Sebbie’s Story – Managing The Behaviour Of Traumatised Children

In the third guidance in her series of dealing with children with trauma related issues , Dr Margot Sunderland offers practical guidance for non-specialist teachers and school staff on how to respond to children in distress

To take challenging behaviour at face value and write disruptive children off as ‘troublemakers’ is to do them a disservice. By failing to acknowledge each child’s unique history and context, we are fundamentally letting children down.

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      string(5742) "can also be trauma triggers. Consider ‘The Suitcase Kid’ by Jacqueline Wilson, where a child is constantly on the move as divorced parents continue to argue with each other. It is vital that adopters are aware of the books their children are studying in school so that potential problems can be averted before they arise.HistoryThere are many aspects of history that might cause difficulties. The study of World War 2 with stories of children being evacuated and moved to other families resonates with children who have been moved from family to family with no control over what happens to them.The story of Anne Frank hiding in a small dark place to avoid being discovered by the Nazis and being in fear for her life is an important part of the curriculum. However, it is the same experience as some of my children have had hiding under beds and in cupboards to escape the threat of parents who have beaten them or beaten each other.Citizenship and PHSE (Personal, Health and Social Education)Topics such as relationships, drugs, alcohol use and sex education are covered in these lessons. Children who have difficulties making relationships with others, or whose lives have been adversely affected by drug and alcohol use may struggle to engage with these topics. They may well be reminded of their past life and all of its traumas. For the sexually abused child who may not have realised that what was happening to them was wrong, the sudden realisation, through learning about what is and is not appropriate, may provoke an intense shame reaction. Lessons about the roles of the emergency services and in particular the role of the police in helping and supporting within the community may well be at odds with our children’s experience. For some of our children, where the police attended the motor accident that killed their sister, they saw the police as being the reason they were removed from the care of their mum and stated to me that they’…hated the police’. Another one of our children, who witnessed that her parents had no respect for the police, has grown up with no respect for them either.One of our children, as part of her Global Citizenship Award, needed to learn about Road Safety and the programme of learning included some very graphic footage of road accidents. Fortunately, in this case school were aware of her history and agreed that rather than watching the video, she could design a poster about road safety.Another, recently, has been considering post-traumatic stress as part of her college course. She has had sufficient preparation from us to understand that she suffers PTSD, herself, as well as developmental trauma. However, this didn’t stop her having to leave the room, to the dismay of her friends and tutor. ScienceOne of our sons has always been very scared of loud noises and chaos, both trauma triggers for him. When we started visiting secondary schools to choose an appropriate one for him, we visited the science labs where teachers and students were showing off their prowess in creating chemical reactions which produced loud explosive bangs. Our son’s reaction was to cover his ears and run sobbing from the room. It has taken some time for him to be comfortable with science experiments.ArtOne of our children’s schools has a programme of cross-curricular work where they use famous paintings to explore different aspects of the curriculum. Some of the pictures they have used have been particularly inappropriate given her history. In particular the picture ‘The Scream’ by Edvard Munch was one that was used. This was so traumatic for her to look at that her teacher suggested that instead exploring the picture, she could use the computer to research the artist and the reason behind the painting. This suggested that he was reflecting the screams he could hear from the nearby lunatic asylum to which his partner had been sent. Our daughter was even further traumatised.Another problem with art lessons is that children are expected to manage using the paints and other equipment at an age-appropriate level. However, for children who have never had the chance to experiment with paints and other art materials at a younger age, this presents them with problems and often they are in trouble for making a mess and experimenting with the equipment. Religious EducationOne of the stories which caused immense problems for at least one of our children is the story of Moses from the Old Testament of the Bible. His birth mother (admittedly by force of circumstance) must deny knowing him. So Moses is abandoned by his Mum and then adopted by the Princess of Egypt. The Hebrews are abused by the Israelites and Moses, who is a Hebrew, kills an Egyptian who he saw hitting a Hebrew. Moses is later called by God to free the Hebrews from Egypt and this is achieved as God sends plague after plague against the Egyptians. Finally, God gives Moses the 10 commandments with rules such as ‘Do not steal’, ‘Do not kill’ and ‘Honour your father and mother’. The themes of rejection, adoption, abuse, murder, stealing and the expectation that you should have respect for parents even if they have abused you proved to be very traumatising for our daughter.As can be seen the curriculum is a minefield of trauma triggers which can easily dysregulate vulnerable children. It is vital then to know in advance what is to be taught in school and prepare the child as much as possible. Even seemingly innocuous subjects can cause problems so keep an open mind and think outside the box to check"
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Emotional and Behavioural Difficulties

