Historically, what are the origins of trauma-informed care?
Bloom said that a good place to start might be 1980. That’s when the American Psychiatric Association put a definition of post-traumatic stress disorder back in its diagnostic manual after removing it in 1968, just as wounded soldiers were coming back from Vietnam in large numbers.
“I’m not sure why it was removed. It may have been political – but it meant there was no way to give them a diagnosis entitling them to treatment,” Bloom said.
“Meanwhile, there was all sorts of research coming in about Holocaust survivors, victims of violence and sexual assault, battered-wife syndrome, disasters, different people from very different groups. But it really took a social movement of Vietnam vets, their families, ministers, psychotherapists and psychiatrists to say, ‘This has to change.’”
Part of that change came with the creation of the Adverse Childhood Experiences (ACE) study in 1998; researchers asked subjects whether they had experienced one or more traumatic experiences as children. But were there other key events?
“In 1985, the International Society for Traumatic Stress Studies had its first meeting,” Bloom said. “This provided an organizational home. And it led to looking at the biology and the sociology of exposure to trauma.”
From the ACE study, Bloom said,“researchers drew a real focus on what’s happening to kids, and not just poor kids, kids of color. It proved that trauma is far more common than had been realized.”
The ACE study – and later versions, including one in Philadelphia – didn’t talk about trauma just in terms of violence and abuse. It included experiences like neglect, being bullied, witnessing violence, having a parent who is a drug addict, for example. Isn’t “trauma” an overly broad description of all this?
“Yes, but unfortunately we don’t have an English word that encompasses it,” Bloom said.
Bloom has written that “children who suffer disrupted attachments may suffer from damage to all of their developmental systems, including their brains, and we are particularly ill-suited to having the people we are attached to also be the people who are violating us."
“A traumatic experience impacts the entire person,” Bloom said. “The way we think, the way we learn, the way we remember things, the way we feel about ourselves, the way we feel about other people, and the way we make sense of the world are all profoundly altered by traumatic experience.”
How do researchers sum up “trauma-informed care”?
They say it shifts the way one looks at human problems. It’s a shift from “What’s wrong with you?” to “What happened to you?” and “How can we help?”
Why is this important in a school setting?
“It might be the only place where the kids have a safe and secure environment six to eight hours a day,” Bloom said.
“It’s really critical that everybody in the school system understands this. They may be teaching kids who have been living under really stressful conditions. It affects their learning, their behavior, their social adaptation.”
Is there a biological component to trauma?
Researchers generally agree that there is. Let’s start with cortisol, the so-called “stress hormone” that’s present in everyone. At normal levels, it helps us deal with stress such as physical danger or recovering from an illness.
But for persons subjected to trauma, higher and more prolonged levels can lead to impaired cognitive performance.
“It ends up bathing a kid’s brain with cortisol,” said Roy Wade, the Children's Hospital researcher.
“That’s toxic for your body in many ways. … It increases your heart rate, your blood sugar level,” he said. “High levels of cortisol actually destroy brain cells. … People’s cognitive skills are affected.”
Bruce Perry, a child psychiatrist and trauma expert, offers the example of a person with a normal IQ, in the 100-110 range. If that person is alarmed, he said, the functional IQ could dip to 80 or 90. And if they’re in fear or terror, it’s much lower than that.
The parts of your brain that help you escape a charging bear are different from those that help you do algebra. And for many children, life is a lot like outrunning a charging bear.
“You don’t get a vacation from poverty,” Bloom said. “And often we’re talking about multi-generational poverty.
One sometimes hears the phrase “secondary traumatic stress.” What does that mean?
This is the emotional stress an individual may incur from hearing about the first-hand traumatic experiences of another. It often refers to therapists or welfare caseworkers, but it can also affect counselors, teachers, and other school personnel.
How can we best bring a trauma-informed culture to schools?
Bloom and others said that the key is trauma-specific training. Essentially, this involves learning about the biology of trauma and its effect on brain chemistry, while mastering a classroom strategy in which empathy is the first resort and discipline a last resort.
Principals and superintendents “need to dedicate time for the teachers to learn and process what they’re learning,” Bloom said.
“You don’t make system change for free.”
And it’s particularly tough in a financially stressed system like Philadelphia’s.
“Organizations can be traumatized just as people can, and going from crisis to crisis to crisis is the sign of a traumatized organization,” Bloom said.
Is the fact that a lot of students have been traumatized well before they even get to school a big part of the problem?
“Sometimes the kids’ brains are not ready to be taught,” Bloom said. “You can’t assume that just because a child is 6, they’re ready to sit in a classroom. It’s a massive social denial of where kids are. Teachers really have to understand child development.”
In schools, is there a relationship between curriculum and a trauma-informed approach?
Bloom said that she is concerned that a test-prep culture will lead to cutting back on subjects like music and art in districts across the country.
“Our need to perform may be nature’s antidote to the prolonged suffering of trauma, and should be heartily encouraged rather than minimalized and marginalized,” Bloom wrote 20 years ago in the Journal for a Just and Caring Education.
“It is entirely possible that a healthy arts program in a school of traumatized children may be more important in preparing those children to learn than any other skills we can provide.