The Need to Address Childhood Trauma: Implications for Child Welfare and Education

thank you for joining us on this important discussion miss Frank on the need to address childhood trauma when I first think are a congressman representative Danny Davis or sponsoring this important legislation well I like this afternoon or this morning with regard to some of the supports that are absolutely necessary and one of this this topic is so important with regard to childhood trauma so um we are we are expecting representative Davis to show up so when he comes to the ground we'll just pause here with our speakers but I want to introduce myself I'm Wendy Ellis I'm at the George Washington University I run the National blood group called building the community resilience but we work with local communities you know healthcare public health and multiple sectors to really get to the root cause of community and childhood adversity so I'll talk about that a little bit detail but first off we're going to set the stage for you with regards what you hear from our speakers well we think about childhood adversity you know many facets of that where it shows up and how it shows up so you know we've we've heard if you're familiar with the average common experiences studies you're thinking about those individual traumas that children experience whether that is there is domestic violence where a parent that is an incarcerated but as we grow to learn more about that science we understand that those traumas that children experience were well beyond just what's happening within that household it has everything to do with the community in which they reside and so when you think about outside of just thinking about abuse and neglect think about personal violence and community violence the some of our own federal statistics that have been collected by the DOJ at CDC the National Survey of Child exposure to violence shows that 25 percent of US children on witness violence violent crime and in one year that's one year statistics so every year at least 25 percent of our children one in four are experiencing or witnessing some sort of violent crime so it so that begins to help you to understand that we're not just talking about unfortunately you know what a child may suffer a personal personal injury but also what they may be how.what woods and other community members and that more than 55% of our show that are experiencing so personal injury a some sort themselves so that begins to think about were disappearing because this can't all the occurring in our households well some of that unfortunate is current within the systems that are should be protecting our children so think about this there's what most senators occurring in our schools and our classrooms and foster care and fortunately there's violence that is attributed to being homeless which we have a rising number children living in poverty living homes and then of course with our opioid crisis and the abuses and the flood that are associated with that so this begins to help you to ending about not only where our children are suffering but what that begins to how it begins to express itself in all of these various environments so when we came with a vulnerability in its association with adversity you know really begin to think about that root cause of these long-term disparities that we see so as I spoke to some of those factors that are associated with poverty you know the violence and homelessness these things have been in the science of adverse childhood experiences also tied to things that get under our skin so we begin to see the health outcomes that are associated with aces so thinking about the higher rates of depression for individuals who have a higher a score for individuals that have a higher rate of alcohol illicit and prescription drug abuse and I think this is you'll see this later in my in my presentation I think this really does begin to inform what we see with our current opioid crisis with regard to individuals that have a higher rate of aces are also associated with having a higher susceptibility of opioid abuse literally self-medicating themselves right so I think I'm acquiring a better one make sure for those who are listening to us on the livestream really understand you know the full context of what we're discussing this morning so as I spoke earlier with regard to violent crime in school confront us can you imagine if you're witnessing this level of crime how in the world are we expecting our children to be able to focus in the classroom if they're coming to school hungry if they're if they're not sure what they're going to walk into when they walk out of that classroom how can i how can they expected to focus so when we see some of these negative behaviors that are occurring in our classrooms than our children can't sit still that they can't focus that they seem to be disruptive quick to anger it was really you know it's not necessarily asking what is wrong with you but Johnny Jill what has happened to you and so you'll hear from our educators on the panel today that we'll talk about exactly what does that look like in a classroom when you have a child that has had these high levels of it burst these exposures you know what does what does that challenge present to our educators some of it is some of the supports and some of the strategies that are being employed to address this so with this opioid crisis obviously you know we have to look beyond what's happening to that individual who has overdosed and really think about the ripple effects so in 2014 in the Illinois opioid overdoses actually outnumbered the number of all one related deaths by so just pause and think about what we see in the headlines when we associate Chicago and gun crime there to understand and that's just the tip of the iceberg that way you actually have a much larger crisis that's occurring that with relationships the opioid overdose rates and that's not just happening to that person as we look at our rates in the cities particularly CDC statistics that show that over the course of the last fourteen years we had the opioid men have always outnumbered or outpaced women with regard to opioid deaths