Trauma In The Curriculum

17 Apr 2018

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      string(5653) "laughter– and are a really good way for carersto share their experiences, skills andknowledge.Each programme will typicallyrun for 9 – 12 months, with childrengraduating before moving onto theirlong-term family home. Our FamilyTherapist will work with the familymember or long term foster carer/adopter prior to a child graduatingso that they are trained and equippedto continue implementing theprogramme on an ‘MTFC light’ scale,with the team continuing to providesupport for a 3 – 6 month period.Our experience to date has shownus the importance of  staying true tothe clinical model, and consultationis provided from the NationalImplementation Team based at theMaudsley Hospital in London.  Theyin turn have direct links to researchersand staff  at Oregon. This line ofconsultation has helped Pitstop stay ontrack clinically, and in working towardssite certification (we are on track tobecome a Certified Site early next year).Is it effective?To date, six out of seven childrenhave successfully graduated from theirprogrammes.  Three of these childrenhave returned to their birth families– something the team is very proud of,as the original care plans were for longterm foster care.  Our preventativeapproach has been made possible bythe support given by the children’ssocial work teams, and proactivepartnerships with the fosteringservice, CAMHS and schools. Asa professional network I think wehave all been really impressed withthe outcomes for these children.These have included improvementsin behaviour, increased skills andconfidence, integration with peers,and attachments to their care givers.The savings made to date aresignificant, with reduced spending onhigher cost placements and additionalservices for each of  the children,particularly for those who havereturned to the care of  their families.http://www.teachingtimes.comThis month’s FeaturesPractice exampleMary was seven years old when she came into care.  She had been brought into the UK illegally by a familymember who had been unable to understand or manage her behaviours.  This resulted in Mary beingphysically chastised, being removed from the home by social workers, and beginning her journey into thechild in care system.Mary experienced numerous foster placements, each struggling to both understand and meet her needs.At the point she joined Pitstop, professionals were expressing concerns at her continuing difficulties inschool, social interactions with adults and peers, and due to her weight and attitude to food, were of theview that she had a compulsive eating disorder.Mary joined Pitstop aged 11 years, and was matched with one of our foster carers.  As the only childin placement (a requirement of the model), the carer was able to notice and report Mary’s behaviours,strengths and difficulties in great detail and on a daily basis.  This information and that from thecomprehensive assessment undertaken by Pitstop prior to Mary being placed, guided the individualisedprogramme for her. Key behavioural targets were set within her daily routine and charts and rewardsagreed to motivate her in working hard.The first targets for Mary were ‘’Kind Hands,”  “Calm Voice” and “Good Personal Space”. The programmesupervisor worked individually with Mary  so that she could see and hear what these skills look like, practiceusing them safely, and gain confidence in order to generalise this learning into school and friendshipcircles.  Twice weekly skills coach sessions supplemented this work and used fun activities such asswimming, dance and sport to help Mary build on her skills and manage the anxieties that come with  newexperiences.In a relatively short time, Mary was confident enough to practice her “hostess with the mostest” skills.Individual team members visited the foster home after school so that Mary could practise welcomingguests to the home, navigating personal space, initiating and responding to conversation, sharing food,and helping to tidy afterwards.  The daily routine addressed hygiene issues, with her foster carer teachingMary the basics in keeping clean and tidy. This developed into “beauty regimes” that included trips to thehair dressers and clothes shopping expeditions.Staff at Mary’s school were incredibly supportive of her programme and worked closely with Pitstop’sAdvisory Teacher to identify key areas of work and the most appropriate interventions.  These includedinput from the Speech and Language Therapist, social skills group and daily input from the TeachingAssistant.  Staff also worked with us to ensure that Mary’s school card was completed every day so that wecould chart her progress in managing each lesson and her school day generally.Mary’s learning curve seemed infinite, and her confidence grew with each achievement.  At the mid waypoint in her placement, Pitstop and her social worker identified a suitable long term foster carer, who hadregular sessions with our Family Therapist.  The carer was taught and coached in using the strategies andinterventions used by Pitstop, so that she could continue implementing them to support Mary’s progress.Our Family Therapist met with Mary’s older sister Elena, and had regular sessions aimed at helping Elenacome to terms with some of the family’s previous difficulties, and to support her in re-establishing contactand rebuilding their relationship.  The Family Therapist collected life family information and photos thatcontributed to Mary’s life story. This included previously unknown information about Mary’s journey to theUK.Mary was placed with her"
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Special Needs

