Violence and trauma are part of the daily life of communities across the United States (US). Many children grow up experiencing childhood trauma, which is an extreme form of stress and anxiety caused by multiple adverse childhood experiences (ACEs). Traumatic stress can arise from the experience of paired ACES that may involve family dysfunction, divorce, and violence, abuse and/or neglect, substance use, or incarceration in addition to the exposure to community violence characterized by shootings, bullying, poverty and homelessness. Compounding the exposure to trauma, children of color experience overlapping stressors stemming from daily macroaggressions of racism. Childhood exposure to traumatic or stressful events can leave children with physical and mental health concerns. It affects their developing brain and nervous system, which may leave them constantly living in survival mode, even when no actual danger is present. The thinking and learning areas of a child’s trauma-exposed brain can be thwarted and become disconnected, fostering unhealthy coping strategies. These children have difficulty regulating their attention span, emotions and behaviors. As they get older, they tend to participate in risky health behaviors such as smoking, eating disorders, substance use, and high-risk sexual behaviors. In school, their ability to concentrate and learn suffers. Their classroom behavior is often disruptive and aggressive resulting in reduced instructional time, frequent absences, and lower grades. Not only do their behaviors impact their education, but also the education of their peers, classroom environment, teachers, and school staff.
The most efficient avenue to address childhood trauma and provide opportunities for healthy development for all children is through the public school system. This is because the vast majority of US children, especially from impoverished communities, attend public schools. Currently no other US institution has an existing and accessible structure to have such a direct, long-term access to children during the thirteen crucial developmental years.
This project, to develop trauma responsive learning communities, is targeting one of ten public school districts in Marion County – the Metropolitan School District of Washington Township (MSDWT) and two local charter schools –Indianapolis Metropolitan High School (Indy Met) and Vanguard Collegiate of Indianapolis (Vanguard). MSDWT is located on the Northside of Indianapolis and provides pre-kindergarten to 12th grade education to over 11,000 students. MSDWT student population is racially diverse, but conversely different than the city of Indianapolis, with the majority (70%) being children of color with 59% of its students qualifying for free/reduced meals. Indy Met and Vanguard are schools both located on the west side of Indianapolis in the Haughville neighborhood. Haughville is a working-class community with over 90% African American with over 40% of its adult population not having a high school diploma. Crime, poverty, and deteriorating infrastructure and housing are major problems in this community. Indy Met serves 270 students grades 9-12 and is predominately African American (78%), qualify for free/reduced meals (81%) and has a graduation rate of 38.2%. This alternative school, provides for the educational needs of youth who have and are experiencing barrier to educational success, such as being young parents, involved in foster care, the criminal justice system or are homeless. Vanguard, in its first year of operation, serves 70 students grades 6-8, with 92% African American and 100% qualifying for free/reduced meals. Vanguard targeted neighborhood students that have had academic and behavioral difficulties in the traditional public schools and desire a smaller learning community.
Wicked Problem Description:
The severe and persistent exposure to violence and trauma imposes lifelong and intergenerational consequences on the overall health and quality of life of communities. This is a wicked problem. With higher numbers of ACEs throughout the lifespan, national data supports the increased risk of developing physical illness, such as childhood diabetes and asthma; mental distress; and associated disabilities. Morbidity and mortality rates are likely to be higher in already impoverished communities with limited healthcare, nutritional, environmental, and recreational resources as found in many Indianapolis neighborhoods. Further, the exposure to persistent trauma impacts other social and health issues, such as juvenile justice, sexual behavior, and mental health. A trauma-exposed child struggles with having a positive educational attainment because it is difficult for them to regulate their attention, emotions and behaviors, which often leads to punitive action by the teacher or administration, including and up to expulsion from school.
A trauma responsive school is a safe and respectful environment that enables students to build caring relationships with adults and peers, self-regulate their emotions and behaviors, and academically succeed while supporting their physical health and well-being. This project aims to improve the culture of behavioral and physical health in selected schools by facilitating participatory action quality improvement trauma collaboratives (teams) to change the culture of the individual schools to develop into trauma responsive communities of learning. This “intentional spread” approach will foster sustainable trauma-responsive programming in each school and teach school personnel how to use implementation science to guide any future initiatives they would like to have in their school. A participatory action approach allows for the maximum power to be given to the school personnel to design their own trauma-responsive school community that best fits their needs.
