Trauma-

Informed
Support for
Students in
Schools
Donna Dockery
Virginia Commonwealth
University
 Goals
Realize the importance of providing
trauma-informed support for
students in our schools,
Reflect on ways to increase trauma-
responsive services,
 Goals
Relate to students who have
experienced trauma, and
Recharge by incorporating trauma-
responsive practices in our programs
and provide self-care
 Plans
ACE Study Interventions
Trauma School Wide
Brain Responses
Development Case Examples
Stress Response Self-care
How Trauma
Presents
 Adverse Childhood Experiences
Felitti, V. J., & Anda, R. F. (2010)
The Adverse Childhood Experiences (ACE) Study is one of the largest
investigations ever conducted to assess associations between
childhood maltreatment and later-life health and well-being.

Large Scope (n=17,337)

2/3rd of folks responding reported at least 1 ACE factor

More than 1 in 5 had 4 or more ACE factors

Factors are linked to higher risks for medical conditions like smoking, severe
obesity, and heart disease

Factors are linked higher risk for substance abuse, depression and suicide
attempts
 Adverse Childhood Experiences Study (ACES)
Researcher Institutions Centers for Disease Control and Prevention and Kaiser
Permanente

Question What is the relationship between childhood abuse/neglect

and later-life health and well-being?

Sample 17,000 HMO members from Southern California receiving

physical exams between 1995-1997

Procedure Confidential survey regarding their childhood experiences

and their current health status and behaviors.

Conclusion Strong graded relationship between the breadth of

exposure to abuse or household dysfunction during
childhood and multiple risk factors for several of the leading
causes of death in adults. (Felitti et al., 1998)

6
Adverse Childhood Experiences (The ACE Study)
Emotional abuse
Physically abuse
Sexual abuse
Not loved, not important
Poverty
Using drugs/substances
Separation/divorce
Mother- interpersonal violence
Substance abuse
Mentally health diagnosis
Prison
The higher the ACE score the more impact on health and well
being over time.
www.acestudy.org
 ACES Questionnaires
Male and Female Versions

8
 ACES Results
ABUSE Women Men Total
(N=9,367) (N=7,970) (N=17,337)

Emotional Abuse 13.1% 7.6% 10.6%

Physical Abuse 27.0% 29.9% 28.3%

Sexual Abuse 24.7% 16.0% 20.7%

NEGLECT Women Men Total
(Collected only during
(N=8,667)
Wave 2)

Emotional 16.7 12.4 14.8

Neglect

Physical Neglect 9.2% 10.7% 9.9%

9
 ACES Results
HOUSEHOLD Women Men Total
DYSFUNCTION (N=9,367) (N=7,970) (N=17,337)

Mother Treated 13.7% 11.5% 12.7%

Violently

Household 29.5% 23.8% 26.9%

Substance Abuse

Household Mental 23.3% 14.8% 19.4%

Illness

Parental Separation 24.5% 21.8% 23.3%

or Divorce

Incarcerated 5.2% 4.1% 4.7%

Household Member

10
 ACES Results
NUMBER OF ACES Women Men Total

0 34.5% 38.0% 36.1%

1 24.5% 27.9% 26.0%

2 15.5% 16.4% 15.9%

3 10.3% 8.6% 9.5%

4 or more 15.2% 9.2% 12.5%

Sample Limits: Mostly middle upper SES , White, college-educated, insured,

employed

11
Risk factors, such as smoking, alcohol abuse, and sexual behaviors for
many common diseases were not randomly distributed in the
population.

Risk factors for many chronic diseases tended to cluster, persons who
had one risk factor tended to have one or more other risk factors as
well.


...as the number of ACE[s] increase, the risk for the following
health problems increases in a strong and graded fashion.

