Collective Trauma and Building a Trauma-Informed Culture: Working with Children

Editor's note: This text-based course is an edited transcript of the webinar, Collective Trauma and Building a Trauma-Informed Culture: Working with Children, presented by Nadia Tourinho, MSW, LICSW, LCSW-C.

This is part two of a four-part series titled Collective Trauma and Building a Trauma-Informed Culture. Once you finish part two, move on to parts three and four.

Learning Outcomes

After this course, participants will be able to:

• Describe how to use effective trauma-informed care techniques when working with parents, children, and staff.
• Identify how to look beyond children's behavior and actively listen to the message children communicate with their behaviors.
• Identify techniques non-clinical staff must develop to provide effective trauma-informed care in the workplace.
• Explain necessary strategies educators must incorporate in the classroom to create a trauma-informed sensitive environment.

Introduction - Look Beyond the Behavior

Research has shown that traumatic experiences alter the brain and can affect children socially, emotionally, behaviorally, and academically. Toxic stress levels shape the child's behavior and may make a child appear angry, checked out, depressed, uncooperative, or distracted. Think back to when I talked about working with parents as I went into the parts of the brain that are affected: the prefrontal cortex, hippocampus, and amygdala. When working with children, we need to look beyond the child's behavior. Rather than conclude the child is the problem, ask yourself, "What happened to this child, and why are they behaving this way?" 

In regards to a trauma-informed environment, one of the most important things to do is to start looking at what's making this child act the way they are. People just don't act a certain way. There is usually a trigger. We need to change our mindset and not think of the child as problematic or difficult, but more so, what is triggering this child to act this way? What is going on in the home? What is going on at school? Explore that and be aware of the parts of the brain that trauma affects, the prefrontal cortex, the hippocampus, and the amygdala.

Children and Trauma

As professionals, we also need to know how trauma exposure impacts behavior and social, emotional, and academic concerns. Some children show signs of stress in the first few weeks after a traumatic event but return to their normal physical and emotional health state. Even those children that do not exhibit severe symptoms may experience some degree of emotional distress, which may continue or even deepen over a long time. This is important to think about parents as well because this emotional stress may be what parents are experiencing with chronic trauma, as symptoms might take a little bit longer or even years for them to come up. Children who have experienced traumatic events may experience problems that impair their day-to-day functioning. 

Thinking back to looking beyond the behavior, this includes those behaviors where you notice that a child was very outgoing and then all of a sudden the child has shut down. Don't forget that children who have experienced traumatic events may have behavioral problems, or their suffering may not be apparent. It is essential to be aware of the children who act out and the quiet children who don't appear to have behavioral problems. These children often fly beneath the radar and do not get help. 

We must look beyond the behavior and what the child is trying to convey to us. Depending on where they are developmentally, some children might not know to come up to us and say I'm feeling this way. While some adults cannot do that, many can express their emotions appropriately. Imagine a child unable to express what they're feeling correctly. It's our job as professionals to be aware of that, whether they're acting out or just being a little more reserved. 

Situations That Can Be Traumatic

Many situations can be traumatic for children of all ages, including the following.  

• Abandonment
• Neglect
• The death or loss of a loved one
• Life-threatening illness in a caregiver
• Witnessing domestic violence
• Automobile accidents or other serious accidents
• Bullying
• Life-threatening health situations and/or painful medical procedures
• Witnessing or experiencing community violence (shootings, stabbings, robbery, or fighting at home, in the neighborhood, or at school)
• Witnessing police activity or having a close relative incarcerated
• Life-threatening natural disasters
• Acts or threats of terrorism (viewed in person or on television)
• Living in chronically chaotic environments in which housing and financial resources are not consistently available 

Sometimes these traumatic events begin very young and continue through childhood or even teen years. As we have learned about working with parents, when these children become parents, their feelings from the trauma they have experienced may return. We must be aware of some traumatic experiences that children can face and be prepared to help them feel safe again. We want to help them so the effects of these traumatic events do not carry on for the rest of their lives.

