Handle with care: Addressing child trauma in West Virginia

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“Their normal is chaos, and we have to bring calm.”

For public school students in West Virginia, the calm therapist Felicia Bush is referring to comes in the form of an innovative, multidisciplinary program that aims to identify and treat trauma in real time.

Bush, a provisionally licensed social worker with a master’s degree in counseling, provides trauma-focused therapy for youth in the public schools through the Defending Childhood Initiative (DCI). The program brings together law enforcement, public school staff and mental health professionals to create a safety net for youngsters, br

For example, a child might witness police responding to a domestic violence incident that occurs in the home in the wee hours of the morning. Through DCI, police officers are trained to note whether a child was present during such incidents. Officers then find out what school the child attends and file a “handle with care” notice with the school. The one-page form doesn’t provide details about what happened but simply lets the school know that the student may need extra attention.

“The child sometimes discloses what happened but not always,” Bush says. “You don’t have to know what happened. You just have to know that something happened that potentially can affect the child’s ability to learn.”

In other cases, a parent or caregiver might alert the school that something is going on at home, such as a parent’s impending military deployment or the death of an extended family member.

After being alerted, DCI’s network clicks into place to provide whatever extra care the child may need at school — from a space to shower, nap and change clothes to a chance to retake a test to recurring sessions with a trauma-focused therapist.

Law enforcement personnel and entire school staffs — from principals to the cooks in the cafeteria — complete DCI training to help them identify and be sensitive to child trauma. The initiative is designed to stem both the short-term and long-term effects of trauma, especially its impact on children’s ability to learn.

“Trauma is a public health issue, not just a counseling issue,” says Carol Smith, a licensed professional counselor (LPC) and member of the DCI advisory board in West Virginia. “[Addressing this] is a huge paradigm shift, and it’s going to take all of us.” That includes medical and mental health professionals, educators, law enforcement personnel, religious leaders and others in the community, she says.

Getting started

The DCI in West Virginia is a localized version of a program first introduced by U.S. Attorney General Eric Holder. He launched DCI in 2010, prompted by the plentiful research showing that trauma affects a child’s ability to learn and is associated with long-term physical and mental harm.

In West Virginia, U.S. Attorney Booth Goodwin has overseen the launch of a DCI program tailored to local needs, including creation of the “handle with care” form used by law enforcement.

A group from the Child Witness to Violence Project, a successful multidisciplinary trauma-focused program in Brockton, Massachusetts, came to West Virginia in 2011 to train DCI participants before the program launched in pilot schools, according to Tracy Chapman, the victim witness coordinator in the U.S. Attorney’s Office for the Southern District of West Virginia.

“We looked at what works, and we looked at the needs of West Virginia — the needs that are impacting our children, our classrooms,” she says.

The first pilot schools in West Virginia adopted the program in 2013. In less than two years, law enforcement personnel have recorded 414 incidents involving 768 children through DCI, according to Charleston Police Lt. Chad Napier, a coordinator for the program.

Now, after its success in five different pilot schools at the elementary, middle and high schools levels, the stage is being set to roll the DCI program out statewide.

This spring, it was announced that the DCI program will now be headquartered in the newly created West Virginia Center for Children’s Justice, located at a state police facility in Dunbar. This change will allow DCI to be more easily implemented statewide while adhering to a consistent model, Chapman says.

“We can no longer work in our silos focused on one piece of a child’s life puzzle. We must work together to make systemic improvements that can truly change the trajectory of a child’s path,” Goodwin said at the center’s unveiling. “… This [Center for Children’s Justice] will improve communication and collaboration between law enforcement, prosecutors, schools, advocates and mental health providers, and help connect families, schools and communities to mental health services.”

Goodwin has been the driving force between DCI in West Virginia, making it a personal priority, Chapman says. “As a federal prosecutor, we can’t arrest our way out of crime and the types of problems that are affecting our communities,” she says. “We have to provide the resources to children and to communities and to schools to actually change and break the cycle. We have to intervene early, and we have to intervene effectively with kids to help keep them on the right track. That’s his [Goodman’s] message.”

Creating a safety net

Through DCI, school staffs work to provide as much specialized care as possible for trauma-affected children, such as partnering them with a mentor or ensuring that they can make up missed homework. The school counselor plays an integral role in these efforts, from readying a schoolwide traumatic crisis response plan to identifying children and families who could benefit from extra mental health support, says Smith, a member of the American Counseling Association and president of the West Virginia Counseling Association.