Chronic obstructive Multiple sexual partners

pulmonary disease (COPD)
Fetal death
Health-related quality of life
Ischemic heart disease
(IHD)
Liver disease
Risk for intimate partner
violence
Unintended pregnancies
Early initiation of smoking
Early initiation of sexual
activity
Adolescent pregnancy

13
 Risk Associated with Trauma
ACE Score of 0 compared to ACE Score of 4
242% more likely to smoke
222% more likely to become obese
357% more likely to experience depression
443% more likely to use illicit drugs
1133% more likely to use injected drugs
298% more likely to contract an STD
1525% more likely to attempt suicide
555% more likely to develop alcoholism
www.acestudy.org
15
 Primary Trauma
Primary trauma results from an event, series of
events, or set of circumstances that is experienced
by an individual as physically or emotionally
harmful or life threatening and that has lasting
adverse effects on the individuals functioning and
mental, physical, social, emotional, or spiritual well-
being.
The experience is more than a person can cope with at
the time or cope with alone.

16
SAMHSA, 2014
 How Traumatization Occurs
EVENT - actual or perceived threat of physical or
psychological harm
EXPERIENCE - overwhelming sense of terror,
helplessness and horror
- varies by individual
- highly influenced by culture, community, and stage of development
EFFECTS - impacts functioning and mental, physical,
social, emotional, or spiritual well-being
- not all trauma occurs at time of incident
-. Produces intense physical effects and potential long term effects on brain
development and functioning
 (Some) Types of Primary Trauma
Terrorism
Traumatic Grief
Abuse and
Neglect

Medical Trauma
Community
Violence

Natural Disasters
Household
Dysfunction
Refugee

(NCTSN,
n.d.(b)) 18
 Other examples of Trauma
School shootings Abandonment
Gang violence Bullying
Terrorist attacks Parent/caregiver
Natural disasters addiction
Accidents Parent/caregiver
Sudden or violent loss incarceration
Physical or sexual assault Parent/caregiver mental
Witnessing IPV illness
Divorce Poverty
Exposure to traumatic Repeated community
stories/incidents violence
Financial hardship
 Types of Trauma
Acute
A single event that lasts for a limited time (tornado/house
fire/rape)
Chronic
Multiple traumatic events, often over a long period of time (living
in a neighborhood with lots of violence, domestic violence)
Complex (developmental trauma)
Multiple traumatic events that begin at a very young age.
Inflicted by adults who should have been caring for/protecting the
child. (ongoing sexual, physical or emotional abuse)
Neglect
Failure to provide for a childs basic needs
Childs brain stays in survival mode
NCTSN 2010
 Also.
Historical
Secondary
Vicarious
Toxic stress
Compassion fatigue
 Prevalence of Trauma
68% of youth have experienced a potentially
traumatic event by age 16
41.2% of youth have been a victim of a physical
assault
5.6% have been a victim of a sexual assault
13.8% have been a victim of maltreatment in the
past year
71% of teenagers in substance abuse centers have
been exposed to trauma
 Brain Development
Neurons: nerve cells that are raw material of brain. 100
billion at birth

Synapses organize brain by forming neuronal pathways

that connect parts of brain governing all we do
Very few present at birth, those govern primary functions

Age 3 - approximately 1,000 trillion synapses

Some strengthen. Those not needed

Adolescence - approximately 500 trillion

(Child Welfare Information Gateway,

2001) 23
 Neurons
Nerve cells that are building block of the nervous system

Experiences create connections in the brain.

Neurons that fire together, wire together.
(this is how trauma triggers develop)
 Brain
Development

Trauma impacts how the brain develops and functions

Neurological pathways begin to form based on what

infants SEE, HEAR, TOUCH, SMELL and FEEL

Your early set of associations becomes your template for

how you view and respond to the world
What pathways in a
brain may look
like...

What pathways in a
brain exposed to
trauma may look
like...
 Creating Memories

Repeated Experiences Strengthened Neural Pathways Pathway Sensitized Memory

Motor Memory Cognitive Emotional

Memory Memory
(Child Welfare Information Gateway,
2001)
27
Mirror Neuron Dysfunction is linked to delays in:
Emotional skills
Social skills
Language skills
Cognitive skills
Gross motor skills
Empathy development
Reading non-verbal communication
Co-regulation (responding appropriately to another persons actions)
http://kyyouth.org/long-term-effects-of-child-abuse-and-neglect
 The Sensitive Periods in Brain Development

The Sensitive Period:

