This article was adapted from a two-part series published by the National Child Traumatic Stress Network.
In early 2019, faculty members and support staff from the National Center for Child Traumatic Stress (NCCTS) and nearly 70 participants from across the country met in Denver to begin an ambitious 18-month journey: the Breakthrough Series Collaborative (BSC) on Trauma-Informed Schools.
Duke Psychiatry & Behavioral Sciences associate professor George “Tripp” Ake III, PhD, was among the NCCTS faculty leading this first “learning session.” In addition to his role at Duke, Ake is the NCCTS Director of Training and Implementation and was one of the key planners for the BSC.
The goal of the initiative is to increase the time students spend in the classroom by transforming their schools into trauma-informed environments. Traumatic stress can be a major obstacle to classroom learning. It’s a common challenge for schools: students who have experienced trauma may not get the help they need, and their trauma-related behaviors can lead to suspensions and interruptions in their development.
Stakeholders understood that the goal of increasing students’ time in the classroom would require a more global effort than simply implementing clinical interventions or training staff. That’s when their thoughts turned to addressing the school systems as a whole, said Jane Halladay Goldman, PhD, NCCTS Program Director.
Why the BSC Model?
The BSC methodology, first developed in 1995 by the Institute of Healthcare Improvement and Associates in Process Improvement, is aimed at achieving rapid change in large systems by using the Model for Improvement and including the use of Plan-Do-Study-Act cycles. This model allows participants to rapidly test the effectiveness of small changes, rather than expending time on long-range planning for massive change.
The BSC model also relies on input from all levels of stakeholders, so changes are initiated from the bottom up. Family partners and frontline stakeholders are encouraged to have equal voices in selecting and testing strategies that can impact the school system.
Input from Stakeholders
Once the need for trauma-informed schools was identified, the BSC planning team accessed a number of resources to hone their focus. From the first discussions about the initiative, the NCTSN efforts included family partners as well as trauma experts. “When we knew we were going to be doing a BSC, we spent some time doing stakeholder interviews,” Halladay Goldman recalled. “We could have just focused on [trauma] screening and assessment, for example, but what we heard from them is that you get the most bang for your buck when you look at the whole system.”
A literature review of similar initiatives bolstered this approach. Shannon Chaplo, PhD, a Duke postdoctoral researcher at the time, looked at other initiatives across the country that had addressed trauma-informed schools. Planners wanted to avoid reinventing the wheel, but also wanted to address gaps in work done by others.
The team then surveyed NCTSN school experts and identified the following domains for the collaborative change framework:
- Psychological and Physical Safety
- Whole-School Trauma-Informed Approach
- Cultural Responsiveness, Racial Justice, and Authentic Inclusion
- Active Child, Youth, Family, and Community Partnerships
- Trauma-Informed Learning Environment
- Trauma-Informed Classroom Responses
Diverse Teams
BSC planners chose three district-based teams and four individual school-based teams from New Mexico, Ohio, Colorado, Missouri, Connecticut, and Louisiana to participate in the collaborative. “We thought it would be important for both types of school teams to be represented,” Ake said.
The teams varied in their experience in developing trauma-informed initiatives, and part of the collaborative activities encouraged cross-team self-assessment so that teams could learn strategies from each other.
Next Sessions and Measuring Change
One of the activities during the initial session in Denver revolved around mapping each school’s physical space. Participants were asked to highlight with red markers those areas that represented “hotspots” and were more likely to trigger students with trauma histories. One team decided that they would target a hallway that had been a source of many disciplinary referrals.
This is one of the advantages of the BSC methodology, Halladay Goldman noted. “Trying to make a big change can be overwhelming,” she said. “Being able to choose a geographic area in the school and try one change is a doable way of making improvements.”
Tracking changes is integral to the Plan-Do-Study-Act cycle. That’s where the collection of data comes in, said Chaplo. She worked with consultant Jen Agosti during the planning process to generate metrics such as students’ engagement in learning, attendance and the perception of school climate, which map onto several of the BSC domains. “Our ultimate goal,” Chaplo said, “is to keep kids in the classroom engaged in learning and making sure the metrics are a proxy for that.”
Teams were encouraged to use data they were already collecting that would also map onto the BSC metrics, such as attendance and school discipline data. Coaching sessions were provided throughout the project.
Impact of COVID-19
The coronavirus pandemic forced BSC organizers to make many adjustments to sustain the work they had begun in 2019. They extended timelines, switched from in-person to virtual meetings and changed the measurement lens as they continued their work with the participants.
Despite the changes, they have found much to celebrate regarding positive outcomes for BSC participants, who also have rich stories to tell about making their schools more trauma-informed.
Ake pointed out that the foundational work done in the first sessions, during which teams bonded and shared with colleagues in other states, helped prepare faculty and participants to deal with the additional trauma of the pandemic. He and the other members of the team have used the pandemic as an opportunity to create a wealth of new products that extend the reach of the collaborative to others in the NCTSN.