The Pitstop Project

6 Oct 2011

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      string(5663) "Managing Schools Today June/July 200624Workforce remodellingWorkforce remodellingWorkforce remodellingWorkforce remodellingWorkforce remodelling PPA timeIn our first two articles in this series, we looked at astrategic approach to workforce remodelling and thechallenges of implementing these strategies. We nowmove on to explore how the new structures and roles areworking and how they are being monitored – how thetransition is becoming a reality.As the autumn term progressed, the school leaders withwhom we work began to see the results of their decisionsenabling PPA time to happen. It is at this stage thatunforeseen problems begin to emerge and even the beststrategic planning may need adapting. Good evaluativemonitoring is crucial and will have been planned carefullyby most school leaders. The following are some of theissues that have arisen.Firstly, there is PPA time, and stick ing to the principle ofemploying only trained teachers to cover teachers’ time.The principle that pupils should always be taught by ateacher had generated heated discussions earlier in theyear, many school governors in particular being adamantthat this was the only acceptable way forward. Some infantschools solved the immediate problem b y using areception class teacher during the autumn term andpossibly into the spring, depending on the nature of theintake (part time or full time), hoping to be able to adjustother staffing in the summer. Other schools have createdcomplicated carousels of cover and release time ratherthan appointing a specific person to cover.Some, mainly secondary, schools have chosen to deletea lesson from the whole school timetable, finishing earlyon one after noon and thus creating PPA time foreverybody. It solves the problem of cover and allows jointplanning meetings to take place as everyone is available.However, it may not be legally acceptable as a long-termsolution (the requiremen t is that PPA time shouldrepresent a certain proportion of contact time: if no pupilsare in school, this cannot de deemed ‘contact’ time).The next discussion was about the people available tocarry out PPA cover. More often than not the actualdecisions taken are less influenced by principle and moreby pragmatism: who is actually available to fulfil the role.PPA time –the story so farSome heads expectedchaos last year as thedeal on PPA time kickedin – but were their fearsjustified? Tessa Atton andBrian Fidler report onhow the transition isbeing managedEven where there is finance, an advertisement for cover staffmay attract no responses from qualified teachers. But theremay already be some support staff known to be perfectlycapable of teaching the pupils. They may be a higher levelteaching assistant who is partly though a BEd., a graduatetrainee or an LSA who is actually a trained teacher butemployed as an assistant. In many primary schools lack offinance has forced the use of teaching assistants to coverPPA time. The principle has given way to pragmatism andsets a precedent for further use of non-teaching staff in afollowing year. This then leads into another debate aboutthe equitable use of teaching assistants: not all can beassumed to want to take responsibility for a whole class,and how should pay differentials be decided?There have been more creative solutions to the problem.One excellent possibility has been the use of music andsports specialists to work with the pupils while the teachershave PPA time. Where these specialists are able to manageJune/July 2006 Managing Schools Today 25Workforce remodellingWorkforce remodellingWorkforce remodellingWorkforce remodellingWorkforce remodelling PPA timepupils’ behaviour effectively and provide a stimulating input,the gain in pupils’ wider experience is invaluable, and bothstaff and pupils gain from the experience. However, someschools have found that the particular coaches in theirschools aren’t able to supervise behaviour in changing roomseffectively, so teachers lose time at the beginning and endof these activities to ensure there are no problems resultingfrom this. Sports or music coaches, who are often used to afriendly, one-to-one relationship with children, are not alwaysable to transfer this effectively when they have 30 pupils tomanage. Where this strategy has been successful, very clearguidelines have been put in place for monitoring itsimplementation. Some training in behaviour managementmay be needed; this generates more costs and may be seento be counterproductive at least in the short term.The final layer addressed the financial implications. Theshortage of money is noticeable ever ywhere; heads,relieved to have fulfilled the legal requirements for thisyear, are well aware that the burden on the school financeswill be difficult to manage in the long term and are hopingthat the initiative will be better funded next year. One largeprimary school has appointed two part-time teachers tocover PPA time. Last year the school experienced a largestaff turnover when six retired and were replaced by NQTs.So this year the budget looks good but staffing costs willincrease as the young teachers move up the pay scales.Not all the costs are financial. Often, it seems that thehead teacher ends up supervising pupils’ activities ratherthan take time from staff. Teaching staff may be reportingpositively on their well-being and reduced workload, butthis seems to be to the detriment of the head teacher’swell-being. Several schools have commented on the factthat as PPA time is covered by those who would normallycover staff absence, there is no slack in the system"
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Leadership