Experiences in the first few
years of life are very
important.
Promote synapse and neural
pathway development

(Child Welfare Information Gateway,

2001)

30
 Trauma and the Brain
Not fully developed until 20s
Undergoes major rewiring and pruning during
adolescence
Most vulnerable to trauma during toddler and
adolescent years (can alter gene expressions)
Trauma causes overactivation in the amygdala
(fear/emotion, quick response)
When brain activity is centered in amygdala, it
interferes with development of frontal lobe
(learning/critical thinking)
 Stress
Stress can be neutral, Stress can negatively
and even help a child impact brain
cope with the world development when it
when it is: is:
brief; prolonged
moderate; and severe; or
Predictable unpredictable
Chronic Stress
Complex/Repeated
(Child Welfare Information Gateway, 2001)
Traumas
32
 Fight, Flight or Freeze Response

There are 3 ways to respond to potential threat

Fight Flight Freeze

(run from or avoid the situation) (when fight or flight wont work)

When trauma is triggered, this response is automatic. If a

person takes time to think about how to respond under
serious threat, they will likely not survive.
 Dissociative Responses

Occurs when we cannot fight or flee.

Primitive reaction.
More common in females.
Brain prepares the body for injury.
Perry, B.D. & Szalavitz, M.(2007)
 Chronic Activation of Neural Pathways
Persistent Fear Hyper-arousal
Response Overload of stress
hormones
Fight (aggression)
Inability to return to
Flight (avoidance) set-point
Freeze (dissociation) Impaired functioning

(Child Welfare Information Gateway,

2001)
36
Blood is shunted away from the limbs and the heart
rate slows.
A flood of opioids are released killing pain, producing
calm and a sense of psychological distance from what
is happening.
If overactive and sensitized the person can become
more inward and removed from life around them.
This can look like day dreaming or
spacing out.
Perry, B.D. & Szalavitz, M.(2007)
 Impacts
Disrupts early patterns of attachment
Impact sense of safety and control

Causes breakdown in capacity to process, integrate and categorize

what is happening
Causes deficits in emotion regulation

Results in:
Lack of continuous sense of self
Poorly modulated affect and impulse control
Uncertainty about reliability and predictability of others
Perry, B.D. & Szalavitz, M.(2007)
 Symptomology
Emotional Outbursts Nightmares

Trouble Sleeping Feelings of Mistrust

Fatigue Poor Concentration

Anxiety Hypervigilance

Irritability Flashbacks

Physical Aches and Pains

Guilt, Shame and Blame

Depression Substance Abuse Acting Out

Effects
 Impact of Trauma on Learning
Children who have experienced trauma might:
Not function at chronological age
Be unable to control emotions/ have frequent outbursts
Be quiet/submissive
Have difficulties learning
Have difficulties getting along with others
Have unusual eating or sleeping behaviors
Attempt to provoke fights or solicit sexual experiences
Be socially or emotionally inappropriate
Be unresponsive to affection
(Child Welfare Information Gateway,
2001) 41
 Trauma in an Elementary or Middle School
Student May Appear As:
Anxiety, fear, and worry about
Distrust of others, affecting how
safety for self and others
children interact *
Changes in behavior:
A change in ability to interpret and
Increase in activity level
respond to social cues*
Decreased attention and/or
Increased somatic complaints
concentration
Changes in school/academic
Withdrawal from others or
performance
activities
Recreating the event*
Angry outbursts and/or
Increased distress*
aggression
Worry about recurrence of violence
Absenteeism

(NCTSN, 2008) (Elementary=*; Middle =**)

42
 Trauma in an Elementary or Middle
School Student May Appear As:
Re-experiencing the trauma Over- or under-reacting to bells,
Hyperarousal physical contact, doors
Avoidance behaviors slamming, sirens, lighting,
Emotional numbing sudden movements
Discomfort with feelings** Statements and questions about
Repeated discussion of events death and dying*
and focus on specific details of Difficulty with authority,
what happened** redirection, or criticism*

(NCTSN, 2008) (Elementary=*; Middle =**)