Case Studies

Here are some case studies about children of various ages. As we progress through this course, many of the techniques I will talk about can be used with some of these children. Keep these in mind as we move forward.

Preschool Age

Ricky, a three-year-old boy, cries inconsolably when his mother drops him off at school in the morning. His teachers thought his crying would stop when he became more comfortable in the classroom; however, he continues to cry every day and does not interact with his teachers or play with his peers. Ricky also has a speech delay and gets very upset when the other students are loud or when his daily routine is interrupted. One day the teacher asked Ricky to talk about his drawing, and he said, "Daddy hurt mommy." Ricky's mother was later observed to have a black eye and bruises consistent with an assault. 

Thinking back to the traumatic situations, this three-year-old is experiencing and witnessing domestic violence in the home. He wants to be with his mom. He might want to protect her and doesn't understand what's happening. He may just want to be with her because of the uncertainty of the situation and seeing his mother hurt.

School Age

Her teacher brought the third grader, who had been a model student, to the school nurse, complaining that she was not paying attention or completing her work. Amy eventually said, quiet and withdrawn in the nurse's office, "May I tell you something?" She then talked about seeing her cat hit and killed by a car. She was both sad and frightened, couldn't understand what had happened, and had nightmares. 

This child became quiet and withdrawn, but it was because of the images of her cat in her head and playing out in her dreams. Some people close their eyes, and that's all they see. For a school-age child, that can be very off-putting because they don't understand why that's all they see, don't know how to express those feelings, and don't know how to self-regulate. What do they do? They act it out through their behavior. They might be quieter and a little bit more reserved. On the other hand, they might do the opposite and become destructive or act out to get that feeling away from what they're feeling at that very moment.

Pre-teen/Adolescent

Trent is constantly getting into fights at school and appears to have significant problems understanding and completing his work. Trent was removed from his home in third grade and placed with his paternal grandmother. When the teacher contacted the teacher about his problems in school, his grandmother explained that Trent lived in a community ridden with gang violence before coming to live with her. His father was part of a gang, and Trent used to see gun battles among gang members in his neighborhood. The grandmother also admits that Trent's father was very aggressive and may have physically abused Trent when he was younger. 

This is an entirely different scenario but goes back to how the brain works. Trent is not able to concentrate, he's having trouble at school, and he's fighting. The connection he needs is not there because he was exposed to different types of trauma, including witnessing violence, gun battles, and possibly being physically abused by his father. He has been removed from his caretaker, which is another type of trauma depending on the child. 

Teenager

Her teacher noticed that the tenth grader, who had been a very outgoing and popular student, suddenly appeared quiet, withdrawn, and "spaced out" during class. When the teacher approached her after class, Nicole reluctantly admitted that she had been forced to have sex on a date the previous week. She was very embarrassed about the experience and had not told anyone because she felt guilty and was afraid of what would happen. 

Any person that has experienced some level of sexual abuse will likely feel guilt and embarrassment. Teenagers and children often feel like no one will believe them. At that point, they isolate, put themselves in a little box, and just feel the pain alone. They feel like people will not believe them and suffer on their own because of the guilt, the shame, their embarrassment, and not knowing what's going to happen. As professionals who may notice these types of behaviors, we can intervene a lot earlier than just letting it drag on, and then, five years later, now this person is an adult, and they still haven't dealt with what happened to them as a teenager.

What do all of these case studies have in common? I would hope that everyone would say they all involve exposure to trauma. Remember, trauma is an experience that threatens life or physical integrity and overwhelms an individual's capability to cope. Generally, traumatic events evoke feelings of extreme fear and helplessness. Reactions to traumatic events are determined by the subjective experience of the child, which developmental and cultural factors could impact. What is extremely traumatic for one child or person may be less so for another. That means trauma can be individually based. Thinking back to Part 1 and the types of trauma, we know there are big T and little T events. Remember that big T includes rape and assaults. People experiencing big T will likely feel the symptoms and may have flashbacks. Little T is usually when people would say trauma is individually based because for certain people, something will happen that is very traumatic for them, but that doesn't necessarily mean that it's going to be traumatic for another person.

