School Wide Implementation of Trauma Informed Practices:

The Voices of Experience

The Neurodevelopmental Skills and Demands Approach

Rick Robinson, Ph.D.www.drricksndlens.comwww.321insight.com

Trauma Informed Care-A Careful Start

It is important for all of us to be mindful that:Trauma is common (WSU AHEC CLEAR Center 2013)

•A large study indicated 90% of respondents reported one incident of life time trauma

•The average number of traumatic life events was 4.8

•2/3 of American adults report significant lifetime exposure to trauma

•20% of the US population is exposed to trauma in a given year

For Helping Professionals (Francois Mathieu, 2012)

•Between 40 and 85% of “helping professionals” develop vicarious trauma, compassion fatigue and/or high rates of traumatic symptoms

And Importantly…

Many of us will have experienced, in our own lives, a number of the Adverse Childhood Experiences we will talk about today

•To be aware of our own “trauma” triggers, or what activates our stress response system

•To be aware of how we react when we experience a “trauma” trigger, or our stress response system is activated

•To develop a self-care plan that addresses how we manage our affect (emotions) in the immediate situation, as well as near and long term self-care strategies. Maintaining “life balance” can be facilitated by attending to domains of self-care that can include: Professional, Physical, Psychological, Emotional, Spiritual and Personal strategies

(Olga Phoenix Project: Healing for Social Change 2013)

The MantrasThe Lens Shift-From:

“What’s wrong with you?” To:

“What’s happened to you?”The focus:

“Trauma Informed and Resilience Oriented”Two core features of trauma-informed environments that promote regulation and the development of resilie

nce are:

“Predictability and Safety”A phrase increasingly heard from those working in the field of childhood adversity is:

“Resilience trumps ACEs”A phrase being used in education is:

“Fostering Resilient Learners”

Trauma-Informed Care

U.S. Substance Abuse and Mental Health Services Admin SAMSHA’s concept of a trauma-informed approach: “A program, organization, or system that istrauma-informed:

1. Realizes the widespread impact of trauma and understands potential paths for recovery;2. Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system;3. Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and4. Seeks to actively resist re-traumatization.”

A trauma-informed approach can be implemented in any type of service setting or organization and is distinct from trauma-specific interventions or treatments that are designed specifically to address the consequences of trauma and to facilitatehealing.

A trauma-informed approach reflects adherence to six key principles rather than a prescribed set of practices or procedures. These principles may be generalizable across multiple types of settings, although terminology and application may be setting- or sector-specific:

1. Safety2. Trustworthiness and transparency3. Peer support4. Collaboration and mutuality5. Empowerment, voice and choice6. Cultural, historical, and gender issues

From SAMHSA’s perspective, it is critical to promote the linkage to recovery and resilience for those individuals and familiesimpacted by trauma. Consistent with SAMHSA’s definition of recovery, services and supports that are trauma-informed build onthe best evidence available and consumer and family engagement, empowerment, and collaboration.

Trauma Informed Oregon Definitions-(Oregon Health Authority)

Clarifying Trauma Informed Care

Trauma Recovery/Trauma Specific Services• Reduce symptoms • Promote healing• Teach skills• Psycho-empowerment, mind-body, other modalities.

Trauma Sensitive• Bring an awareness of trauma into view • Trauma lens

Robinson, 2016

The Road Map

Robinson, 2016

The Neurodevelopmental Skills and Demands Approach:

5 Key Concepts

Core Elements of the Environment

Use-dependent Development

Kids do Well if They Can

Regulation

Engagement in Relevant Instruction

Core Elements of the EnvironmentBruce Perry, M.D., Ph.D., The Child Trauma Academy

• Relational (safe)• Relevant (developmentally-matched)• Repetitive (patterned)• Rewarding (pleasurable)• Rhythmic (resonant with neural patterns)• Respectful (child, family, culture)

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Use-dependent DevelopmentBruce Perry, M.D., Ph.D., The Child Trauma Academy

“Neurons and neural systems are designed to change in a ‘use-dependent’ fashion…Healthy organization depends on the pattern, frequency, and timing of key experiences during development. Patterned, repetitive activity changes the brain…Repetition, repetition, repetition: Neural systems, and children change with repetition.”

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Kids do Well if They CanRoss Greene, Ph.D., Level 1 Advanced Training-Collaborative Problem Solving-2010

Lagging SkillsEnvironmental

Demands

“Challenging Behavior occurs when the cognitive demand being placed upon a person outstrip the person’s capacity to respond adaptively.”

