Quinn: “Quinn” was a little, 45-pound, 7-year-old, second grader in foster care (with great dimples when he smiled!). He was a pencil tapper while he worked but distracted other students with his pencil-tapping noise. The teacher warned him to stop, but he persisted. The teacher went over and placed his hand on Quinn’s shoulder. Quinn reflexively punched the teacher, ran out of the room, and destroyed another classroom. The school was prepared to expel Quinn for “assaulting” the teacher and destroying property. The principal deemed Quinn a danger to staff and students. What the school did not know was that Quinn had been physically and sexually abused by every caregiver until he entered foster care. When Quinn was touched by the teacher, Quinn’s brain could not register if that was a safe touch or a bad touch.
As Quinn’s attorney, I was prepared to fight to keep Quinn in his regular school. I knew that Quinn would have more difficulty if he were placed in an alternative setting. Instead of seeing Quinn as a “danger,” I wanted the school to consider that Quinn was a great kid but needed to feel safe and supported. I worked with the school to maintain his placement (with some strongly worded legal encouragement regarding Quinn’s educational right to be in the least restrictive setting). In lieu of an expulsion proceeding, the school agreed to conduct a functional behavior assessment and developed a behavior support plan to give him another chance. Quinn remained in the school building, and the teachers received additional training on how to help Quinn feel safe. In addition, Quinn’s foster family ultimately became a long-term adoptive resource.
Lina: “Lina” was an eighth-grade student in foster care who had a connection to her grandmother, but her parents were not involved in her life. One of her projects was to do a family tree. Lina struggled with the project, and during class, another student called her a “dirty foster kid.” Lina punched the student and received a three-day suspension. (Fortunately, the other student was disciplined too). As Lina’s attorney, I had Lina’s permission to have contact with the assistant principal and the guidance counselor prior to the incident. I had a good working relationship with them and kept them apprised of issues related to Lina’s permanency plan. Although Lina served her suspension, the staff understood why Lina reacted the way she did. They brought her back for a transition meeting and asked her if she wanted to have a meeting with the other student or whether she preferred to have her schedule change to avoid that student (or both). Lina chose to have her schedule changed because she had already had a number of run-ins with that student. She was given additional supports in school to help ensure that she felt safe. Lina was ultimately placed with her grandmother under guardianship.
Time to Shift Our Lens to Understand the B.S.
It is often quick and easy for schools to look at students like Quinn and Lina as “behavioral problems.” But I was able to help change the educational trajectory for Quinn and Lina with legal advocacy and an understanding of trauma. When a child’s attorney forges a strong connection with the child and understands the brain science behind the impact of trauma, the child will often have a better chance at obtaining educational success and permanency. To do this, it is important to believe the B.S.! The B.S., or brain science, provides a compelling explanation regarding the profound neurological and physiological changes to the brains and bodies of children who experience adversity from complex trauma and toxic stress. Complex trauma and toxic stress often entail a child experiencing profound, repeated, or prolonged adverse experiences. Children who experience complex trauma are more likely to struggle with self-regulation and academic success. As a result, children’s attorneys need to understand the impact of trauma on the brain and behavior in order to be effective advocates for children in the foster care system, both in the courtroom and the classroom.
Adverse childhood experiences. Trauma often causes significant neurological and physiological changes to children’s growing brains and bodies. The science regarding such changes is robust and compelling. In the 1990s, the Centers for Disease Control and Kaiser Permanente published the Adverse Childhood Experiences (ACEs) Study. Centers for Disease Control & Prevention, Adverse Childhood Experiences (ACEs). The original ACE study surveyed 17,500 adults on their experience with early adversity. The results demonstrated that ACEs are incredibly common and have a strong correlation to significant health and behavioral outcomes for both children and adults. In the original study, having a high ACE score had a strong correlation to increased risks of depression, cancer, stroke, and risk-taking behaviors. As shown in the graph below, the original 10 ACEs were physical, emotional, and sexual abuse; physical and emotional neglect; and household challenges: parental separation, incarceration, domestic violence, substance abuse, and parental mental illness. Notably, this original study showing the prevalence of ACEs was conducted primarily among Caucasian, college-educated individuals who had private health insurance.
