School recovery through PACE and a plea to policy makers – inspired by chapter 8 of Boy who was Raised as a Dog

Chapter 8 illustrates the impact of toxic stress on an adolescent more vividly than anything most of us at book club last week had ever read.  The aim of this post is to use Amber’s story as a reference point against which to consider the lockdown-fuelled stressors bearing down on vulnerable children right now and then to look at how schools might mitigate some of that toxicity through a focus on Kim Golding’s attitude of PACE.

I’ll suggest some of the things that I think need to change in schools, especially in relation to behaviour policy and practice, for PACE approaches to stabilise those children whose stress response systems will be in need of consistent regulating experiences after lockdown.

The post concludes with a call on Westminster to flip the narrative around school recovery such that it focuses squarely on pupil wellbeing, following the example set by Welsh Minister for Education, Kirsty Williams. If ministerial guidance for English schools creates the kind of pressure cooker that stems from focusing narrowly (and counter-productively) on academic progress alone, then the most vulnerable will pay the heaviest  price.

That’s fact, not alarmism – it’s what we know from a plethora of research such as this about the impact of disasters on the most disadvantaged. We can expect, if we are not biologically-informed in the way that we meet vulnerability, a sharp increase in ‘conduct disorders,’ emotional disturbance and exclusion. Let’s use all of the very good evidence that we have at our disposal to avoid that.

Amber’s Story

Amber was found unconscious in her high school toilets. Her condition worsened in ER when her heart suddenly stopped beating and Dr. Perry arrived on the scene just as she was being revived and stabilised. He spoke to Jill, Amber’s distraught mother, whilst numerous tests were being undertaken to identify the cause of the problem.

Noticing evidence of recent self-harm, Dr. Perry asked Jill whether anything had happened to distress her daughter. It transpired that Amber had answered the phone to an ex boyfriend who called unexpectedly the night before. ‘Duane’ had been thrown out eight years previously, when Jill discovered him in bed with her then 9 year old daughter, whom he had sexually abused for several years.

Dr. Perry explains to the reader that many ‘cutters’ have a history of trauma, the self-mutilation inducing a dissociative state, similar to the adaptive response of escaping somewhere safe in the mind to survive the experience of the traumatic event itself. Such dissociative states, from dreamlike absences at one end of the spectrum to loss of consciousness at the other, are linked with the release of high levels of opioids, the brain’s natural heroin-like substance that kills pain and produces a calming sense of distance.

Whilst medics were extremely skeptical about this explanation for Amber’s condition, they agreed to try naloxone just as if she had overdosed on heroine, and the results were indeed rapid. She was conscious within 90 seconds of receiving the injection and Dr. Perry’s work with her, once he had gained some trust (using elements of PACE), could begin.

It is important to note that those who respond to extreme, prolonged or uncontrollable stress like Amber, through freeze or dissociation, might not be visible to us as educators, unlike others whose survival strategies tend towards flight or fight. This is one of the many reasons that trauma-informed practice is a matter of whole school culture and practice, not merely targeted intervention for individuals. It’s a community commitment. It’s a way of being with children, many of whom struggle silently.

Why we should be very concerned about toxic stress

The ACE study should have been a public-health game-changer and will need to be now. This animation from Public Health Wales is a quick but powerful summary of its key messages and here is an excellent free, one hour and certificated e-module from Barnardos and partner organisations. Leaders might want to consider sharing these resources with staff before schools reopen, as essential CPD if they are to prepare for the professional challenges ahead, when children return from stress-filled households profoundly impacted by the pandemic.

There are ten types of childhood trauma measured in the ACE Study. Five are personal — physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect. Five are related to other family members:

• an alcoholic parent (read this in relation to the pandemic)
• a mother who’s a victim of domestic violence (read this about our soaring rate of DV)
• a family member in jail (lockdown currently distorting this data)
• a family member diagnosed with a mental illness (alarming impact of Covid on mental health covered here)
• the disappearance of a parent through divorce, death or abandonment (flagged in this research from the Lancet.)

Each type of trauma counts as one for the purpose of the ACE study. (Health warning – it’s a survey not an assessment and shouldn’t be used to ‘score’ pupils.) So a child who’s been physically abused, with one alcoholic parent, and a mother who has experienced DV has an ACE score of three. However, there are, of course, many other types of childhood traumas — racism, bullying, watching a sibling being abused, losing a caregiver (grandmother, mother, grandfather, etc.), homelessness, surviving and recovering from a serious accident, involvement with the juvenile justice system, and so on. Equally, the impact of one ACE might be just as devastating as the experience of ten, especially if it happened very early in life. However, the ACE study remains the most compelling data we have about the lifelong and indeed intergenerational impact of stressful events during childhood and it’s data that we cannot afford to ignore any longer.

