Education assistant

A Framework for Trauma-Sensitive Schools Infusing Trauma-Informed Practices Into

Early Childhood Education Systems Neena McConnico

Child Witness to Violence Project at Boston Medical Center Boston, Massachusetts

Renee Boynton-Jarrett Boston Medical Center Boston, Massachusetts

Courtney Bailey Child Witness to Violence Project at Boston Medical Center

Boston, Massachusetts

Meghna Nandi Boston Medical Center Boston, Massachusetts

Abstract Traumatic experiences are common in early childhood and may have enduring consequences on health and development. Cost-effective and developmentally appropriate interventions are needed to support the educational success of children affected by trauma. The Supportive Trauma Interventions for Educators (STRIVE) Project emphasized strategies for teachers to support social-emotional learning through the use of classroom-specific strategies and activities and a toolbox of resources to help students regulate their emotions while remaining in the classroom. This cost-effective and scalable intervention may provide needed supports to children and educators and therefore may be suitable for replication.

Childhood trauma is a significant public health threat that adversely impacts health and social, emotional, and cognitive development. In the United States an estimated 26% of children will witness or experience a traumatic event before they turn 4 years old (National Center for Mental Health Promotion and Youth Violence Prevention, 2012). National data suggest that 1 in 4 children who attends school has experienced a trau­ matic event (National Child Traumatic Stress Network, 2008). This number is even higher for youth residing in socioeco­ nomically disadvantaged neighborhoods and racial/ethnic minority youth who are at increased risk for chronic or ongoing exposures (Buka, Stichick, Birdthistle b Earls, 2001; Finkelhor, Turner, Shattuck, b Hamby, 2013; Richters b Martinez, 1993).

Disparities in exposure to adverse childhood experiences may contribute to academic inequities, commonly referred to as the achievement gap.

A growing body of research evidence supports the association between social adversities and suboptimal learning, behav­ ior, and performance in school that begins during the early childhood years. Traumatic experiences may directly affect memory, language, emotional, and brain development, all of which interfere with mastery and acquisition of new skills (Child Welfare Information Gateway, 2015). Exposure to multiple adverse and traumatic childhood experiences has been shown to be associated with poor attention and impulse control, difficulties regulating emotions, aggression, and self-harming

36 ZERO TO THREE M AY 2016

behavior that impedes children's ability to interact with others and function in the classroom (Chu & Lieberman, 2010; Cole, Eisner, Gregory, & Ristuccia, 2013). Chronic exposure to trauma can also result in young children experiencing a sense of low self-worth, difficulty trusting others, and misperceiving the in­ tentions and cues of others (Cook, Blaustein, Spinazzola, & van der Kolk, 2003). As a result of these difficulties, children with histories of violence exposure may become stigmatized and excluded by peers due to the dramatic nature of their behav­ ioral challenges.

Experiencing chronic trauma during the early childhood years can be particularly detrimental as the time period between birth and 5 years old is a critical time for growth and develop­ ment of the brain. It is during this time that the brain is most impressionable to adverse experiences (National Scientific Council on the Developing Child, 2005/2014, 2010; Shonkoff, Boyce, & McEwen, 2009). As a result of the significant neuro- biological, social, emotional, and cognitive effects of chronic trauma exposure, it is particularly important to intervene early to promote optimal development and success.

Traditional systems of education have not been structured to address the unique needs of children who have experi­ enced trauma. While there are increasing initiatives to im ­ plement programs and services that address these kinds of social-emotional and psychological concerns among elemen­ tary, middle, and high school students, initiatives are lacking for children under 5 years old. Early childhood programs are often ill-equipped to manage the kinds of challenging behav­ iors that children exposed to traumatic events exhibit in the classroom and lack the understanding and training needed to intervene effectively (Osofsky & Lieberman, 2011). Professional development programs for educators have not yet systemat­ ically incorporated psycho-education on childhood trauma and how it impacts behavior and learning or classroom-based

strategies to promote optimal learning among children with a history of trauma.

In this article we discuss a pilot intervention, Supportive Trauma Interventions for Educators (STRIVE), aimed at helping schools and early education systems of care increase their capacity to identify, respond to, and optimally support the unique needs of young children who have been impacted by trauma expo­ sure. Uniquely, this is a universal intervention, delivered at the class level to all classroom students. We review the theoretical framework and collaborative process of developing the STRIVE model. We discuss preliminary findings about the impact of the STRIVE intervention on classroom climate and student-teacher interactions.