“Unsolved Problems: Specific conditions in which the demands being placed upon a person exceed the person’s capacity to respond adaptively.”

“Behind every challenging behavior is a lagging skill and a demand for that skill.”

“Your explanation guides your intervention.”Robinson, 2016

“Executive functions is a term referring to a set of cognitive functions involved in the top down control of behavior in the service of a goal. They are needed whenever ‘going on automatic’ would be insufficient or detrimental (Diamond).”

“Self-regulation refers primarily to emotional control and regulation…self-regulation also embraces the importance of motivation and alertness. Self-regulation researchers view emotions as equal partners in the learning process and in the achievement of one’s goals (Diamond).”

“Regulation involves monitoring and modifying processes across time, for example. Affect and emotion, physiology and motor movement or communication. In essence, integration leads to optimal regulation (Siegel).”

Robinson, 2016

RegulationAdele Diamond (2010) & Daniel Siegel (2012)

Engagement in Relevant InstructionFrom Barker Bausell, Ph.D.

Too Simple to Fail-A Case for Educational Change, 2011.

Theory of School Learning:

“The only way schools can increase learning is to increase the amount of relevant instructional time delivered.”

Relevant Instruction-Defined:

“Instruction that can be understood, attended to, and involves topics that have not already been learned and that are mandated by the curriculum (which assumes the existence of tests that match the curriculum as well).”

Robinson, 2016

Routines, Rituals and Classroom

Ecology

Consistent Adult

Responses

Adult Regulation and

Self-Care

Adult Attunement

Identification

of Emotions

Managing Emotions

Expressing

Emotions

Executive

Skills

Self-Development and Identity

Trauma Experience Integration

Promoting Predictability and Safety: The ARC model-With NDSD Adjustments

Blaustein, M. E., & Kinniburgh, K. M. (2010). Treating Traumatic Stress in Children and Adolescents: How to Foster Resiliencethrough Attachment, Self-Regulation, and Competency (First ed., pp. 35-41). New York, NY: The Guildford Press

This work conducted by our Mental Health Collaborators & Partners

Hope and Resilience

Social Thinking and Interaction

Skills

Regulation Strategies

Community Building:

Culture of Care

Promoting Predictability and Safety:The ARC model-With NDSD Adjustments

Blaustein, M. E., & Kinniburgh, K. M. (2010). Treating Traumatic Stress in Children and Adolescents: How to Foster Resilience through Attachment, Self-Regulation, and Competency (First ed., pp. 35-41). New York, NY: The Guildford Press

Attachment Level-Develop a predictable and safe environment to support student learning.

Self-Regulation Level-Teach students regulation skills and provide opportunities for guided practice.

Competency Level-Teach students to initiate skills and make adaptivechoices, to meet their goals.

Key Ingredients for Promoting Students’ Regulation SkillsIngredient 1-Routines, Rituals, Ecology: Predictability1. Environmental Supports

• Classroom Skills Assessments (Class and individual)• Classroom Ecology• Classroom Schedules• Classroom Expectations• Classroom Routines and Rituals• Regulation Strategies

2. Embedded Skills Training3. Direct Skills Training

Thinking/Regulation Skills are developed through patterned, repetitive practice, at the point of performance in a relationally safe environment

Ingredient 2-Facilitative Student Teacher Relationships: Relational Safety1. Adult Attunement2. Adult Consistent Responses3. Adult Regulation and Self Care4. Community Building

Robinson, 2016

The SurveyFindings are derived from a survey sent to school leaders from approximately 85 schools in 12 different school districts, as well as one therapeutic school. Implementations of school wide-trauma informed practices were in their 1st, 2nd, and 3rd years, and included schools from the:

• Gladstone School District• Hillsboro School District• Beaverton School District• Redmond School District• North Clackamas School District• NWESD-Columbia ACEs Collaborative (Scappoose, St. Helens, Rainier, Clatskanie, & Vernonia School Districts)• Canby School District• Forest Grove School District

• Serendipity Center

The survey, comprised of 6 open-ended questions, was sent to 70 school leaders. The survey continues to be open at this time; today’s results are based on a 50% return rate, as of this date. (Note that surveys from Survey Monkey frequently were identified as “spam” and went to “clutter” or “junk.” In addition, a number of teams are in the process of fitting in completion of the survey, within the complexity of spring time school demands. The return rate was consistent across districts)

Question 1

Please list implementation events/strategies that worked well.