We know then that ACEs are increasing at an exponential rate as this pandemic plays out. The graphic below, from Young Minds, refers to a population study undertaken in England before coronavirus. Even then, and linked with austerity, ACEs were very common.

We know that, in the absence of buffering relationships, ACES lead to a multitude of illnesses in middle age and ultimately to premature death. The full report from Young Minds is worth reading.

The pandemic is not only a current public health emergency, therefore, but one that will continue for generations to come if we don’t respond to it in an evidence-informed way. Schools are clearly key players, as communities that can wrap around and soothe children who return with toxic levels of stress coursing through the system. (Without getting bogged down in the neuroscience, and I am an educator, not a scientist, its cortisol that does the lasting damage) There is hope, therefore. There is an abundant supply of want children need to bounce-back – consistent and caring adults.  Research overwhelmingly shows that social buffering is the root of resilience. But this needs to be proactively created by leaders, because the young people who need us the most tend to push us away:

PACE was developed as a way around this problem, within the therapeutic parenting field, but its potential for use in schools is, for me, enormous. I think the warmest, most nurturing school communities are already imbued with it and I’ve worked with some  individual teachers whose inclusive practice has been underpinned by an intuitive understanding of the need to regulate highly sensitised children through PACE. I think it can be traced in Mark Goodwin’s wonderful piece about school recovery here. So PACE principles are not revolutionary, necessarily, but they are paradigm shifting.

Playfulness, Acceptance, Curiosity, Empathy

Playfulness

This is described by the DDP Network (which I borrow heavily from in this section) as being about creating an atmosphere of lightness and interest when communicating with vulnerable children and young people. “It means learning how to use a light tone with your voice, rather than an irritated or lecturing tone. It’s about having fun, and expressing a sense of joy.”

It’s not suggesting that teachers need to become stand-up comedians, but rather that they should endeavour to adopt a playful stance. This can diffuse difficult situations and forge connections. In the pandemic age, with crushing worries, uncertainty and stressors so acutely felt at home by many, not to mention death and devastation on the news daily, children and young people will have felt the loss of those feel-good hormones that are released when we laugh. We know too that social bonds between humans are strengthened by social fun and laughter, so playfulness is a protective factor. It’s also highly rated by pupils: categorised as Fun and Funny in this YouGov poll from 2018, it’s topped only by Kindness, which is actually the essence of PACE.

The strongest school communities make time for fun, inside and outside the classroom. Pudsey days, staff v pupil rounders, end of summer barbecues, trips to the panto, even the prom – they’re all about having fun together. Staff can relax, interact more informally with children, delight in them, forge bonds. The saddest thing in education is the barring of vulnerable pupils from such events as ‘consequences’  – thereby denying them the very experiences they need to thrive. This is the kind of medicine that kills the patient and it should be purged from the post-pandemic era. Consequences yes; vengeful, ostracising ones – no.

Acceptance

Unconditional acceptance is at the core of the child’s sense of safety. It is therefore also at the core of regulated behaviour – dysregulation being in essence a search for safety, driven by the brainstem and not the cortex which gives way when we feel threatened.

Creating acceptance within vulnerable children means actively communicating they we accept the wishes, feelings, thoughts, urges, motives and perceptions that are underneath any unwanted outward behaviour. It is about accepting, without judgment or evaluation, a person’s inner life. The child’s inner life simply is; it is not right or wrong.

(DDP Network)

Of course, the PACE-informed teacher may be very firm in limiting behaviour but will at the same time accept the motives for the behaviour. This way, the pupil learns that while behaviour may be criticised and limited, this is not the same as criticising the self and the relationship remains intact.

It is worth reflecting on behaviour policy at this point because some consequences deliver an intolerably heavy blow to a child’s sense of acceptance. A book club member reported that her school stopped issuing fixed term exclusions some years ago, when staff observed that it worsened children’s behaviour on return. This is entirely consistent with what we know about access to the regulating cortex when we feel threatened…and make no mistake, anything that pushes the human being out of the clan is registered by the ancient brain as a threat to life.

The repeated experience of fixed term exclusion, or isolation, is hugely detrimental to the wellbeing of children and young people with alternative strategies, around lowering demands such that the dysregulated pupil can build resilience over time, needed instead. In Lincolnshire, schools use a PSP in these situations with many more children and young people successfully included as a result of their solutions-focused flexibility.

Curiosity

Curiosity, without judgment, is how we help children become more aware of their inner life and able to reflect on the reasons for their behaviour. It is wondering about the meaning behind the behaviour, for the child. It links to a mantra within the trauma field, that we ask what happened to you, not what’s wrong with you.