For example, I once had a client who had lived in Angola her whole life. There was a civil war in Angola, and it was very common for her and others to hide out in the hallways or run away, trying not to get shot. When she came to the United States, she had no trauma symptoms because it was normal for her. She mentioned that she couldn't understand why people who go to war and come back have PTSD. In this situation, the trauma was individually based. While this would be a big T for someone living in the United States who goes to war, for her, it was normal because she was born into that and didn't know anything different.

Behaviors Observed

There are certain behaviors children may have due to trauma that you might observe and need to be on the lookout for. Young children do not always have the words to tell you what has happened to them or how they feel. Behavior is a better gauge, and sudden changes in behavior can be a sign of trauma exposure. We will discuss children from preschool age through teenagers. You'll see that within the developmental ages, there are some similarities with what you might observe in some of these children.

Preschool Children

You may see separation anxiety or clinginess towards teachers or primary caregivers in preschool children. Sometimes there is a regression in previously mastered stages of development, including talking, bedwetting, and toileting accidents. There may be a lack of developmental progress that includes children not progressing at the same level as their peers. Children may re-create the traumatic event by repeatedly talking about it, playing it out, or drawing the event. I once saw a little boy in a preschool who drew his father hitting his mother. Some children may have difficulty at naptime or bedtime, avoiding sleep, waking up, or having nightmares. For some, once they close their eyes, that's what they see. They're not going to want to stay asleep, and they're going to want to fight you to go to sleep. You may also notice increased somatic complaints such as headaches, stomach aches, and overreacting to minor bumps and bruises.

Some children will have changes in behaviors such as increased or decreased appetite, unexplained absences, anger outbursts, decreased attention, or withdrawal. In a couple of the case examples, the children were withdrawn. Children may over- or under-react to physical contact, bright lights, sudden movements, or loud noises such as bells, slamming doors, or sirens. You may see increased distress displayed in the child when they are unusually whiny, irritable, and moody. They may show anxiety, fear, and worry about the safety of themselves and others. In the first case study, it was evident that the little boy was worried about his mother's safety. Worry about the reoccurrence of the traumatic event or new fears, such as fear of the dark, animals, or monsters, may be seen in young children. They may make statements and ask questions about death and dying. Remember that many of these behaviors will cross over between the age groups.

School-Age Children

School-age children may display fear, anxiety, and worry about the safety of themselves and others, being more clingy with teachers or parents. Just as young children, they too may worry about the recurrence of violence and have increased distress, being unusually whiny, irritable, and moody. They may have an increase in activity level. You may see decreased attention or concentration in school-age children because that part of the brain is affected. They may withdraw from other activities and have angry outbursts or aggression. School-age children may distrust others which can affect how they interact with adults and peers.

There may be a change in their ability to interpret and respond appropriately to social cues. They may also have increased somatic complaints of headaches, stomach aches, or overreacting to minor bumps and bruises. There may be changes in school performance. School-age children may recreate the event by repeatedly talking about it, playing it out, or drawing the event. They may over- or underreact to bells, physical contact, door slamming, sirens, lighting, or sudden movements. School-age children may make statements and ask questions about death. They may have difficulty with authority, redirection, or criticism. They may re-experience the trauma through nightmares or disturbing memories during the day, which could lead to hyperarousal with sleep disturbances or a tendency to be easily startled.

Children this age may display avoidance behaviors where they resist going to certain places that might remind them of the event. They may have emotional numbing and seem to have no feeling about the event. To heal from trauma, we need to feel the emotions versus running away from them. For children that don't understand, what they're feeling can be very hard. As professionals, we need to be there to let children know they'll get through this, and we'll be there to help the child with anything they may need. We must reassure the child that they are safe and will be okay. We will talk later about how to help children regulate their emotions and cope with feelings.