but that gap is closing and it's closing pretty rapidly so you have to think about what's happening to those children because typically you know if something happens to that moms have been able to pick up and and move forward and you know you have that that tradition of single mothers always you know pulling it together what happens the next time a mother is gone what happens when it's grandparents that are trying to take care of these children that our systems unfortunately don't provide the same level of support financial support for kinship care so you have grandparents that are on fixed incomes that they're trying to support the orphans of their own child's overdose that can't do that so it's no wonder that when you see in Ohio the FSM literally of our opioid crisis 7000 placements for 14,000 children who are waiting I just thought that hang there for my life so when we talk about childhood adversity and opiate crisis as you can imagine we've had a five-fold increase of infants that are being born drug dependent so what does that mean again let's not just think about this thing you look put in time it lets how much that infant but the longitudinal impacts of this that will show up in education and two or three years when a child in the school that will show up in five to seven years perhaps in juvenile justice we know the trajectory of children that are born behind the curve or behind the curve with rules that are in their way so you can begin to understand the neurological and the biological impacts that are happening to these children across our country and an increased rate so know it's not just the tell me more that has a crisis right now we have a coming crisis in education a current crisis in foster care and child welfare and we have a crisis that's on the verge for our dual justice system if we don't do the early intervention now so these are the states that have the significant and increases and one of the things that I want to point out to you is this is this other issue this isn't a northeastern corridor issue this is a coastal issue this is a true American issue it cuts across regionally across our country and it's also similar to what we see with adverse childhood experiences again average child and experience in one of my previous four things I pointed out the fact that average childhood experiences a curb pretty flat across all race on economic all education levels yet we know that the outcomes for individuals are quite different so that begins to speak to what's happening not what has happened to that person but what's happened after that exposure so that begins to speak to we understand some of the supports that will make the difference between having a high a score and then completely dysfunctional and having an eye high a score like myself and being quite functional and productive and it speaks to the support in community so there's a responsibility here for us to think about this austere care crisis the increase in the children that are in our state systems and how do we respond how do we think about a place like Cincinnati Ohio where Monica doubt on one of our speakers here we'll talk about when we see this increased need for children that are waiting for adoption since our opioid crisis began and yet our systems have not yet been able to respond effectively because there isn't the ability to gable to coordinate and collaborate across systems so it's not necessarily asking for additional funding it's asking for a helping hand on across systems that are also responding how do we coordinate those efforts and that's an important piece of the legislation that Danny Davison and colleagues have brought forth to think about how can we work smarter not necessarily with more money but work smarter across across sectors in a way where we can be much more effective in responding to these crises so when we think about foster care in childhood childhood trauma one of the other things for us to think about is again we're talking about child welfare and yet this system unfortunately the way it's designed the way that we deliver programs actually ash trauma on top of children who have already experienced trauma let's face it if you're in foster care things haven't been rosy something has occurred in your life that is traumatic if it's just that ace of being put into foster care that's significant in itself so we really do have to ask ourselves we're able to send individuals off to war and they have a lower rate of post-traumatic disorder and the children that are in our states care there's something significantly wrong with that system so those are some of those statistics at least statistics with regard to children that are in our best care and obviously those that are a child welfare in foster care they don't go to work thinking that I'm going to make sure that this child doesn't party their entire life that's not their intention most people that are working in child welfare in foster care are going to work there because they really want to make a difference their heart is there for the babies yeah it's stones that the way that programs and policies are designed much like I said the kinship care what a grandparent to be to live in poverty not be able to put food on the table if they want to be there for their child so those are some of the things that we have to really critically analyze and think about what can we do better with what we have so what I'm describe to you by pointing out the opioid crisis I'm thinking about you know many facets of diversity is what we call nobility community resilience collaborative as the pair of aces so it's not enough to look at those individual exposures the traditional Tenace is areas of aces but to think about this as a tree and so those individual Easter's are like release on a tree it's what we will see well it comes abundantly obvious when a child presents themselves at school setting and a hospital setting an emergency room unfortunately or just a playgroup those things are abundantly obvious that something's not right here but what we don't necessarily see just like with a tree you know doesn't slowly see how deep those roots are we don't see what's planted below