In the school context, it is important to convey a sense of curiosity about what might have triggered an explosive incident, rather than just relationship-risking opprobrium. Kim Golding’s connection before correction is a superb step-by-step guide to this. Clearly, the approach requires the adult to be regulated. And it might feel clunky at first. Without doubt, it takes a few minutes longer than the swift direction to isolation that is the modus operandi of some secondary schools. But it is rooted in our understanding of the neurobiology of stress.

Connection* “Tyler, what I think happened there was that you felt really overwhelmed. I know there’s a lot going on at home at the moment – you’re worried about your mum and you’re arriving at school with your stress bucket pretty full. It doesn’t take much for it to spill over and I think that’s what we saw back then. Do you think that might be about right?”

Tyler might not reply, or he might think his teacher is completely wrong. But one thing is certain, he will have been soothed by these words because they communicate unconditional acceptance. More than that, they say to Tyler, here is an adult really trying to get me. Not condemning or judging me but curious, interested and seeking to understand.

*possible only when the child is out of crisis, with thinking brain online

Correction “But Tyler, it’s not ok for you to throw my books on the floor.”

And a consequence may then be needed, depending on the gravity of the incident, whether others were harmed. However, provided the experience is not shaming, a logical consequence will not overwhelm even the most highly-sensitised pupil if it is clear that the relationship remains intact and safe – stronger, even, for those moments of connection.

Empathy

Tyler, it must be really scary to feel out of control like that. Trust me, it’ll get better and I’m always here to help you, but right now it’s hard for you and I just want you to know that I’m really sorry about that.

With empathy, the teacher is demonstrating that he or she knows how difficult an experience is for the pupil and that comfort and support is available. Empathy is indistinguishable from kindness: the quality that pupils rate twice as highly as any other. (Oftsed makes reference to ‘fairness’ in its Handbook – assuming that children interpret this in the crudest possible way, as treating everyone exactly the same despite the scale of their personal challenges. I would posit that they don’t, having worked with thousands of them, but look anyway at how low fairness ranks, next to kindness.)

If children are to heal, then staff will need to be empathic and another training resource, just as important as the ACES material, is this brilliant animation about empathy as driver of human connection from the great Brene Brown. It has the added advantage of being wonderfully playful.

Plea to policy-makers

Clearly, pressurised or burnt-out teachers cannot interact with PACE – it requires huge reserves of compassion and regulation within the adult. If we are to protect the wellbeing of children and young people, then we must prioritise the wellbeing of their teachers and TAs. Strong leaders will do their best to ameliorate the full impact of the ‘catching-up’ agenda, but it would be better if this were replaced altogether with priorities more humane.

In practical terms, this means slimming down GCSE content for the current Y10. Speaking at a ResearchEd event recently, Dylan Wiliam used the word ‘immoral’ to describe the mountain of GCSE content that casts its shadow over KS4. (Story here) Having seen this volume crush one of my own daughters, I am inclined to agree with him. She’s Year 11 so it’s over now but when I asked her how she felt she would have coped as a Year 10 learner faced with the challenge of catching-up post-lockdown, I saw her blood run cold. (I must emphasise here, the school have been fantastic – there is nothing leaders can do about the exam system, apart from allow pupils to drop GCSEs when they sink – which we did.)

Ofqual has already mooted the idea of slimmed down exams for the current Y11 to sit during the autumn if they are disappointed with their grades this summer. These need to be used in the 2021 exam series too – so that teachers can ‘pace’ their work, in the fullest sense of that word. The Welsh minister for education has already advised that performance tables and national testing will be suspended. That should be the case on this side of the border too.

Those who assume that very, very few children will return to school traumatised (quoting leader of a flagship MAT last week) – and are therefore not preparing for this eventuality – would be well advised to read the ACES research and every one of the articles I linked in this post about the tsunami of adversity that is gathering and how that will effect children and young people. There is a clear need, exposed by a lets not assume children will be impacted attitude, for the DfE to launch a nationwide trauma-informed workforce development programme.

Edward Timpson recommended this very thing in his Review of School Exclusion of course – but then the department went on to launch its 10m behaviour hubs project, branding it a “crackdown on bad behaviour.” Just this week, a further 1.5m was found for a school leadership programme, aimed exclusively at those leaders with a strong record of traditional ‘behaviour management’. It’s almost as if Timpson wasted his time, and that of a great number of contributors.

Whilst any expenditure of public money that will widen the disadvantage gap and drive exclusion (if it’s taken seriously) is a matter of deep regret, I want to conclude on a hopeful note. It’s that we are seeing a grassroots movement gather momentum as a result of this pandemic. Ideologically motivated DfE projects will come and go but I do believe that psychologically informed practice is here to stay.