How Interconnected Systems Framework ISF Supports Trauma Informed

How Interconnected Systems Framework (ISF) Supports Trauma Informed Practices Kelly Perales Behavioral Alliance of SC Webinar November 21, 2019 Thank you for joining our 2019 -2020 webinar series made possible through a collaborative grant with the SC Department of Education-Office of Special Education Services and the University of South Carolina Southeastern School Behavioral Health Community

Please note: • The Interconnected Systems Framework (ISF) has been developed by a team of leaders from our National PBIS TA Center and leaders in the field of School Mental Health, including the National Center for School Mental Health • Content on how ISF is Trauma-Informed was developed by the Midwest PBIS Network team

WHAT IS INTERCONNECTED SYSTEMS FRAMEWORK (ISF)?

“Expanded” School Mental Health (SMH) • Full continuum of effective mental health promotion and intervention for students in general and special education • Reflecting a “shared agenda” involving school-family -community system partnerships • Collaborating community professionals (not outsiders) augment the work of school-employed staff

Positive Behavior Intervention and Support (www. pbis. org) • In over 27, 000 schools • Decision making framework to guide selection and implementation of best practices for improving academic and behavioral functioning – Data based decision making – Measurable outcomes – Evidence-based practices – Systems to support effective implementation

Outcomes associated with Implementation (George, H. 2018)

Mapping PBIS and SMH

Public Health Implementation Framework Social Emotional and Behavioral Mental Health • We organize our resources – Multi-Tier Mapping, Gap Analysis • So kids get help early – Actions based on outcomes (data!), not procedures • We do stuff that’s likely to work – Evidence-Based interventions • We provide supports to staff to do it right – Fidelity: Benchmarks of Quality • And make sure they’re successful – – Coaching and Support Progress monitoring and performance feedback Problem-Solving process Increasing levels of intensity

ISF Volume 2: An Implementation Guide (*currently available at www. midwestpbis. org) • Chapter 1: Context and Structure for Volume • Chapter 2: Defining ISF: Origins, Critical Features, and Key Messages • Chapter 3: Exploration and Adoption • Chapter 4: Installing ISF at the District and Community Level • Chapter 5: Installing and Initial Implementation of ISF at the Building Level • Chapter 6: Implementation, Sustainability and Recommendations to the Field

An Interconnected Systems Framework (ISF) Defined – A Structure and process for education and mental health systems to interact in most effective and efficient way. – guided by key stakeholders in education and mental health/community systems, youth/family – who have the authority to reallocate resources, change role and function of staff, and change policy.

ISF Enhances Multi-Tiered Systems of Support (MTSS) Core Features Effective teams that include community mental health providers Data-based decision making that include school data beyond ODRs and community data Formal processes for the selection & implementation of evidence-based practices (EBP) across tiers with team decision making Early access through use of comprehensive screening, which includes internalizing and externalizing needs Rigorous progress-monitoring for both fidelity & effectiveness of all interventions regardless of who delivers Ongoing coaching at both the systems & practices level for both school and community employed professionals

1. Single System of Delivery is s s e c c A 2. ugh o n e T O N Key Messages 4. MTSS essential to install SMH 3. Mental Health is for ALL

WHAT DOES IT MEAN TO BE TRAUMA INFORMED?

Why Start with Self-Care? “The best thing about being a teacher is that it matters. The hardest thing about being a teacher is that it matters EVERYDAY. ” -Todd Whitaker

What is trauma?

National Childhood Traumatic Stress Network (NCTSN) Definition: “Trauma occurs when a child experiences an intense event that threatens or causes harm to his or her emotional and physical wellbeing. ” *Trauma can happen at any age.

Big T & Little t Trauma Adverse Experiences Chronic Stress Toxic Stress

What we are talking about? Extreme or chronic stress that overwhelms a person’s ability to cope & results in feeling vulnerable, helpless & afraid ▪ Can result from one event or a series of events ▪ Event(s) may be witnessed or experienced directly ▪ Experience is subjective ▪ Often interferes with relationships; self regulation; & fundamental beliefs about oneself, others & one’s place in the world

We do not get to decide what is stressful or traumatic for someone else.

