Trauma-Informed Schools

Nature of the Problem

The issue: Throughout Greater New Haven, children and families are living under extraordinarily stressful circumstances. How do we know? For SY 16-17, we screened over 400 students and 43% reported exposure to somewhere between 4 and 9 traumatic events. Note: at our general outpatient clinic, children report exposure to less than two (2) traumatic events. This suggests that the need for care is far greater than we ever believed and that far too many children and families, as previously stated, are living under extraordinarily stressful circumstances. Moreover, there is an alarming rate of posttraumatic stress disorder in schools. For SY 16-17, 49% — nearly half – of students assessed through Clifford Beers’ school-based programming were near or at the clinical level for PTSD. This means that children as young as six are: being plagued by intrusive thoughts, negativity in thinking and mood; experiencing physical/emotional challenges (like being easily frightened, always guarded), and; practicing avoidance of anything reminiscent of the traumatic event(s). Untreated childhood stress/trauma is known to bring about poor health, mental health, and social outcomes. Fortunately, we can help these children and families course correct.

Program Description

The response: building trauma-informed schools that bring behavioral health and related support services to children and families who have experienced trauma. Why? Because working with children and families in schools removes so many barriers to care including scheduling conflicts, transportation, and stigma. Students in care become part of a community that fosters healing, health, and wellness. A trauma-informed school also provides to these families home-based services including care coordination that involves the whole family in a way that meaningfully addresses social determinants of health. In this way the student and family can move forward. Additionally, direct care runs concurrently with trauma-based professional development for teachers/administrators and all school personnel to help them understand trauma: what it looks like, and how it can be addressed in ways that help the student and help the teacher better manage the classroom. Equipped with de-escalation strategies, teachers can better keep all students safe while also supporting the student in need of care. The combination of this work creates a trauma-informed school — a scholastic ecosystem that responds to poor behavior not with discipline but instead with support services. The results? Improved attendance, improved grades, and reduced absenteeism

Disruption

School-based health centers, support services, social workers, and school psychologists are the norm in most schools; most have some impact, but their effectiveness is hampered by traditional constraints of office-based 1:1 interaction. By creating a community that involves absolutely everyone who interacts with students — teachers, administrators, support staff, service providers, lunchroom attendants, bus drivers, truancy officers, etc. — the school and NOT just a few industry types pivots in response to poor behavior. Instead of “What’s wrong with you?” the collective question becomes “What HAPPENED to you?” This allows school personnel to ask deeper questions and use trauma-informed clinicians and care coordinators who will look deeper and explore what’s really driving behavior, including home-based care and involving the whole family for the greatest chance for success.

Leadership

Since its 2013 Centennial year, Clifford Beers has been advocating for a whole-family approach to behavioral health for children and families that integrates mental health, physical health, and social determinants of health. This unique perspective combines unique service delivery — going into schools and using those schools as portal through which connection to families in their homes can be made. This is critical to the work. No longer can providers sit back and expect families to walk into traditional outpatient clinics for hour-long therapy. It simply isn’t enough. Instead, we are leading the charge to find and use new touchpoints to deliver this whole-family/whole-person care from a trauma-informed perspective. The effort has garnered statewide attention. To date nearly 15 separate school districts representing suburban, urban and rural populations have reached out to inquire about services for their students and families.

Scalability

Many resources are devoted to scaling/expanding trauma-informed schools work. The agency has a director of public affairs (DPA) whose is charged with engaging public payers, i.e., the city and state, for the purposes of reaching more students in more schools. Presently, efforts center on advocating for braided/blended funding that would draw funding from multiple state agencies who are working piecemeal to solve a common problem. Most recently, this idea was presented to CT Governor-elect Ned Lamont as part of working on his transition team healthcare committee. Next steps would be see this appear in the state’s 2019 budget across multiple agencies (public health, children and families, education, and social services). The DPA also works to secure contracts with district leadership for professional development with the intention of using that as a springboard for direct services contracting. Additionally, an agency team led by the CEO works to identify private funding opportunities.

Results/Outcomes

For the same students mentioned above, CBITS (Cognitive Behavioral Intervention for Trauma in Schools) had a direct impact on PTSD. Nearly half had a very significant (6-point) reduction in PTSD symptoms – moving from the harmful “clinical” level to a stable “non-clinical” PTSD score. The result? 39% improved their attendance over the previous year, and 52% had a higher GPA over the previous year. For the most complex children and families, a combination of clinical care and care coordination (“comprehensive services”) begets results. With comprehensive services, 50% of students began passing their classes. With school-based support services in place, suspension rates can drop. This is because the behavior can trigger support services as opposed to traditional (and often ineffective) discipline. Over time, the impact is significant. After two years of consistent school-based care, suspensions reduced for 18% of students.