Trauma-Sensitive Education Approach and Framework The current systems that most public schools use to edu­ cate their young students who have been exposed to trauma have fallen short in efforts to improve the academic success and social-emotional well-being of these students. Most existing models focus on the individual student, rather than student-teacher interactions. Few programs exist that take a comprehensive approach to address the multiple levels of intervention that are required to adequately result in sustain­ able and effective practice change. Many tiered models that encompass universal, targeted strategies and intensive supports generally focus on individual needs of children and do not take into account the resources and knowledge acquisition needed by teachers to support the optimal development of their stu­ dents. An alternative approach is one that considers teacher and student needs as well as the overall structure of the school and its ability to meet the needs of children and their families impacted by trauma. The framework of STRIVE (see Figure 1) is

Figure 1. Supportive Trauma Interventions fo r Educators (STRIVE) Framework

Attachment Responsive Adults

Power/Control Flave Choices

Self-Regulation

Resilience Activities and curriculum that promote

agency, self-esteem, and mastery

Social Connectedness

Trauma-Informed Schools

Social Justice Privilege

Power Dynamics

Safety

Trust

Predictability

Consistent Routines

Family Sense of Agency

Advocacy Highlight and Build on Strengths

Culture

Child Coping Skills

Self-Regulation Problem-Solving Sense of Control

Positive Self-Esteem

Teachers/School Staff Reflective Practice Feel Empowered

Knowledge and Skill Building

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Disparities in exposure to adverse childhood experiences may contribute to academic inequities, commonly referred to as the achievement gap.

un iq u e in th a t it is resilie ncy-b ased and in clud es in te rve n tio n at th re e d iffe re n t levels: in d ivid u a l student, teacher, and ove rall school.

Trauma im p acts th e w a y c h ild re n v ie w them selves, o th e r people, and th e w o rld . E xperiencing to x ic stress has th e a b ility to s ig n ifica n tly im p a c t th e d e v e lo p m e n t o f he a lth y a tta c h m e n t and th e a b ility to fee l safe, tru s t others, and fee l a sense o f p o w e r o r c o n tro l ove r on e's self and life. A tra u m a -se n sitive cla ssroo m s fra m e w o rk takes this fa c t in to c o n sid e ra tio n and results in system s cre a tin g policies and practices th a t em p o w e r, build resiliency, and s u p p o rt th e o p tim a l d e v e lo p m e n t o f c h il­ dren and th e ir fam ilies im p a cte d by traum a. W hen childre n's sense o f safety and tru st in th e w o rld and oth e rs is restored, and th e y feel a sense o f agency, and th e y are able to heal and thrive . These and o th e r p ro te c tiv e fa c to rs can serve as buffers and help m itig a te th e negative im p a cts o f exp e rie n cin g traum a.

In th e process o f d e ve lo p in g th e STRIVE in te rve n tio n , Vital Village N e tw o rk helped s u p p o rt partnerships be tw e e n th e Child W itness to V io le n c e P roject and several Boston p u b lic schools. The go a l was to c o lla b o ra te w ith scho ols to help crea te a sys­ te m o f care in w h ic h everyone is tra in e d to respond to a child's needs using a tra u m a -s e n s itiv e ap p ro a ch (see Figure 2). For a s c h o o l t o b e c o m e tra u m a -se n sitive , th e re needs to be a shift in th in k in g a b o u t c h ild re n 's behaviors fro m all staff w o rk in g in th e s c h o o l in c lu d in g a d m in istra tio n , teachers, paraprofessionals, and s u p p o rt staff. H elping staff unde rsta nd and v ie w be h a v­ io r as c o m m u n ic a tin g a need fo r a ch ild rathe r than seeing th e ch ild 's be ha vior as w illfu l o r ju s t a "behavior," is on e o f the fo u n d a tio n s o f cre a tin g a tra u m a -se n sitive scho ol.

T he STRIVE in te rve n tio n provides in fo rm a tio n a b o u t the prevalence o f traum a and th e association w ith s o c io e c o n o m ­ ic inequities and n e ig h b o rh o o d o p p o rtu n ity structures. An em phasis is placed o n raising awareness and understanding a b o u t th e various ways in w h ic h systems can u n in te n tio n a lly re -tra u m a tize childre n and th e ir families. STRIVE also focused o n th e s o c io -p o litic a l unde rpin nings o f racism, oppression, privilege, and th e in te rc o n n e c tio n to th e ph ilo so p h y o f Am erican

ed u ca tio n system s o f care th a t are s tru ctu re d aro u n d th e values and beliefs o f th e d o m in a n t cultu re. T he im p a c t o f such a system o n c h ild re n and its re la tio n to tra u m a exposure are also discussed. By m aking teachers aw are o f th e p ro b le m th e y can begin to unde rsta nd behaviors fro m a social ju s tic e perspective and adjust th e ir p ra ctice acco rd in g ly. Next, STRIVE provides p s y c h o -e d u c a tio n o n th e im p a c t o f tra u m a o n health and e d u c a tio n a l o u tco m e s, s p e cifica lly by review ing w h a t is kno w n a b o u t n e u ro b io lo g ica l processes. T hen STRIVE provides teachers w ith this skill set and kno w le d g e by discussing h o w traum a im ­ pacts children's d e ve lo p m e n t and ability to self-regulate. Teach­ ers are given suggestions and to o ls o n h o w to address d iffic u lt behaviors in th e classroom and are encou rage d to use th e ir ow n crea tivity to develop traum a -sen sitive approaches.