The NCCTS planning group had completed three of their four planned learning sessions when COVID-19 cut short their plans for the BSC’s last in-person meeting in Ohio. That meeting, originally planned for the spring of 2020, took place virtually this past October.
Halladay Goldman recalled that in early 2020, before the pandemic lockdowns, the BSC faculty adjusted the model by conducting in-person consultation visits in order to better accommodate school systems and schedules. “We added these visits as a way to provide more in-depth assistance in specific areas of need,” she said, “and to provide time, space and a method for teams to assess their progress so far and to plan for next stages.”
During visits to teams in Ohio, the faculty videotaped interviews with participants, who reflected on the benefits of participating in the BSC. Ake said the interviews generated so much rich material that the BSC team decided during the pandemic to create videos to underscore key themes for trauma-informed schools. Four videos highlighting major themes are now accessible in the Resources section of the NCTSN website.
Measuring Progress
BSC organizers are now in the midst of collecting and synthesizing data and planning more products and papers based on lessons learned. The main metric for measuring the success of the Breakthrough Series Collaborative on Trauma-Informed Schools—keeping students in classrooms—“is obviously going to look a bit different,” Ake said. As the pandemic perseveres, schools have faced challenges to keep their students engaged. Some schools have been offering online classes only, while others have tried moving to a hybrid, in-school/at-home model, only to be shut down after resurgences of the virus.
Still, BSC participants have reported progress in specific domains. One school team, at North Avondale Montessori Elementary in Cincinnati, OH, eliminated what it had labeled “In-School Suspension,” and changed the term to “Alternative Learning Center.” The team also created a calming room where students could go freely to practice mindfulness if they were feeling stressed.
In one of the videos, Montessori teacher Andrew McClellan noted that participating in the BSC had helped him realize that psychological safety starts from a place of trust. “For me,” McClellan said, “that looks like trying to start each day with a clean slate, presenting the opportunity to say to that student, ‘I trust you, and here are ways that we can build that relationship.’” From that place, the teacher can give students practical steps toward achieving a trusting relationship. “I don’t think that all children have adults that they can trust in their lives,” he said.
Watch other videos from the collaborative.
Ake recalled that the Cincinnati school district had shown a 13 percent gain in kindergarten through third grade literacy levels. Linking this with the discipline data—such as instituting the Alternative Learning Center and the calming room—it is clear “that schools are using their own data for change, which is something that the BSC helped to promote,” Ake observed.
Halladay Goldman cited two BSC teams that had used disciplinary data to identify profound racial inequities. One team, at a site in Cortez, CO, realized from its data that most students referred to the office for discipline were Native American children who lived on a nearby reservation. Another team in Cincinnati identified the fact that every student on suspension was a Black male. “Both of these sites made huge leaps in terms of addressing inequity,” Halladay Goldman noted.
This meant, she said, that when the Black Lives Matter movement became more prominent after the murder of George Floyd, the schools had already created a foundation that allowed them to do deeper work toward racial equity.
A Reframing
Laura Danna, LCSW-BACS, Director of Project Fleur-de-lis, a program of the Mercy Family Center in Metairie, LA, was also on the faculty for the BSC. Danna began her career as a school social worker, and from that grew her passion and commitment to treat trauma in youth and secondary traumatic stress in adults. “The importance of the adults in the building taking care of themselves and one another—that became my flag to fly in every BSC meeting,” she said.
Hoping to dispel misconceptions about self-care—it’s not just about burning a candle or taking a bath— she encouraged BSC participants to use the test-of-small-change framework to explore ways to bring practical changes into their workday. For example, she said, “It really is helpful to take five minutes between classes to walk around the classroom and take some deep breaths—as opposed to scrolling through Facebook on your phone!” Now, with the pandemic, Danna feels the message of self-care is even more important.
During affinity group and other calls, Danna has noticed that participants have been apologetic about not completing all assignments. Her role as a BSC faculty member, she said, is to name, identify and cheer on everyone’s accomplishments, however small. “It’s easy to fall into that trap of not having met our indicators,” she observed. “The pandemic has necessitated changing the lens on how we measure, and then acknowledging all the things we are doing well. We still have such a rich story to tell.”
Other Duke Psychiatry & Behavioral Sciences collaborators on this project include:
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Lisa Amaya-Jackson, MD, MPH
Professor, Psychiatry & Behavioral Sciences
NCCTS Co-Director -
Katelyn Donisch, PhD
Clinical Associate, Psychiatry & Behavioral Sciences
Improvement Advisor, NCCTS Training & Implementation Program -
Falesha Houston, MSW
Program Coordinator, NCCTS Training & Implementation Program -
Nick Tise, MPH
Managing Director, NCCTS Training & Implementation Program
Read the original articles in the National Child Traumatic Stress Network newsletters (Part 1, Spring 2019, and Part 2, Spring 2021).