In 2013, Philadelphia’s Public Health Management Corporation published an urban ACE survey of 1,700 adults that included additional questions regarding experiences with community violence, bullying, discrimination, and foster care and found the same high-risk correlation. Institute for Safe Families, Findings from the Philadelphia Urban ACE Survey (Sept. 18, 2013). The Philadelphia urban ACE study surveyed a significant percentage of minorities and individuals on Medicaid. The study is generally more aligned with the population of children and families enmeshed in the child welfare system, and it provides an even more compelling correlation between trauma, toxic stress, and neurobiological changes from toxic stress.
An even more recent analysis of states by Child Trends showed that nearly half of all youth in the United States have experienced at least one ACE and almost a fifth have experienced two or more ACEs by the time they are 18. Vanessa Sacks & David Murphey, The Prevalence of Adverse Childhood Experiences, Nationally, by State, and by Race or Ethnicity. The recent data also indicate that children of color (African American, Latino, and Native American) are more likely to experience higher ACE scores than Caucasian children. It is not surprising that ACEs are often more profound and numerous for children involved in the child welfare system and may cause significant neurological and developmental changes to children’s brains, including delayed brain development and educational challenges. B. Fortson, J. Klevens, M. Merrick, L. Gilbert & S. Alexander, National Center for Injury Prevention & Control, Centers for Disease Control & Prevention, Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities (2016).
If we apply the correlations found in the Philadelphia Urban ACE Survey and the Child Trend data, we can deduce that children involved in the child welfare system will likely have a minimum of two ACEs: the event that triggered removal from their families and the subsequent placement into foster care itself. But it is not uncommon for many children in the child welfare system to have even higher ACEs. For example, many of my child clients have eight or more ACEs because, prior to entering foster care, they experienced sexual abuse, physical abuse, emotional and physical neglect, community violence, an incarcerated parent, and a parent diagnosed with mental illness and substance abuse.
The impact of trauma and toxic stress on cognitive and social functioning. How does this impact school-aged youth? Oftentimes, children with complex trauma and toxic stress look at the world as a dangerous place. The neurobiology for many children indicates that they have an overactive fear response system and are more likely to enter a state of fight, flight, or freeze. B.A. van der Kolk, “The neurobiology of childhood trauma and abuse,” 12 Child & Adolescent Psychiatric Clinics of N. Am., 293–317 (2003). In addition to an overactive fear response system in the brain, trauma is stored at a cellular level, so a sight, smell, touch, or sound can trigger a traumatic reaction. Because school is often an inherently stressful and chaotic environment, almost anything can trigger kids. For that reason, complex trauma and toxic stress often cause significant cognitive impacts such as slowed language and speech development, attention problems, and poor verbal memory or recall. Maura McInerney & Amy McKlindon, Unlocking the Door to Learning: Trauma-Informed Classrooms and Transformational Schools (Dec. 2014). Trauma and toxic stress may also overload a child’s ability to navigate social and emotional learning and create difficulty taking someone else’s perspective and difficulty navigating social relationships, as well as emotional dysregulation. Such experiences often leave traumatized children to be mistrustful and guarded with others. Furthermore, trauma and toxic stress have profound impacts on behavior and physiology, including somatic complaints, impulsivity, aggression, defiance, and withdrawal. See Justice Consortium Attorney Workgroup Subcomm., National Child Traumatic Stress Network, Trauma: What Child Welfare Attorneys Should Know (2017).
Given the neurobiological changes that occur from trauma, it is not surprising that children in foster care historically have some of the worst school performance outcomes. Children in foster care are twice as likely to be absent from school. Legal Center on Foster Care & Education, Fostering Success in Education: National Factsheet on the Educational Outcomes of Children in Foster Care (Apr. 2018) (“Download the factsheet” link under Research & Statistics). They are twice as likely to be suspended, and three times as likely to be expelled. They are 35 to 47 percent more likely to be placed in special education. Only about 65 percent of youth in foster care graduate from high school, and only between 3 percent and 10 percent graduate from college. The academic data paint a bleak picture of educational success as a result of the significant impacts of trauma and toxic stress.
How do we help our children succeed in school settings? Individual and systemic approaches. Piecing together the brain science and the data on academic performance for youth in foster care should spark an urgency for us to do more to help our clients. To reverse what seems like such an intractable problem, the Delaware Office of the Child Advocate (OCA) undertook a campaign to train professionals on trauma, address systemic barriers to education, and build resilience in our child clients. We advocate on an individual and systemic level by applying brain science to create strategies to build resilience and suggestions to help keep kids connected in school. The results we have achieved prove that this is not an insurmountable challenge but, instead, with awareness and effective strategies, this is something that we can address and change.