Social and e m o tio n a l c o n n e cte d n e ss is a b u ffe r fo r tra u m a t­ ic events. W hat is k n o w n a b o u t traum a exposure and yo u n g c h ild re n is th a t positive, caring, and s u p p o rtive relationships w ith s ig n ifica n t adults such as parents, grandparents, and teachers are p a ra m o u n t to he lp fa c ilita te th e healing process (Groves, 2002). Early c h ild h o o d providers are in on e o f the m o st vita l p o sitio ns to (a) tea ch c h ild re n a ffe cte d by traum a exposure c o p in g skills, (b) c o m m u n ic a te th a t th e y care, and (c) respond in ways th a t are sensitive to th e m u ltip le traum as these c h ild re n have likely experienced. Such tra u m a -in fo rm e d approaches are g ro w in g n a tio n a lly and have been s u p p o rte d by research evidence. W hen c h ild re n fe e l th e y have a caring and s u p p o rtive adult, th e y are able to feel m o re secure. The STRIVE in te rv e n tio n w o rks w ith teachers to assure th e m tha t th e ir relatio nship w ith stud ents can help crea te resilie ncy and e m p o w e rm e n t. M oreover, relatio nships th a t stud ents have w ith th e ir tea chers can crea te an un d e rsta n d in g o f he a lth y re la ­ tio n sh ip , w h ic h can he lp th e m be m o re succe ssful w ith peers and later in life. Next, teachers are ta u g h t strategies to use in

Figure 2. A Trauma-Sensitive Approach in Education

Social justice

Mindset change: Addressing cause

of behavior

Knowledge of prevalence and impact of

trauma

Empowerment and resiliency

3 8 ZERO TO THREE M A Y 2 0 1 6

the classroom to help children w ith se lf-reg ula tion skills and managing their emotions. When children feel like they have the tools to self-regulate they have a sense of accom plishm ent and em pow erm ent.

Core Principles of Intervention The STRIVE in te rv e n tio n aim s to help educators create an acad em ic a tm o sp h ere th a t draw s u p o n children's stren g th s to p ro m o te resiliency, efficacy, a sen se of self-w orth, and positive w ell-being, a n d to offer a m u ltitude of o p p o rtu n i­ ties for success. It is in te n d e d to be in fu sed into th e existing cu rricu lu m of th e early child h o o d setting. Specific objec­ tives include:

1. Increase teachers' and school personnel's understanding and awareness o f various kinds o f trauma that young children are exposed to and ways this exposure impacts their developm ent and academic functioning and perfor­ mance.

2. Provide teachers with concrete strategies and interventions that they can use in the classroom to support their students and address the behavioral challenges they may exhibit.

3. Improve young children's ability to access the curriculum by providing a supportive school atmosphere in w hich children can feel safe, encouraged, and a sense o f agency.

This innovation is structured around five core com ponents: a t­ tachm ent, safety, trust, pow er/control, and reflective practice. In order for children to begin to heal and thrive in the face o f experiencing toxic stress, there must be a restored sense of trust, safety, and pow er and co n tro l in themselves, others, and the w ord in w hich they live. Healthy attachm ent is the hall­ mark of all future relationships. Teachers and early childhood educators play an im portant role in the healthy developm ent of young children.

Attachm ent

Attachm ent is the building block to all future relationships. Research illustrates that when children w ho have experienced chronic trauma or toxic stress have positive, healthy, nurturing relationships w ith significant caregivers it contributes to their healing and ability to thrive. Such positive relationships help to shift a child's view o f self, the world, and others in the world. Healthy attachments help to restore a child's sense of safety, trust, and pow er and control. Engaging in m utually reinforcing interactions serves as a protective factor by facilitating neural activity in the brain that can increase the likelihood o f adaptive developm ent o f the stress response system (National Scientific Council on the Developing Child, 2010).

Resiliency

The ability to bounce back in the face of adversity develops when children feel safe, loved, and capable (National Child Traumatic Stress Network, 2008). Although children w ho have experienced trauma and adversity can be negatively im pact­ ed, they also com e w ith several strengths and qualities that

serve as protective factors to build resiliency. Resiliency is built and maintained in the context of healthy nurturing relation­ ships that are characterized by em otional attunem ent and cyclical interactions that com m unicate a sense o f value and respect. Interventions that focus on the skills that children have—and use them as building blocks to intentionally teach self-regulation, problem -solving skills, and em otional lite ra c y - w ill contribute to the academic success o f children.