the soil but very much so this represents the soil in which our communities are rooted the soil enrich our communities are rooted in which our children are drawing from so when you have a soil that's that's poor in the nutrients around violence that's what's being fed is right where there's discrimination or those factors associate with poverty whether there's a major community disruption on which were canvassing across our entire country about gentrification revitalization of our space revitalization that is not coming in an equitable fashion because we have individuals that are at the lower end of the economic spectrum that are being pushed out of our neighborhoods you see that here in DC we see that in Portland we said it across the country that in itself is a traumatic experience so we have to think about this in a holistic fashion if we can't expect to do a point of service whether that's in the foster care system or in schools or in the hospital or clinic setting within send pokes right back out to feed off of this very coarse so this begins to help you understand what we're talking about how we have to respond to these multiple adversities in a multi-sector fashion so this is just quickly to let you to give you sort of an analogy we found it to be quite helpful with folks to understand that when we talk about these things this is the culmination of toxic stress when you have this adverse childhood experience is occurring in the context of average community environments unrelenting without bumpers is absolutely vast toxic stress and just like the branches on the tree it has the same effect of pruning those branches so what you see on the top is what a child of healthy development should occur there's this branching that occurs when a child is in a vibrant community what is being and nurtured what it has gone that's loving that it has new experiences on a regular basis well that doesn't happen it's just like taking shears to a tree and it's printing those branches so when so a Monica sees a child that can't focus that can't sit still that isn't developmentally on track she understands 30-some branches that have not been allowed to grow and this is when I salute Lee impact this child's academic performance and their trajectory of life so building community resilience quickly we're in five cities across the country where we're joined this work on the ground where we're working with clinicians public health child welfare Juvenile Justice and our city managers to think about how do we come together with the resources that are our already being brought to bear not duplicating but working more effectively together to address these issues what we've learned so far the two and a half years that we come up doing this collaboration is extremely hard string what the party fun exported and we've got the success stories to talk about you can go to our website and see some of the some of the projects the demonstration projects that are going on across the country the data sharing across agencies is absolutely important so that we're doing informed work targeted work and that we're working with communities so we're sharing our resources not just across agencies but with community and providing a community voice to do this work that education foster care child welfare public health juvenile justice are critical partners in this work on the ground so House Resolution 1757 that was introduced by representative Danny Davis a trauma-informed care for children and families act fosters this type of collaboration of prospectors with community coordination it would help us to improve coordination across federal programs support a trauma-informed workforce again that critical question at that slipping of the question of you know what is wrong with you – what has happened to you is so important what we have to train our workforce those are on the front one we have to give you the tools and resources to be effective and responding to these crises and then the supporting it for the innovation around prevention and care and incentivizing working smarter incentivizing working smarter making sure that we're just working the best that we can with those resources that we have in hand so there is a companion bill for 1757 in the Senate that was introduced by Senator Heitkamp Durbin and Franken it's a Senate bill 774 so we have bicameral support for this effort and I will say this area around trauma informed care has been in China more practices has been one in a few areas where we actually have some bipartisan support so yes this is something that actually you know resonates um no matter what your strike may be your political strength maybe and I you know I think that's we're all about the babies so I want to introduce quickly introduce our speakers we have dr. Acosta Olga Koster Christ is an associate professor and the department of prevention and community health at the George Washington University and she's also the director of the Center for health and healthcare in schools a national resource and technical assistance center committed to building effective school health programs catherine Laren is the acting director of the US Government Accountability Office and a member of gos executive candidate assessment and development program this larren has served as assistant assistant director NGOs education workforce and income security team led evaluations and research studies on a broad range of issues affecting low-income and vulnerable populations including elementary and secondary education principal amount of the battle has been an accomplice in today's colorful fundamental Academy since 2013 over her 19 years in education she worked in classrooms even here in the District of Columbia before returning to her hometown of Cincinnati to take on a leadership position in schools that serve some of the city's most vulnerable children pencils battles work exemplifies the need to recognize that teaching and learning are in rapid evolution and must take into account new technologies as well as the need to adapt to community context in which our children live Whitney Iliad entered foster care at the age of 14 after enduring years of physical and