Pre-Teens

The behaviors often seen in pre-teens are almost the same as for school-age children. They also have anxiety, fear, and worry about the safety of themselves and others. They worry about recurrence or consequences of violence. They often have a decrease in attention and concentration and an increase in activity level. You may see changes in academic performance. They may be more irritable with friends, teachers, and events, sometimes having angry outbursts and/or aggression. They may withdraw from others and activities and be absent from school. They also might have increased somatic complaints such as stomach aches, headaches, or chest pains. Pre-teens may have discomfort with feelings, such as troubling thoughts of revenge. This is important to keep an eye on because that falls into a completely different category if they want to harm somebody else. We don't want anyone to ruin their lives because they're focused on revenge. Revenge will not help them heal from their feelings. 

You may hear repeated discussions of the event focusing on specific details of what happened. This is also important to look for because a pre-teen might be focused on what they think they did wrong. That might be the only thing they focus on, but certain things happen out of our control. For example, the teen that was sexually assaulted might solely focus on, I accepted the date, and it's my fault. I'm the one that did that. As professionals, we need to be there and correct that information because while they may have accepted the date, they did not accept being assaulted. They may over- or underreact to bells, physical contact, doors slamming, sirens, lightning, and sudden movements. Just like school-age children, they may re-experience the trauma through nightmares or disturbing memories throughout the days, which are usually flashbacks.

A pre-teen with a flashback might be able to articulate things a little better than a preschool-age or school-age child. Sometimes they still don't know that the movie is playing in their head every time someone slams the door because slamming the door is the trigger. Again, you may see hyperarousal, including sleep disturbances and being easily startled. They too, will often display avoidance behaviors as they resist going to places that remind them of the event. They will also have emotional numbness. As I said with school-age children, it's just not being able to process what they're feeling because once they process what they're feeling, it just becomes too painful. No one wants to sit there willingly and feel pain. When something is painful, you want to hide and not feel it. Emotional numbness is where people go to. It's like their safe place in their mind.

Teenagers

Teenagers often display the same behaviors as pre-teens. You will see some you've heard about before, as well as some new ones below.

• Anxiety, fear, and worry about the safety of self and others
• Worry about recurrence or consequences of violence
• Withdrawal from others or activities
• Irritability with friends, teachers, events
• Angry outbursts and/or aggression
• Change in academic performance
• Decreased attention and/or concentration 
• Increase in activity level
• Absenteeism
• Increase in impulsivity, risk-taking behavior
• Discomfort with feelings (such as troubling thoughts of revenge)
• Increased risk for substance abuse
• Discussion of events and reviewing of details
• Negative impact on issues of trust and perceptions of others
• Over- or under-reacting to bells, physical contact, doors slamming, sirens, lighting, sudden movements
• Repetitive thoughts and comments about death or dying (including suicidal thoughts, writing, art, or notebook covers about violent or morbid topics, and internet searches)
• Heightened difficulty with authority, redirection, or criticism
• Re-experiencing the trauma (e.g., nightmares or disturbing memories during the day) 
• Hyperarousal (e.g., sleep disturbance, tendency to be easily startled)
• Avoidance behaviors (e.g., resisting going to places that remind them of the event)
• Emotional numbing (e.g., seeming to have no feeling about the event) 

A teen's increased activity level could be a red flag because they are trying to stay busy, so they don't think about what happened. They can be running from if I stop, I'm going to think about X, Y, and Z. In my experience, many people abuse substances because they have some level of trauma. They don't want to deal with their feelings, so they numb it. They numb the feeling, and even if it's just for 30 minutes, they're not thinking about X, Y, and Z, which makes them feel horrible.

Supporting Children

How can we support these children, starting from preschool to the teenage years? If given support, some children recover within a few weeks or months from the fear and anxiety caused by traumatic experiences. However, some children will need more help over a more extended time in order to heal and may need continuous support from family, teachers, and mental health professionals. It's important to note that anniversaries of the event or media reports may act as reminders to adolescents, causing a recurrence of symptoms, feelings, and behaviors.

Usually, when people think of anniversaries, they think of engagements, weddings, and things like that. There are also traumatic anniversaries, such as the day you were removed from your mom, the day your mom got punched in the face by your dad, or the day you got raped. The first anniversary is very hard for adults, so you can only imagine what that is like for a young child who can't process what is happening.