Reflective Practice

In order for professionals to truly be effective and im pactful in the interactions they have w ith the children and families they serve, they must be honest and authentic about the thoughts, beliefs, and assumptions that influence their practice and the relationships they have w ith children and their families. Reflec­ tive practice provides teachers w ith the opportunity to reflect on their successes and challenges and aids in the prevention of burnout and vicarious trauma.

Program Development STRIVE was developed through a collaborative partnership among Boston Medical Center Child Witness to Violence Project, Boston Public Schools, and Vital Village Network. The intervention aims to improve student success, specifically aca­ demic performance and attendance, by improving the quality of teacher-student interactions using an evidence-based, trau­ m a-inform ed model. For several years, the Vital Village Network has collaborated with the Child Witness to Violence Project and the Orchard Gardens Pilot School to engage educators in a process of co-designing resources to support trauma-sensitive classroom environments. What emerged from that engagement process was a series of recommendations by teachers for more professional development on trauma and concrete strategies to use, leading to the design and piloting o f an evidence-based curriculum accompanied by a classroom toolkit.

We conducted the pilot intervention among all kindergarten, first, and second grade classrooms at the Orchard Gardens Pilot School. This supported training of 12 educators, across 3 grade levels. Across the classrooms, approximately 250 stu­ dents were included. The Institutional Review Board of Boston University Medical Center approved this study.

The STRIVE intervention consisted o f the follow ing c o m p o ­ nents: (1) developing and im plem enting a training program fo r early childhood educators that provides psycho-education about the impacts o f trauma on young children and ways to incorporate traum a-inform ed practices when addressing chal­ lenging and disruptive behaviors in the classroom; and (2) infusing a curriculum that promotes feelings o f high self-esteem and efficacy among the children in this setting.

Training

Early childhood and elementary providers and administrators received 10 hours o f professional developm ent training aimed at building their capacity to foster resiliency and address the

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unique needs of the youngsters in their classrooms. Train­ ings focused on increasing teachers' understanding of ways in which trauma can impact young children's physical, social, emotional, cognitive, neurobiological, and academic function­ ing. Training workshops also focused on (a) increasing these early childhood educators' understanding and awareness of re­ actions that are typical among children who have experienced traumatic events and (b) providing them with an understanding of environmental cues/events that may trigger a traumatic response from a child. In addition, these trainings also provided educators with concrete strategies and resources for managing challenging behaviors as well as preventative strategies. Teach­ ers learn about the importance of establishing and maintaining positive, caring, and supportive relationships with their students that will instill a sense of trust, security, safety, and hope among the most vulnerable victims of trauma exposure.

Consultation and Coaching

As part of this intervention, teachers and administrators were provided with ongoing consultation and coaching to help them implement the trauma-informed strategies and practices they were taught. Interventions that include consultation and coaching have been found to be more effective than providing trainings in isolation as they are responsive to the teachers and students' needs, and they provide feedback about practice in context (Li-Grining et al„ 2010; Mashburn et al„ 2008). Coach­ ing and consultation in the context of a supportive relationship also allows space for teachers to reflect on their practice and apply the knowledge and skills they are learning.

Toolkit

The STRIVE Toolkit (see Table 1) contains a set of concrete, hands-on tools that can help children learn how to identi­ fy and self-regulate their emotions. For instance, the toolkit contains a set of emotion flash cards that provide children with shared language around recognizing their emotions and talking about their feelings. The toolkit also contains various coping tools appealing to the different senses, including stress balls, noise-cancelling headphones, calming scents, and visual barri­ ers, to name a few. With effective instruction and support from teachers and classroom staff, the STRIVE Toolkit components can teach children to identify and then regulate their emotions independently. Introducing these tools in the classroom and providing teachers with an awareness of trauma's effects on child development helps schools create a safe and supportive learning environment that not only reduces stigma and associ­ ated behavioral challenges for children with trauma history, but also optimally enhances socioemotional development for all children within school systems.

Program Evaluation A combination of standardized and non-standardized mea­ sures and evaluations were used pre-intervention and post-intervention to evaluate the effectiveness of this inter­ vention on children's functioning in the classroom, teachers' feelings about their knowledge of the impacts of trauma, and teachers' perceived level of confidence in their ability to implement trauma-informed practices in their interactions with students.

Table 1. Mean Pre- and Post-Intervention Scores fo r Quality o f Student Statements Relationships and Difference by Wilcoxan Rank Test Qualitative statements from students reflected on the

ability to identify and verbalize feelings and affective

states.

• A kindergarten student said, "It makes me feel happy.

When I feel happy, I go back to the group."

Students reported the ability to use multiple tools to

address needs independently.

• "Sometimes I use putty when I get mad because

sometimes people get me mad. Sometimes it makes

me feel better, but sometimes, they do it all over

again. That's when I use the headphones."