When children affected by trauma need extra help beyond what the school can provide, they are referred to mental health practitioners who provide in-school therapy as part of DCI. All of these practitioners are specially trained to treat trauma. One of DCI’s pilot schools, an elementary school in Charleston, has established a permanent mental health clinic in the school.

“[DCI] gives services to the child immediately upon the experience of a potentially traumatic event. If it’s needed, the service is there, and there’s no stigma to it,” says Bush, executive director of Harmony Mental Health, a nonprofit mental health and social services agency based in Parkersburg.

Prior to the launch of DCI, Bush says, school staff members had to guess when something had happened in a child’s life outside of school, clued in by sudden behavior changes or when Child Protective Services personnel came to the school — often weeks later — to ask the child questions. Now the initiative is allowing professionals to help students deal with trauma in its immediate aftermath.

Professionals involved in DCI agree that the program is helping to reach students who might have previously fallen through the cracks and not been identified as needing help. “A lot of these kids were never on anyone’s radar unless they were a direct victim,” Chapman says.

A culture of safety

In addition to providing extra help for individual children, the DCI program trains educators to introduce schoolwide initiatives that focus on mental health.

In one example, the school principal and other staff members greet students coming off the bus each morning. The students are asked to give a thumbs up or thumbs down, depending on how they are feeling that day. The principal uses this to gauge the school population’s overall climate for the day and tailors the school day accordingly. On “thumbs down” days, this could include having a therapy dog visit the school, postponing testing or introducing extra small group counseling sessions with a school counselor.

A similar initiative is introduced for classrooms. Upon arriving, students are asked to take a marble and place it in a bowl. They select a green marble if they are feeling OK and a red marble if they are feeling bad. The teacher can gauge the classroom’s needs by checking the bowl, adding extra wellness initiatives to the day such as breathing exercises or playing soothing music in the classroom (see sidebar, below).

The program also requires a provider of trauma-focused cognitive behavior therapy to be available at each school, Chapman says.

Individual children who are referred to mental health practitioners through DCI are given an initial screening to see whether they need general counseling or trauma-focused counseling, Bush says. If the case does involve trauma, the therapist will go over a treatment plan with the child’s parent or caretaker.

In addition to trauma-focused cognitive behavior therapy, the mental health practitioners provide lots of psychoeducation, Bush explains. DCI therapists work to help the children understand what trauma is and guide them in learning coping mechanisms, including the management of behavior, anger and emotions.

“Some of [these children] have no ability to identify or control their emotions,” says Bush, who has worked with victims of domestic violence and trauma for more than a decade. “The goal is to help them identify the trauma they’ve experienced, put it into a narrative and begin to express it so it doesn’t affect them for their whole lives.”

Because the therapy is conducted in the schools, mental health practitioners are able to collaborate with school staff, check in often with the children’s teachers and see the students “in context,” Bush says. The mental health practitioners often visit a child’s classroom, the lunchroom or a gym class just to observe the child in a group setting. “We do a lot of listening,” Bush says.

By being so ingrained in the schools, the therapists are also able to schedule therapy around field trips and other events the child would not want to miss, Bush says. Teachers have been very willing to work with Bush and her therapist colleagues, she says, even participating in department and individualized education plan (IEP) meetings when asked.

One of the most helpful aspects of the DCI program is that the children “realize they’re important to us [the adults], to the school and to all the people who have put in extra effort to make this available for them,” Bush says.

It takes a village

The DCI program brings together professions that were not always good about communicating with one another, Chapman notes. “Unfortunately, for far too long we’ve all worked in our individual silos. Children do not live in silos. They live in all of our worlds,” Chapman says. “… For far too long we haven’t communicated and collaborated and broken out of our silos to make sure that we’re comprehensively addressing the needs of the child. For far too long these kids have fallen through the cracks.”

Chapman and Bush both use the metaphor of putting pieces of a puzzle together to describe the program’s multidisciplinary approach.

“We all have a little piece of the puzzle, a little piece of a child’s life,” says Bush, adding that anytime those puzzle pieces are connected, it benefits the child. “We’re blurring the lines for the benefit of the child. Not the lines of confidentiality or procedure, but making the community safer by providing a safety net for children so they’re not the next generation of perpetrators or the next generation of adult victims.”

Treating the effects of trauma in young children “is the only place we can truly change the cycle of violence in our community,” she says.

DCI stakeholders — including law enforcement personnel, public school representatives, mental health providers and community partners such as social service agencies — meet often to review and evaluate the work being done.

In some ways, the program’s training has also ushered in a cultural shift, Chapman says, in part by introducing a level of care and follow-up that didn’t often exist previously in the state’s law enforcement. New protocols guide police to avoid making arrests or interviewing witnesses in the Blackwater Falls State Park, West Virginia

presence of children whenever possible and to make regular, noncrisis visits to local schools.