The selected public schools will implement a breakthrough series collaborative to impact the effects of severe and persistent exposure to violence and trauma in children. A breakthrough series collaborative is a short-term (6-15 months) evidence-based quality improvement learning model that enables multiple organizations (schools) to make ‘breakthrough’ improvements by learning from each other and from experts in the areas where improvements are desired. Each school will develop an inter-professional trauma collaboratives or teams (TC) of eight to ten people that includes school staff from administration to the custodian, as well as parents and possibly older students. The TCs will use a participatory action approach to design their own trauma-responsive school improvements that best fits their needs. All TCs will participate in three group learning sessions, led by the Clinical Scholars and project staff over the course of a year, while being coached by project staff to develop and implement their sustainable trauma responsive improvements between the learning sessions. To guide the trauma-responsive improvements and any future school initiatives beyond this project, the TCs will be taught how to use the ‘Plan-Do-Study-Act’ implementation and continuous quality Improvement approach.
By changing the trauma responsive culture of schools, children will have improved behavioral self-regulation, increased educational attainment, increased school attendance, and decreased discipline referrals. The teachers and staff will be able to recognize compassion fatigue and secondary traumatic stress and seek self-care to manage their effects.
The participatory action approach of utilizing school trauma collaboratives and collaborative learning will increase collaboration between and among inter-professional teams and other schools, leading to the development of sustainable programming in schools and the use of implementation science, the Plan-Do-Study-Act approach, to guide additional organizational changes for future school quality improvement initiatives and projects.
Will include hiring, training and implementation planning with the project staff. Training will include information on the prevalence and impact of ACEs leading to trauma; best practices of a trauma responsive learning community including the ten core areas of a trauma-informed school and the multi-tiered systems framework; Positive Behavior Intervention and Supports (PBIS) and the Plan, Do, Study, Act (PDSA) implementation model. Planning will include securing commitment from the school administration, identifying each school’s TC and developing a timeline of key steps to be achieved prior to implementation.
The Clinical Scholars and project staff will work with the schools’ administration and TC to facilitate an assessment of their school culture to determine strengths and areas of need, which will guide the trajectory in developing trauma responsive changes. Each school will identify their major problematic areas, identified from the assessment that they all agree to change. The TC from each school will participate in three daylong trainings spaced at 3-4 months apart around trauma responsive approaches and progress and barriers to success. Each TC will be coached by one of the Clinical Scholars and project staff to identify, develop, implement, and evaluate their projects using the PDSA approach. Each TC will report on their planned methods, successes, and barriers to implementation of changes at each training day and work to develop a community of partners within and among all of the other TCs.
Full implementation of the newly developed trauma-responsive model in the schools by ensuring the ten core areas of the trauma-informed framework and the three intervention tiers are fully addressed. The TC will be the “champions” and lead the school during the transition. Evaluation and data analysis of the implementation process and project outcomes will be conducted throughout the three years. Dissemination of the project data will be prepared and conducted during the third year.
- Indiana University Schools of Social Work and Nursing
- Metropolitan School District of Washington Township
- Indianapolis Metropolitan High School
- Vanguard Collegiate of Indianapolis
- Indiana University Health
- Various community mental and physical health centers
- Parents and students
We will conduct a process evaluation, qualitative and quantitative data, of the participatory action approach of the Breakthrough Series Collaborative process using Kirkpatrick’s Four Level Evaluation Model. Outcomes will be measured using quantitative data from the pre/post NCTSN Organizational Readiness Assessment and results from satisfaction surveys given after each training session. The effects of school changes will be measured using single subject design, where the baseline metric serves as the control and is compared with the same behaviors during and following the intervention. The Professional Quality of Life Measure will measure secondary traumatic stress in school personnel.