Secondary Traumatic Stress in Alternative EducationJUD I VAN D ERHAAR, K EN TUC K Y D EPARTM EN T OF ED UC ATION

D IAN E GRUEN -K ID D, K EN TUC K Y D EPARTM EN T FOR B EHAVIORAL HEALTH, D EVELOPM EN TAL AN D IN TELLEC TUAL D ISAB IL IT IES

Self-Awareness Reminder

•Pay attention to your own needs & responses

•Take care of yourself however you need to during the presentation

•You may be impacted even after you leave

•Use coping skills that help you metabolize your responses to trauma

•Find a safe space in which you can process your experiences – this may mean using coping strategies including talking to colleagues, friends, family, or a professional provider

Group Check-in: Write in the Q&A box 1-3 words that describe how you are feeling right now

Identifying our feelings is a simple practice to increase awareness, emotional literacy and connection. This practice has powerful effects for our youth and ourselves.

Name it to tame it!

Define trauma and identify types of staff trauma exposures

Understand Secondary Traumatic Stress and Burnout

Recognize the impact of trauma on the brain

Learn ways to manage secondary traumatic stress responses

Identify workplace strategies to build resilience

Roadmap

WHAT IS TRAUMA?

Three E’s of trauma

Prevalence of trauma

Different types of trauma

Section Overview

What is Trauma?

The three E’s concept of trauma:

Event

Experience

Effect

What is a Traumatic Event?

One which conveys

actual or perceived threat of

death, serious injury or sexual violation

to one’s self or someone close.

What is a Traumatic Experience?

The unique,

individual,

perception of threat

to one’s self or someone close.

What are Some Effects of Trauma?

Effects of a traumatic experience are adverse,

may be long-lasting, and impact

social, emotional, cognitive, spiritual and

physical development and functioning.

Discrimination

Types of Traumatic Events

Sexual Abuse

Separation from Family

School ViolenceNeglect

Community Violence

Domestic Violence

Natural Disaster

Arrest or Incarceration

Car Accident

Forced Displacement

Sexual Assault Bullying

Medical Illness or Procedure

War

Terrorism

Emotional Abuse

Historical Trauma

Human Trafficking

Physical Abuse

Racial Trauma

Traumatic Grief

Trauma & Alternative Programs •There is an overrepresentation of students in alternative schools with respect to poverty, racial minority, disability, and experiences of school exclusion (NCES, KDE alternative program reports 2016,2017).

•One alternative school found the average ACEs score among their students is 4.5◦ 84% have lost a loved one.

◦ 66% feel abandoned by their parents.

◦ 65% have an immediate family member in jail.

◦ 80% have suffered serious depression

◦ 50% live with someone who abuses alcohol or other drugs.

•In Kentucky 42% of students in alternative programs move between schools/programs 3 or more times across one school year (lack of stability). 49.5% of students are chronically absent from school when enrolled in alternative programs.

•Nearly half of all alternative schools have a graduation rate lower than 50%

What about staff?

Primary trauma exposure: having a history of trauma exposure

➢We may have our own history of trauma, or adverse childhood or adult experiences

➢We may be reminded of our own traumas or adversity when seeing our students

Secondary trauma exposure: knowing about the trauma others experience

➢ Reading a student’s file

➢ Suspecting a student is experiencing trauma and feeling powerless to help or intervene

➢ Seeing the impact of trauma on a student physically or psychologically

➢ Having a student tell us about their traumatic experiences

➢ Seeing traumatic play or reading traumatic material created by students

➢ Hearing about student trauma from colleagues, other professionals, caregivers, etc.

Poll

To what degree do you feel that you have been impacted by student trauma?

Lacheena Carothers: Why Alternative Educators Need to Talk About TraumaHTTPS://DRIVE.GOOGLE.COM/FILE/D/1LWF1T0TKRUPJSPCKD2KPVSWDDHRW_MKI/VIEW

THE IMPACT OF EXPOSURE

TO STUDENT TRAUMA

ON STAFF

Section Overview

What is Secondary Traumatic Stress

Signs and Symptoms

Sources, Risk & Protective Factors

“…the natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by a significant other – the stress resulting from helping or wanting to help a traumatized or suffering person.”

