Here is an article that is particularly relevant to our treatment philosophies, recently published in the New York Times Opinion Pages:
When Luke gets angry, he tries to remember to look at his bracelet. It reminds him of what he can do to calm himself: stop, take a deep breath, count to four, give yourself a hug and, if necessary, ask an adult for help.
Luke is 5 and he has been practicing these steps for half a year at school and at home, thanks to a program called Head Start Trauma Smart that currently serves some 3,300 children annually in 26 counties in Kansas and Missouri. “We used to have to do these steps four or five times a day,” said Connie, his grandmother (who requested that I change her grandson’s name and omit her surname). “Now we’re down to four or five times a week.”
Luke’s difficulties stem from his earliest experiences. Before and after his birth, his parents regularly used drugs. His mother was unable to attend to him and his father was sent to prison shortly after his first birthday. Now he lives with his grandparents.
Children like Luke, who experience neglect, severe stress or sudden separation at a young age can be traumatized. Without appropriate adult support, trauma can interfere with healthy brain development, inhibiting children’s ability to make good decisions, use memory or use sequential thought processes to work through problems. “Kids who have had significant chronic adversity become hypervigilant,” said Janine Hron, C.E.O. of the Crittenton Children’s Center, which developed the Head Start Trauma Smart program. “Their emotions overwhelm them. They have difficulty sleeping, difficulty tracking in class, they act out, and then they get kicked out of school. The numbers of people who are experiencing these traumas are really epidemic.”
As I have reported in this column, chronic childhood adversity is now understood to be far more prevalent than researchers have imagined. More than 50 percent of the children served by Head Start Trauma Smart have had three or more adverse childhood experiences. The list includes a family member incarcerated, an unexpected death in the family, depression, violence, abuse or drug use in the home, or periods of homelessness.
The education system responds bluntly to kids with these challenges. The standard arsenal of disciplinary measures — from yelling and “timeouts” to detentions and suspensions — are not just ineffective for children who have experienced traumatic stress; they make things worse. By some estimates, preschool expulsions are 13 times more common than K-12 expulsions — a finding that, given the bleak future it portends for these children (and the associated costs for society), should send alarm bells ringing across the nation.
In his Head Start class, Luke would explode into rages, screaming, pushing or hitting other children or his teachers. It inhibited his ability to learn and caused considerable distress to his classmates, teachers and grandparents.
Luke is receiving individual therapy. But he is also surrounded by caregivers who understand his needs and know how to respond when he needs help. Through the Head Start Trauma Smart model, teachers, parents and even the bus drivers and cafeteria workers who interact with children receive training in trauma.
This allows them to respond more skillfully, rather than reacting out of anger, frustration or resentment. Indeed, one of the biggest lessons for teachers and parents who undergo this training is that the very first step is learning how to calm, and care for, themselves, especially when they are overstressed.
The Head Start Trauma Smart program is still in its early stages, but the evidence is highly promising (pdf). To date, the program has produced significant gains as measured by the Classroom Assessment Scoring System, an instrument for gauging the quality of classroom relationships, as well as emotional and instructional support.
And using another standard assessment tool, the Achenbach system, parents and guardians of children who are receiving individual therapy (like Luke) have reported gains in a variety of areas: kids are less anxious and emotionally reactive, and less aggressive or withdrawn; attention deficit, hyperactivity and “oppositional defiant” problems have decreased; and parents report overwhelmingly that their children are sleeping better. The scores indicate that many kids have moved out of a “clinical range of concern” on several factors to within a normal range — a sign that they are better prepared to succeed in kindergarten.
That has been Luke’s experience, too. “Before the program, Luke was constantly in trouble, either off by himself or hitting other kids,” Connie said. “Now he can sit right next to others and he doesn’t bother them. Before he had no friends because other kids were scared of him. Now he’s got three friends. He knows his address and his ABCs and colors and we’re working on counting to 20.”
Head Start Trauma Smart is based on an evidence-based trauma intervention framework known as ARC (Attachment, Self-Regulation and Competency) developed by Kristine Kinniburgh and Margaret Blaustein at the Trauma Center at Justice Resource Institute in Brookline, Mass. Trauma interventions can be highly effective, but the challenge today is extending them from therapeutic settings — which are limited and expensive — into the broad systems that serve larger numbers of children.
Through the Head Start Trauma Smart training and mentoring programs, teachers, parents and others come to understand how trauma affects the brain and manifests itself in daily life. “Every behavior communicates a need,” said Kinniburgh, the co-developer of ARC and co-author of “Treating Traumatic Stress in Children and Adolescents.” “The question is, how do we help caregivers and teachers tune in and understand the messages that kids are really sending through their behavior?” And how to do it in real-time in a classroom with two dozen children or the checkout counter at Wal-Mart?