Students also endorsed the community-building aspects

of the tools in terms of understanding emotions in other

children.

• "If you're sad or mad, you can go and squeeze the

squishy ball. Some people in this class have anger

issues. If you squeeze the ball, the anger issues will

get out of your body."

Domain Baseline Follow-up p-value Educational Support Domain 5.18 6.13 0.0002

Positive classroom climate 5.48 6.38 0.0015

Negative classroom climate 1.43 1.11 0.0078

Teacher sensitivity 5.48 6.5 0.0046

Respect for student perspective 3.18 4.75 0.0002

Classroom O rganization Domain 5.47 6.14 0.003

Behavior management 5.41 6.23 0.0009

Productivity 5.84 6.38 0.0045

Instructional learning formats 5.16 5.79 0.004

In structio nal Support Dom ain 2.48 2.46 0.69

Concept development 2.18 2.32 0.5

Quality of feedback 2.54 2.19 0.21

Language modeling 2.73 2.77 0.94

40 ZERO TO THREE M A Y 2016

Classroom Assessment Scoring System (CLASS)

Classroom observations were conducted using the Classroom Assessment Scoring System (CLASS; Pianta, La Paro, & Ham- re, 2008). Observations took place in each classroom on two occasions: prior to staff training and again several months after the training during the same academic year. The CLASS is a reliable and valid instrument used to assess the quality of rela­ tionships in the classroom environment between students and teachers. The CLASS has three domains: Emotional Support, Classroom Organization, and Instructional Support. Within these domains there are 10 dimensions. Scoring ranges from 1 (low) to 7 (high). The CLASS instrument assesses classroom environment, rather than individual students. CLASS obser­ vations were conducted by one certified observer (Meghna Nandi) to assess the impact of the STRIVE intervention.

Teacher Questionnaire

Teacher questionnaires were administered prior to the training series and at the end of the intervention to assess teachers' knowledge about trauma and its impacts on young children, trauma-informed strategies, and their confidence in their ability to implement strategies they had learned. The teacher questionnaires assessed teacher's perceptions of their own self-efficacy with respect to managing challenging classroom behaviors, identifying trauma, and responding to the needs of children with trauma. Moreover, the teacher questionnaire assessed teacher's perceptions of school-level efficacy. The follow -up questionnaire also assessed the perceived utility to the training and STRIVE toolkit.

Results

Twelve teachers participated in the STRIVE intervention. Of these, 81% were women and the majority (68%) were from 25-34 years old. The educators worked in approximately 12 classrooms. Two independent CLASS observations were conducted pre-intervention and post-intervention in each classroom by a certified CLASS observer.

We observed an increase in knowledge among educators comparing pre- and post-intervention self-report surveys. At baseline 56% percent of teachers felt they had a good idea of how trauma affects children's development whereas 80% of teachers felt this way at follow-up. At baseline, 75% of edu­ cators agreed/strongly agreed that they were aware of the effects of trauma on students' behaviors, as opposed to 90% at follow-up. However, we did not see a significant increase in knowledge of available resources from baseline (56%) to follow -up (60%).

Teachers also endorsed higher self-efficacy and confidence. Only 44% felt prepared to respond to children who have been exposed to trauma at baseline. At follow-up, 60% agreed that they felt prepared to respond to children who have been exposed to trauma. At follow-up, 70% of educators agreed/ strongly agreed that the trauma-informed curriculum and professional development tools were an important invest­ ment of their time, and 60% agreed/strongly agreed that the trauma-informed classroom tools educators introduced help their students manage their emotions. Qualitative remarks from teachers indicated that the classroom resources (a) helped stu-

Table 2. STRIVE In tervention Toolkit

Tool Topic/Goal Directions for Use

Green barrie r Sight (calming and focusing) The barrie r can b lo ck o u t o th e r visual s tim u la tio n and th e green c o lo r can be so o th in g fo r child ren .

C alm ing scent Sm ell (calming and relaxing) The scent can be so o th in g and relaxing to som e ch ild ren . The act o f ro llin g it o n to hands can have a massage e ffect.

L o w -p itch e d w h ite noise Sound (calming and comforting) This lo w -p itc h e d w h ite noise sound is sim ila r to th e h um o f a fan o r buzz o f a d rivin g car and can be very ca lm in g and so o th in g fo r som e children.

i/» o

£ N oise -ca n ce llin g headphones Sound (calming and focusing) H eadphones w ill b lo ck o u t and m u ffle sounds in th e classroom , th e re by help ing

ch ild re n calm them selves and refocus o n th e task at hand. C Q. O

U W eighted lap pad Touch (calming and comforting) Provides deep pressure, p roprioceptive in p u t to m uscles and join ts, to allo w better

integration o f inp u t in th e central nervous system to calm and regulate em otions.