43
 Trauma in High School Student May Appear As:
Anxiety, fear, and worry about Changes in behavior:
safety of self and others Withdrawal from others/
Worry about recurrence or activities
consequences of violence Irritability with friends,
Discomfort with feelings (such as teachers, events
troubling thoughts of revenge) Angry outbursts and/or
Increased risk for substance abuse aggression
Discussion of events /reviewing Change in academic
details performance
Negative impact on trust and Decreased attention and/or
perceptions of others concentration
Over- or under-reacting to bells, Increase in activity level
physical contact, doors slamming, Absenteeism
sirens, lighting, sudden movements Increase in impulsivity, risk-
taking behavior
44
Trauma in a High School Student May Appear As:
Repetitive thoughts comments
Avoidance behaviors (e.g., resisting
about death or dying (including
going to places that remind them of
suicidal thoughts, writing, art, or
event)
notebook covers about violent or
Emotional numbing (e.g., seeming
morbid topics, internet searches)
to have no feeling about event)
Heightened difficulty with
Hyperarousal (e.g., sleep
authority, redirection, or criticism
disturbance, tendency to be easily
Re-experiencing trauma (e.g.,
startled)
nightmares or disturbing memories
during the day)
Also,
Lack of self-regulation
Frequently tired
Frequent visits to nurse

45
 Common Diagnoses & Comorbidity

Acute Stress Disorder OCD

Depression Reactive attachment
Oppositional Defiant disorder
Disorder Depression
Anxiety
ADHD
 Trauma-Informed Counseling
Establish safety and trust
Empower and avoid power struggles
Unconditional positive regard
Maintain high expectations
Engage and question to avoid misunderstandings
Guide and help students build relationships
Validate their experiences
 Responding to the Downstairs Brain

Connect before you correct (join with the child)

Respond to the need, not the behavior
Acknowledge their feelings
Use non-judgmental facial expressions
Use calm voice and caring touch

Remove threats/triggers
Minimize talking - executive function is impaired

Use Distractions- novelty can reboot the brain

Engage the right and left side of the brain

Get the child moving
Get the child to look right and left

Change temperature
(bath, hot cocoa, frozen fruit, popsicles)

Movement
Dancing, bi-lateral movement games
 Helping Children Cope with Trauma
Incorporate grounding techniques (notice body
sensations, notice things in the room, count
colors, count foods, sit on floor, etc.)
Integrate sensory practices: i.e., yoga, mindfulness
(be careful!), breath work, sand tray, play, art,
etc.
Help students identify triggers
 De-Escalating
Awareness - body, mind, breath
Time/space to breathe and return to normal
physiological states
Redirecting behavior
Giving child a choice in consequences (if
necessary)
Providing alternate activities
 Affect Regulation
Relaxation & Breath Control
Progressive relaxation
Breath Training

Increasing regulation capacity

Identifying and discriminating emotions
Correctly perceive & label emotions as they are experienced
Identifying and countering thoughts
Understand which cognitions exacerbate or trigger trauma
related emotions
 Distress Regulation
Grounding - Helpful in acute situations when student is
overwhelmed by intrusive symptoms or escalating traumatic
memories
Focus attention on the counselor & counseling
Ask student to describe his/her internal experience
Orient student to immediate, external environment
Focus on breathing or other methods of relaxation
Repeat step 2, assess students ability to return to
therapeutic process
Repeat steps 3 & 4 as needed
 Trauma-Informed Consequences
Analyze cause of behavioral concern (trauma,
trigger, something else?)
Help child develop positive ways to meet needs
Build trust/connection with behavioral
expectations
Help child understand impact of behavior on
others
Consistency with consequences
Be creative and resourceful, this can be a long
process Restorative practices
Childrens Resilience Initiative
Three basic building blocks to success:
Adapted from the research of Dr. Margaret Blaustein