Adverse Childhood Experiences (ACES)

“One of the biggest Public Health Studies… you’ve never heard of” Over 17, 000 HMO members 1 in 6 people reported 4 or more ACEs College educated, middle class, mostly Caucasian

Study Findings Adverse Childhood Experiences are common • Two-thirds reported at least 1 ACE • 1 in 6 people reported 4 or more ACEs Those with 4 or more ACEs were: • • • Twice as likely to smoke Seven times as likely to be alcoholics Six times as likely to have had sex before 15 Twice as likely to have cancer or heart disease Twelve times more likely to have attempted suicide Men with six or more ACEs 46 times more likely to have injected drugs than men with no history of adverse childhood experiences Source: Adverse Childhood Experiences (ACE) Study. Information available at: http: //www. cdc. gov/ace/index. htm

ACES Impacts Learning 51% of children with 4+ ACE scores had learning and behavior problems in school Compared with only 3% of children with NO ACE score Source: Burke, N. J. , Hellman, J. L. , Scott, B. G. , Weems, C. F & Carrion, V. C. (June 2011). “The Impact of Adverse Childhood Experiences on an Urban Pediatric Population, ” Child Abuse and Neglect, 35, No. 6.

Prevalence 13 of every 30 students in a classroom experience toxic stress from 3 or more Adverse Childhood Experiences (ACEs) Source: Washington State Family Policy Council 25

Trauma or Mental Health? (2010, March 23). Overlapping Behavioral Characteristics & Related Mental Health. . Retrieved October 11, 2017, from https: //www. unh. edu/cpe/sites/unh. edu. cpe/files/media/Conf 2014/F 5%20 Fetal%20 Alcohol%20 Syndrome%20 FASD %20 Overlapping%20 Behavioral%20 Characteristics%20&%20 Related%20 Mental%20 Health%20 Diagnoses%20 in

Key Triggers for Students • Lack of personal power or control • Unexpected change • Feeling threatened or attacked • Feeling vulnerable or frightened • Feeling shame • Positive feelings or intimacy Triggers can be internal and/or external 27

Trauma Informed Response

A belief that a person has control over his/her behavior leads to one being more likely to be angry with that person when his/her behavior is inappropriate.

The Needed Perspective Shift “What’s wrong with you? ” “What happened to you & how can we help? ”

How Do We See Students? Uninformed view Informed view Anger management problems May have ADHD Choosing to act out & disrupt classroom (e. g. , disrespectful or manipulative) ▪ Uncontrollable, destructive ▪ Non-responsive ▪ ▪ ▪ ▪ Uninformed response ▪ Student needs consequences to correct behavior or maybe an ADHD evaluation Adapted from Daniel & Zarling (2012) ▪ ▪ Maladaptive responses (in school setting) Seeking to get needs met Difficulty regulating emotions Lacking necessary skills Negative view of world (e. g. , adults cannot be trusted) Trauma response was triggered Informed response ▪ Student needs to learn skills to regulate emotions & we need to provide support

Teacher Responses to Student Outburst “Ashley just transferred into my 5 th grade classroom after being placed in foster care. I wanted to make her feel welcome. I moved to put my hand lightly on her shoulder when I was explaining an assignment & she slapped my hand away. Then she stared at me defiantly. ” ▪ Teacher response #1 – teacher-centered ▪ Teacher response #2 – student-centered

Uninformed Teacher Response “Why she just decided to slap me is beyond me. I was trying to be helpful & welcoming. Her reaction was totally out of proportion to the situation. Physical aggression simply cannot be tolerated or excused. She needed to learn that right away. There had to be immediate & significant consequences if I’m to maintain order in my classroom. When I tried to remove Ashley to the office, she just lost it. Instead of complying, she chose to struggle & started kicking me. I don’t like to see students suspended from school, but Ashley needs to learn that she cannot behave that way in school. ”