Kinetic sand Touch (calming and distracting) The o p p o rtu n ity to m o ld th e sand creatively can be distractin g and re dire ct th e ir a tte n tio n away fro m any stressors.

Stress "eggs" Touch (tension release) Release stress and tensio n as th e y tig h te n and relax th e ir m uscles. D iffe re n t levels o f firm ness fo r sensory preferences.

T h e ra p u tty Touch (tension release) Useful fo r releasing te n sio n and m ay serve as d istra ctio n because it can be m o ld e d in to d iffe re n t shapes.

(/) V)

e § E m o tion cards Feeling ide n tifica tio n

Build a shared vo cab u lary to id e n tify and express w h a t th e y are fe e lin g so th a t they can b e tte r se lf-reg u late tho se em otio n s.

S - o m E

LU R eflection jo u rn a l Id e n tify in g co p in g strategies Provides ch ild re n an o p p o rtu n ity to re fle c t and share th e ir th o u g h ts and concerns w ith th e ir teacher.

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Social and emotional connectedness is a buffer for traumatic events.

dents calm down with minimal transitions: (b) helped students de-escalate without interrupting the class, and (c) provided teachers with an intervention that allowed students to remain in the classroom. They felt the classroom-based materials were used by the majority of students in the class and therefore there was limited stigma, and the toolbox itself was neither a consequence nor an incentive. Teachers felt the emphasis on social-emotional learning helped create a more compassion­ ate and accepting classroom climate. Students also expressed positive reactions (see box Student Statements).

Table 2 demonstrates changes in class scores over time, pre- versus post-intervention. CLASS scores are rated on a scale of 1-7. We observed statistically significant differences in the CLASS scores for two domains: Educational Support and Classroom Organization. There were also statistically signifi­ cant differences in pre- and post-intervention CLASS scores for each sub-dimension for the Educational Support and Class­ room Organization domains. The most significant differences were in Respect for Student Perspective, Positive and Negative Classroom Climate, and Productivity. No significant differ­ ence was observed in the Instructional Support domain or sub-dimensions, as predicted because our intervention did not address these interactions.

Discussion Our preliminary findings support the impact of the STRIVE pro­ gram on classroom climate and student-teacher interactions, as well as teacher knowledge and efficacy. Supporting schools to address the impact of trauma on learning by creating safe and supportive learning environments both reduces stigma for children with trauma history and associated behavioral chal­ lenges and optimally enhances socio-emotional development for all children within school systems This project is unique in the sense that, rather than being expert-driven and focused, it places an emphasis on collaboration and co-design of the model by engaging educators at the beginning of the process and on iterative changes prior to piloting the program.

Because many young children spend the majority of their time in school or early childhood education settings, school-based interventions are critical to promoting optimal socio-emotional development. Positive, caring, and supportive relationships with significant adults such as parents, grandparents, and teachers are paramount to help facilitate the healing process for young children who have been exposed to trauma (Groves, 2002) by serving as protective factors that help to re-establish a sense of safety, security, and hope within these young children. Position­ ing early childhood educators to identify and intervene early may help foster the healthy development of these children.

There are limitations of our pilot study. The small sample size limits the generalizability of our findings. Because we worked with a relatively small number of classrooms, there are a very small number of teachers, making it difficult to evaluate statistically significant changes in efficacy. With consideration for these limitations, our study provides preliminary evidence for the impact of improving teacher education, resources, and classroom environments to better address the needs of chil­ dren exposed to trauma.

Recommendations for Practice

Optimizing trauma-informed approaches within schools and early childhood education systems of care is possible and may help promote successful students, schools, and healthy com ­ munities. Building the capacity of teachers to support students by enhancing their understanding of trauma and its impact on learning and behavior is crucial. Supporting schools to address the impact of trauma on learning by creating safe and sup­ portive learning environments reduces stigma for children with trauma histories and associated behavioral challenges, and optimally enhances socio-emotional development for all chil­ dren in the classroom. Each o f these are critical components to improving the educational success of all students. Below are some recommendations for educational systems to consider.

1. Schools and early childhood systems of care should be given a readiness assessment to determine whether they have the resources and time to engage in the curriculum. This readiness assessment would help schools begin the process of discussing whether it is feasible for their school to participate in the curriculum in a way that is most effective for their teacher and students. The level of investment from administration should be included in a readiness assessment to evaluate the degree to which administration will support teachers and staff. Changes that occur in a school need to be supported by senior administration so that all staff members can feel their work is appreciated and valued.