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Question 1 (90)

Question 1: Sample Responses

• Sending many staff to Restorative Practices & Community Circle training; Offering Community Circles as a strategy but not requiring it (but modeling it often with staff); Giving staff background info on ACES; meeting with our team for longer blocks of time; providing resources for calming spaces in each classroom; all staff engaging in restorative practices - including our counselor and principal.

• 321 Insight videos on self-regulation, using the self-regulation quadrants with staff and students, teaching staff and students about the hand/brain model, using 5 point scale for self awareness.

Question 1: Response Frequency less than 6%

• Consistent Routines, Classroom Ecology and Adult Responses• Tiered support planning for students with significant lagging skills• PLC leaders as part of the implementation plan and process• Classroom observations with feedback/coaching

Question 2

Please list implementation events/strategies that did not work well.

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TimeConstraints

All Worked Well Staff Buy-in/Mindset

A StrategyProblem

ImplementationProblems

Question 2 (36)

Question 2: Sample Responses• Not that they don't work well, but we need to do more around connecting what is being done in the Wellness Center with Calming Corners in classrooms.

• Trying to get 100% of staff to understand the need for trauma informed practices.....some are still doing it the same way as always.

• There's so much information and opportunities out there, the one thing that we have found challenging is narrowing down the training and information as well as having a fully articulated and aligned approach across the district. So that the right and left hand knows what is happening across the district.

Question 2: Response Frequency less than 6%

• Wellness Center-development in progress• Calming Corners-development in progress• Integration of Calming Corners and Wellness Centers

Question 3

Please list the 3 most important considerations for a successful trauma informed implementation.

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Question 3 (59)

Question 3: Sample Responses

• Strong leadership team that includes admin, certified and classified. PD that goes beyond the basic "trauma 101"- must include guided practice for staff, coaching feedback and support. Core environmental practices-routine, regulation, relationships, consistent response (ARC model).

• Buy in from staff, simplicity in roll-out of ideas, practical implementation ideas that can be put in place immediately

• Staff training and understanding, common agreements with the whole staff on practices, and on going training

Question 3: Response Frequency less than 6%• Strong Core Team• Physical space• Adequate training time• Data tracking system for decision making• Start slow to go fast• Consultation• Focus on relationships with students• Focus on staff self-reflection and self-care

Question 4

Please list key challenges/issues that remain in your implementation.

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Question 4 (59)

Question 4: Sample Responses

• Having staff stick with the implementation of trauma informed practice when they are stressed and NOT switching back to their old ways of handling students with trauma.

• Whole staff philosophy consistent adult response standardizing calm corners non- punitive behavior practices

• Time for ongoing training and coaching for individual teachers on implementation

• Tier 3 behavior strategies

Question 4: Response Frequency less than 6%

• Professional development for new staff- “on boarding”• Wellness Center development• Data tracking system for decision making• Family/Community communication and collaboration

Question 5

Have there been surprises in your implementation?

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Question 5 (35)

Question 5: Sample Responses

• We have been able to shift our conversations about student behavior fairly quickly and focus on lagging skills rather than on students having purposeful, manipulative behaviors.

• Not really.

• We have been pleasantly surprised by how much it works if we follow guidelines.

• Not really surprises, but rather cultural norms that will have to be changed as this work moves forward. So much of past disciplinary practices have been built on punishment rather than restorative justice or CPS.

Question 5: Response Frequency less than 6%

• How much our students need trauma-informed practices• Student desire for adult connections• “Noticing” the number of students with significant lagging skills• Lack of results for students needing “red zone” supports• Staff dysregulation• First graders understanding “flipping you lid” and the effectiveness of “name it to tame it.”• Lack of resource support from the state

Question 6

Please summarize information related to outcomes you have collected regarding your implementation.

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Increased StaffSkills

DecreasedDiscipline Referrals

Buy-in Beginning No Data Yet

Question 6 (44)

Question 6: Sample Responses

• Teachers rarely call the office and ask for a student to be removed from class. Instead they ask for someone to give a student a break. We don't have students referred to the office for someone else to handle the situation. Teachers are helping students solve problems in class and resolve conflicts.