Informed Teacher Response “I must have frightened Ashley without meaning to. It’s clear she does not want to be touched. She may have other triggers, as well. Right now she is hyper-aroused & feels cornered. If I put any extra demands or expectations on her right now, she could escalate & that will just make the situation worse. I told Ashley we would talk about what just happened when she calms down. I need to help her feel safe or she won’t be able to learn in my classroom. I know it’s common for kids in foster care to have multiple adverse experiences. I need to find out more about what her needs are, maybe from her school records or from her foster parents & the caseworker. If I need to, I’ll contact our Building Consultation Team for support. ”

Schools That Are Sensitive to Trauma • recognize the prevalence & impact of traumatic occurrence in students’ lives & • create a flexible framework that provides universal supports, is sensitive to the unique needs of students & is mindful of avoiding re -traumatization. Adapted from Helping Traumatized Children Learn

It’s a Journey

IMPACT OF TRAUMA ON BRAIN DEVELOPMENT Upstairs/Downstairs Brain

Bottom-Up Development Typical Development Adverse Experiences Cognition Social/ Emotional Regulation Survival Adapted from Holt & Jordan, Ohio Dept. of Education

THE WHOLE BRAIN CHILD: 12 12 REVOLUTIONARY STRATEGIES TO NURTURE YOUR CHILD’S DEVELOPING MIND DANIEL J. SIEGEL, TINA PAYNE BRYSON

Impact Trauma on Learning

Impact on Student’s View of World Typical Development Impacted by Trauma vs. • I live in a predictable & benevolent world • I am worthwhile • I am hopeful & optimistic about my future • I have the ability to impact & change my life The world is not safe People want to hurt me I am afraid No one will help me I am not good/smart/ worthy enough for people to care about me • It will never get better • I need to establish personal power & control • • • 41

Higher Baseline State of Arousal • Students impacted by trauma may be in a persistent physiological state of alarm • Constant “yellow alert” • Likely to be more reactive than peers, as external stressors are introduced (e. g. , complicated task at school, disagreement with a peer) • Fight, flight, freeze • Over-reading possibility of threat leads to lower brain functioning & impulsive acts • e. g. , striking out physically or verbally, leaving the classroom, shutting down • Student views his/her actions as defensive & justified Adapted from Chris Dunning

Affects Learning Adversely affects students’ ability to … ▪ ▪ ▪ ▪ Acquire language & communication skills Understand cause & effect Take another person’s perspective Attend to classroom instruction Regulate emotions Engage the curriculum Utilize executive functions ▪ Make plans ▪ Organize work ▪ Follow classroom rules The Heart of Learning & Teaching Compassion, Resiliency & Academic Success (Wolpow et al, 2009)

Affects School Performance Lower scores on standardized achievement tests (Goodman et al, 2011) Substantial decrements in IQ, reading achievement & language (Delaney-Black et al, 2002) 2. 5 x more likely to be retained (Grevstad, 2007; Sanger et al, 2000; Shonk et al, 2001) Suspended & expelled more often 2007; Sanger et al, 2000; Shonk et al, 2001) Daniel & Zarling (2012) (Grevstad,

Misreading Cues Young children impacted by adverse experiences spend much time in a low-level state of fear learning to read adults’ non-verbal cues to keep themselves safe ▪ Their safety depends upon knowing when an adult becomes a “dangerous bear” Student may not interpret innocent or neutral looks, actions, & touches from others at school as benign ▪ Difficult for student to re-learn these cues as meaning different things in different environments Adapted from Chris Dunning

What Flight, Fight, or Freeze Looks Like in the Classroom Flight Freeze • Withdrawing • Acting out • Exhibiting numbness • Fleeing the classroom • Behaving aggressively • Refusing to answer • Skipping class • Acting silly • Refusing to get needs met • Daydreaming • Exhibiting defiance • Giving a blank look • Seeming to sleep • Being hyperactive • Feeling unable to move/act • Avoiding others • Arguing • Hiding or wandering • Screaming/yelling • Becoming disengaged Fostering Resilient Learners Strategies for Creating a Trauma-Sensitive Classroom Kristin Souers with Pete Hall

How ISF is Trauma Informed?