2. Cultural considerations should be woven throughout the curriculum. When cultures have been discriminated against and marginalized, they can pass down trauma symptoms from generation to generation. This phe­ nomenon is referred to as intergenerational trauma. It is essential to provide teachers with the knowledge and understanding about how intergenerational trauma may

4 2 ZERO TO THREE M A Y 2 0 1 6

impact the way symptoms may be manifested in children and their parents. Although the children have not directly been impacted by trauma, they have learned ways to deal with stressful situations from their caregivers. If teachers are trained in recognizing intergenerational trauma they can approach the child's behaviors with a trauma lens.

3. Awareness of one's own culture and belief system can help with recognizing how they impact the way teachers respond to children. Trainings to bring cultural awareness to schools would help teachers become aware of how they support ethnicity and diversity in the classroom from the visuals displayed around the school to the op­ portunities they are given for professional development around issues related to culture.

4. Attachment to caregivers is a critical protective factor for children who have been exposed to a traumatic event. Incorporating parents in learning the techniques and tools their child may be using in the classroom will help parents continue to support their children in other domains. Supporting parents in understanding how trauma may impact their child's behaviors and emotional responses can help foster the parent-child relationship. Many times, caregivers underestimate how their chil­ dren may be impacted by the violence they see or hear in their home or in the community. Giving caregivers psycho-education around their children's development can help caregivers feel empowered and competent in their abilities to care for their children.

5. Teachers' training is heavily focused on academics, but little of their education is focused on how to support children's social and emotional needs. This is an area that has been found to be problematic. "It is not only teachers'jobs to educate children," Colleen, a Boston public school teacher, stated, "it is their job to support a child's social and emotional needs." (C. Labbe, personal communication, February 4, 2016). Teachers often feel responsible for their students' emotional needs but are not given adequate training or resources to effectively address them. If teacher-training programs include ways to address trauma, teachers may feel more proficient in discussing issues related to trauma with students, par­ ents, and administration.

Conclusion Improving the health trajectory for children who have experi­ enced trauma in early life remains an underaddressed issue that influences both health and educational outcomes. Our STRIVE intervention is a promising model that shows preliminary evi­ dence for improving classroom environments and increasing teacher knowledge and self-efficacy with classroom manage­ ment of behavioral issues and meeting the needs of children exposed to trauma. This is a low-cost intervention that can be easily implemented in school environments. Considering the high prevalence of exposure to adversities in early life, particu­ larly for children in urban communities, a school-based inter­

vention is a promising method for reaching greater numbers of youth. In addition to the direct benefits of learned coping skills and improved communication strategies, the indirect benefit of supporting an inclusive classroom environment promotes optimal learning for all children. Infusing trauma-informed strategies and tools into the educational setting may help address some of the root causes of inequities in educational opportunity. Future studies should investigate the long-term impact of this program on educators and students, as well as the impact on classroom instructional hours and school performance.

Acknowledgments This research was supported by the Doris Duke Charitable Foundation. The content is solely the responsibility of the authors and does not necessarily represent the views of the Doris Duke Charitable Foundation. The authors thank the children, educa­ tors, and administrators from Boston Public Schools. The authors also thank Todd Sponholtz for assistance with data analysis.

Neena McConnico, PhD, LMHC, holds a doctorate degree in clinical psychology and is a licensed mental health counselor. In addition, Dr. McConnico has a bachelor's degree in early childhood education and has extensive experience working with underserved populations as a mental health provider, consultant, and teacher in early childhood, elementary, and college settings. Dr. McConnico currently serves as the program director for the Child Witness to Violence Project and serves as faculty and clinical consultant on the Boston Defending Childhood Initiative. Dr. McConnico's professional interests include the impact of a neonatal intensive care unit stay on child-parent attachment as well as how the impacts of trauma interface with children's academic and social development. Dr. McConnico has a clinical and research interest in creating and infusing developmentally appropriate, trauma-informed approaches into early childhood care and elementary school systems.

Renee Boynton-Jarrett, MD, ScD, is a practicing primary care pediatrician at Boston Medical Center, a social epidemiolo­ gist, and the founding director of the Vital Village Community Engagement Network. Through the Vital Village Network, she is supporting the development of community-based strategies to promote child well-being in three Boston neighborhoods. She joined the faculty at Boston University School of Medicine in 2007 and is currently an associate professor of pediatrics. She received her AB from Princeton University, her MD from Yale School of Medicine, a ScD in social epidemiology from Harvard School of Public Health, and completed residency in pediat­ rics at Johns Hopkins Hospital. Her work focuses on the role of early-life adversities as life course social determinants of health.

Courtney Bailey, MSW, LICSW, graduated from Simmons College in Boston, Massachusetts, and holds a master's degree in social work. She has worked in a variety of settings includ­ ing outpatient, residential, and community-based programs providing psychotherapy for children and their families. She is

ZERO TO THREE MAY 2016 43

currently a clinician at the Child Witness to Violence Project at Boston Medical Center and provides individual and dyadic psychotherapy. Ms. Bailey has provided a variety of trainings to mental health providers on the impact of trauma on children. Ms. Bailey has been involved in training teachers on ways to provide trauma-informed systems of care.