The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, by Bessel van der Kolk, MD, is a great book about this. You might not remember a traumatic event, but your body remembers it. For example, a five-year-old may not know why they're feeling like this, so they can't express what they're feeling. Instead, they may act out or not be themselves. A teenager may know what's coming and try to keep to themselves. It is vital for us to be aware of these anniversaries so we can help the child through them. Coping with the anniversary of trauma is extremely hard. Some say it is like reliving the event again. 

Trauma-Informed Care

Trauma-informed care begins with a safe environment. Everyone needs to be and feel safe. The second part of trauma-informed care is connection. Connection is essential because we are social creatures who need to be connected to our peers, teachers, and providers. This is especially important for children. They need to be able to feel that connection and feel safe. The third part of trauma-informed care is regulation. We need to be able to self-regulate ourselves and help children self-regulate and self-soothe.

Safe Environment

Create a safe environment. All children, regardless of background, need to feel safe. Safety is the launching pad for everything, including resiliency, growth, healing, and recovery. Safety is not just physical. It also includes how we respond to various needs, such as emotional, psychological, social, spiritual, and behavioral. So much is often out of our control. Creating a safe environment is something that is within our control. We can start doing that now as providers, no matter your role with children. Here are some things to remember and do as you create a safe environment.

Remember that not all strategies work for all children. What might help with one child might not help with another child. Find strengths even in children with the most challenging behaviors. Remind them often of what they are doing well. Children that are always called bad might feel bad about themselves. But if you highlight even that little strength, they will feel good about themselves and know that someone cares about them, especially if it's a child that has experienced trauma.

Create and maintain consistent daily routines for the classroom. While this refers explicitly to classrooms, it's important for anyone working with young children to implement or help parents implement daily routines and consistency in any setting. Stability helps children understand that the world can be a safe place. They feel empowered when they know the order of the events and how they will be carried out. For example, place a visual calendar on a wall or create a book with images or photographs outlining the daily schedule. For teenagers, you can do this more verbally unless they prefer the visual schedule.

A related suggestion is to tell children when something unexpected is going to occur. This is important because, for children with some trauma, the unexpected can be highly triggering to them. The most minor unexpected event, such as a loud noise or a visit from an outsider, can be a reminder of trauma and trigger children's stress responses. Therefore, it is essential to try to mitigate the fear and uncertainty that often come with unexpected changes by letting children know about changes to the schedule or routine. 

Offer children developmentally appropriate choices. Traumatic events often involve loss of control. Remember, people feel fear and helplessness. Empowering children to have ownership of their behaviors and interests by giving them choices about things like where they want to sit at lunch or which songs to sing at circle time can help build healthy self-esteem. That empowers them as well. They might not have had that power before because they felt helpless.

Anticipate difficult periods and transitions during the school day and offer extra support during these times. Many situations can remind children of their traumas, but your support can help alleviate their responses. Use techniques to support children's self-regulation. Introducing deep breathing and other centering activities, such as mindfulness, helps children self-regulate. Starting each day with a special breathing ritual gives them the strategy they need to pay attention to and modify their breaths when they are stressed. Deep breathing and any form of mindfulness are beneficial because it centers the body. Starting that off in the morning is not only helpful for children that have experienced some level of trauma but for all children.

Be nurturing and affectionate but also sensitive to children's triggers. Being physically close to young children can reassure them, but with children with a history of sexual abuse, a good rule of thumb is to be physically affectionate only when they seek it. Being too close to them can be a trigger. Wait until they want to feel that affection to offer it. Use positive guidance to help all children. Strive to create supportive interventions to guide children to appropriate activities. 

Activities for a Trauma-Sensitive Environment

We've talked about ways to create a safe environment. Now let's talk about activities for a trauma-sensitive environment. At the beginning of class, one easy thing to do is to ask all of the children, "How are you today? How are you feeling?" At the beginning of the school year, older children can write their needs on an index card, and you can collect them to refer to throughout the year. This shows them that you care and are willing to listen to them. Another idea for older children is to have a prescription pad at the end of the table. When the child is having a difficult time, they can write you a note and give it to you. This helps you to understand what is going on with them and what they need. For younger children, you might have dolls with different meanings instead of a prescription pad. They can give you a doll that represents how they are feeling.

