Trauma-informed practice. Where do I start?

The short answer to this is with Dr. Bruce Perry’s reversed triangle diagram of the brain, the implications of which need to be understood by all staff, if schools are to meet the greatest challenge of the day: securing the wellbeing of our children. Perry summarises the model in ‘The Boy who was Raised as a Dog’ as follows: 

The human brain develops sequentially in roughly the same order in which its regions evolved. The most primitive, central areas, starting with the brainstem, develop first. As a child grows, each successive brain region (moving out towards the cortex), in turn, undergoes important changes and growth. But in order to develop properly each area requires appropriate timed, patterned, repetitive experiences. The neurosequential approach to helping traumatised and maltreated children first examines which regions and functions are underdeveloped or poorly functioning and then works to provide the missing stimulation to help the brain resume a more normal development.

These interconnected regions of the brain are wired so as to ensure survival. All incoming sensory signals from the outside world and from the body (the inside world) are first processed in the brainstem. This lower region then passes that information up to higher areas for sorting, integration and interpretation. 

If the incoming sensory material is familiar or felt from prior experience to be ‘safe’, the brainstem does not activate a stress response. However, if the incoming information is unfamiliar or previously associated with threat, pain, or fear, a stress response is activated – before the information can reach the higher, thinking part of the brain. This stress response interferes with accurate cortical processing by shutting down certain areas of the cortex, to a greater or lesser extent, depending on the height of arousal. 

Highly sensitised, traumatised children are frequently activated by apparently inconsequential stimuli and this is the root of their manifest difficulties in school.

Eye contact for too long may be perceived as a life-threatening signal. A friendly touch on the shoulder may remind one child of sexual abuse by a stepfather. A well-intentioned gentle tease to one may be a humiliating cut to another, similar to the endless sarcastic and degrading abuse he experiences at home. A request to solve a problem on the board may terrify the girl living in a home where she can never do well enough. A slightly raised voice may feel like a shout to the boy living in a violent home. (Perry, The Boy who was Raised as a Dog)

These children will at times be quite literally unable to consider the potential consequences of their actions because of the arousal state of their brains. The goal then is to ‘get to the cortex’….over time, to widen the window of tolerance (the stressors that can be endured) so that pupils can settle, learn and thrive. Put simply, this involves moving from the bottom of the brain to the top through Perry’s 3 Rs of Regulate, Relate and Reason.

Regulate

(Brainstem and midbrain – the sensory motor brain)

Help the child to regulate and calm their stress responses – fight, flight, freeze. Offer soothing comfort and reassurance. (Perry)

Every adult within school, from site-manager to headteacher, should be ready and willing to ground and regulate a fellow human being in distress. It needn’t be difficult, though it does require the adult to be regulated. Perry is clear that, because of the mirroring neurobiology of our brains, one of the best ways to help another become calm and centred is simply to be present for them, calm and centred ourselves. Emotional contagion means that the reverse is also true of course – dysregulated adults dysregulate children. This is why staff wellbeing is such a high priority within the school that priorities high quality pastoral care.

However, we obviously want children to be able to develop strategies that they will be able to draw upon to regulate themselves, ultimately. Self-soothing techniques, if you like. These need to be introduced and practiced when children are calm, and emotionally intelligent school communities will share the learning with all pupils, not least so that they are in the best possible position to support their struggling peers.

This excellent resource suggests a number of grounding and regulating strategies, from deep breathing exercises to muscle relaxation. Every child is different and will benefit from a different approach, so it’s important to practice a range, possibly as brain breaks within lessons. I find it very helpful to watch demonstrations (never personally having been taught this stuff) and in this regard Dr. Karen Treisman’s relaxation and emotional regulation  videos are invaluable. She stresses the importance of repetition, if lasting and therapeutic change is to occur.

Walking is of course rhythmic, repetitive and grounding and it is worth noting here that the practice of requiring dysregulated children to stop walking and to stand still, perhaps against a wall, only succeeds in escalating the threat and shutting down the cortex. Furthermore, trauma is rooted in the experience of utter powerlessness and power-over adult behaviours are therefore dangerously retraumatizing. Many exclusions would have been avoided were this better understood. The adult who walks alongside, calming and connecting before expecting reason, is the adult we need leading behaviour in our schools, modelling the best practice and not the absolute worst.

Thought needs to be given to the school day itself and whether it is biologically respectful. We are not designed to be still for long periods. There’s a strong case for continuing the Daily Mile activity that many schools have introduced as part of their current childcare offer, this summary of the research.  confirming its benefits, both wellbeing and academic related. 