PPA time – the story so far

1 Jan 2005

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      string(5694) "expertsin their child’s behaviour and that any concerns expressedabout sensory status, health needs or changes in behaviourshould be taken seriously by all professionals.Vol 2.4 n www.teachingtimes.comDisabilities/ConditionsEvery Child Journal52Despite the fact that all the children of parents whotook part in the study were deaf, 12 of the children hadno reported access to a Teacher of the Deaf (ToD). Parentsvalued support where the ToD was actively involved andcommunicated with them. Parents were less satisfiedwhere the ToD input was sporadic, where it was identifiedon the child’s statement but did not materialise andwhere identification of a learning disability resulted in theToD being withdrawn. For one family trying to establishcommunication with their daughter who has profounddisabilities, lack of access to sign language tuition raisedsignificant problems:“It has been a bit disastrous I would say. It is a bitself-help, self-taught because we have a busy home… Dhas been trying to self-teach himself and then I will sayto him, ‘what is she doing, what is she signing?’ and hewill either know and say ‘oh, that means…’ or he doesn’tknow and we both look at each other – we don’t know. It’sheartbreaking.”[10]Parents were clear that whilst services should be readilyavailable, access came at a personal cost for many. Whereparents were able to advocate and challenge they weremindful of others for whom this may be not be possible:“You have just got to be persistent really. I think a lot offamilies just haven’t got the energy to do it or they are notarticulate enough to do it and they are really disadvantaged.If you can’t do that then you do just get fobbed off.”[23]Poor professional practiceLack of training, understanding and insight all lead to a poorexperience for children. Even at a basic level, professionalsfail to identify and diagnose symptoms. Parents whoqueried their child’s very poor head control were falselyreassured to learn a year and half later that the child hadhydrocephalus which should have been recognised andtreated in the first months of life. In other cases poorpractice resulted from a lack of detailed consideration ofneeds. One parent with a profoundly deaf daughter whohad very complex needs was advised to use sign language.This meant the mother learning British Sign Language(BSL) whilst caring for a very premature baby who was fedthrough a nasogastric tube and required significant medicalintervention. The mother’s regrets around this issue providean insight into the problem of well-meant advice that wasbased on incomplete knowledge of a child’s needs. Thismother shares her story:“And when we started to learn the sign language,obviously we didn’t get a response, we went to the doctorsand the paediatrician at nine months and said we arelearning sign language and doing everything – in a way itwas causing a bit of friction at home because I was tryingto learn it and my husband said she is not responding, andI said well they say it takes a hundred times or a thousandmillion times before a child says mum, but we never realisedshe was blind. In a way I wish I had maybe just cuddledher, we were just desperate to do everything correctly tomaximise the child’s potential.”[49]The mother’s sense of guilt and recognition of lostopportunity is a timely reminder that professionals needto take a holistic approach to meeting needs. In seeking toprovide early intervention, particularly where children havevery complex needs, the importance of a holistic approachshould not be underestimated.Where lack of training is evident parental outrage isunderstandable. Parents have to learn how to appropriatelymanage their child’s identified special needs quickly. Thismay include complex medical interventions or simply bestpractice in managing hearing aids as illustrated in thisparents comments:“Sure Start Nursery: we pulled him out of that becausewe went to pick him up, it was happening quite often, butI started to pick him up at times other than when I said Iwould pick up because I was worried about him, and henever ever had his hearing aids whenever I went to collecthim, they said they were a risk to the other children, achoking hazard.”[39]In removing this child’s hearing aids the nursery nursehad effectively isolated this child, making it impossible forwww.teachingtimes.com n Vol 2.4Disabilities/Conditions Every Child Journal53him to have any contact with the adults or other children inthe group. Importantly, the nursery had made no requestto the mother or other professionals regarding how toappropriately handle their concerns.In many cases there was a sense of professionals beingoverwhelmed by the complexity of needs. Typically insuch situations the default position is to focus on what anindividual knows. This results in the child being seen as anumber of labels rather than an individual with complexneeds. A holistic approach that seeks to understand thepotential synergies that exist between different conditionsand needs is one that parents felt most benefited their child.For those children who are medically fragile andtechnology-dependent, requiring a high level of support andexpertise, finding a suitable placement can be challenging:“There are no facilities for [child] for that, nonewhatsoever. We couldn’t get anybody to take her from acare point of view. Some special needs children do go tonurseries where they have additional training, but there isnowhere in this area that would accept her. Even for the sixweek holidays, because I am"
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Special Needs