Pro-Social Skills on Matrix

Teaching Matrix Expectations Respectful Achieving & Organized INCORPORATE Coping Strategies for Managing Stress s n o i t a t c pe All Settings Be on task. Give your best effort. Be prepared. x E 1. Be kind. Hands/feet to self. Help/share with others. Halls Playgrounds Walk. Have a plan. Share equipment. Include others. Use normal voice volume. Walk to right. c i f i ec p S r o s s e r l o u i v R a. h 3 Be Responsible Recycle. Clean up after self. Pick up litter. Maintain physical space. Use equipment properly. Put litter in garbage can. Lunch Invite those sitting alone to join in Have a lunch plan and choose quiet or social lunch area Invite friends to join me Use my breathing technique Listen to my signals 2. Library/ Computer Lab Study, read, compute. Whisper. Return books. Push in chairs. Treat books carefully. NA Assembly Bus TU (Lo RAL ca CO tio N ns T ) Sit in one spot. Watch for your stop. Listen/watch. Use appropriate applause. Use a quiet voice. Stay in your seat. Pick up. Treat chairs carefully. Wipe your feet.

How Classroom Practices Are Trauma Informed?

Example of a Classroom Matrix Classroom 214 Routines The Wilson Way Morning Routine If You Finish Early How to Transition/ Line Up When you feel upset 1. Put materials away 2. Get materials ready 1. Display your ‘pause Classroom Rules • • • Stay on task Clean up area Apologize for mistakes 1. Turn in homework 2. Put instructional • • • Raise hand Listen to speaker Follow directions 4. Say “good morning” • • Walk quietly Keep hands and feet to self 6. Put personal Be Responsible Be Respectful Be Safe materials in desk 3. Begin morning work to teacher and classmates 5. Talk in soft voices belongings in designated areas 7. Take your seat 1. Re-check your work 2. Read a book 3. Organize supplies 4. Journal 5. Math flash cards 6. Be quiet 7. Allow others to for next activity strategy 3. Listen for direction to next activity complete their work 8. Sweep under 9. your desk Clean signal’ 2. Choose a coping 4. Stand up 5. Push in chair 6. Wait for group to be called to line up 3. Use “I statement” to express feelings and needs 4. 5. Use Calm Corner as necessary Talk to someone if you need help

Teaching Matrix Expectations Respectful Safe INCORPORATE Trauma Informed Strategies Halls Be on task. Give your best effort. Be prepared. Walk. Be kind. Hands/feet to self. Help/share with others. Use normal voice volume. Walk to right. x E 1. Classroom Have a plan. Use your words Use safe hands Share equipment. Include others. c i f i ec p S r o s s e r l o u i v R a. h 3 Be Responsible Playgrounds s n o i t a t c pe All Settings Recycle. Clean up after self. Pick up litter. Maintain physical space. Use equipment properly. Put litter in garbage can. Self Check Use Calming Strategy Ask for help Connect with Safe Person 2. Library/ Computer Lab Study, read, compute. Whisper. Return books. Push in chairs. Treat books carefully. NA Assembly Bus TU (Lo RAL ca CO tio N ns T ) Sit in one spot. Watch for your stop. Listen/watch. Use appropriate applause. Use a quiet voice. Stay in your seat. Pick up. Treat chairs carefully. Wipe your feet.