Not to be confused with discredited ‘brain gym’, stress-reducing classroom brain breaks are also strongly supported by the evidence, as proven here. These could also be utilised as the ten-minute distractor breaks that enable spaced learning, another biologically respectful approach. In addition, sensory circuits are now widely used in primary schools, the motor exercises setting children up for the day, or perhaps for next lesson when they are situated along corridors. 

Relate

(Limbic brain – the emotional relational brain)

Connect with the child through attuned, sensitive relationship. Empathise and validate the child’s feelings so that they feel seen, heard and understood. (Perry)

Articulated quite brilliantly by Kim Golding in this ‘journal paper‘, ‘connection before correction’ is another way of framing the ‘Relate’ stage of the bottom up process. Connection with a distressed child creates relational safety such that reason is possible. Here is psychologist Karen Young’s take on the process:

I know you’re a great human. I know that for certain. That decision you made didn’t end so well, but I imagine there was something that might have felt okay about it at the time. What made it feel like a good idea?’ Then, ‘I get that. I’ve felt that way myself. How do you think it went wrong?’ And finally, ‘What might be a better thing to do next time?’ Or, if needed, ‘Is there anything I can do to make it easier for you to do that?’. Or, ‘Things seem pretty upside down right now. What might you be able to do to put things right?’

Scripts are not difficult to imagine. Their key features are validation of feelings – a child needs to feel seen, heard and understood (“I see you are angry and frustrated and I can understand why”) and empathy (“It must be awful to feel overwhelmed like that.”)

Of course, within inclusive schools, adults understand the importance of making connections with vulnerable and insecure children throughout the day, not just at times of crisis. This is what we mean by ‘therapeutic dosing’. The regulating impact of small doses of kindness should never be under-estimated. As pastoral leaders, how do you know that the young people who need those interactions the most are receiving them?

Relational work needs to be strategic – not left to chance.

We are a deeply social species, our survival having once depended upon group membership. If we don’t relate to children, create within them a sense of belonging and acceptance, then our efforts to reason with them will always be futile because they will feel threatened and activated within a school environment that isn’t psychologically safe.

Reason

(Cortical brain – the great human thinking brain)

Now that the child is calm and connected they are able to fully engage in learning. Heading straight for the reasoning part of the brain CANNOT work if the child is dysregulated and disconnected from others. (Perry)

It is now possible to set limits on behaviour, which clearly we must do for the safety of both school community and child. The question is not whether but how to do this. Perry observes that ‘If we want our children to behave well, we have to treat them well’ (p273) suggesting that radical change is needed to the approach that is traditionally taken:

Troubled children are in some kind of pain – and pain makes people irritable, anxious and aggressive. Only patient, loving, consistent care works: there are no short-term miracle cures. This is as true of the child of three or four as it is for a teenager. Just because a child is older does not mean a punitive approach is more appropriate or effective. Unfortunately, again, the system doesn’t seem to recognise this. It tends to provide ‘quick fixes’ and when those fail, then there are long punishments. We need programs and resources that acknowledge that punishment, deprivation and force merely re-traumatize these children and exacerbate their difficulties. (The Boy who was Raised as a Dog)

This doesn’t mean that rules do not apply, it’s more a matter of how we teach vulnerable children to work within them and how we respond when they slip us, as they surely will. There will inevitably be occasions when it won’t be possible for them to remain in class, for example, and a reliable 3 R respecting plan is needed for such occasions. This would typically involve reporting to a safe base within school where thought is given to repair. For example, When you’re ready, let’s go and pick up your maths book and repair it with some Selloptape. We can then make a small apology card for Sir. Because Sir is trauma-informed, he will accept the apology graciously and ensure that the child knows that there is no rupture to the relationship.

Conclusion

It is important to emphasise that there is nothing suggested within this post that is not achievable if we are creative in our use of all the human and physical resource available within schools. Safe bases don’t need to be spare classrooms; perhaps it’s the clay-room for one  (thinking now about my youngest daughter) or an office for another (mine was always exactly this). 

What is needed if our schools are to rise to the challenges of this pandemic age is not new resources or new services but a new approach, rooted in the science. However, with the current policy focus on traditional behaviour management in mainstream alongside alternative provision for those who flounder, we do not seem to be grasping this. Segregation is not a solution and the evidence is stacked against it, for reasons that Perry explains in biological terms:

Another important implication of our mirrored biology is that concentrating children with aggressive or impulsive tendencies together is a bad idea, as they will tend to reflect and magnify this, rather than calm each other. (The Boy who was Raised as a Dog)

Trailblazing leaders are already proving that their schools are capable of holding, containing and healing distressed children. We must hope that others follow them as they prepare to meet the huge societal challenges of this pandemic age.