Lessons Learned from Individual Strategies
After reading, researching, collaborating with professionals, and trial and error with various clients, the OCA distilled some major strategies to help educators, judges, and professionals understand what often happens to kids who experience significant trauma and what we can do to help our clients begin to heal.
1. Treat trauma as a universal precaution. Data show that 50 percent of all kids have experienced ACEs and 50 percent of all kids who attend public school live in poverty. See Lyndsey Layton, “Majority of U.S. Public School Students Are in Poverty,” Wash. Post, Jan. 16, 2015. As a result, it is fair to assume that most children both in and out of the child welfare system have experienced some type of early childhood adversity.
Just as doctors and nurses wear latex gloves to administer immunizations or draw blood—no matter what the patient’s health history—all of us should treat trauma as a universal precaution. Assume that the kids we represent have experienced trauma. Having an awareness and understanding of the changes to the brain and how trauma manifests can be very powerful. Such a view helps us change our lens from looking at behavior as pathological or “bad.” Instead, considering trauma as a universal precaution allows us to ask the question “what can I do to help support this child?” By shifting the narrative from what is wrong with the child (and, by extension, the families), we stop blaming the child for negative behaviors. Instead, we can transform our view of children and their families, and focus on what we can do to build resilience in the child (or family).
2. Ask before you touch a child. Hugs, high fives, fist bumps, elbow taps, and handshakes are all great ways to build rapport with child clients. However, many children in foster care have experienced physical abuse, sexual abuse, neglect, or other adversity. Many kids do not look at the world and the adults who are there to “help” as safe. From their view, adults may have let them down repeatedly, so few adults are trustworthy. Before we can build resilient children, we need them to feel safe. Kids who have experienced abuse, neglect, or other adversity may be hyper-vigilant and chronically ready to move toward “fight or flight” as a matter of survival. Like my client Quinn, many kids do not know if a touch from an adult (or anyone) is a safe touch or a dangerous touch.
Asking the child if you can give a hug or high five gives the child a choice and an opportunity to consider the options. It gives the child control over his or her body. It is also a powerful way to build rapport with a child. Over time, asking permission before entering a child’s personal space enables the child to assess whether he or she feels safe. In Quinn’s case, the teacher could have asked Quinn if he could touch his shoulder to divert him from tapping. (The teacher could have even potentially prevented the whole incident by placing felt on the desk so that Quinn could tap and move without distracting others, which would be a more trauma-informed response). Asking for permission builds confidence and self-determination for many kids who often feel they have no control over their lives.
3. Be consistent, and do not make promises you cannot keep. A famous social science study developed in the 1960s by Stanford psychologist Walter Mischel, called the “marshmallow test,” demonstrated that children who delay gratification (by waiting to consume marshmallows) did very well academically and professionally. The concept of the study was for a researcher to offer a child a marshmallow right away or two marshmallows if the child waited for a period of time. The intent of the study was to show whether children can set goals and delay gratification. However, children who experience trauma do not typically do well on such tests to delay gratification—perhaps because they do not find adults trustworthy, they are food-insecure, they are impulsive, or perhaps another reason. When most of the adults in a child’s life fail to keep their promises, it is no surprise that such kids would do poorly on a marshmallow-type test. However, a more recent study conducted by the University of Rochester modified the original marshmallow study and had the researcher build rapport with the child before making such a promise. Once the child spent time with the researcher, the child was more likely to delay gratification and trust the adult to keep the promise of an additional marshmallow. Celeste Kidd, Holly Palmeri & Richard N. Aslin, “Rational Snacking: Young Children’s Decision-Making on the Marshmallow Task Is Moderated by Beliefs about Environmental Reliability,” 126 Cognition 109–14 (Jan. 2013). As a result, the connection and rapport with the adult end up being the key ingredient to enable a child to feel more secure and consequently able to make better choices.