Charles Figley, 1995

Secondary Traumatic Stress: “The Cost of Caring”

Signs & Symptoms of STS

Avoidance:

absenteeism, tardiness, not completing things,

inability to listen, minimizing

Intrusions:

dreams, persistent intrusive thoughts,

rumination

Physical Symptoms:

exhaustion, headaches, muscle tension, twitches, GI problems, poor sleep

Cognitive Changes:

hopelessness, negativity, loss of creativity, poor concentration, poor

memory

Emotional Changes:

depression, sadness, anxiety, exaggerated fears, guilt, isolation, feeling numb, anger

Social/ Interpersonal Changes:

avoidance, lack of initiative, lack of interest,

inability to have fun

Grounding or Mindful Focusing Activity

Examples:

❖Breath as an Anchor

❖Piece of Chocolate

❖5-4-3-2-1

❖Guided imagery

❖Deep breathing – Box breathing

❖Body scan

❖Three Synch (scan of body, emotional, mental landscape)

Organizational Symptoms of STS

Low level of staff satisfaction

Poor retention, high turnover

Disruption of continuity of teaching and learning

Miscommunication/ errors

Increased class size -> increased exposure -> increased STS

risk

Economic challenges for programs

Poor care for administrators, students, & staff

Sources of STS• Hearing the stories of students

• Reading about traumatic experiences of students in records or assignments

• Seeing results of trauma

• High dose of secondary trauma exposure (cumulative dose, and/or severity of trauma content)

• Learning about a trauma that seems close to you personally (e.g. same age child as one in your family)

• Chronic poor outcomes for students you serve

Risk Factors for STS• Professionals working with populations who have experienced

trauma

• High rates of exposure to traumatic material: high caseloads, high percentages of trauma cases

• Personal history of trauma that feels unresolved

• Not feeling trained, prepared or competent to do your job

• Being new to the field

• High level of emotional intelligence and strong empathy

Organizational Risk Factors

• High student loads

• Limited or no access to reflective supervision and support

• Lack of training & preparation of workforce

• Re-traumatization through sharing of traumatic content

• Culture of “sucking it up” or “stiff upper lip”

What is Burnout?

“the extinction of motivation or incentive, especially when one’s devotion to a cause or relationship fails to produce the desired results”

(Freudenberger, 1980)

Sources of Burnout Too much to do, heavy workloads

Actual or perceived lack of peer support and connectivity in the workplace

Actual or perceived lack of supervisory support, poor communication with supervisor/ leadership

Lack of role clarity, sense of limited or no control

Perfectionism, taking on too much responsibility

Limited successful outcomes, working in a helping profession

Other life stressors, poor work-life balance

What’s the Relationship?

BurnoutSecondary Traumatic

Stress

Protective Factors

•Social Support: collegial support & opportunities to discuss stress

•Mentoring: structured, supervised, or casual

•Sense of satisfaction: savoring successes with students (joy jar)

•Self care: hobbies, nature, spirituality, mindfulness, etc.

Ludick & Figley (2017). Toward a mechanism for secondary trauma

induction and reduction: Reimagining a theory of secondary traumatic

stress, Traumatology, 23(1), 112-12

Poll

How would you assess the overall stress level among adults in your building during a typical week?

THE BRAIN & BODY

RESPONSE TO

TRAUMA EXPOSURE

Section Overview

Adverse Childhood Experiences

Traumatic Stress

Trauma & the Brain

Lessons from the ACE Study

• Adversity and trauma are more common than we may realize

• What happens in childhood can impact us for a long time

• Dose of exposure matters

• Adversity increases risk for additional adversity

• Trauma and adversity impact all areas of development and functioning

33

Newer Thinking on ACEs

Abuse & Neglect Household Dysfunction ACE Plus 5

1. Emotional abuse

2. Physical abuse

3. Sexual abuse

4. Emotional neglect

5. Physical neglect

6. Mother Treated Violently

7. Household Substance Abuse

8. Household Mental Illness

9. Parental Separation or Divorce

10.Incarcerated Household Member

1. Experiencing racism

2. Witnessing violence

3. Living in an unsafe neighborhood/community violence

4. Living in foster care

5. Experiencing bullying

The “Pair of ACEs”

Race-Based Trauma

▪Racial trauma (also known as race-based traumatic stress) refers to the stressful impact or emotional pain of one’s experience with racism and discrimination (Carter,

2007). This can have a profound impact on the mental health of people.