emotional emotional abuse the aim of foster care is to lift our children out of abuse and provide nurturing and single environments but as Whitney will share all too often the very system that is designed to heal life's hurts can be the source of new and personal trauma so I am going to turn the panel over to a discussion over to Olga and if you want to just come on up I just lost you yes give me just a second here well you know I'll take the liberty of going and starting because I actually won that just first say that I'm honored to be with you and thank you to Wendy and and to Hearst team and to all of you for the time that you're taking to be with us today I appreciate being invited in addition to the statistics that that Wendy yeah that when he shared I actually wanted to start with a quote which I'll read to you and it'll show up at some point that I love at least that a young person sorted that we a snippet of her life that again we're gonna have the pleasure on the honor of hearing from Whitney and so glad you with us but I think it underscores and it illustrates for us what those roots look like that Wendy was talking about the depth and the chronicity of adversity that many young people live with the quote from this young woman said is my whole life is stressful I ran away from him there were like 13 people in that house after a while you know there's not enough food and everything for everybody to be there one winter we had no heat we had no electricity we had no water it was bad unfortunately what we know is that that is not an isolated piece there are too many of our young people in the United States who live in conditions like that and that in and of itself are some of those impoverished conditions increases their risk in our risk for exposures to a number of adversities what we know from the Southern Education Foundation report that was released a number of years ago is that now the majority 51% of our public school youth meet criteria for free or reduced lunch which is our proxy for poverty so we have the majority among the young people in the United States attending public school who have a greater likelihood of daily stress in their life related to disadvantage related to not having the kind of resources that they need children do not leave now let me thank everybody for coming who did it that come because I think what we are dealing with theatre it is one of the more important things is that our society these stickers and we can't let it go by without addressing it in a very serious way therefore I am delighted to doing the Congressional foster youth caucus George Washington University schools probably helped and the campaign's of trauma informed policy and practice and hold in today's briefing today we are here in first hand from experts at youth about how we can help children and their families who have exposed things bows to trauma be healed and be successful in school worked in life I have partnered with my colleagues representative Robin Kelly and Cheri Bustos in the House and Senate Durbin in the Senate to introduce the trauma-informed care for children and families act more than one in four children and adolescents experience a significant trauma five adult hood when children experience traumatic events like child abuse and neglect stress alters the development bringing with impact social emotional well-being and forced children into survival mode the child's natural responses trouble they result in difficulty and attention are regulating emotions that often are overlooked on this understood in a school setting this can lead to school suspend both student achievement or escalation of conflicts our bill provides comprehensive system reform to support these children and their families research indicates that over seventy percent of children for receive mental health services access these services in their school social-emotional hearing is smooth bring effective interventions into the school settings to ensure more children learn coping and resiliency skills before their symptoms escalate 18 per million of the bill would improve pre-service training programs to prepare educators to work with students who have experienced trauma we include incentives for the development of curricula focus don't build it teachers trauma skills related to their dedication support interventions and discipline our bill has been supported by over 50 organizations including the National Education Association and the town Welfare League of America to organizations expertise in the fields of child welfare and education I'm excited about the town with experts that we have with us today who are sharing their wisdom and best practices proven to address the mental health needs of children and families involved in the child welfare system and reduce absenteeism due to trauma exposure in our public school and just to note that personally I have taught in one of the poorest most undesirable committed people communities and neighborhoods in North America a narrative called North ilandia in the Chicago area I taught in a public school setting where children who came directly from that community and children who in Arthur rated in the Illinois Department of Correction in a program for many different reasons and that community has been an integral part of my life and my work for the last 40 years or so I've also had the experience unfortunately recently of heaven a grandson who was murdered and heaven a granddaughter who was there Wendy was she had managed fairly well but she also continues to experience difficulty she's 17 years old she is a senior in high school her brother was 15 years old and of course he would be a junior in high school and their friends all of them have been impacted there seriously there are times when they reminisce and when they talk about things that they do and also no health professional by treated in terms of haven't been a psychologist's and having my own counseling service at one point that I can tell you that mental health is one of the greatest needs a public health weight that exists in our entire society and so the work and interest that all of you do with the injuries that you are showing