November 7, 2019
By Wenimo Okoya, EDD, MPH, Assistant Vice President, Children’s Health Fund Healthy and Ready to Learn Initiative and Karen Redlener, MS, Children’s Health Fund Co-founder & Executive Vice President
As published in the American Academy of Pediatrics Council on School Health Newsletter
Imagine walking into school each day preoccupied with the violence you witnessed in your home last night. Once again, your mom’s boyfriend has come back into the picture and after two weeks of good behavior, he is back to his old ways and has started hitting your mom again. You walk into school 30 minutes late because you wanted to be with your mom until her boyfriend left for work. You walk into class and your teacher is asking you to take out your homework and prepare to work on a new group math project. You are slow to follow directions because all you can think about is what happened last night, only to have your teacher bark at you in an all too familiar tone, “Let’s go! I’ve told you twice! What is your problem!”
Your already flooded nervous system is triggered and your response is to throw your pencil on the ground and grunt loudly to protect yourself from the object of perceived danger standing before you but that only gets you into more trouble. You are sent out of the classroom to the principal’s office, much like he sends you out when you are trying to defend your mom. You are terrified and start crying and yelling at your teacher as she directs you out of the classroom. How might your day be different if your school was prepared to better support you so that you could learn despite what you might be experiencing at home?
The terms “trauma-sensitive” and “trauma-informed” are buzzwords consuming the current education and school health arenas but few schools, school-linked health programs, or school-based clinics are working to operationalize an environment in which students who have experienced trauma and may be impacted by toxic stress can learn and thrive.
According to the Trauma Policy and Learning Initiative, a trauma-sensitive school is one in which “all students feel safe, welcomed and supported and where addressing trauma’s impact on learning on a school-wide basis is at the center of its educational mission.” Understanding and addressing childhood trauma should be built into both educational and healthcare environments. Having a shared understanding of this impact will help build common understandings and approaches across the education and health sectors. It can also build linkages between pediatric practices and clinics as well as school-based health centers and school nurses and the schools they work in. If schools commit to a trauma-sensitive approach, school-based health organizations should participate in relevant training and align their interventions to the trauma-sensitive principles being rolled out.
The Children’s Health Fund’s Healthy and Ready to Learn (HRL) Initiative works with its partner elementary schools in New York City to apply a three-tiered public health framework to address specific health barriers to learning and to realize a trauma-sensitive school environment for the students they serve. The goal of the first tier is to promote a safe, supportive school environment for all students. It includes a universal, schoolwide training of school staff about the prevalence of adverse childhood experiences and other traumatic experiences, the impact of toxic stress, and strategies to support students who have experienced trauma. This training equips teachers and other school staff with the skills they need to approach students with empathy, high expectations, and predictable learning environments. Additionally, HRL provides opportunities for students to learn social-emotional and de-escalation skills. The second tier interventions address students who have identified needs to prevent triggering trauma and support their emotional self-regulation. The third tier addresses students and families who need the greatest level of support by providing counseling and case management to support their mental health and health issues.
It is imperative that the pediatric community supports schools that are working to build trauma-sensitive practices. Relationship building between community-based health care providers and local schools is a salient first step in establishing effective communication and referral protocols to address issues that impede students’ success in schools. Pediatric providers should be aware of this growing trend to build trauma-sensitive schools and consider their roles in building safe spaces for all children and young people to learn and grow.