• We have common definitions and language for TIP. We have continued interest and need for PD. Our work moving forward will include and action plan with timelines for completing.

• Improved SBAC and Dibels assessment scores. Reduction in office referrals and minor referrals over 3 years. Staff report more understanding of what to do for students who are impacted by trauma.

• Behavior referrals are down except for top-tier students in the red zone.

• Staff buy-in is vital and ongoing trainings and debriefing is important and we need to keep current and keep the transformational process moving forward.

Question 6: Response Frequency less than 6%• Increased academic achievement• Decreased staff absences• Increased common language• Increased Wellness Center visits• Decreased student visits to the Health Center• Positive effect on school climate• Increase use of student regulation tools• Decrease in punitive discipline strategies• Increase in community partnerships/collaboration• Increase staff frustration regarding change in disciplinary philosophy

ReferencesAblon, Stuart. Think:Kids. www.thinkkids.org.

Anda, R.F., & Brown, D.W. Adverse Experiences & Population Health in Washington: The Face of a Chronic Public Health Disaster. Results from the 2009 Behavioral Risk Factor Surveillance System. Prepared for the Washington State Family Policy Council, 2010.

Archer, A., & Hughes, C. Explicit Instruction: Effective and Efficient Teaching. New York, NY: The Guilford Press, 2011.

Barkley, R.A. ADHD from A to Z: Advances in the Understanding & Management of ADHD in Children and Adolescents. CMI Education Institute, 2012.

Bausell, R.B. Too Simple to Fail-A Case for Educational Change. New York, NY: Oxford University Press, 2011.

Blaustein, M. E., & Kinniburgh, K. M. Treating Traumatic Stress in Children and Adolescents: How to Foster Resilience through Attachment, Self-Regulation, and Competency. New York, NY: The Guildford Press, 2010.

Blodgett, Christopher. http://ext100.wsu.edu/cafru.

CDC-ACE Study-Adverse Childhood Experiences. http://www.cdc.gov/ace/index.htm.

Center on the Developing Child Harvard University. www.developingchild.harvard.edu.

Cook, A.; Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., DeRosa, R., Hubbard, R., Kagan, R., Liautaud, J., Mallah, K., Olafson, E., van der Kolk, B., Complex Trauma in Children and Adolescents. Psychiatric Annals. 2005; 35-5: 390-395.

Denton, P. & Kriete, R. The First Six Weeks of School. Massachusetts: North East Foundation for Children, Inc., 2000.

Diamond, A. The Evidence Base for Improving School Outcomes by Addressing the Whole Child and by Addressing Skills and Attitudes, Not Just Content. Early Education and Development. 2010; 21-5: 780-793.

Greene, Ross. Lives in the Balance. www.livesinthebalance.org.

ReferencesOregon Behavioral Risk Factor Surveilliance System (BRFSS). www.public.health.oregon.gov/BirthDeathCertificates/Surveys/AdultBehaviorRisk/Pages/index.aspx.

Perry, Bruce. The Child Trauma Academy. www.childtrauma.org.

Porter, L. & Carson, K. Adverse Childhood Experiences and Evidence-Based Home Visiting. Maternal and Child Public Health Leadership Training Program, University of Washington, 2011.

Robinson, Rick. Dr. Rick Robinson’s Neurodevelopmental Lens. www.drricksndlens.com.

Siegel, Daniel J. The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are (Second Edition). New York, NY: The Giuldford Press, 2012.

Siegel, Daniel J., and Bryson, Tina Payne. The Whole Brain Child: 12 Revolutionary Strategies to Nurture our Child’s Developing Mind. New York, NY: Delacorte Press, 2011.

Sprick, R. CHAMPS: A Proactive and Positive Approach to Classroom Management (2nd Ed.). Eugene, OR: Pacific Northwest Publishing, Inc., 2009.

Sroufe, L.A., England, B., Carlson E., Collins, W.A. The Development of the Person-The Minnesota Study of Risk and Adaptation from Birth to Adulthood. The Guilford Press, 2005.

Trauma Informed Oregon (Oregon Health Authority). www.traumainformedoregon.org.

U.S. Substance Abuse and Mental Health Services Administration. www.samhsa.gov/trauma-violence.

van der Kolk, Bessel. The Trauma Center at Justice Resource Institute. www.traumacenter.org.

Contact InformationRick Robinson Ph.D.

rickrobinsonphd@drricksndlens.com

Robinson, 2016