▪Common traumatic stress reactions reflecting racial trauma include:▪increased vigilance and suspicion, increased sensitivity to threat, sense of a

foreshortened future, and more detrimental responses to stress such as aggression or substance use (Comas-Diaz, 2016).

▪These traumatic stress reactions are worsened by the cumulative impact of exposure to multiple traumas. This is particularly important for youth in communities where there is increased risk for community violence and victimization (Wade et al., 2014).

▪We must recognize this impact on both students and staff in our settings.

▪We must be responsive to this issues for students and staff.

What is a Traumatic Stress Response?Traumatic stress occurs when exposure to a traumatic event overwhelms one’s coping capacity.

This can result in feelings of terror, powerlessness and out-of-control physiological arousal.

Traumatic stress can be experienced as an emotional, cognitive, social, behavioral or physiological response to trauma exposure.

Symptoms of Traumatic Stress

Intrusion Avoidance

Hyperarousal/ Reactivity

Negative alterations in thoughts &

feelings

Dissociation

Impact of Trauma on Brain & Body

“Hostile takeover of consciousness by

negative emotions”

LeDoux 2002

Brain & Body Responses to Trauma

Brain ResponsesAmygdala: Activated by perception of fear; actually enlarges

Prefrontal Cortex: Underused as brain focuses on threat response; less activity & neural development

Hippocampus: Disorganized as fear memories are imprinted more than memories from learning and non-threatening experiences

Body ReactionsHeart beats faster

Breathing increases & becomes more shallow

Palms sweaty

Blood flow redirected away from non-essential organs & processes

Muscles tense and clench

Body agitated, highly reactive, hypervigilant

Barking Dog/Wise Owl

Why Do We Get So Emotional about Everything?

Affect tolerance

Affect regulation

Window of tolerance

Severity and speed of emotional response

Levine, Ogden & Siegel, from https://www.attachment-and-trauma-treatment-centre-for-healing.com/blogs/understanding-and-working-with-the-window-of-tolerance

Levine, Ogden & Siegel, from https://www.attachment-and-trauma-treatment-centre-for-healing.com/blogs/understanding-and-working-with-the-window-of-tolerance

Trauma Reminders & CuesInternal trauma cues:

Emotions e.g. anxiety, fear, shame, humiliation,

guilt, loneliness

Thoughts e.g. failure, hopelessness, futility,

powerlessness

Memories

Physiological sensations: hot, cold, tired, sweaty,

sexual attraction, muscle tension

External trauma cues:

People

Places

Things:

Weather, time of day

Sensory Stimuli e.g. smells, touch,

temperature, light

Holidays, anniversaries, birthdays

Poll

How much attention is given to staff self-care and resilience building in your district/agency?

SUPPORTING & BUILDING

STAFF RESILIENCE

What can WE do about STS?

AwarenessAvoid Re-traumatizationABalanceBuild Compassion SatisfactionBConnect & CollaborateCrisis ResponseSelf-Care/Self-CompassionC

Awareness & Monitoring

Organizations• Normalize STS as a potential occupational

hazard

• Avoid stigmatization of STS

• Recognize risk factors

• Check in with people regularly

• Include assessing STS as part of supervision; don’t make quantity the only measure of valuable work

• Support workforce activities that promote self-reflection & self-awareness

Individuals• Stay present

• Recognize risk factors

• Hear what peers & supervisors are saying

• Assume supervision includes STS monitoring

• Use self-report measures periodically

• Acknowledge when there is exposure and monitor carefully afterwards

• Ask for assistance

A

1. Self-Awareness

2. Fair Warning

3. Consent

4. Limited Disclosure

Copyright 2019, TEND Academy: www.tendacademy.ca

Avoid Re-traumatization: Low Impact DebriefingA

Avoid Re-traumatization

OrganizationsBuild low-impact approach into all protocols:

• minimize sharing of details by only repeating those that are actually necessary

• focus on how the situation is impacting our work with the student rather than what happened to the student

• adopt a Low Impact De-Briefing processing approach

• focus on how the situation makes us feel rather than the details of the student’s experience

Individuals• Use Low Impact De-Briefing

• Know when you need to say “no” to a request to debrief from someone else

• Identify your triggers; prepare or avoid them when possible

• Speak up to peers, supervisors, friends and family about what you need and what

A

BalanceBIntegrating work with life

Integrating compassion & empathy with self-protection

Integrating teaching with helping & supporting

Compassion Satisfaction

Compassion Fatigue

BalanceBuild Compassion SatisfactionB

Recognize, share, celebrate, remember these momentsin staff meetings, PLC’s, newsletters, supervision, morning announcements, personnel files…Give awards, recognition, joy jar.