Meghna Nandi graduated from Washington University in St. Louis in 2014 with a bachelor of arts in anthropology and psychology. During her undergraduate career, she engaged in much community-based work and research around domes­ tic violence intervention in both the United States and Chile, where she spent a semester studying abroad. After graduation, her interests in community health along with her desire to understand how to address the impact of trauma on health led her to a year of service as an AmeriCorps VISTA with the Vital Village Network where she helped pilot the STRIVE project. Af­ ter completing her year of service, Meghna joined the Connors Center for Women's Health and Gender Biology as a research assistant. In the fall, Meghna will start medical school.

References Buka, S„ Stichick, T„ Birdthistle, I., & Earls, F. (2001). Youth exposure to violence:

Prevalence, risks, and consequences. American Journal of Orthopsychiatry, 71(3), 298-310.

Child Welfare Inform ation Gateway. (2015). Understanding the effects of mal­ treatment on brain development. Retreived from http s://w ww .childw elfare. gov/pubs/issue-briefs/brain-development

Chu, A. T„ & Lieberman, A. F. (2010). Clinical im plications o f traumatic stress from birth to age five. Annual Review of Clinical Psychology, 6, 569 -49 4.

Cole, S. F„ Eisner, A., Gregory, M„ & Ristuccia, J. (2013). Helping traumatized children learn: Creating and advocating for trauma-sensitive schools, safe, supportive learning environments that benefit all children. Boston: Massa­ chusetts Advocates for Children.

Cook, A., Blaustein, M„ Spinazolla, J „ & van der Kolk, B. (Eds.). (2003). Complex trauma in children and adolescents: White paper from the National Child Traumatic Stress Network Complex Trauma Task Force. Retrieved from www.nctsnet.org/nctsn_assets/pdfs/edu_materials/ComplexTrauma_All.pdf

Finkelhor, D„ Turner, H„ Shattuck, A., & Hamby, S. L. (2013). Violence, crime, and abuse exposure in a national sample of children and youth: An update. Pediatrics, 167 {7), 614-621.

Groves, B. (2002). Children who see too much: Lessons from the child witness to violence project. Boston, MA: Beacon Press.

Li-Grining, C„ Raver, C, Champion, K., Sardin, L„ Metzger, M„ & Jones, S. (2010). Understandingand im proving classroom em otional climate in the "real world.”: The role o f teachers' psychosocial stressors. Early Education and Development, 21, 65 -9 4 .

Mashburn, A., Pianta, R„ Hamre, B., Downer, J „ Barbarin, A., Bryant, D„ & Howes, C. (2008). Measures o f classroom quality in prekindergarten and children's development o f academics, language, and social skills. Child Development, 79, 732-749.

National Center fo r Mental Health Promotion and Youth Violence Prevention. (2012). Childhood trauma and it's effect on healthy development. Retrieved from http://justice.aksummit.com/PDF/081712_childhood_trauma.pdf

National Child Traumatic Stress Network. (2008). Toolkit for educators Retrieved from http://nctsn.org/sites/default/files/assets/pdfs/Child_Trauma_ Toolkit_Final.pdf

National Scientific Council on the Developing Child. (2005/2014). Excessive stress disrupts the architecture of the developing brain: Working paper no. 3. Updated Edition. Retrieved from http://developingchild.harvard.edu/ wp-content/uploads/2005/05/Stress_Disrupts_Architecture_Develop- ing_Brain-l.pdf

National Scientific Council on the Developing Child. (2010). Early experiences can alter gene expression and affect long-term development: Working paper no. 10. Retrieved from http://developingchild.harvard.edu/wp-content/ uploads/2010/05/Early-Experiences-Can-Alter-Gene-Expression-and- Affect-Long-Term-Development.pdf

Osofsky, J. D., & Lieberman, A. F. (2011). A call fo r integrating a mental health perspective into systems o f care fo r abused and neglected infants and young children. American Psychologist, 66(2), 120-128.

Pianta, R. C„ La Paro, K. M„ & Hamre, B. K. (2008). Classroom Assessment Scor­ ing System (CLASS) manual, K-3. Baltimore, MD: Brookes.

Richters, J. E„ & Martinez, P. (1993). The NIMH Comm unity Violence Project I: Children as victims and witnesses to violence. Psychiatry, Interpersonal and Biological Processes [Special Issuel, 56(1), 7-21.

Shonkoff, J. P„ Boyce, W. T., & McEwen, B. S. (2009). Neuroscience, m olecular biology, and the childhood roots o f health disparities: Building a new fram e­ work fo r health prom otion and disease prevention. Journal of the American Medical Association, 301(21), 2252-2259.

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