that is helping to lead a nation to another level of commitment to understanding the mental emotional health speeds of our populations or any I thank you very much and it's all politicians around here too we're always running from one to the next okay so we're gonna do our best to try to describe some of the slides that I had for you so and actually to a slide that is I can attribute to a partner organization the Center for school health and education at American Public Health Association that I think illustrates again the severity I would amend something that Wendy said earlier that that crisis in education that's not a future crisis there's a current crisis in education in terms of the lack of capacity and the lack of appropriate services and knowledge around how to address the depth of need that presents itself at this hold or these issues do not you know don't present themselves into certain bits of here as soon as you start class they absolutely do impact the learning environment as we already know but in the prevalence is quite high one in every four children attending school is estimated is and exposed to a traumatic event that we know increases their likelihood of having difficulty the other issue as representative neighbors are very much heed up for me is that the way that that presents itself is in the expression of particular mental health difficulties in symptoms of depression symptoms of anxiety post-traumatic stress which are very normal reactions to these abnormal conditions at any of our young people our living room and so what this slide does is help us understand that mental illness in adulthood you know from epidemiological studies actually show up very early in childhood and early adolescence we know that half of lifetime diagnosable disorders and mental illness to start by age fourteen first symptoms of of difficulty start by age 14 on average and about 75% by age 24 what's important also to note from this from this chart is that the age of first symptom there's a discrepancy between the age of the first expression of the symptom and the age of first diagnosis which from many of our systems in particularly behavioral health system is when the traditional mental health services can be provided when you've now had enough suffering that you meet criteria for medical necessity but often that's very late if you look at how long young people have to wait to access that care in on what we know is that again these adversities are pervasive and that health and education are inextricably linked poor health is linked to poor education poor education is linked to poor health and what this slide helps is doing this analysis for child trends is to bring home the fact that that that the greater than exposure the greater the number of adverse conditions that a young person and in this case it was account recording on a young person's their child's life that the greater the number of aces the greater the likelihood they would be disengaged and family from school okay so that Association is very real and there are two main pathways two general pathways that actually can help us understand those educational disparities one has to do with the individual coping and symptoms that we see among young people that there are changes as we know from the burgeoning neuroscience literature in brain development and functioning in the processes and the structures of the brain that are impacted by exposure to trauma and ongoing chronic exposure that there are lags that when you talk about in concentration and memory in social development in cognitive development and behavioral health that absolutely are necessary to succeed in school so these are skills that are necessary to be successful and to access your learning environment but also there are ways that unfortunately the education system has historically also pushed out individuals that have high difficulty again because this system has not been has not had the capability has not was not designed to be a health system it wasn't designed to be one whose aim was to educate well he's now come to realize that we cannot separate these things a healthy young person is one who will be able to learn and therefore educators absolutely get that but that doesn't mean that they have the requisite skills and knowledge and experience to know what to do with that so what we're finding is that young people particularly those with mental health or behavioral health problems are more likely to be disengaged from school to be expelled suspended dropout we also know that although very prevalent unmet mental health needs are significant and access to care is unfortunately very limited what we what was alluded to and is juicy over and over again is that when you do get the care that you need that most often happens in the context of schools script or school based care that is incredibly important if we think about the reach of schools schools have there are 56 million children in the United States who go to school seven hours a day five days a week nine months in year people under the age of 18 make up 24 percent of the u.s. population so we're talking about almost a quarter of their population under age 18 many of whom you already statistics have a great level of vulnerability and are maybe not eating healthy milestones that again are making it very difficult for them to succeed in school but school and some education is not only a location they are dynamic systems and very much influential because they can be significant parts of solutions that we can provide and that we can offer in community why is that because what I'd like to call them instead of just being the police there are other pieces one of the other pieces a tremendous number of influential people who work uses teachers administrators health providers parents volunteers who create relationships and maintain relationships with young people which are very healing and which very much in in many cases reverse the impacts or at least mitigate the impacts of trauma and stress and adversity there are a plethora of programs as principals can often tell you some things too many that are available in schools on health promotion around