Build Satisfaction: Celebrate Grace & GoosebumpsB

◦ Moments of grace

◦ Moments that give you

goosebumps

Build Satisfaction: Remember Your Inspiration B

◦ Why did you enter the field?

◦ What’s a case that reminds you why you do this work?

◦ Share, remember & cherish your inspiration

Organizations• Promote collaborative work for problem-

solving, innovation and creativity

• Support connections between workers for work and celebration & support

• Encourage supervisors & leaders to connect on a human level with staff

• Create opportunities for staff to have a meaningful voice

• Create an inviting space for staff to decompress and/or connect

Individuals

• Connect with peers & colleagues

• Connect with supervisors & leadership

• Offer input

• Collaborate to problem solve

• Collaborate to become more STS-informed

• Connect with family and friends

Connect & CollaborateC ;)

:)

:(

:\:)

:/

Hot Walk & Talk 1. Go to the person – don’t wait for

them to come to you

2. Walk away from the “hot spot”

3. Walk beside them briskly enough to help discharge energy & stress

4. Have water available & offer it

5. Establish a sense of psychological safety; normalize the stress response

6. Ask them to recount the incident; help them get to the end

7. Complete incident report as required

8. Prompt them to use calming strategies e.g. deep breathing

9. Ask them what they need next: sandwich? break? back to work?

10.Offer support & BH resources

Crisis Response in the MomentC

Extend to yourself what you give to others

Self Compassion: Grace & ForgivenessC3 Components:

1.Self-kindness

2.Common humanity

3.Mindful self-awareness

What to do:

• Positive self-talk

• Visualize how you would respond to a friend or colleague

• Notice your own suffering & Seek support. Ask for help!

1. Take care of your body: eat well, exercise, sleep enough

2. Quiet or focus your mind: use mindfulness, meditation or mental focusing strategies

3. Metabolize your feelings: consider journaling or talking about what you are feeling

4. Practice self-compassion: give yourself permission to be “good enough” instead of “perfect” or “the best”

5. Maintain healthy boundaries: know when to say “no” or “not now”

6. Ask for help from others: use peer consultation & supervision; know how to seek assistance from professionals

Self-Care: Nourishing YourselfC

Self-Regulation Requires Self-Awareness

Mindfulness

Paying attention on purpose

With Kindness (without judgement, shame or blame)

To OURSELVES (first!)

To OTHERS

To The World

Self-Regulation & Balance

The Science of Self-Regulation

Sympathetic Nervous System

Activated by the Alarm response

Sends body into flight, flee or freeze mode by releasing cortisol and adrenaline

Diverts blood flow to muscles needed for fight, flee, freeze & contracts muscles

Releases glucose from liver to provide energy

Increases heart rate, dilates lungs to breathe more quickly, dilates blood vessels to promote flow,

Parasympathetic Nervous SystemMaintains system in a non-alarm state of rest

Restores body to state of normal functioning, ideally one of calm and rest; no stress hormones released

Blood flow goes to all areas of body working, e.g. digestion, thinking

Energy production is paced and relatively even

Decreases heart rate, constricts bronchial tubes, constricts blood vessels,

Mindfulness Strategies• Breathing

• Progressive muscle relaxation

• Meditation

• Grounding

• Mindful walking

• Mindful eating

• Try Headspace, Calm and Stop, Breathe & Think

• Physical

• Psychological

• Emotional

• Spiritual

• Personal

• Professional• Available at:

https://www.olgaphoenix.com/key-offerings/self-care-wheel/

Using the Self-Care Wheel

• Write one thing in each pie piece

• Rate each thing 1, 2 or 3: 1 = never use it; not helpful

2 = use it some; somewhat helpful

3 = use it regularly; helpful

• Forget the 1’s; modify the 2’s

• What else can you do?