Listening Loss And Bad Behaviour

14 Oct 2011

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      string(5678) "sk ills. Add to this the factthat in a substantial number of schools the demandson teaching staff will be higher, and we can confidentlyargue that our training model of ten hours of basicfollowed by ten hours of Inset throughout the yearrepresents a useful baseline. That training will need tocover both the full range of basic management skills,as well as lo oking at how to deal with the more complexand demanding behaviours associat ed with emotional,behavioural and social difficulties.What qualities does a trainer require in this area? Firstof all is subject knowledge and a strong grounding inbehaviour al, co gnitive and affective approaches tobehaviour, as well as an understanding of theinstitutional and social contexts in which issues aroundbehaviour are set. Such knowledge is available throughgovernment-promoted pro grammes such as theBehaviour4Learning courses associa ted with the KeyStage 3 strat egy and via indep endent courses andtrainers such as those asso ciat ed with Asser tiveDiscipline. The way in which such training is deliv eredwill correspond to that outlined in figure 1; the trainerdemonstrates and models skills, and then supports theint ernalisation of those skills on the job. We wouldsuggest that two further factors need to be taken intoaccount.The first of these is personality differ ence and behaviourmanagement. Teachers and other classroom staff differconsiderably in the way the y deal with issues of socialrelationships and behaviour in the classroom. In previousarticles we have outlined the different ‘faces’ that adultscan show in the classroom.8 The ‘rules and consequences’teacher is essentially directiv e, keeping a kindly butextremely firm hand on behaviour. The ‘confront–contract’teacher controls the classroom by mak ing clear tostudents the formal and informal contracts that areavailable to them. Students are given more room forpersonal choice but in return are called to give a clearaccount of themselves. Finally, the ‘relationships–listening’teacher tends to treat behaviour as a symptom and directstheir attention at the underlying emotions and feelingsof the child.In practice most teachers use a mixture of these threeapproaches, tailored to the children and the situa tionthey are dealing with at the time. Nonetheless, teacherswill tend t o have preferenc es in behaviourmanagement style, and these preferences will tend toreflect personalit y differences. There can also be anegative aspec t to such personality differences. Forexample, in most schools a minority of staff (usuallyaround 10 per cent) ar e responsible f or the greatmajorit y of ro om ejec tions, which are oft enaccompanied by considerable anger on the part of theadult. Now, in some cases, there may be structuralreasons for this – as, say, when schools follow theundesirable practice of giving lower sets or difficultclasses to new or inexperienced teachers. However, itis also highly likely that adult personality is having aneffect, and training has to take account of personalitydifference. We use two models to adapt training forindividual staff members: trimodal profiling andsituational leadership.Figure 5: The ‘change triangle’ActionsThinking FeelingsDealing with the challenging behaviour of young peoplerequires teachers to apply behavioural skills (what we do),cognitive skills (how we think about it) and emotionalqualities (how we feel ab out it). As we learn copingstrategies we are making changes in all three modalities –hence our use of trimodal profiling. We pointed out earlierthat every time we learn a new set of skills we are likely to56 Managing Schools Today November/December 2006Behaviour managementBehaviour managementBehaviour managementBehaviour managementBehaviour managementfeel stress on some or all of these fronts. If that level of stressis too high, we may find the required changes too difficultto make. In that case we will need specific support. We canillustrate this approach with a story.We were once working with a teacher who wasfrequently involved in conflict with children. This took theform of a lot of shouting and frequent ‘sendings out’. Inour first sessions we spent three or four hours goingcarefully over reinforcement theory, in particular lookingat the ways in which adult over-reaction feeds pupilprovo cation. In the session we used some timedobservational material to demonstrate the effect betweenhis behaviour and that of his pupils. 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Special Needs

Training and the art of behaviour

16 Apr 2018