt: Strategies for Your Classroom (Susan Craig)

• Fostering Resilient Learners (Kristin Souers & Peter A. Hall• Culturally Responsive Teaching and the Brain (Zaretta

Hammond)


Resources• The Restorative Practices Handbook for Teachers,

Disciplinarians and Administrators (Costello, Wachtel, & Wachtel)• www.iirp.org

• The Heart of Learning: Compassion, Resiliency, and Academic Success (Ray Wolpow, et al.)• Freely downloadable at the website below• http://www.k12.wa.us/CompassionateSchools/HeartofLear

ning.aspx

• Lost at School (Ross Greene) (Collaborative Problem Solving)• www.livesinthebalance.org

• Mindfulness in Education• www.mindfuleducation.org/resources.html

Acknowledgements• Lynn Dolce, MFT, for collaboration on UCSF HEARTS

Training of Trainers Curriculum• San Francisco Unified School District• Massachusetts Advocates for Children: Trauma and

Learning Policy Initiative• UCSF HEARTS made possible through generous funding

from Metta Fund, as well from the John and Lisa Pritzker Family Fund; the SF Dept. of Children, Youth, and Their Families (Mayor’s Wellness Fund); Lieff, Cabraser, Heimann & Bernstein, LLP; The Tipping Point Foundation; and SFUSD School Improvement Grant (SIG) funds

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