Attachment - feeling connected, loved, valued, a part

of family, community, world

Regulation - learning about emotions and feelings and

how to express them in a healthy way

Competence - acting rather than reacting, accepting

oneself and making good choices
 Categories of Triggers
Environment In children:
Emotional state Lack of control
Physical state Startle
Social pressure
Sudden change in
Activities
routine/schedule
Thoughts
Presence of others Confrontation
Loud situations
Feeling rejected
Trigger Awareness & Intervention
Identify thought, feeling, sensation
Evaluate stimuli & identify which are trauma
reminiscent
Construct an adaptive strategy
 Post-Traumatic Growth
Trust/ability to develop/maintain supportive
relationships
Communication skills
Ability to express feelings/emotions
Positive self-identity
Positive values
Develop/maintain healthy boundaries
 Foster Resilience
the ability of an individual, family, or community to
cope with adversity and trauma, and adapt to
challenges or change.
(SAMHSA, 2016)

Protective Factors
Individual
Family
Community

58
 Fostering Resilience in Children
Instill:
Hope Growth mindset
Trust Ability to attach
Social support Asking for/receiving help
Identifying triggers/take responsibility for actions
Skill mastery/feeling accomplished
Ability to regulate emotions
Familial support (if available)
Healthy coping mechanisms
Positive regard for others (empathy)
 Psychoeducation
Educate on nature of Usual reasons why
trauma and effects perpetrators engage in
interpersonal violence
Typically presented early
in treatment, but helpful Typical immediate
throughout responses to trauma
Major topics in The lasting post-traumatic
Psychoeducation responses to victimization
Prevalence of trauma Reframing symptoms as
trauma processing
Common myths
associated with trauma Safety Plans
http://www.dcoe.mil/content/Navigation/Docume
nts/PTSD_Myths_and_Misconceptions_Factsheet.p
df
 The Handy Model

Upstairs

Downstairs

Palm/Thumb represents Downstairs Brain - primitive brain responsible

for survival functions (breathing, fight or flight, strong emotions, etc.
Fingers represent the Upstairs Brain - cerebral cortex responsible for
thinking, planning, emotional regulation, self control, empathy, etc.
 Barking Dog Wise Owl

When a childs dog is barking we have to calm the brain down so the wise
owl can return and allow them to use their thinking (rational) brain
Feelings Identification and Expression
Identify feelings be a feelings detective (I wonder if.)
Build a feelings vocabulary
Connect emotions to experiences
 Triggers and
Trigger Mapping
Incredible 5 point scale
1-5 rating

Looks like...

Feels like...

Safe people can help me by

Mindfulness - a state of active, open attention on the present
- psychologytoday.com

Breathing exercises - balloon breaths, stuffies on tummy

Drawing - mandalas

Somatic experiences - Observe, touch, smell and describe

Mindfulness Meditation
SAMHSAs Six Key Principles of TIC
1.Safety
2.Trustworthiness and transparency
3.Peer support
4.Collaboration and mutuality
5.Empowerment, voice, and choice
6.Cultural, historical, and gender issues
 Trauma-Informed Schools
A trauma-informed school provides a network of
support for students experiencing daily stressors
or extreme events.

Student

Treatment Services Adaptation Center,

n.d.
67
Respond to the NEED not the behavior
Use Connection and Relationships
L Looking through a Trauma Informed Lens
Ask: What happened to this person?
Not: What is wrong with this person?
Childrens Resilience Initiative
SKILL BUILDING

Think: lack of skill not intentional

misbehavior
Think: building missing skills not shaming
for lack of skills
Think: nurture not criticize
Think: teach not blame
Think: discipline not punishment
 Defense Mechanisms
Why are defense mechanisms so hard to stop?

What breaks down defense mechanisms?

 Trauma Informed Approach
A Trauma-Informed Approach:

Realizes widespread impact of trauma and understands

potential paths for recovery;

Recognizes signs and symptoms of trauma in students, families,

staff, and others involved with the system;

Responds by fully integrating knowledge about trauma into

policies, procedures, and practices; and

Seeks to actively resist re-traumatization."