skill building around prevention around early identification treatment that are offered across the spectrum of health as well as practices that have to do with how to maintain healthy school climates how you create environments or learning and health can happen what are the practices and what are the norms and values that get expressed in schools and then there are the policies that help establish and maintain those practices right I have the school district state and federal levels and then we always have to remember those of us in public health and health but there's a lot of other priorities competing priorities that educators and administrators have to deal with around accountability around pressures to deal with and caring to multiple stakeholders around the politics that occur in education and we have to be mindful that although they are essential partners that we can't expect that they will simply be again doors or access to care without also understanding the many demands that are being placed on education so we are there are numerous arrangements that occur in schools all right and I think it's important to recognize that that again education and educators have been ways at forefront of trying to figure out how to do this sometimes by using just their internal resources from within the system and other times more often looking outside of education to other partners health systems community providers ways that arrangements can be forged to allow those schools to have the capacity and the skills and the qualifications to actually address the array of services that are needed one such example is expanded school mental health programs which is an example of co-locating a licensed mental health provider who often is hired let's say by the district by government or by a community behavioral health system but it is co-located in the schools to expand the array of what is available and not just in terms of treatment which and often these individuals are trained to be able to do effective evidence-based treatment in schools but also to address the systemic issues and yet early identification that needs to happen and that again schools are not often prepared to know how to do well given that they're often shaped to look at educational learning you know cognitive kinds of issues and not necessarily on what to do around the careful emotional issues that arise similarly it's important to talk about the fact that there is a growing interest and the depth of knowledge being built from trauma sensitive schools and these are some of the essential elements of their events a slide I apologize but certainly a number of resources and expertise in here in the room who can talk more about that but just to highlight a number of them you know what we're talking about are against changes to the system that allows the educational system to maximize learning and one of the ways to do that is to again increase the shared understanding of what adverse experiences are how common they are and how it impacts learning and that often is done through professional development the school supporting all children feeling safe and physically socially emotionally state through whole school approaches social-emotional learning positive behavior intervention supports kinds of approaches and the needs to offer an array everything from crisis intervention to social services supports in and out of the school it's also the awareness I want to say the prevalence and the impact of secondary traumatic stress on teachers it's really important that we really recognize that this that part of why we're having such difficulty in retaining good teachers has to do with the same issue the vicarious traumatization that is occurring and the lack of support that teachers are feeling as key frontline providers so the ability of school staff to be present and to be part of the healing process that a lot of our young people need is dependent on their own well-being we don't have a lot of literature a lot of programs or understanding of what those best practices are and it's just really starting to get attention now so my last point is on well what are some of the policy implications then of what I'm trying to say one is that we need to think about ways to improve the capacity of the adults to effectively identify and support young people exposed to high levels of stress both to pre-service opportunities and through professional development opportunities to think about promoting positive school climates and trauma sensitive practices in schools and providing guidance to schools around how to do that particularly essa offers the the reauthorized Education Act every student succeeds act particularly the school quality and student success indicator earth both that law requires States to essentially identify a non academic indicator for accountability purposes that must be included in their state plans that offers an incredible opportunity for states to identify these allows school climate around social emotional learning and absolutely kenefick impact not just the traumatized individuals our context that the entire school population the improving the spread of school age approaches that really are not coordinated and integrated care full service community schools school-based health centers these are models of service prevention that are about coordinating resources and bringing together us providers and finally to facilitate methods to blend in for eight public funds to sustain I didn't say much about it but really you know you have you know a lot about effective programs we know a lot about how to provide them in schools what we know very little about is how to effectively sustain them and part of why yes it's about dollars yes it's about funding and we have to get diamonds to local communities about and the freedom to figure out have a great and planned funding from various sectors but it's also about how to use to tional right these practices and we where there's long term a long term impact so I will end there and again thank you very much I'm happy to take good morning I'm going to start by sharing with you why I am so passionate about this work was almost six years