Recognizing Complex Trauma

Teen girl sitting by herself

It’s sobering to realize that many of our school students have to deal with trauma every day, from physical abuse to food uncertainty to the death of a loved one. The pandemic has only added to the stress that teens have felt and the trauma they have experienced. As school leaders, part of our job is to help our students through this trauma and allow them to heal. To delve into how to do that, we spoke with Cat Davis, the chief program officer of Miss Kendra Programs through the Foundation for the Arts and Trauma in New Haven, CT; Colleen Lelli, an associate professor of education at Cabrini University in Radnor, PA; and Stacey Bailey, a clinic director for WellSpan Health Philhaven and Water Street Outpatient Mental Health in Lancaster, PA. Principal Leadership senior editor Christine Savicky moderated the discussion.

Savicky: If schools continue to be closed, how can principals and teachers help maintain students’ social-emotional health?

Davis: We’re in unprecedented times. If and when we return to brick-and-mortar schools, the students will have been out of school for at least six months, but it’s not just the learning that they’ve missed. The aspects of social engagement that school provides and social development in relationships to peers and school personnel are also impacted. Being able to provide opportunities for students to engage with one another is really important in maintaining social-emotional health. If everyone’s still working remotely, those opportunities are limited in terms of the peer-to-peer relationships.

Schools have used Google Classroom to have students interface, even if it’s through a computer. Yet we know that not every family has access to the necessary technology, so one of the key things that principals and teachers can do to help maintain students’ social-emotional health is to be individually reaching out to each and every child and family to let them know that staff is still connected to them, that you care, and you genuinely want to know what their experience has been. It’s just jumping into the conversations and being ready to listen to what each family’s unique experiences have been, but providing that consistency and letting them know you’re still there.

Lelli: Communication, consistency, and control. With communication, you’re allowing time for children to check in, for parents to check in. Providing teachers the opportunity to use a trauma-informed approach to check in with students is really important to check on their mental health and allow them to express their feelings. The consistency allows for a sense of predictability so that students feel safe. So, having a consistent type of pattern—online or in the classroom—is really important. When a student is experiencing trauma, they feel helpless, as if they’ve lost control. During this pandemic, many folks have felt like the unknown has made them lose control. Having a plan and teaching students to have the to-do list—also having a regular schedule— will help regain that sense of control. All of this helps build relationships. To Davis’ point—relationships are so important, and so it’s building the relationships by communicating and having the consistency and supporting them to feel the control that they need.

Bailey: Consistency is very important. Principals and teachers should encourage caregivers at home to also keep a routine and schedule. The school staff also needs to give support to the parents if the parents are having difficulty keeping that schedule. What we have asked the parents to do is extremely difficult. They have to live their own lives and then also figure out how to educate their child at home. I agree that the social- emotional health of the students is really important. The students really miss seeing their friends and being social, and they really enjoy the Zoom virtual opportunities. So, it’s important for principals and teachers to create social opportunities through social media to reduce those feelings of isolation. They could organize support groups through Zoom, Duo, Skype, Google Meet, whatever they have at their disposal. They should also partner with behavioral health organizations such as Mental Health America. They can do behavioral health and psychoeducational presentations over Zoom and help identify at-risk students. Mental Health America may link them with school-based behavioral health providers that can provide further services to the students in need.

And then there’s also programs and apps that principals can encourage. At WellSpan Health Philhaven, we use myStrength, which is partnered with 130 different health care providers in the United States. But there’s also SuperBetter, Middle School Confidential, Social Express, Smiling Mind—they’re free apps that principals could promote that suggest mindful activities, and they really help kids monitor their own social-emotional health.

Savicky: What are some of the signs of trauma that adults in the schools should be looking for in their students? How can they recognize it?

Lelli: Depending on the child’s age, the signs may vary. It also depends on the traumatic event. For instance, the signs we see with domestic violence could be very different than what we might see with another traumatic event, [e.g.] the pandemic. But all children, including teenagers, may mention feeling helpless or uncertain. They feel a loss of power and control. What we have found is that students who have been through a traumatic event struggle with expressive language. There’s all kinds of neuroscience and the way in which the neurological piece fits into that, but they might seem uncommunicative because they don’t have the words to describe their feelings. They may be tired in school because they are having sleeping disturbances. They might have fears that the events will repeat. There may be a notice of a self-protective attitude. Older students put up a wall. Some students may be jumpy—loud noises or even sirens could retrigger some type of traumatizing event.