(SAMHSA, 2015)

72
 Traumatized Students in School

Schools can help traumatized children when they:

Maintain usual routines
Provide choices
Address inappropriate behavior with clear, firm limits
Develop logical (non-punitive) consequences

(NCTSN, 2008)

73
 Traumatized Students in School
Provide safe and appropriate place for students to talk
Be aware of triggers in school environment
Provide additional support for anticipated difficult times
Warn students before potential triggers, even if they are
standard for school environments

(NCTSN, 2008)

74
 Traumatized Students in School
Consider whether behaviors are trauma-related/trauma-driven
Expect children to re-enact traumatic events
Protect children from peer curiosity
Make appropriate referrals

(NCTSN, 2008)

75
 Educators Can
Respond to the need .Not react to the behavior
Educate
Collaborate
Advocate
Kids who are experiencing the toxic stress of severe and chronic
trauma just cant learn. Its physiologically impossible. Jim Sporleder
 Trauma Informed System
A service system with a trauma-informed perspective is one in which programs,
agencies, and service providers do the following:
1. Routinely screen for trauma exposure and related symptoms
2. Use culturally appropriate evidence-based assessment and treatment for
traumatic stress and associated mental health symptoms
3. Make resources available to youth, families, and providers on trauma
exposure, its impact, and treatment
4. Engage in efforts to strengthen the resilience and protective factors of youth
and families affected by and vulnerable to trauma
5. Address parent and caregiver trauma and its impact on the family system
6. Emphasize continuity of care and collaboration across youth-serving systems
7. Maintain an environment of care for staff that addresses, reduces, and treats
secondary traumatic stress and increases staff resilience
 CASE STUDIES
At the beginning of her fifth grade year, Denise was a very outgoing and engaged
student. However, lately she has been very quiet in class and rarely raises her hand or
speaks unless prompted directly by the teacher. She has started complaining of
stomach pains and headaches and frequently visits the school nurse. Denise has also
recently missed several days of school. (p. 13)

Tom is walking to lunch in the cafeteria when his classmate Marc bumps into him in
the crowded hallway. The student's eighth grade math teacher, Ms. Clark, hears Tom
and Marc begin to yell at one another and steps into the hall just as Tom punches
Marc in the face. Ms. Clark and her colleague Mr. Jones step in to break up the fight.
This is the third fight Tom has been in this school year. (p. 12)
http://www.elc-pa.org/wp-content/uploads/2015/06/Trauma-Informed-in-Schools-Classrooms-FINAL-
December2014-2.pdf
 Secondary Traumatic Stress
The emotional duress that results
when an individual hears about the
firsthand trauma experiences
of another.

(NCTSN, n.d.(a))

79
 Secondary Traumatic Stress and Self-Care
Primary Traumatic Stress
Secondary Traumatic Stress/Compassion Fatigue
Self-Care and Wellness

80
 Recognize Secondary Traumatic Stress
Increased irritability or impatience with students
Difficulty planning classroom activities and lessons
Decreased concentration
Denying that traumatic events impact students
Feeling numb or detached
Intense feelings/intrusive thoughts about students trauma ,
that dont lessen over time
Dreams about students traumas
(NCTSN, 2008 citing Figley,
1995)
81
 Self-Care
Recognize compassion fatigue
Keep perspective
Eat well
Exercise
Participate in fun activities
Take breaks during the workday, as possible
Other, individual-specific

82
 A Few Misconceptions
- Children will forget traumatic incidents
- All who experience trauma need help
- We can predict
who will be affected by trauma
impact of trauma
- One cannot heal from trauma
- If you are strong, you will not be impacted by
trauma
 References
Adoption and Foster Care Analysis Reporting System (AFCARS). Children's Bureau. U.S. Department of Health and Human
Services, Administration for Children and Families (ACF). http://www.acf.hhs.gov/programs/cb/research-data-
technology/statistics-research/afcars

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington,
DC: Author.

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence
Prevention (June 24, 2016). About the CDC-Kaiser ACE Study. Retrieved
fromhttps://www.cdc.gov/violenceprevention/acestudy/about.html.

Child Welfare Information Gateway (2001). Understanding the Effects of Maltreatment on Early Brain Development.
Retrieved from https://www.childwelfare.gov/pubPDFs/earlybrain.pdf

Conradi, L. (2012). Chadwick Trauma Informed System Project. P. 54

Courtois, C. A. & Ford, J. D. (2009). Treating Complex Traumatic Stress Disorders. Guilford Press.

