(PAARR)

TRAUMA INFORMED

CLASSROOM MANAGEMENT

The Adverse Childhood Experiences (ACE) Study

The largest study of its kind ever done to examine the health and social effects of adverse childhood experiences over the lifespan (18,000 participants)

The majority of participants were 50 or older (62%), were white (77%) and had attended college (72%)

Categories of Adverse Childhood Experiences

Abuse, by Category Psychological (by parents) 11%

Physical (by parents) 11%

Sexual (anyone) 22% 22%

Household Dysfunction, by Category

Substance Abuse 26%

Mental Illness 19%

Mother Treated Violently 13%

Imprisoned Household Member

3%

Adverse Childhood Experiences Score

ACE Score Prevalence

0 48%

1 25%

2 13%

3 7%

4 or more 7%

•More than half have at least one ACE

•If one ACE is present, the ACE Score is likely to range from 2.4 to 4

ACE’s Study

• One in four was exposed to two categories of abusive experience,

• One in 16 to four categories

• Smoking • COPD • Hepatitis • Fractures • Diabetes • Obesity • Alcoholism • Other Substance Abuse • Depression and attempted suicide • Teen pregnancy – including paternity • Sexually transmitted diseases • Occupational health • Job performance

ACE’s Study

• Adverse Childhood Experiences determine the likelihood of the ten most common causes of death in the United States.

• With an ACE Score of 0, the majority of adults have few, if any, risk factors for these diseases.

• However, with an ACE Score of 4 or more, the majority of adults have multiple risk factors for these diseases or the diseases themselves.

Disrupted Neurodevelopment

Adverse Childhood Experiences

Early Death

Disease, Disability & Social

Problems

Adoption of Health Risk Behaviors

Death

Conception

Mechanism by Which Adverse Childhood Experiences influence Health & Wellbeing Throughout the

Lifespan

CORTEX

HIPPOCAMPUS

SENSORY

THALAMUS AMYGDALA

CORTEX

HIPPOCAMPUS

SENSORY THALAMUS

AMYGDALA

CORTEX

HIPPOCAMPUS

SENSORY THALAMUS

AMYGDALA

CORTEX

HIPPOCAMPUS

SENSORY THALAMUS

AMYGDALA

HIPPOCAMPUS

SENSORY THALAMUS

AMYGDALA

CORTEX

Exposure to Chronic Stress

Implications for Response

Recognition of fight-flight condition

Help to accurately assess degree of threat/danger

Reduce threat and increase safety

Minimize physiological hyperarousal

Reinforce Self-soothing techniques

Address continuing dissociation – grounding

Attend to physical illness

Tap cognitive skills

Understand addictive behaviors – substance and behavioral

CHILD TRAUMATIC STRESS AND

LEARNING IMPAIRMENTS

TYPE OF IMPAIRMENT MALTREATED CONTROL

Language/speech 12.6% 8.4%

Developmentally

Disabled 9.1% 1.3%

Hearing 9.0% 7.5%

Learning Disabled 7.4% 2.6%

ADD 3.9% .8%

Stages of Treatment

Stage One-Stabilization, Trust and Safety

Alliance building, safety affect regulation,

support, self care and stabilization issues

Stage Two-Trauma Work

Resolution and integration of trauma

Stage Three-Learning to Live in the Moment

Self and relational development and daily

life enhancement

Definition of a Physical Crisis:

A situation of confrontation between

client/client, client/staff, client/self, or

client/environment in which prior

interventions along the continuum may be

ineffective;

Or

Between a staff/client, where the client has

been “set up” or has not been allowed to

“save face”.

Avoidance Techniques

1. Defining the physical crisis

“Call a duck a duck….”

2. Assessing the potential for violence

• Trigger factors

• History

• Predictive factors

• Contraindications for physical restraint

3. A consistent philosophy of discipline

4. Crisis protocols

• Self awareness

• Intervention continuum

• Verbal intervention continuum

• Remediation

Avoidance Techniques (cont.)