There are many signs, and I think that the important thing is to use the resources—like Bailey mentioned— especially your community partners. Engage with them. Communicate frequently with counselors and social workers so that—if you suspect something—you will have a team of professionals ready to help. If you’re an educator and you’re not sure if what you’re seeing is a reaction to trauma, use the community resources, use your in-house resources as support so you do your best to support the child.

Bailey: First, we can talk about trauma, and we can talk about trauma due to COVID. But it’s not just COVID that they’ve been dealing with. They had to deal with a rapid shift from brick-and-mortar-based to virtual online school, learning new software, adjusting to all of the changes. They also had the overarching threat of a potentially deadly virus that they had trouble understanding—directives were changed. Then there’s also a lot of traumatic social events that have recently occurred, and that’s triggering a collective emotional response that heightens everything, too. Just those three incidents on top of one another could heighten people’s emotional response and trigger other trauma that they were coping with before but are unable to cope with now.

Students will have a wide range of responses. Some of them are indifferent and uninterested. There are also students who are anxious, afraid, and panicking. Some of the emotional responses that they’re having are normal, because it’s an unusual situation. It’s not their usual mood or it’s not their usual behavior, but it’s normal within this situation. They could be anxious and worried. They are concerned about being isolated; they have FOMO—fear of missing out. They have increased anger, frustration, agitation, boredom. Those things are all normal, but then they also might start unhealthy coping skills—overeating, sleeping, using substances. Posting inappropriate material on social media is a big one for teens.

And then there’s depression symptoms that principals and teachers should be looking out for. If there’s a behavioral issue, suicidal ideation, serious acting out, or a sudden drop in grades, you would want to do a behavioral health referral or, in the extreme cases, send them to the emergency department. Principals should also ensure that all school staff are provided psychoeducation so students’ needs are better identified by the frontline teachers and school staff.

Davis: I would add that kids are innately resilient. Not all students will have a traumatic reaction. There will be some students who have, within the quarantine, been exposed to not just fear of COVID-19, but some other type of abuse in the home: physical, emotional, or sexual abuse, extreme poverty, or domestic violence. These will amplify their response. We can’t just assume that it’s COVID-19. It could be any number of these more interpersonal traumas or toxic stress kind of environments. There may be some students whose behaviors are showing themselves more explicitly, and you know that student is having a tough time, but then there may be also a lot of students who will keep their symptoms of trauma close to the surface but don’t let them break through. We must be mindful not to forget about those who may seem like they’re “hanging in there.”

I agree, teachers may see it in a student’s academic disengagement or dropping of grades. What we see is a lot of inattention in school when kids are doing OK, but there’s something bubbling up; it can seem like distractibility, maybe a little more antsy than usual in terms of the pandemic, maybe talking to their friends more because they’ve missed them—all of those smaller signs, as well, could be showing that there’s some anxiety under the surface. We have to think of every child, not just the child who’s exhibiting symptoms.

Savicky: What are some actions that teachers and principals can take to help those students who have experienced trauma?

Bailey: I encourage teachers and principals to partner with the guidance counselors, social workers, school psychologists. Those people are invaluable in the school system right now. It is important to make sure that they are given the tools necessary to help them identify students and the time to really think about who may be at risk. If the teachers and principals are able to identify those students who feel like they’re experiencing traumatic aftereffects from the pandemic, then those students should be referred to school-based behavioral health services or to the appropriate out-patient mental health services. If the teacher and the principal have a good rapport with the student, they could gently ask the student how they’re doing, ask to meet with them, tell them they’re concerned about them because they’ve seen a change in their behavior. And if they do that, it would be important to really listen, validate the student, and refer to outpatient therapy if needed.

Make sure that the student feels safe in their home environment, because—as Davis said—they are at home more, and if there are home difficulties, that could be exacerbating the pandemic’s traumatic aftereffects. The teacher should ask questions to see if the child feels safe in the home. We call it “safety plan” in mental behavioral health—talk with the child and make sure that they know what they could do to remain safe, [e.g.] call 911, or go to a trusted adult. If the trauma is the aftereffect of the pandemic or is on top of another trauma, then it’s important to make sure that the student’s caregivers are informed and aware that the student is struggling.