Building rapport and a relationship is a central component to effective representation of children. To build rapport, it is important to show your trustworthiness by being consistent and by making promises only when you can keep them. For example, I had a 12-year-old client, “Jay,” who was extremely guarded with me when I first met him. It took him months to start talking with me, despite my visiting him every month whether at his foster placement, school, or the Boys and Girls Club. One month, I promised him I would take him out for fast food (which he loved!) on a particular Thursday. It turned out there was a blizzard on that Thursday and I was not able to meet with him because of the massive storm. The next time I saw Jay, a few weeks later, he was extremely angry with me because I broke my promise (no matter how legitimate my reason was). It took a while to rebuild my relationship with Jay and to garner his trust again. Jay, and kids just like him, do not trust easily.
Once you have earned a child’s trust, you must maintain it. For that reason, you need to be consistent and keep your promises and, by extension, only make promises you know you can honor. Now when I meet Jay (or any client), I say, “I will come visit you in a couple of weeks.” That gives me plenty of time to honor my promise. Keeping promises not only builds rapport with clients—it also builds resilience for kids who have experienced trauma by building a safe relationship with a trusted adult. See Bari Walsh, “The Science of Resilience: Why Some Children Can Thrive Despite Adversity,” Usable Knowledge, Mar. 23, 2015 (quoting Jack Shonkoff, director of the Center on the Developing Child at Harvard: “Resilience depends on supportive, responsive relationships and mastering a set of capabilities that can help us respond and adapt to adversity in healthy ways.”).
4. Teach kids to make things right. It is normal for kids to make mistakes—that is how they learn. However, the difference for children in foster care is that oftentimes their mistakes have huge consequences. Their mistakes may disrupt a foster placement or a school placement, or create an entanglement with the juvenile justice system without an opportunity to make things right and learn from their mistakes.
For example, I had a client, “T,” who had a long rap sheet for juvenile adjudications related to her aggressive and impulsive behavior. T had an extensive trauma history, and I was one of the few adults she trusted because I showed up to support her every time she was charged. After each juvenile delinquency charge, T and I would talk. I would always ask her two questions: “What could you have done differently?” “What could you do to make it right?” We talked about the importance of using coping skills and the power of apologizing. When T aged out of foster care with very few connections, I worried about her ability to stay out of the adult criminal justice system. She came to see me often after she aged out. One day, she came to my office when she was 19 and she told me she made a huge mistake and almost assaulted someone. However, she was able to start breathing and apologize to the person. I was so proud of her for regulating her emotions (and not incurring a new adult criminal charge)!
Just as in T’s case, sometimes helping our clients learn to make things right can take years of trust and relationship building. Most of our clients never get the chance to figure out how to change their behavior, and the consequences often escalate. Instead of holding our clients accountable while simultaneously giving them the opportunity to learn how to replace a negative behavior with something more constructive, we are often fighting upstream to either keep them out of a residential treatment center or avoid a change of placement. Advocating for an opportunity to apologize (in writing or in person) can sometimes make a difference between whether child clients return to a foster placement or a school, or whether they incur criminal charges. Although some placement changes may be unavoidable, helping our kids understand the power of an apology is an important life skill that will unlock so many opportunities on their path to permanency and beyond.
Because we know that kids who experience trauma are more likely to be impulsive based on a heightened fear response center in the brain, we have an important opportunity to empower our clients to make amends. Advocates can use this information to argue that accountability can come in the form of receiving opportunities to make things right rather than receiving harsh punishments. Collaborative problem solving and restorative practices are compelling models that demonstrate how to reconcile difficult relationships in a constructive way to hold wrongdoers responsible, help repair relationships, and give children insight into their behaviors and actions. See Massachusetts General Hospital, Dep’t of Psychiatry, Think:Kids, Rethinking Challenging Kids. Enabling our clients to repair relationships still holds them accountable for their actions, but it gives them an opportunity to learn how to approach people and situations differently next time. Repairing a difficult situation also has two powerful benefits for our clients. First, we can help them learn to strengthen existing relationships with adults and peers. More importantly, we have the potential to help intercept future impulsivity by asking our clients to think about ways to deescalate or change their behavior the next time they have a difficult interaction. Consequently, what I call “reconciliation advocacy” can have a lasting impact on our clients’ current and future relationships.