Systems

System Features TFI Items Trauma Informed Enhancements 1. 1 Team Composition • Individual(s) with knowledge, expertise, and ability to provide coaching/support around trauma are part of team 1. 2 Team Operating Procedures • • All items on agenda are considered through trauma informed lens. Action steps for trauma informed are integrated one plan. 1. 5 Problem Behavior Definitions • Problem behavior definitions create consistency and safety. 1. 6 Discipline Policies • Discipline policies encourage (a) regulation, (b) relationship development, (c) teaching skills, and (d) promoting safe, consistent and positive environments. 1. 7 Professional Development • All staff receive professional development to understand the impact trauma can have on student learning and practices to support. Process defined for faculty to request assistance on maintaining trauma informed lens. •

System Features Continued TFI Features 1. 10 Faculty Involvement Trauma Informed Enhancements • • 1. 11 Student/Family/Comm unity Involvement • • • 1. 13 Data-based Decision Making • • Faculty are provided data used to monitor trauma informed care on regular basis. Faculty provide input on trauma informed implementation. Students perception is collected on school climate and culture. Families and community partners provide feedback and input on trauma informed practice. Students, families, and community have access to information and resources on trauma. Tier I team utilizes a trauma informed lens to problem solve and action plan. Team reviews data decision rules for identifying students for Tier I to consider additional data points (e. g. : universal screening data, nurse or counselor visits).

Data

Data Features TFI Feature Trauma Informed Enhancements 1. 12 • Discipline Data • 1. 14 Fidelity Data • • • 1. 15 Annual Evaluation • Additional data points are monitored to help identify need for trauma informed practices universally (e. g. : universal screening data, hospitalizations, violent crime rates). Individual students response to Tier I is measured by expanded data points (e. g. : universal screening data, nurse or counselor visits). Team utilizes trauma informed enhancements to TFI annually. Team completes TFI walkthrough trauma informed enhancements annually. Classroom Practices Observation tool used to assess implementation in classrooms. Tier I team documents fidelity (e. g. : TFI with trauma enhancements) and effectiveness (e. g. : climate surveys, restraints, least restrictive environment data) of trauma informed implementation and shares with stakeholders at least annually.

Practices

Practice Features TFI Features Trauma Informed Enhancements 1. 3 Behavioral Expectations • Behavioral expectations are established and behavior matrix has been reviewed to add skills to support students impacted by trauma. 1. 4 Teaching Expectations • Data is utilized to determine need for additional behavioral skills (e. g. : identifying stress response, utilizing calm down strategies) to teach to students. 1. 8 Classroom Procedures • Staff have assessed current classroom practices from trauma informed lens to increase use or add practices to support students impacted by trauma. 1. 9 Feedback and Acknowledgeme nt • Staff consistently utilize BSPS with high frequency acknowledgements to assist in developing relationships. School-wide celebrations include all students and focus on community building.

What might that look like? Tier 3: • FBA-BIP • Wraparound/RENEW Tier 2: • CICO • Modified CICO • SAIG Tier 1: • School-wide expectations • Teaching expectations • Social Emotional Learning (SEL) • Acknowledgement System • Regulation routines in classrooms

Interventions for Trauma Intervention Target Populatio n Implementation Details Getting Started Support for Students Exposed to Trauma (SSET) 10 to 14 years • • Tier 2 10 sessions • • • Non-clinical adaptation of CBITS Teachers and school counselors Free resources to implement Trauma Focused Coping (TFC) 9 to 18 years • • Tier 2 14 sessions • Mental health provider with Master’s Degree Manual available for free Training available, but not required $2400 per day • • Bounce Back https: //bouncebackprogra m. org/ 5 to 11 years • • • Tier 2 Adaptation to CBITS 10 sessions • • • Clinicians with CBT aptitude may only need trainer manual Free online training and resources In-person training available from$20008000 CBITS Cognitive Behavior Intervention for Trauma in Schools 8 to 15 years • • Tier 2 Group, individual, parent and teacher sessions • • • Master’s or doctorate in clinical field Free online training and resources In-person training available from $400010, 000 SPARCS (Structured Psychotherapy for Adolescents Responding to Chronic Stress) 12 to 18 years • • Tier 2 16 sessions • Generally mental health clinicians with Master’s Degree 4 days of training with follow-up support (contact developers for cost) Trauma-Focused 3 to 18 • • Tier 3 • Master’s degree and training