Have plenty of relaxing activities in the classroom. This includes fidget toys, silly putty, pillows, or coloring pages. Children can engage in these after they're done with their work. Ask students how they're doing and tell them to give you a thumbs up or a thumbs down. This helps them to communicate with you if they are doing okay. If their thumb is down, you can pull them aside and ask them what is happening. If you are a teacher or other classroom provider, you may feel like they need more clinical support, and you can call the social worker. If needed, have students work alone on projects. Provide a table in the back of the room where students can relax and recollect themselves when feeling overwhelmed.

Ideas for a Trauma-Sensitive Environment

Fostering Resilient Learners, by Souers and Hall, discusses the downstairs brain and the upstairs brain. The upstairs brain is the prefrontal cortex, where reasoning takes place. The downstairs brain is the limbic system, the "seat of the emotions." This is where emotions take place. When students are in their downstairs brain, we need to get them to their upstairs brain. It would be a good idea to introduce students to this idea and ask if they are in their upstairs or downstairs brain. This can help children understand what is going on in their minds and how we can help them.

We can create a trauma-sensitive environment by playing calming music in the classroom. Have a place where students can cool off if they're feeling overwhelmed. Include relaxing things such as a water fountain, a Himalayan salt lamp, pillows, and other items they can feel and touch. At the beginning of class, maintain consistency. Tell students what will be done in the classroom and what is expected for the day. This will provide them with predictability. Remain positive at all times with students and highlight their good qualities. Promote creativity and individuality in the classroom by having fun activities. For pre-teens and teenagers, teach them how to monitor their behavior and see the positive in things. Have positive posters on the wall and tell your students to come to you if they need anything in the classroom. Some of the techniques are geared toward different age groups but can be modified to work with various children. 

The Power of Connection

Connection is critical. Children who have had traumatic experiences inflicted on them by adults learn that adults are not to be trusted. Disconnection occurs when power imbalances disrupt the connection. Teachers/providers are in charge and make the rules, which can make children feel powerless. If a child has experienced an adult using their power to abuse others, this power imbalance will impair connection. It may also create a situation where the child seeks power and control to feel safe, creating disconnection. 

If disconnection has occurred, we can work to establish connections with children. It can be helpful to start by setting some ground rules and asking each student/client to voice their own needs, either by creating a rule or agreeing with a rule made by a peer. The school environment offers a significant opportunity for children to develop positive experiences through new social interactions with adults and peers that are in contrast to their negative models of relationships. Your tone of voice also needs to always be at a calm level. If the child is escalating, remain calm. 

Connections for maltreated children are developed through consistent adult responses, helping them to understand the rules that create predictable responses. Peer interactions are the hallmark of school-age children's experiences, and classrooms are a natural context to help traumatized children make classmate connections. Routines and rituals are an antidote to life's chaos and disruptions, allowing children to shift out of survival mode and into new patterns of adaptive social interactions with adults. If things are predictable for children, they thrive.

The Test

Teachers and providers can get drawn in into a trauma re-enactment with a child who is testing them to learn how they respond. This is not done purposefully but instead comes from a defensive, self-protective action when a child engages as they would with the abusive adult. The child wants to know what to expect and to confirm their suspicion that the adult is unsafe and the child may engage in a conflictual way. This can be done through aggressive or unsafe behavior, verbal assaults designed to hurt or bring about rejection, or mistreatment of another child in the classroom. They're trying to test you as an adult to see if you will act the way the abuser might have acted. If you do react and feed into that, then that child will know you also can't be trusted, just like the other person could not be trusted. As I mentioned, children do not do this purposefully. It's something children do to make sure you are someone they feel they can be safe with. If you are not, then they're going to have in their head that you are not someone they can be safe with, and at that point, you have failed the test. Pay close attention to when children are testing your authority or your boundaries. Think about where that might be coming from. 