ago today when a young lady walks into my school and I met with her as a new incoming student that was entering at mid-year my interaction with her and this experience is what directed my mission moving forward and absolutely ignited the passion that I have today to make a difference as an educator in a different way I'm going to share with you her story she was 12 years old at the time just placed in a foster home and that's why she was famous for that point in the year she had been neglected by her mother and several other adults throughout her life experienced physical and emotional abuse and just delivered a baby boy a week before she walked through my door and yes I am the principal of an elementary school sat down with her that day and I was shocked at what this young girl before me had experienced all I wanted to do was hug her and say it's going to be okay I don't know how yet but we're gonna help you I'm so glad you're here and that's what I did that was the beginning of my relationship with her she shared with me her story willingly and almost once she started talking she couldn't stop so if there became my personal responsibility as the owner of the story to try to do something to help her and she attended classes went back and forth to school for a couple days we had a security when he come through the door of the school they were checking for weapons and such forth and she had a little backpack just a normal sized backpack but in this backpack she had everything that she owned it was her life she had a few clothes few personal items and a picture of the baby boy that she had delivered she did not want to really push the backpack this particular day to have it searched in gone through him and in a little bit of a scuffle and she was being disrespectful to the adults trying to get the backpack to the point I was in the office and I heard the commotion and ran out I was able to get her attention and have her focus on me to kind of calm down and realize give me the backpack it's going to be okay because of the discipline system there were consequences for behavior and that's what I explained you to my students if you do something there is a consequence she was actually put up for removal and expulsion they did go to her hearing and pleaded on her I've noticed cannot happen but this one story is just a glimpse into the window of so many schools I have a hundred plus more stories starting with children as young as the age of four three four and five so she meant staying at our school through probably mid year next year her goal by the way was to find a foster home placement that would accept mother and baby it didn't happen her son was adopted when a family and she didn't go on to do well but that's how that phase of her life started so I'm here today as you can quite imagine to build awareness about one of the root causes of underperformance in our schools today yes we are measured by academic performance but the measures the really matter is being able to get the children where we need them to be to be available for learning before we can even teach them I want to talk to you about the challenges that we're faced today with the students not being available for learning you've heard today about the aces and some of the adversities that face our students in particular in Cincinnati my own town the Center for Disease Control names these aces as pre determinants or future health that's pretty powerful for most people it is still an unknown epidemic this is absolutely a health crisis that we are facing because of the efforts of my staff my district and we are doing things differently in Cincinnati and I'm very proud of fact we recognized early on that early intervention early identification training is critical education is supposed to be a great equalizer in this country again if a child is not available to learn if we cannot reach them we cannot teach them so recognizing that we decided to see what we can do differently education differently my a moment at my school is 475 students my district serves 35,000 students so imagine the small impact they're having at my school with my staff with children it's just the size of a pinhead really the need is great students with disabilities represent about 19% of the population and then when you're talking about economically disadvantaged families in our district it's about 82% at my school it's 92% I want you to think about the possibilities and the impact that we can collectively have when the right support comes together to change the outcome for our students our mission at College Hill is to prepare students by giving them the tools they need to carve out their own destiny the tools and what's in the toolbox has changed at one time it was teaching them and preparing them to go on to high school college and beyond now we're teaching them and preparing them to self-soothe to cope to learn how to adapt to an ever-changing situation a world that isn't conned to build resilience identifying what their strengths are and capitalize on those strengths to use them to their advantage so that when they're old enough to then make decisions for themselves they have these very fundamental tools that many of us learned just in growing up in our own households so schools now we don't just educate children we really shape mold and educate them preparing them truly to be able to carve out their own destiny and beyond as staff we've partnered with local agencies and groups to increase our understanding this was one of the first steps that I took teacher training was paramount teachers are trained educators and practitioners and they are very good at it it is a different ballgame when you're facing is that children walk through the door sweat so we need a training we focus on having a growth mindset with our students and each other teaching our students to identify their strengths and use their aspects ultimately building resiliency and acceptance creating an environment that supports and accelerates healthy student development and academic achievement is are nearly goal we can't change the students situations but you can provide a safe place to learn and the tools needed to cope and