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Friday, June 1

For School Social Workers: Trauma-Informed Care

The NASW Illinois Chapter is looking to start a shared interest group (SIG) devoted to the issues of school social workers around the state. To be become involved in forming this group, please contact NASW Illinois Chapter Executive Director Joel L. Rubin at .(JavaScript must be enabled to view this email address).

A second grade boy was on the school playground swing. He stared off, not really focusing on anything, just swinging. When a playmate said a friendly, “Hi,” the boy’s reactions were aggressive and more intense than warranted for a simple greeting. Or were they? A first grade girl was repetitively picking at her arm when she was moved to a new table after a four-day weekend. Then she picked at her new classmate’s nametag. She didn’t attend to her teacher and was intensely startled when her teacher touched her shoulder. This little girl’s self-absorbed behaviors were certainly psychopathological. Or were they?

All school staff—not just social workers—benefit from knowing about trauma reactions and interventions, and trauma-informed care brings a healing atmosphere to a school. If together we could see trauma though the eyes of the above two children, their reactions and those of so many others would be seen as expected responses to terror, as normal reactions to an abnormal situation. We could then anticipate the collapse of coping mechanisms as a result of the traumatized child’s sense of powerlessness, helplessness, at fault, and anger. We would believe any child old enough to laugh and experience pleasure could also experience trauma and grief. We would know trauma is sensory, not cognitive, and would be prepared to help soothe activated trauma-aroused survival mechanisms. The arousal stress of trauma damages the left brain (the language side, neocortex) which is responsible for certain cognitive tasks and storing memories. This makes it difficult for traumatized children to use language to make sense of and cope with their experience. It can then become hard to follow directions, to recall what a teacher has said, to focus, to plan, or learn from consequences. Often behaviors associated with attention deficit hyperactivity disorder (ADHD) or learning disabilities (LD) are actually unidentified trauma reactions. Coping, planning, and thinking don’t occur in trauma—survival does. Restoring safety and control helps the student shift back into the neocortex, which makes learning possible again. 

Trauma refers to the sensory and emotionally overwhelming situations that create feelings of loss of safety, power, and control. All developmental areas can be affected, including identity formation, body integrity, reactivity, ability to manage behavior, moral, and spiritual development, and the ability to trust. Trauma affects learning, cognitive processing, memory, and the brain. According to James (1994), “Symptoms of trauma, such as flashbacks, hyperactivity, and dissociation, not only interfere with children’s learning but are often not recognized as such; they can be mislabeled as conduct disorder, oppositional and defiant behavior, lying.” (p. 11). Characteristics of the fight-flight-freeze responses of trauma as listed online in the Parent Trauma Resource Center of The National Institute for Trauma and Loss in Children (TLC) include: distressing memories; unwanted, intrusive images and thoughts; distressing dreams or difficulty going to sleep for fear of having the dreams; acting or feeling as if the event were recurring; irritability, anger; sense of a foreshortened future; hypervigilance; exaggerated startle response; regression; and post-traumatic play that is not fun. If no trauma-specific interventions are provided, trauma reactions can last for years after the experience, or suddenly reappear years later when the sensory memory of the trauma is aroused by a sight or smell or feeling. Trauma reactions may not be prevented, but trauma’s powerful hold on our students’ learning and behavior can be loosened if sensory interventions are provided appropriately.

Trauma’s cognitive distortions impede using cognitive-based interventions alone. It’s not enough to simply tell children they are safe because that telling happens on a cognitive thinking level. But trauma images and sensations are stored implicitly in the right brain (limbic area) which controls our social and emotional functioning. By reducing the trauma arousal level, the right brain can function again because the child feels safe. It is this emotional right brain which ultimately determines the manner in which the thinking left brain will react: tune out or listen; dissociate or have fun; be in constant motion to keep memories at bay or learn; feel terrified and helpless or feel safe and capable; react and survive or think and relate. When safety, power, and control are returned to the student through sensory interventions offered within a caring relationship, a child’s story is given a visual language so it can be cognitively reordered. This brings the healing. 

In becoming a trauma-informed school, knowing the above information must direct all staff interventions, but a school social worker is usually the one at the front line, helping, soothing, listening. We social workers tend to forget a crucial first step: self-care. My district calls this “Having ice cream for dinner” if that’s what takes care of you. Reflect: Ask yourself, “How do I feel right now?” Calm yourself and own your own feelings about what the child has told or shown you. Relate: Say to the child, “I feel scared right now, and I need to know how you feel. Show me or tell me what happened.” And Regulate: When we reflect and regulate ourselves, we are able to co-regulate with a child, like breathing a dance together. Co-regulating brings oxytocin, the soothing anti-stress hormone, into the trauma-aroused brain. The primary factors in healing the brain are positive relationships and positive environments—and repetition of both. 