One key is remembering that children who have experienced trauma feel profoundly unsafe. When they are acting out, their primary need is often to feel a sense of connection. Instead of yelling, “Stop!” when a child is throwing a tantrum, or making the child sit alone in the corner, teachers learn to notice and name the child’s experience. (They wear bracelets, as reminders, too.)
“The minute you say to a child: ‘I can see you are so angry. Your fists are balled up and your face is scrunched up,’ they can relax because they know they’re being attuned to,” said Avis Smith, who directs the Prevention and Early Intervention Programs for the Crittenton Children’s Center.
At that point, the teacher can validate the child’s emotions by saying, “I’d be mad too if somebody took my block,” added Suzee Schulz-Marks, a Head Start teacher who has taught for 18 years and has found the trauma smart model — a new approach for her — to be highly effective. “You can let them know it’s O.K. to have those strong feelings, and that they are not alone with them.”
Next, the teacher, or parent, can help the child find a way to shift. Together, they problem-solve. The teacher might say, “‘Maybe you can use your words and say that everybody should get a chance to play with the blocks?’” added Schulz-Marks. But the child may not be ready for that. Or: “Would you like to go to the safe spot or sit on my lap? Take some deep breaths or use the breathing star?”
Breathing stars (playful breathing aids made out of file folders) are invaluable, teachers say. So are safe spots, or “calm-down corners,” with shoeboxes filled with sunglasses, pinwheels and tactile things: nail brushes with soft bristles, bendy Gumby animals, or pieces of burlap or velvet. (Some parents create their own calm-down corners at home, as well.) The main thing is for the children to discover the tools and methods that work for them. Through this process, they learn over time that they can gain control over themselves and return to an emotional place where they can enjoy playing and genuinely benefit from learning opportunities.
“Many adults are skeptical that kids can learn to respond to themselves,” said Lauren Clithero, a therapist who delivers the program’s training sessions in mid-Missouri. “It’s a big paradigm shift in how adults think they are supposed to take care of children. We think our job is to jump in and take control, but it’s much better to give kids choices and control over themselves.”
Another common misunderstanding, said Avis Smith, is when adults say: “He’s just looking for attention. I’m not going to give it to him because it will reinforce the behavior.”
“There’s a big difference between attention-seeking behavior and children seeking connection,” she added. “Validating children’s feelings and connecting with them on a personal level is a core need.”
It’s not just something for teachers or parents to do. Any adult can play a part in helping to heal a child, or anyone else, for that matter. One of the core goals of the Head Start Trauma Smart model is to create a common context so that everyone understands the impact and extent of traumatic stress, not just on children’s lives, but also on their lives of their friends and colleagues, and perhaps on their own lives, too.
Stephanie McIntosh said the training has changed the way she looks at the world. McIntosh has been a bus driver for more than 20 years. “I deal with preschoolers,” she said. “I’m the next adult the kids see in the morning when they go to school.” Sometimes the kids get on the bus in the morning carrying heavy feelings from home, fears about school, crying, sometimes acting out.
“I used to be the kind of person who said, ‘The way it looks is the way it is.’ But I don’t look at it that way anymore,” McIntosh said. “There are things that happen to people that we don’t know about. Now, I watch the kids better, their body language. I’m not the grouchy person who yells, ‘Sit down!’ or gets angry. I give them reassurances. They always want to give me hugs before they get off the bus. It makes my work more enjoyable.”
“I use my trauma training all the time,” she added. “I use it to calm myself down better. I use it in my home atmosphere and with adults in my church setting.”
The problem that Head Start Trauma Smart is trying to address is so widespread and so essential to human well-being that it’s hard to imagine an intervention that could yield greater payback for society — if the model proves to be scalable and transportable from community to community. Those are big questions, of course, and I will be tracking this work carefully as the answers emerge.
“What trauma does is steal from people the ability to feel safe and navigate relationships successfully,” said Chris Blodgett, who directs the Clear Trauma Center at Washington State University and is the principal researcher for the Spokane Safe Start program, which is similar to Head Start Trauma Smart. “Three- or 4-year-old children who have been exposed to trauma are at much greater risk of lacking the biological foundations or the behavior skills that will allow them to succeed in school and in life. The trauma keeps stealing their opportunities moment by moment and day by day.”
“If we can strengthen the sense of safety and the relationships around children, it creates a foundation for the natural process of development to get back on track,” he added. “We’re built to succeed as human beings. If that normal process gets disrupted, we need to do anything we can do to put it back on track.”
For Connie, the impact has been direct: “Before, I was always the bad guy. Whenever I made Luke sit quietly by himself, he said, ‘Grandma, I hate you.’ Now I know that’s not what was needed. And he’s also able to step back and look. He even says, ‘Thank you, Grandma,’ and gives me a hug after he calms down. He’s a very intelligent person if he can get past the anger.”