Building relationships is extremely important. It is critical to establish a good relationship with your students/clients. For children who have been affected by trauma, strong connections are vital. Rich relationships with teachers/providers help children form the foundations of resilience. We play a critical role in making students/clients feel welcome. Children must feel secure and connected, both to adults and to peers. 

Self-regulation 

Children need to be able to appropriately manage their feelings, emotions, and impulses. They might act a certain way when they're feeling scared or something is happening and don't know how to react. As providers and as professionals, we need to be able to help children learn how to self-regulate. Children need to be taught how to identify and appropriately express emotions. They require guidance on how to tolerate distressing emotions and calm themselves through self-soothing and self-regulation.

To teach self-regulation, I like to use a model which includes the following: label, place, provide, work, add, and use. Label the emotions you see the children demonstrating. This will give them the language they are missing. By labeling the feeling as it is being expressed, children learn what is going on inside themselves. Place emotion faces with the identifying labels. This will help children develop the language of emotion as they learn what sad, happy, confused, and so forth look like. Have spaces on the walls so small children can point out how they feel. Provide an opportunity to reflect on the behavior and feelings exhibited. Having a quiet space where the child can reflect and process what happened and why is a wonderful way to achieve this task. 

Work with the child to calm down. This is known as co-regulation and is particularly useful with adolescents. By focusing on the emotions, not the behaviors, and staying calm while speaking in a soothing voice, the adult identifies the distress and invites the child into a reflective, problem-solving encounter. Add calming and mindfulness exercises. This includes practicing deep breathing with them, and having them hold their stomach to feel it going in and out as they breathe. A young child can hold a teddy bear on their stomach and feel it going in and out as they breathe. Use times of emotional dysregulation and distress as an opportunity to educate children about how their brain works and how we can all get overwhelmed by feelings. Remember, label, place, provide, work, add, and use.

COVID-19 Trauma

COVID-19 has been very traumatic for some children because of school closures which led to little to no social interactions. No in-person contact with teachers and providers leaves some children experiencing abuse at home hidden and in danger of further traumatization. Other children may have witnessed a parent or family member with COVID gasping for air and suffering before death. That's a very traumatic memory for a child.

How can we help children bounce back from this stress? One thing is to adjust your expectations. It is normal not to be yourself when so much has been taken away from you. Take a step back and identify developmental milestones that are important to the child. Find opportunities to help the child reach those milestones. Once the areas of growth are identified, find small ways for the child to work on those skills. Then at the same time, you're building their self-esteem and how they feel about themselves. With coronavirus, a lot of things are uncertain. We need to be able to adopt a trauma-informed environment and not expect things to be the way that they were two years ago when there was no COVID 19.

Mandated Reporters

When working with children that have trauma, it's very important to remember that we are mandated, reporters. As mandated reporters, we are required by law to report some things we see. For example, if you observe some of the behaviors children are displaying and pull them aside, and they disclose something to you, you must report that. It's imperative that you report this information because if you don't, the child will likely continue to suffer.

The Federal Child Abuse Prevention and Treatment Act (CAPTA) requires each state to have provisions or procedures for requiring certain individuals to report known or suspected instances of child abuse and neglect. The professionals most commonly mandated to report across the states include the following:

• Social workers 
• Teachers, principals, and other school personnel
• Physicians, nurses, and other healthcare workers
• Counselors, therapists, and other mental health professionals
• Child-care providers
• Medical examiners or coroners
• Law enforcement officers

This list of professionals can change depending on the state, so make sure you review the requirements for your state.

References

Cénat, J.M., & Dalexis, R.D. (2020). The complex trauma spectrum during the COVID-19 pandemic: A threat for children and adolescents' physical and mental health. Psychiatry Research, 293, 113473. https://doi.org/10.1016/j.psychres.2020.113473 

Dombo, E.A., & Sabatino, C.A. (2019). Creating trauma-informed schools: A guide for school social workers and educators. Oxford University Press. 

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