Obtaining research-based training is the key to becoming a trauma-informed school. An excellent resource is The National Institute for Trauma and Loss in Children (TLC) located in Michigan. On-site and online classes are available and informative. From this training, staff will learn that educating with facts and normalizing reactions are both interventions that heal a traumatized child. Consider this statement: “Perhaps it’s not the situation that induces trauma but how that situation is being experienced” (Steele & Kuban, 2011). An event traumatic to one child may just be a bad experience to another. It may also be traumatizing at one stage of life and not earlier or later. Other factors to consider when assessing the impact of an event: the child’s temperament, strengths, health, attachments, intelligence; cultural and community understanding of trauma; reaction of caregivers and first responders; safety given afterwards; degree of bodily violation and violence; persistence of threat, terror, and proximity. Traumatized children experience themselves, their world, and us as helpers through the distorted lens of trauma so this knowledge must shape our responses. It also prevents any secondary wounding through poorly-attuned treatment. 

Sensory-based interventions take the “can’t think” (no language) state to the “can think” (language) state of cognitive reframing, from victim thinking to survivor/thriver thinking. Sensory interventions are shaped by the characteristics of the child, the personal environment, and the traumatic event itself. The process of recovery must include nurturing interventions such as holding, touch and gentle eye contact, and corrective interventions, such as time in (not time out), predictability, consistency, and infinite patience. Stepping back (Teachers, too!) when confronted by an outburst, then self-regulating and using describing words (“I think this surprised you and you wanted it to stop. What would help you feel safe?”) all validate the child’s experience. These actions, which strengthen a caring relationship, help students trust enough to self-regulate. They empower children to make choices and identify things that self-soothe. It is the relationship that heals, and you make the difference! 

Teachers can integrate soothing, predictable activities into everyday lessons, from doing relaxation exercises at the start of the day or during difficult transitions to announcing schedule changes. Encourage teachers to anticipate behavior triggers, reduce external sensory stimuli, and build in breaks for playing. Laugh together! Use a confidential question box, or let students write an advice column. Have a child make a personal Care Box or set aside a Cool-Down Corner filled with sensory calmers because children can’t learn until they are calm. Use visual cues for academics and emotions. Make and display posters of Coping with Difficult Feelings. Constantly acknowledge strengths. Activities in social work times can include the psychomotor activity of drawing the event or creating symbolic stories. Teach deep breathing, self-talk, and body awareness. Play games that require planning, future-thinking, and helping others. Begin and end the day in a safe and empowered place. These activities give language to feelings and soothe the emotional right brain so learning can occur. Knowing that “routine is structure, structure is control, and control is safety” can inform all our approaches to soothing the arousal of trauma. 

Remember the child is more than the trauma! All staff can recognize trauma reactions and use the trauma-specific sensory interventions children need. School social workers can actually lead the way for a school to be trauma-informed. Normalizing the reactions to the event and asking questions about then and now help create hope for a future. When traumatized children feel safe and in control, they can swing freely and play; they can attend to teachers and learn. If we “see” the child’s behavior as expected reactions to trauma, not intentional defiance; if we do not judge the rightness of the behavior but witness the trauma story; and if we unfold together the child’s strengths, the healing journey towards a resilient future has begun. 

REFERENCES

• James, B. (1994). Handbook for the Treatment of Attachment-Trauma in Children. New York, NY: The Free Press.
• Parent Trauma Resource Center. (2007). Retrieved April 25, 2012, from www.starrtraining.org/tlc. 
• Steele, W., & Kuban, C. (2011). Advancing Trauma-Informed Practices. Clinton Township, MI: TLC Institute.

Lori S. Rueffer, MSW, LCSW, ACSW, CTC-S, has been a school social worker for East Aurora School District #131 since 1997. She is certified as a Trauma Consultant Supervisor through The National Institute for Trauma and Loss in Children. Lori implemented the district-wide trauma intervention program and provides yearly trainings for staff. She supervises MSW interns, has presented at the annual Illinois Association of School Social Workers (IASSW) conference, and volunteers as a GriefShare facilitator at her church. She was a crisis counselor at Northern Illinois University (NIU) after the shooting tragedy of 02/14/08. Her self-care includes praying, gardening, walking with her husband, and FaceTiming with her married daughters.