DifferenceBetween.info http://www.differencebetween.info/difference-between-sympathetic-and-parasympathetic

Grogger, J.T. (1997). Local Violence and Education Attainment. The Journal of Human Resources 32(4):659-682

84
 References
Halligan, S. L. & Yehuda, R. (2000). Risk Factors for PTSD. PTSD Research Quartley, 11(3)
http://www.ptsd.va.gov/professional/newsletters/research-quarterly/V11N3.pdf.
Harris, M. and Fallot, R. (Eds.) (2001). Using Trauma Theory to Design Service Systems. New Directions for Mental Health
Services. San Francisco: Jossey-Bass.
Hurt, H., Malmud, E., Brodsky, N.L., and Giannetta, J. 2001. Exposure to violence: Psychological and academic correlates
in child witnesses. Archives of Pediatrics; Adolescent Medicine 155(12):1351-1356. Kendall-Tackett, K. 2003
Jim Casey Youth Opportunities Initiative. Trauma Informed Practice with Young People in Foster Care. Issue Brief #5.
http://www.jimcaseyyouth.org/sites/default/files/documents/Issue%20Brief%20-
%20Trauma%20Informed%20Practice.pdf
Fang, X., Brown, D.S., Florence, C. & Mercy, J.A. (2012). The Economic Burden of Child Maltreatment in the United States
and Implications for Prevention. Child Abuse and Neglect, 36(2); 156-165.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3776454/
Felittie, V. J., & Anda, R. F. (2010) Adverse Childhood Experiences
Felittie, V.J., Anda, F.A., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, B.A., Koss, M.P., & Marks, J.S. (1998).
Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults.
American Journal of Preventative Medicine. 14(4), 245-258.

85
 References
Figley, C.R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the
traumatized. New York: Brunner/Mazel, Inc.
Lesli et. Al. (2005). Developmental and Behavioral Pediatrics, 26(3), 177-185
Mental Health Connection of Tarrant County http://www.recognizetrauma.org/statistics.php
The National Child Traumatic Stress Network. Creating Trauma-Informed Systems.
http://www.nctsn.org/resources/topics/creating-trauma-informed-systems
National Child Traumatic Stress Network (n.d.(a)). Secondary Traumatic Stress. Retrieved from
http://www.nctsn.org/resources/topics/secondary-traumatic-stress
National Child Traumatic Stress Network. (2008) Trauma Toolkit for Educators. Retrieved from
http://www.nctsn.org/sites/default/files/assets/pdfs/Child_Trauma_Toolkit_Final.pdf
National Child Traumatic Stress Network (n.d.(b)) Types of Traumatic Stress. Retrieved from http://nctsn.org/trauma-
types
Pecora, P. J., Kessler, R. C., Williams, J., OBrien, K., Downs, A. C., English, D., White, J., Hiripi, E., Roller White, C.,
Wiggins, T., and Holmes, K. (2005). Improving family foster care: Findings from the Northwest foster care alumni study.
Seattle, WA: Casey Family Programs.

86
 References
Perry, B.D. & Szalavitz, M.(2007). The Boy Who Was Raised As A Dog. Philadelphia, PA. Perseus Book Group.
Rees, P., Booth, R., & Jones, A. (2016). The emergence of neuroscientific evidence on brain plasticity: Implications for
educational practice. Educational & Child Psychology, 33(1), 8-19.
Sokol, R. J., Delaney-Black, V., & Nordstrom, B. (2003). Fetal Alcohol Spectrum Disorder. Journal of the American Medical
Association, 290(22), 2996-2999.
Substance Abuse and Mental Health Services Administration. (2014) SAMHSAs Concept of Trauma and Guidance for a
Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD:
Substance Abuse and Mental Health Services Administration. (2014) SAMHSAs Concept of Trauma and Guidance for a
Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health
Services Administration. Retrieved from http://store.samhsa.gov/shin/content/SMA14-4884/SMA14-4884.pdf
Substance Abuse and Mental Health Services Administration (August 14, 2015). Trauma-Informed Approach and Trauma-
Specific Interventions. Retrieved from http://www.samhsa.gov/nctic/trauma-interventions

87