5. Don’t take it personally. Just like adults, kids do not always know all of their triggers. As mentioned above, trauma is stored at a cellular level, so a sight, smell, touch, or sound can trigger a reaction, and it is important that we not take a reaction personally. This is good advice for children’s attorneys as much as it is for any person who works with children. I once had a client psychiatrically hospitalized following a pizza party at his school. A month prior to the party, “John” came into foster care following an extreme domestic violence incident between his parents. Shortly before the incident, John’s mom picked up a pizza on the ride home from school. The teacher did not know the reason John entered foster care and that the pizza would be a trigger to John. The teacher was upset at the thought that he had triggered John. I explained that the pizza might have been a trigger for John, and it was not the teacher’s fault. The important point was for the teacher to keep checking in with John when he returned to school to build a relationship.
It is important for us to understand that our kids are likely to have bad moments—or bad days. They might cuss us out. They might feel triggered by something we do or say. But we cannot take their bad moments personally and it is critical that we stay calm. The calmer we are with our clients, the more we can help them regulate their often overstimulated fear response center. Consequently, both the attorney and the client benefit—the attorney can model good behavior, and the client can learn some calming strategies.
After attending numerous discipline meetings in schools for my clients, it seemed an appropriate time to expand our systemic advocacy so that educators, judges, and others could learn about the profound impacts of trauma and toxic stress. In January 2016, the OCA received a Casey Family Programs grant to improve education outcomes for youth in foster care. The OCA targeted strategies and trainings to address the social and emotional needs of “systems-involved youth” and efforts to improve interagency cooperation and coordination of educational services for all systems-involved youth. As a result, I helped to develop the Delaware Compassionate Schools Learning Collaborative.
The Compassionate Schools Learning Collaborative team provides trainings to schools and community partners with the goal of improving education outcomes for youth in foster care, youth at risk, and systems-involved youth. The trainings include (1) Trauma, Toxic Stress, and the Impact on Learning, (2) How to Support Youth Following a Child Abuse Hotline Report, (3) Self-Care for Educators, and (4) Strategies to Build Resilience in Students Who Have Experienced Trauma. Over the past three years, the Compassionate Schools Learning Collaborative has trained more than 8,000 educators on trauma and our various other trainings. Delaware educators, school superintendents, all of our family court judges, attorneys, and other professionals have received training on trauma. Since our initial inception, on October 17, 2018, the governor signed Executive Order 24, a proclamation making Delaware a “trauma-informed state.” The order calls upon all state agencies to develop strategic plans to become trauma-informed and consider how to support individuals and families who have experienced trauma. The OCA has also worked collaboratively with Delaware’s first spouse’s First Chance initiative, which has a focus on supporting youth and families who have experienced trauma. We have aligned our strategies and efforts to support the work of the First Chance initiative and to make this a large-scale sustainable endeavor.
The trainings and presentations on trauma with the Delaware school superintendents, special education professionals, school nurses, and other educators have had a direct impact on helping schools understand the devastating impact that out-of-school suspensions can have on youth in foster care and other systems-involved youth. Since the inception of this work, the data show a dramatic decrease in out-of-school suspensions. Before, youth in foster care were suspended at 1.5 times the rate of the general student population. Now they are suspended at about the same rate as the general population.
The OCA’s management of the Casey Family Programs grant ended in December 2018, but we remain involved in the exciting work to make systems more trauma-informed. Our most significant achievement, however, is that the Delaware child welfare system now places educational outcomes at the forefront of child well-being measurements for youth in foster care.
We have to remember that even when we are sensitive and trauma-aware, we may not always know what might have a positive or negative impact for our child clients. But we can do four things to help our clients. First, always remind people to treat trauma as a universal precaution. Second, we have to figure out what we can do to support our clients, make them feel safe, and help others see the strengths in our clients—it is a big part of our job to humanize our clients and we often have more information on our clients’ trauma history, if we are able to reveal that within the confines of our confidential relationship. Third, we have to make sure that no one blames our clients for predictable reactions to trauma that are often out of their control. Finally, we have to be good role models for self-regulation—being patient and practicing mindfulness and self-care are all important ways to sustain working as a child’s attorney. Most importantly, modeling these tools may also help our clients figure out ways to calm themselves.
Once we understand the brain science behind trauma, we can help our child clients become resilient. In doing so, we can help change the narrative for our clients from “what is wrong with these kids?” to “what happened to these kids?” and “what is right with them?” and “how can we support them?” See National Ass’n of State Mental Health Program Directors, NASMHPD’s Center for Innovation in Behavioral Health Policy and Practice.