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Trouble concentrating in class.
Not completing homework.
These outcomes are linked to exposure to adverse childhood experiences (ACEs). ACEs, such as abuse or parental substance abuse, can trigger the biological toxic stress response and hinder school learning, behavior, attendance, and academics.
That’s why, in December 2020, Dr. Nadine Burke Harris released her Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health.
Salud America! is exploring the report as part of its 11-part series on toxic stress.
Below are primary prevention, early detection, and early intervention strategies for education personnel to address ACEs and toxic stress among Latino and all people.
“Given their high-quality and prolonged daily contact with children, educators play a critical role in providing the daily doses of nurturing interactions that are key to buffering the toxic stress response,” Burke Harris’ roadmap states.
Primary Prevention Strategies in the Education Sector
Primary prevention includes efforts that target healthy individuals and aim to prevent harmful exposures and behaviors from ever occurring.
The goal is to reduce adversity and increase the buffering effects of a positive adult relationship.
For the education sector, this means universal positive school climates that emphasize safety, kindness, empathy, inclusiveness, and predictable rules and routines.
After all, children spend the better part of their lives in K-12 education.
Achieving the safe, supportive, and nurturing relationships and environments necessary to buffer against toxic stress, depends on the wellbeing of school personnel.
Thus, ensuring all staff understand the impacts of ACEs and toxic stress on behavioral, relational, educational, and health outcomes and understand the protective effects of safe, stable, nurturing relationships is a critical component of primary prevention.
Ensuring staff wellness is also a critical component of primary prevention.
“The ability of adults to proactively model kindness and empathy to promote supportive, safe, and nurturing learning environments is greatly reinforced by their understanding of the impacts of ACEs and toxic stress on school functioning, and also on their own resilience to vicarious trauma and burnout,” Burke Harris’ roadmap states.
Health promotion programs, such physical activity, mind-body practices, nutrition, and employee assistance can help.
“Key to establishing trauma-sensitive and trauma-responsive educational environments is recognition and response of the prevalence of ACEs among educators and prevention of vicarious trauma and burnout,” Burke Harris’ roadmap states.
Strategies for children and staff should start in the early years in early child care and education before formal K-12 education and extend to late adolescence and early adulthood in higher education.
“Early education and care for children from birth to five years also counts as primary prevention of ACEs and toxic stress because it targets a particularly critical period for healthy development and lays the foundation for long-term preventive health and education benefits,” Burke Harris’ roadmap states.
Early education interventions and programs like the Carolina Abecedarian intervention and High/Scope Perry Preschool Program have found reduced blood pressure, heart disease risk, and criminal activity as well as higher lifetime earnings.
Early education programs are important for Latino children who are at risk of not getting the proper services and environments needed for healthy formative development.
“Culturally-sensitive programs and policies can prevent or reduce the effects of traumatic childhood experiences, improve mental health, and boost school readiness,” according to a Salud America! research review.
Amid COVID-19, schools are tasked with addressing social-emotional wellbeing more than ever.
In addition to disrupting children’s academic opportunities, the pandemic has also disrupted important relationships and exposed new and difficult physical, emotional, health, and financial strains in the home, which simultaneously increases adversity and reduces buffering support.
The California Department of Education provides guidance to address these issues in Stronger Together: A Guidebook for the Safe Reopening of California’s Public Schools.
Early Detection Strategies in the Education Sector
Early detection aims to identify and target individuals who have risk factors or are showing signs of toxic stress to build protective factors and provide support.
While the healthcare sector is charged with ACES screening, the education sector should understand how to recognize and respond to the signs and symptoms of toxic stress.
For example, a child who has experienced ACEs may be hyper-aroused and have trouble sitting still, may be aggressive and appear oppositional, or may be spaced-out and appear unmotivated. They may engage in risky behavior or may have somatic complaints, such as headache and abdominal pain.
Schools should also be prepared to connect students and families to community resources.
The following strategies to respond to symptoms and help reduce the impact of toxic stress can be applied in the school setting, at home, and in coordination with healthcare providers:
- Supportive relationships
- High-quality, sufficient sleep
- Balanced nutrition
- Regular physical activity
- Mindfulness and meditation
- Access to nature
- Mental and behavioral healthcare
“Nature most likely improves health for children and adults with toxic stress by directly calming the stress response system, as well as by increasing healthy behaviors such as physical activity, mindfulness, and relational health,” Burke Harris’ roadmap states.
The Handle With Care program is one way to give schools a heads-up to be on the lookout for signs and symptoms of trauma so they can respond by providing extra precautions in supporting students.
