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

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Stress vs. Trauma

What Is Child Traumatic Stress?

• Direct exposure• Witnessing, in person• Indirectly• Repeated, extreme indirect exposure to

aversive details

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• 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

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 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• 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 experienceMay experience the self as detached from the body, on the ceiling, somewhere else in the roomMay feel as if in a dream or unreal state

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

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

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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

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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

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...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

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