Davis: You need to take a holistic approach with the understanding that the kids have been through a lot. Outside everything that Bailey just mentioned, in terms of getting kids access to different resources, schools are going to want to keep their expectations reasonable. Many educators are going to want to be playing catch-up on everything that the students missed. If they go into the school year saying, “We’re going to jump right on the bandwagon, and we’re going to go, go, go,” to be able to make up for lost time, that would be detrimental to the students’ well-being and could backfire. It’s going to take time to readjust.

Likewise, schools need to set a norm that the school is a safe space to talk about things that have happened, again, so that every child has the opportunity to share. Teachers, administration, and students really need to connect to one another again as they’re coming back in and create a sense of common language and universality around what these experiences have been. We have been through something together, but each person’s experience is unique. So, I would say that focusing on some of those social components of coming back together, and really connecting and fostering compassion within the classrooms, would be essential.

Lelli: Slow and steady for sure. Everyone has been through something we could never have fathomed, so I think mental health has got to be the first priority. Beyond that, once we’ve identified and we’ve provided the mental health support, there are strategies that can be used in the classroom to support students’ learning, either online or face to face. I mentioned earlier expressive and receptive language are usually impacted by trauma. And so, when we talk about expressive language—speaking and writing—and receptive language— listening and reading—those areas are going to be really impacted. Using children’s literature to discuss feelings, to express themselves, is really important. A graphic organizer is really helpful in not just being able to organize information for writing, but also trying to manage incoming information. Many times, students will have executive functioning difficulties, and so they’ll have difficulty planning a project or struggle to tell a story. The graphic organizers are really helpful in terms of helping them to summarize directions, helping them to visually have task cards to figure out how to reach their goals. Setting short-term goals when you have long-term projects helps with executive functioning as well as expressive and receptive language. Using memory games is really helpful to remember key content. All of these things can be incorporated.

To round up what we all said, the slow and steady pace is so important because we’ve all faced something that we never could have imagined. I think that it’s really important for teachers as well to take care of themselves. We have many teachers who are caregivers themselves, whether it be for students or their own parents, so it’s really important that we just ease back into whatever that modality is.

Savicky: How can principals, teachers, and students manage their stress during this pandemic?

Davis: There’s so many things you can do to help bolster your resilience and manage stress, but it’s because of that stress that it becomes hard to implement those self-care practices. You can kind of get in this cyclical, stuck feeling. I think it’s also really about the intentionality that you set behind each of those practices. You can make yoga a piece of your self-care; you can make exercise a piece of your self-care; but also, self-care is cooking for yourself and taking a shower, or if you take meds, make sure that you are doing those things as part of your routine. It’s really easy when you’re working from home to not get dressed in the morning and to stay in your pajamas, or maybe skip a shower here and there. Then you get to day three and you’re like “Ewww. I’m feeling a little nasty about myself.” Say to yourself with intention, “I am doing this to take care of myself. It’s important.” I have a little sticky note that says, “Shower. Feed yourself.” Because, you know, when you’re sitting around, sometimes you just forget.

Lelli: One of the things, too, I think that would help manage teachers’ and students’ stress during a pandemic would also be consistency with assignments—when they’re due, and when they’re posted if it’s online—so that way, going back to the first question when we talked about consistency, what I did for my own classes is: Every Sunday night I said, “Hey, here’s what we’re doing this week,” like a to-do list. There are many creative ways that you can list the work that also makes it engaging and fun, and visually, it looks very positive. That consistency piece with when assignments are due and just being clear with students will help alleviate or help to lessen everyone’s stress.

Bailey: They need to practice self-care. They need to take care of their mental, spiritual, emotional, and physical well-being during this time. To do that, they should make sure to exercise regularly. They need to practice good sleep habits; if there’s any major changes to their sleep habits, they should probably talk to their PCP [primary care provider] or behavioral health provider. They should try and eat healthy, and then, if they slip up, forgive themselves and try and eat healthy again. They need to find ways to stay social. They need to find ways to fill their spiritual bucket. They should try and be more patient with themselves and others during this time, because it’s just really important to realize everybody’s going through it; it’s a time of uncertainty, and people should probably find reasons to be flexible. They should use a gratefulness journal. At the end of the day, they can write or type three to five things that they’re grateful for during the day. That act is scientifically proven to improve mood over a short period of time just by improving gratefulness.