The program establishes coordination between law enforcement and schools to notify schools when police encounter children at a traumatic scene, so that school personnel are prepared to respond to children who exhibit signs of trauma in a particularly nurturing way.
Without revealing any information about the incident, the notification simply lets schools know that a child should be handled with care in the days to come.
“All of these efforts support building school capacity for students exposed to ACEs to learn in a safe, supportive environment with the promotion of nurturing relationships both inside and outside school,” Burke Harris’ roadmap states.
In California, the Healthy Environment and Response to Trauma in Schools (HEARTS) program utilizes the Multi-Tiered System of Supports (MTSS) model with the following strategies to incorporate assessment and response to toxic stress and build capacity of school personnel:
- Train personnel on the effects of complex trauma and trauma-informed practices
- Promote staff wellness by addressing stress, burnout, and vicarious trauma
- Regular meetings with school leadership and key school staff to build competency and skills to implement trauma-informed supports and systems
- Focusing on restorative justice principles and reducing racial disparities in disciplinary action
- Professional development training and consultation for school personnel and community partners
- Workshops for parents and caregivers
Early Intervention Strategies in the Education Sector
Early intervention includes efforts to target students that already exhibit negative behavioral and educational outcomes to minimize re-traumatization, escalation, and worsening outcomes.
In addition to the strategies mentioned above for primary and early detection, early intervention strategies also need to address and prevent existing problems, such as chronic behavioral or learning difficulties, chronic absenteeism, and school suspension, expulsion, or dropping out.
- School-based health services
- Restorative disciplinary strategies that emphasize redirection, de-escalation, and time in the classroom
- Coordination between school and healthcare personnel, to include targeted health and mental health interventions, family-based treatment, and coordination of a student’s Individualized Education Program (IEP)
- Wraparound services that include healthcare, social services, therapeutic counseling, and trauma-specific therapy
- Parent education and involvement
- After-school programs for juvenile offenders, similar to Project Back-on-Track
This is where the Handle With Care notification can help in the promotion of sleep, nutrition, physical activity, relationships, mental healthcare, mindfulness practices, and access to nature as mechanisms for regulating toxic stress.
In California, Project Cal-Well utilizes the Multi-Tiered System of Supports (MTSS) model with the following intervention strategies to incorporate assessment and response to toxic stress to address adversity:
- Positive Behavioral Interventions and Supports (PBIS)
- Trauma-informed care
- Restorative Practices in Schools
- Youth Mental Health First Aid
- Suicide prevention policies and trainings
- School-based health services and group counseling
- Intensive mental health interventions
“When public schools increasingly rely on school resource officers to discipline students at school, school-based arrests go up,” Burke Harris’ report states.
What Can We Do About Toxic Stress?
Share our Salud America! team’s 11-part exploration into the important recommendations in Dr. Nadine Burke Harris’ roadmap to address ACEs and toxic stress:
- Toxic Stress and its Lifelong Health Consequences.Toxic stress is a public health crisis that has lifelong impacts on physical, mental, and behavioral health.
- We Need to Recognize Toxic Stress as a Health Condition with Clinical Implications. Health experts are pushing to elevate toxic stress and developmental trauma on national research and policy agendas.
- Cut Toxic Stress with 3 Types of Public Health Prevention Interventions. Preventing toxic stress requires a three-level public health intervention approach.
- How to Use Healthcare Strategies to Address Toxic Stress. In clinics, hospitals, and other healthcare settings, workers can provide universal trauma-informed care and more.
- Using Public Health Strategies to Address Toxic Stress. When it comes to ACEs and resulting toxic stress, the public health sector can play a critical role by strengthening economic support, positive family relationships, and social services.
- How to Use Social Service Strategies to Address Toxic Stress. We need trauma-informed training for social workers, as well as family-friendly workplaces and home visits.
- Toxic Stress in Early Childhood and How to Prevent It. Early childhood is a key time for preventing ACEs and toxic stress.
- Toxic Stress in Justice and How to Address It. Encounters with police are “intrinsically stressful and potentially traumatic,” especially for youth of color.
- Toxic Stress in Education and How to Address It. ACEs and toxic stress can hinder a person’s learning and school success. (current article)
- California’s Epic Response to Toxic Stress and ACEs. California, already leading the nation in addressing ACEs, is making inroads to address toxic stress.
- 5 Upstream Ways You Can Take Action to Address Toxic Stress. Here are ways you can take action to address toxic stress.
“For staff to effectively implement trauma-informed practices, procedures, and policies, they must have the competency and skills to respond to behavioral, health, relational, and learning difficulties,” Burke Harris’ roadmap states.