The Six Pillars of Self Care from Stephanie Winn, LMFT

Rest Nourishment Cleansing Grounding EnergySafety/Protection

Physical

Mental

Emotional

Spiritual

Available at: https://adai.uw.edu/nwattc/pdfs/6pillarscare.pdf

RestNourish-ment Cleansing Grounding Energy

Safety/Protection

Physical

Good sleep hygieneGetting enough sleep

Healthy snacksRegular meals & water

Showers/ bathsClean work & living spaces

Daily routinesTime in nature

ExerciseNutritionSunshine

Safe work & home spaces

MentalMeditation AcceptanceLetting go

Lifelong learningBrain-teasers

MeditationDigital detox

Setting intentionsMaking a listBeing present

Inspirations Meaningful work

TherapyDiscernmentPriorities

Emotional

Self-acceptanceSocial media breaksLetting go

FriendsPetsAffirmations

GrievingCrying“Letting it out”Unburdening

Sensory groundingMemoriesHands in dirt

LaughterMusic, dance, artSports, exercise

Setting boundariesTrusted connections

SpiritualContemplationMeditationPrayer

Spiritual reading, music, community

Spiritual ritualsRites of passageHolidayscelebrations

Finding purposeSpiritual community

Protection prayersTalisman

Reflection

1. One thing you plan to use

2. One thing you want to learn more about

3. One thing that worries you about being more STS-sensitive

Resources for Child-Serving Professionals Regarding Secondary Traumatic StressNCTSN STS Info Page: https://www.nctsn.org/trauma-informed-care/secondary-traumatic-stress/introduction

NCTSN STS Resources, includes specific resources for child welfare workers, educators, therapists, community violence workers, CAC staff: https://www.nctsn.org/trauma-informed-care/secondary-traumatic-stress/nctsn-resources

Administration for Children and Families STS Page: https://www.acf.hhs.gov/trauma-toolkit/secondary-traumatic-stress

For Educators, addressing both providing trauma-informed services during COVID-19 and the impact of COVID-19 on physical and emotional well-being of staff: https://www.nctsn.org/sites/default/files/resources/fact-sheet/trauma_informed_school_strategies_during_covid-19.pdf

Resources for Educators Regarding Race and RacismThe following resources may also be useful to educators, although they do not necessarily reflect the views and opinions of the NCTSN.

Education World (2016). Multicultural book selections. Retrieved from http://www.educationworld.com/a_lesson/multicultural-book-suggestions.shtml

McClure, L. (2016, July 25). 10 TED classroom resources about race in America. [TED-ED Blog] Retrieved from http://blog.ed.ted.com/2016/07/25/10-ted-classroom-resources-about-race-in-america/

National Education Association (2016). Diversity toolkit: Race and ethnicity. Retrieved from http://www.nea.org/tools/30417.htm

Southern Poverty Law Center (2014, December). Teaching about race, racism, and police violence. Teaching Tolerance, Retrieved from http://www.tolerance.org/racism-and-police-violence

St. John, Maria Seymour; Thomas, Kandace; Noroña, Carmen Rosa. (2012). Infant mental health professional development: Together in the struggle for social justice. Zero to Three (J), v33 n2, p13-22.

Strauss, V. (2016, July 11). Teaching about race, racism, and police violence: Resources for educators and parents. Washington Post, Retrieved from https://www.washingtonpost.com/news/answer-sheet/wp/2016/07/11/teaching-about-race-racism-and-police-violence-resources-for-educators-and-parents/?utm_term=.d82ff5c46c1a

Van Ness, L. (2016, July 30). 60+ resources for talking to kids about racism. Bounceback Parenting, Retrieved from http://bouncebackparenting.com/resources-for-talking-to-kids-about-race-and-racism/

APP Recommendations for MindfulnessCALM◦ FREE for Educators!

Headspace

10% Happier

Virtual Hope Box◦ FREE!◦ Coping, relaxation, distraction, positive thinking◦ Useful for parents and students engaged in treatment services

Insight Timer◦ FREE meditation App!

https://insighttimer.com/

For More InformationJudi Vanderhaar, Kentucky Department of Education, Division of Student Success

Judi.Vanderhaar@education.ky.gov

Diane Gruen-Kidd, Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities

Diane.Gruen-Kidd@ky.gov