“There’s a whole new culture and mindset in the police department that they need to recognize when kids are present [during an incident] and the potential impact that could have on the child,” Chapman says.

In your neighborhood

DCI was launched in some of the neediest schools in West Virginia. At the program’s first pilot school, an elementary school in Charleston, 93 percent of the students are from low-income families. But those involved in the initiative agree that DCI’s multidisciplinary approach is needed everywhere as well.

All communities have children and households that are affected by trauma, Chapman notes. “We all have to think differently. … If we continue to do the same things we’ve always been doing, we’ll continue to get the same results. That goes for schools, mental health [practitioners] and law enforcement,” Chapman says. “Counselors play a vital role in this process as well. … I would encourage mental health providers to think outside of the box [and] understand the limitations that some families have with coming to their offices [outside of the school day].”

“People don’t exist in a vacuum of 50 minutes” — the length of a typical in-office counseling session, agrees Bush. “You want to send them out into as much support as you can possibly garner on their behalf. If you want [clients] to be successful, it’s a no-brainer. Make yourself familiar with all the [support] systems that are available.”

The collaborative work being done in programs such as DCI involves going the extra mile, but it’s well worth it, Bush says. “Step out of your comfort zone and you will have a richness of experience that you can’t imagine,” she says, her voice breaking with emotion. “Open up your world to experiences, people and situations that you wouldn’t normally experience. It’s just such a growth experience for everyone.”

DCI also models what adults regularly try to teach children: to be cooperative. “[Students] see adults working together not in a negative way, but in a healing way,” Bush says.

Both Chapman and Bush stress that communities interested in DCI should adopt the program as a whole. It doesn’t do any good to have law enforcement record and refer children involved in traumatic incidents unless a trauma-sensitive network is set up in the community’s schools, Chapman asserts.

“It takes all these components working together to get this initiative to succeed,” Bush agrees. “It’s important that [communities] don’t piecemeal it.”

Meeting a need

Through her involvement in DCI, Smith has decided to devote the remainder of her career to focusing on trauma. At Marshall University, where she is an associate professor of counseling, Smith is involved in the launch of a graduate certificate program in violence, loss and trauma counseling. In addition, several Marshall University counseling interns have been involved in DCI under Bush, Smith says.

“When your eyes are opened to trauma, you realize it’s everywhere. Everyone who walks through your door has it, and if you don’t handle it correctly, you can restigmatize or cause harm,” Smith says. “Counselors can become change agents in the community. … The field is waking up and becoming savvy to the issues that are swirling around us. Yes, it’s exhausting, but it’s worth it.”

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Learn more about DCI in West Virginia: handlewithcarewv.org

Much of DCI’s schoolwide trauma training is adapted from the book Helping Traumatized Children Learn, a publication of the Massachusetts-based Trauma and Learning Policy Initiative. Find out more, and download the book for free, at traumasensitiveschools.org.

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Classroom initiatives for “thumbs down” days

What should happen on days when the majority of students indicate that they’re not OK? The possibilities are limitless, says Carol Smith, a licensed professional counselor, member of West Virginia’s Defending Childhood Initiative advisory board and president of the West Virginia Counseling Association.

Examples of activities to calm and refocus students include:

  • Doodle-quilts: Each child is asked to take out a 4-by-4-inch piece of paper (already cut and available for such a time as this) and to spend five minutes quietly doodling on it in whatever colors the child chooses. Students then pass the pieces of paper to the front of the room. The teacher tapes the pieces together and posts the “quilt” of doodles on a bulletin board, observing that the doodles show the students’ “processing” of whatever caused the heated (unhappy/stressed) temperature.

  • Round robins: Children sit or stand in a circle, facing each other. With the process explained and structured by the teacher, each child, in order, identifies one thing that is on his or her mind. The teacher summarizes, validates, encourages and then redirects the children to the work at hand.

  • Stand up and stretch: The teacher validates the students’ collective temperature and provides structure: “We are going to breathe a few breaths and do a few stretches to process our feelings, and then we’ll get to today’s lesson.” The teacher takes students through a couple of deep breaths and a short series of stretches to allow students to “reboot.” The verbal validation, structuring and limited activity work to restore equilibrium and allow students to get back to business.

  • An agreed-to, brief regrounding ritual that has been previously co-constructed by the teacher with the children, typically at the beginning of the school year.

Source: Carol Smith, associate professor of counseling, Marshall University

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook: facebook.com/CounselingToday

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