5. Safe, therapeutic application of physical techniques

• Team approach

• Techniques

• De-escalation

• Physical and emotional safety

• Mediating considerations

Predictive Factors:

1. Severe emotional deprivation or overt rejection in early childhood.

2. Parental seduction.

3. Exposure to brutality and extreme violence.

4. Childhood fire setting.

5. Cruelty to other children and/or animals.

Menninger & Modlin, 1971

1. History of homicidal threats.

2. Lack of suicide attempts (among those who frequently threaten homicide).

3. Symbolic acts of murder.

4. Males.

5. Social class.

6. Depressed mood building

7. A penchant for weapons.

8. Dehumanizing view of mankind.

9. History of drug or alcohol abuse (presently under the influence).

10. A plan to injure or kill someone.

Walker, 1983

Discipline

A broad program designed to help the client learn new ways to handle his/her behavior and feelings.

PHASE 1 (Milieu)

STRUCTURE/ROUTINE

EXPECTATIONS

CHOICE

CONSEQUENCES (Positive and Negative)

DEPENDENCE INDEPENDENCE

P h y s i c a l V e r b a l N o n -V e r b a l

0 1 2 3 4 5 6 7 8 9 10 11

R S P R D T V D P S V R S T P P F E E C I C

E E H E I O E I R O E E U O H R A X Y O N O

S C Y S R U R R O L R M P U Y O C P E N T N

T L S T E C B E B V B I P C S X I R T E T

R U I R C H A C L I A N O H I I A E A R R

A S C A T I L T E N L D R I C M L S C N O

I I A I I N I M G E T N A I S T A L

N O L N V G O R I G L T I L

T N T E N V Y O

S E N

GENERAL FACTORS WHICH AFFECT FUNCTIONING IMMEDIATE FACTORS WHICH AFFECT FUNCTIONING

LEVEL ON THE CONTINUUM: LEVEL ON THE CONTINUUM:

I.Q. RELATIONSHIPS WITH STAFF

AGE RELATIONSHIPS WITH PEERS

LEARNING ABILITY MEDICATION

PSYCHO-SOCIAL HISTORY FAMILY DYNAMICS -- VISITS

EDUCATION LIFE PLAN -- STAFFING

EMOTIONAL STATE LEVEL OF SELF-ESTEEM

AN INTERVENTION CONTINNUUM

AN INTERVENTION CONTINNUUM

Other Self

Regulated Regulated

Physical Non-Verbal Verbal

0

P R

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S T

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D V

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I S.

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4

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V V

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P P

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7

V D

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D

A CONTINUUM OF VERBAL RESPONSE TECHNIQUES

RE-ESTABLISH

ESTABLISHING CONTACT

REDIRECTIVE

(PHYSICAL) ESCALATION

CONTACT PROBLEM-SOLVE

CLOSURE/ESCAPE

ENGAGEMENT

REFLECT I VE

SUPPORT I VE

PROTECT I VE

ESTABLISHING CONTACT

Engagement: Empathetic icebreakers used to create “helping” atmosphere.

Reflective Response: Active Listening):

Paraphrasing: Testing your understanding by repeating the statement in your own words.

Reflection of Feelings: Expressing an understanding of the feelings that you perceive behind the speaker’s verbal and no-verbal messages.

Perception Checking: Expressing your understanding of the person’s words and feelings and asking them to confirm it.

Illustrating: Asking for or giving examples of the issues being expressed or received.

Supportive Responses: Statements that express your willingness to work through the issue with the person and do your best to provide whatever

help and support that you’re able to provide.

Protective Responses: Statements that reassure the person that you (hopefully the “collective you”) will keep him/her safe and will not allow him/her

to hurt or be hurt. (Only say it if you can back it!)

PHASE II (Cognitive)

Remediation/Mutual Problem Solving

1. Intervention

2. Definition of Problem

3. Development of Alternative

4. Commitment to a Plan

5. Rehearsal

6. Reinforcement/Feedback

7. Reinvolve

TEAM LEADER RESPONSIBILITIES

ASSESS SITUATION

CALL FOR HELP (IF NEEDED)

STATE NEED (WHEN HELP ARRIVES)

BRIEFLY DESCRIBE SITUATION

CUE THE TEAM

DIRECT THE TEAM

DE-ESCALATE

REMEDIATE

FOR MORE INFORMATION

THE NATIONAL CHILD TRAUMATIC STRESS NETWORK www.NCTSN.org

ACE STUDY www.acestudy.org

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION www.samhsa.gov

AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY www.aacap.org

THE SANCTUARY MODEL www.sanctuaryweb.com

TIM SCHAFFNER email; schaft@odjfs.state.oh.us