They should also practice mindfulness. Google “mindfulness” and you will find many apps that can help with that. They should have open discussions about the trauma and how the pandemic can cause trauma. It’s important for everyone to talk about how they’re feeling and what’s going on. If people are feeling rage or a desire to fight for change, they should search locally for ways that they can be a force for change—helping at a food pantry— or finding ways online to help. Then also, a really important thing—one of the most important—is to set a routine and try to stick to that schedule and make sure that in that schedule you put that time in there for self-care.

Savicky: Do you think the pandemic will cause long-term effects on students? What might those effects be?

Lelli: It’s definitely going to shape our thinking; it’s going to shape the way we react. It is going to impact future generations. It’s going to change the way we live and the way we educate, but we don’t know what this will look like yet. It will make for interesting research, for sure. But if anything, we’ve learned in the past when these types of things happen that it does change people. So, it’s really important that we keep that in mind, because we still don’t know how our students may be impacted. We have to know that this is an ongoing trauma. So many times people think one traumatic event happens and it’s over. We expect someone to bounce back or move on. We don’t realize how multiple traumatic events—complex trauma— could impact someone. During the pandemic, students and teachers alike could be impacted by complex trauma. We do not know if a child has been affected by multiple traumas during their time away from school. There could be retriggering. So, again, making sure we’re taking care of everyone’s mental health is really, really important.

Bailey: This pandemic is, hopefully, a once-in-a-lifetime occurrence. It’s a type of world event when people remember where they were, what they were doing during that event. It shapes our current thinking, and it will impact generations and whole cultures. Right now, students may not fully understand what’s really occurring in the whole world. Teens and kids tend to be more egocentric—more concerned about themselves. So, keeping tabs on what they understand and what they don’t and meeting them where they are is important. Many students are adopting their parents’ views on the pandemic and might have a difficult time forming their own, so I think that it’s important to give them time to understand why they might be thinking the way they are.

The pandemic is going to shape education for years to come—virtual learning is going to exist in all areas of education, and some students across the country are going to realize that they enjoy online schooling more than traditional education. I think students are going to have hybrid choices. I see where people are already doing that, but more people are going to be aware of it. There’s going to need to be a whole system to support the influx of online students, which will need to be created quickly, then studied and upgraded. The process will be continuous.

Principals are going to have to work hard at creating a community feel that will be lost by not coming to school. We’re going to have to help the families feel like they are part of a team, the school team, and communication between administration or teachers and the students and parents will need to improve. Students will most likely have more school choice because they will be able to choose based on educational factors, not just location. This will be a huge change for students. It’s going to change the game.

Davis: From a psychological perspective, any time there’s a collective or individual trauma, people have to adapt to their present circumstances. They tend to create different trauma schemas or cognitive frameworks that they adapt to in order to deal with their environment. Those schemas or frameworks become a lens through which they view the world, or a generalization about the world that they’re living in. So, in terms of the pandemic, again, you can’t globalize it—it’s not going to be the same for every person—but some of those generalizations that I might think we would see would be things such as “There’s never enough” in terms of resources.

Families that might have had more financial impact, this idea of “there’s never enough” could manifest as hoarding, consolidating everything they have and holding on to it, similar to the Depression. If you think about toilet paper, our stores are stocked now again, but a lot of people are going to keep a surplus of toilet paper. We’re going to see some of those types of long-lasting impacts.

Then, of course, based on individual traumas that have happened throughout COVID as well, if trauma within the home increased during the pandemic, then those kinds of generalizations would also potentially be long-lasting unless treated. If there’s physical abuse in the home, and the child gets hit whenever they’re not quiet, then they learn things like, “I have to be good all the time, or anytime I get in trouble I’m going to get hurt.” There will be some psychological impacts, and hopefully they will be able to be mediated when things return back to normal, whatever that new normal will be. But for individuals where the trauma was more severe, where the impacts of the coronavirus were more severe, I would expect some of those trauma schemas and generalizations about the world to stick with them for a longer period of time.