Is CICO Trauma Informed? § Relationship § Morning and afternoon CICO facilitator § Scheduled feedback from teacher § Behavior Specific Praise § Higher dose of Skill Teaching § Feedback on school-wide expectations § Safety, Consistency, Predictability § Consistent person to begin and end the day § Scheduled feedback § Regulation § All students in CICO select a regulation activity from short list each morning § Some (Modified CICO) check-in with special facilitator who l leads a body scan with students before going to class

Trauma-Informed Tier 2 Group Daily Progress Report (DPR) Sample NAME: ___________ DATE: _________ Teachers please indicate YES (2), SO-SO (1), or NO (0) regarding the student’s achievement in relation to the following sets of expectations/behaviors. 1 st block 2 nd block 3 rd block 4 th block EXPECTATIONS Be Safe 2 1 0 Body Scan Use calming strategy Be Respectful 2 1 0 2 1 0 Use your words Use safe hands Be Responsible Used My Courage Cards Identified My Feelings Total Points Teacher Initials Adapted from Grant Middle School STAR CLUB --- Specific Skills from Bounce Back

Trauma Informed FBA

Trauma Informed BIP Replacement behavior: Use pass to go to the nurse’s office

Trauma Informed Practices • Create safe, predictable, & consistent environments • Building community and relationships • Teaches new skills (specifically coping skills) • Support regulation

Example: Demographic Data ▪ Percent of low income enrollment has increased by 20% over past ten years. ▪ Loss of business in community has increased unemployment by 3% over past ten years. ▪ Hospitalizations for adults mental health have increased by 10% and youth by 15% in last year. ▪ Drug use in the county has increased by 5% over past 5 years. ▪ Moves to more restrictive placements has increased by 20% in the district.

Noticeable Impact of Data ▪ Families are being separated due to ▪ Treatment ▪ Hospitalizations ▪ Incarceration ▪ These factors may impact schools within community in different ways

Identify Level of Supports School A School B School-Community data indicates: ▪ ▪ ▪ 85% attendance rate 22% of students receive more than 1 ODR last school year 20% of students were referred or requested to see counselor more than 1 time last school year 30% of students were in an elevated range on universal screener Crisis calls were made for 5% of students last year ▪ ▪ ▪ 97% attendance rate 8% of students received more than 1 ODR last school year 5% of students were referred or requested to see counselor more than 1 time last school year 12% of students were in an elevated range on universal screener Crisis calls were made for 2% of students last year

School A – Strengthen Universal & Tier II Supports School A School-Community data indicates: ▪ ▪ ▪ 85% attendance rate 22% of students receive more than 1 ODR last school year 20% of students were referred or requested to see counselor more than 1 time last school year 30% of students were in an elevated range on universal screener Crisis calls were made for 5% of students last year Examples: § Expand universal teaching to include social-emotional skills (e. g. : identifying feelings, expressing feelings) § Teach all students about brain development § All classrooms have schedule for regulation § Trauma Informed Tier II group

School B – Tier II Supports School B School-Community data indicates: ▪ 97% attendance rate ▪ 8% of students received more than 1 ODR last school year ▪ 5% of students were referred or requested to see counselor more than 1 time last school year ▪ 12% of students were in an elevated range on universal screener ▪ Crisis calls were made for 2% of students last year Examples: § Add lesson on brain development to Problem Solving Skills Group & Academic Behavior Skills Group § Install a Trauma Informed Tier II group

Want more information? • www. midwestpbis. org • Look under content, then trauma • Also see Mental Health Integration/ISF pages – *New materials available

Check Out the Fact Sheets: www. pbis. org www. midwestpbis. org

THANK YOU! Kelly. perales@midwestpbis. org