School-Based
Psychiatric Social Worker
Meeting
April 17, 2013
Objectives
• Increased understanding and awareness of trauma
informed schools and services.
• Understanding of the Department of Mental
Health’s (DMH) Emergency Outreach Bureau.
• Collective contribution of ideas for the development
of a PSW Menu of Services.
Trauma Informed Schools
Pia Escudero, Director
School Mental Health
Student Health and Human Services
Our Approach
• Evidence Based Practices
• Fully Integrated Mental Health Services
• Trauma Informed Approach
Evidence Based Practices (EBP)
• Cognitive Behavior Interventions for Trauma in
Schools (CBITS)
• Trauma Focused Cognitive Behavior Therapy (TFCBT)
• Triple P
• FOCUS (Families OverComing Under Stress™)
The Influence of Adverse
Childhood Experiences (ACE) Throughout Life
Early
Death
Disease,
Disease, Disability
Disability
Adoption
of of
Health-risk
Adoption
Health-Risk
Behaviors
Behaviors
Social, Emotional,
&Cognitive
Impairment
Social, Emotional
& Cognitive
Impairment
Adverse Childhood Experiences
Adverse Childhood Experiences
6
Adverse Childhood Experiences (ACEs)
Growing up (prior to age 18) in a household with:
•
•
•
•
•
•
•
•
One or no parents.
Emotional or physical neglect
Recurrent physical abuse.
Recurrent emotional abuse.
Sexual abuse.
An alcohol or drug abuser.
An incarcerated household member.
Someone who is chronically depressed, suicidal, institutionalized or
mentally ill.
• Mother being treated violently.
7
ACE Findings
Ace Score
Prevalence
0
33%
1
26%
2
16%
3
10%
4 or more
17%
•Almost 60% had at least 1 ACE
•
•
ACEs determine the likelihood of the 10 leading causes of death in the
US
With an ACE of 4 or more, the majority of adults have multiple risk
factors for these diseases OR the diseases themselves
Strong relationship between ACEs and risk
factors for the leading causes of death:
•
•
•
•
•
•
•
•
Smoking
COPD
Hepatitis
Heart Disease
Fractures
Diabetes
Obesity
Alcoholism
•
•
•
•
Substance Use
Depression
Suicide Attempts
Teen pregnancy and
paternity
• STDs
• Occupational Health
problems
• Poor Job Performance
Fully Integrated Mental Health Services
INTENSIVE
•Evidence based mental health services
•Intensive Case Management
•IEP’s/504 Plans
•Parent/Caregiver training and support
TARGETED
• Screening
• Monitoring
• Community Referral
• Classroom Supports
• 504 Plans/IEPs
• Evidence-Based Group Interventions
UNIVERSAL
School Policies , practices and approaches that promote a culture that protects all students and boosts
resiliency factors.
• Behavior management
• Modeling
• Classroom Consultation
• Comprehensive student support
Trauma Informed Approach
Looking through a Trauma Lens, we can see that it is
just as important, if not more so, to focus on
students’ emotional responses as their behavioral
responses.
Behavior may often communicate a student’s
emotional need.
Trauma Informed Approach
• Trauma Informed Schools & Services recognize that
all students who misbehave need safety and security
in order for them to adopt more acceptable
behaviors.
• Trauma Informed Schools & Services are sensitive,
predictable, and respectful.
Trauma Informed Schools…
•
•
•
•
•
•
•
•
•
Teach affect management skills
Teach conflict resolution skills
Alter negative attitudes toward authority figures
Teach parenting skills
Address traumatic reenactment
Encourage pathways for grieving behavior
Restore capacity for healthy relationships
Pull students toward a vision of a better future
Inspire hope and transformation
Adjustment Over Time in Crisis
G = continued impairment (PTS)
H = return to baseline
I = post-traumatic growth
A = baseline functioning
B = event
C = vulnerable state
D = usual coping mechanisms fail
E = helplessness, hopelessness
F = improved functioning
A
I
B
H
C
F
D
E
G
What can be done for youth?
• Maximize the young person’s sense of safety.
• Be aware of the trauma signs (Use a “trauma lens”
to better understand youth’s behavior).
• Give youth consistency and choices
• Understand that youth process their experiences
through their interactions with others (Know this is a
way to cope with trauma).
15
Every adult can play an important role everyday.
Crisis
• PFA:LPC





Listen
Protect
Connect
Model
Teach
Daily Interaction
• Sanctuary Model
 How are you today?
 What’s your goal for
today?
 Who are you going to ask
for help today?
16
Trauma-Informed schools
Trauma-sensitive school environments benefit all students:
• Those whose trauma history is known.
• Those whose trauma will never be clearly identified.
• Those who may be impacted by their traumatized
classmates.
17
Ten Principles of a Compassionate School
1. Focus on culture and climate in the school and community.
2. Train and support all staff regarding trauma and learning.
3. Encourage and sustain open and regular communication
for all.
4. Develop a strengths based approach in working with
students and peers.
5. Ensure discipline policies are both compassionate and
effective (Restorative Practices).
18
Ten Principles of a Compassionate School
6. Weave compassionate strategies into school improvement
planning.
7. Provide tiered support for all students based on what they
need.
8. Create flexible accommodations for diverse learners.
9. Provide access, voice, and ownership for staff, students and
community.
10.Use data to identify vulnerable students, and determine
outcomes and strategies for continuous quality
improvement.
19
A B Each Teach
Silent Reading
A. Trauma-Sensitive Schools Are Better Schools
B. Trauma-Sensitive Schools Are Better Schools, Part Two
Dialogue
• Share key points with partner.
• What aspects of what you read resonate with you?
• How might you be more purposeful about bringing traumasensitive services to your school site next year?
DMH-Emergency Outreach Bureau
Linda Boyd
Mental Health Clinical Program Head
The 5-Day Menu
• If you were at your school for ____ day(s), what
services might you be able to provide the school
site?