Trauma Informed Care: Responding to Bullying within a Multi-tiered Framework Ginny Sprang, Ph.D. University of Kentucky Professor, College of Medicine Executive Director, Center on Trauma and Children

BLUF TI-Informed approach advances our understanding of ACES and provides targets for intervention TI-Care and PBIS are compatible Trauma exposure, traumatic stress and bullying are interrelated

Preview Trailer Terminology and conceptual issues Trauma Model Traumatic Stress Trauma Informed Principles Application within a PBIS approach

Terminology Adverse Childhood Experiences refer to inherently disruptive experiences in childhood that produce significant and potentially damaging levels of stress and associated physical changes

Terminology Trauma refers to the physiological and psychological responses and adaptations that result from adversity

Terminology Complex Trauma refers to cumulative exposure and persistent effects over time

Conceptual Distinctions ACEs identify targets of intervention not scientifically informed methods of intervention. Understanding trauma provides a framework for specific interventions.

Trauma Informed Model Defines application and boundaries of the science Trauma literature defines “signature sets of risk” Improves application and intervention

Bullying Research demonstrates a link between bullying and Post-traumatic Stress Disorder Trauma can be the antecedent and consequence of bullying

14 Stress vs. Trauma

What Is Child Traumatic Stress? Direct exposure Witnessing, in person Indirectly Repeated, extreme indirect exposure to aversive details 15

Traumatic events overwhelm a child’s capacity to cope and may elicit feelings of terror, powerlessness, and out-of-control physiological arousal.

How Youth Respond to Trauma: Traumatic Stress Reactions Intrusion Avoidance Alterations in arousal and reactivity Dissociation Negative alternations in cognitions and mood

How Children/Youth Respond to Trauma: Images, sensations, or memories of the traumatic event recur uncontrollably. This includes nightmares disturbing thoughts flashbacks physiological reactions intense/prolonged psychological distress This includes nightmares disturbing thoughts flashbacks physiological reactions intense/prolonged psychological distress INTRUSIVE SYMPTOMS INTRUSIVE SYMPTOMS

How Children/Youth Can Respond to Trauma: Avoidance of internal reminders thoughts, feelings, or physical sensations Avoidance of external reminders People, places, objects Activities, situations, conversations Avoidance of internal reminders thoughts, feelings, or physical sensations Avoidance of external reminders People, places, objects Activities, situations, conversations AVOIDANCE SYMPTOMS AVOIDANCE SYMPTOMS

How Youth Can Respond to Trauma: Bullying and aggressive behavior Self-destructive or reckless behavior Jumpiness or quick to startle Problems with concentration Sleep disturbance Bullying and aggressive behavior Self-destructive or reckless behavior Jumpiness or quick to startle Problems with concentration Sleep disturbance Hyperarousal can lead to hypervigiliance: a need to constantly scan the environment and other people for danger. Hyperarousal can lead to hypervigiliance: a need to constantly scan the environment and other people for danger. ALTERATIONS IN AROUSAL & REACTIVITY

How Youth Can Respond to Trauma: Mentally separating the self from the experience May experience the self as detached from the body, on the ceiling, somewhere else in the room May feel as if in a dream or unreal state DISSOCIATION DISSOCIATION

How Youth Can Respond to Trauma: Inability to remember parts of traumatic event Persistent negative emotions Persistent difficulty experiencing positive emotions Decreased interest or participation in activities Feeling detached from others Persistent exaggerated negative expectations Persistent distorted blame of self or others Inability to remember parts of traumatic event Persistent negative emotions Persistent difficulty experiencing positive emotions Decreased interest or participation in activities Feeling detached from others Persistent exaggerated negative expectations Persistent distorted blame of self or others NEGATIVE ALTERATIONS IN COGNITION/MOOD NEGATIVE ALTERATIONS IN COGNITION/MOOD

Trauma Reminders Things, events, situations, places, sensations, and even people that a youth consciously or unconsciously connects with a traumatic event

Trauma Reminders A seven-year-old boy whose father and older brother fought physically in front of him becomes frantic and tries to separate classmates playfully wrestling on the schoolyard. A ten year old physically abused boy who is innocently bumped by another student passing him in the classroom and erupts in anger, tackling the child to the ground. A teenage girl who was abused by her stepfather refuses to go to gym class after meeting the new gym teacher who wears the same aftershave as her stepfather.

Types of Traumatic Stress Acute Chronic Complex 26

Types of Trauma: What About Neglect? Failure to provide for a child’s basic needs Perceived as trauma by a young child who is completely dependent on adults for care Opens the door to other traumatic events May interfere with a child’s ability to recover from trauma 27

Summary Childhood trauma impacts many domains of functioning Initiates a coping response that may be maladaptive A shift in perspective allows for targeted intervention

A trauma informed education system Recognizes and addresses impact of trauma on all they serve Infuses and sustains trauma informed awareness knowledge and skills that are evident in policies and practices Works collaboratively with other organizations to achieve recovery and promote resiliency

...If we fail to look through a trauma lens and to conceptualize client problems as related to current or past trauma, we may fail to see that trauma victims, young and old, organize much of their lives around repetitive patterns of reliving and warding off traumatic memories, reminders, and affects Moroz, 2005, p.12 30

Trauma Informed Principles Safety Empowerment Collaboration Trust Choice Cultural sensitivity

What is a trauma sensitive school? A safe and respectful environment that enables students to –build caring relationships with adults and peers, –self-regulate their emotions and behaviors, and –succeed academically, while supporting their physical health and well-being.

Examples of TI-Care in PBIS Context Tier 1: Universal School policies, culture and climate establish a physically and emotionally safe climate Prompt intervention for behaviors by students or adults that are inconsistent with this standard (e.g. bullying).

Examples of TI-Care in PBIS Context Tier 2: Supplemental Support Screening students for trauma symptoms to determine if other assessments or referrals are warranted Building consultation teams that support classroom teachers’ efforts to be more responsive to students affected by trauma

Examples of TI-Care in PBIS Context Tier 3: Intensive Intervention Teacher/environmental interventions that identify triggers and develop strategies to reduce and address these issues Comprehensive functional behavioral assessments coupled with intensive, evidence- based trauma interventions to teach individual students alternative, appropriate methods to meet their needs

Take Home Message Bullying can be a manifestation of trauma exposure and/or can cause traumatic stress in victims PBIS is a positive step towards a trauma informed approach

Take Home Message A trauma- informed perspective provides a knowledge base to understand problem behavior and difficulties in learning, and Provides a pathway to intervention