succeed in spite of what's happened to them so I'm gonna mention some of these practices that you can see evident in my school and the teacher training program I mentioned we have also incorporated safe zones in our schools for students and teachers to regroup and deescalate in the hallways and in the classrooms this helps build and increase self regulatory capacity in children while creating safe supportive spaces for students and staff we talked about the staffs self care and second hand trauma that is also very real so safe spaces for staff and self care homes is something that he now fights our school as well with also trained with students on response strategies and how to assist plan in crisis or when another student is in crisis peer peer mediation and support is powerful when creating a culture of accountability to self and accountability to others multi-sensory experiences for students both inside and outside of the classroom are also creative this concludes exercise bikes drawing clay obstacle courses finger and foot phases in various other activities to re-enter refocus and deescalate children that are living at higher levels of stress and handling adversity need to learn these very essential basic coping mechanisms and techniques we are currently working on adding two additional programs that I'm very excited about this year a music therapy program and a pet therapy program these furros will contribute also to teaching the self soothing calm down and how to prepare and reenter the classroom for learning we also provide the therapy kids management on-site I have five therapists and they see in the coast load of plaster ie probably this year nine each 100 students this strengthens the students adaptive skills executive function skills and self regulatory capacities but therapists conduct a hybrid sessions and come into the classroom and work with the students families and peers this year were also adding a component of working with the teachers we have advisory for social-emotional learning it's dedicated time that focuses on identifying and building upon social emotional strengths and character strengths these small groups in our school we made them gender based and no larger than 15 grades three through six 45 minutes per week led by the teachers amazing conversations these shows the impact of being more trauma responsive creates a school culture that can meet the individual needs of all of our students as a result increasing teacher effectiveness ultimately accelerating students development and academic achievement building resiliency is critical to building a strong academic foundation the two go hand in hand we all understand the impact that healthy nutrition has on our children's development and to this point we have free breakfast and free lunch programs in all of our tools this is wonderful I would argue that this is just as essential to their healthy development I really want to sincerely thank representative Davis I know he had a step away for supporting this legislation and I appreciate your time and willingness to consider the possibilities or supporting education and educators in this work it takes collaboration with politicians researchers medical professionals along with practice and field based groups to make a difference and in closing I asked you to consider policy implications of what we're discussing today at the federal level thank you [Applause] the opportunity to participate in this panel this morning I'm going to start by providing a brief overview of what we know about trauma and adverse childhood experiences among children who were involved in the child welfare system I'm also going to talk about how this impacts the services and supports that these children need and finally I'll wrap up with some policy implications with a focus on recommendations that we have Gao have made in the work that we've done in this area in 2015 there were about four hundred and thirty thousand children in this country who were in the child welfare system and now was a significant increase after steady declines over most of the prior decades the increase was driven as Wendy mentioned largely by the Oakland crisis and as a result those numbers are probably significantly even higher today on children enter foster care when they they were moved from their parents for reasons such as abuse and neglect so almost by definition children in foster care have experienced trauma and adverse childhood experiences additionally as was mentioned earlier foster children who can be placed in a near life at home of a nearby relative are deprived of some of the key protective factors that can help them cope with the toxic stress a trauma on some of these key protective factors are ongoing continuing relationships with a caring adult and maintaining familiar familiar environments instead over half of foster children are placed in non family settings and at over 40% our place in foster care when they're under the age of five which is in the age at which they are particularly vulnerable to the adverse impact of trauma so it's not surprising that children in foster care are more likely special needs and more likely to have mental health conditions and children in the general population in a survey that was done in 2008 42% of children who had been removed from them their homes after an investigation into abuse neglect were found to either have emotional or behavioral problems or possibly need mental health services another study found that children in foster care are twice as likely to cut a learning disability and 3 times as likely to suffer from ADHD as was also mentioned earlier Charlie as children very vulnerable to a range of mental health conditions including post-traumatic stress disorder depression and other mental health issues so turning to services and supports that are needed for this population I'm going to focus on three earrings which Gao has done work first is placing children in appropriate settings on the second is going to be maintaining that stability and continuity that I mentioned us protective factors and third is mental health services and there I'm also going to focus on the use of psychotropic drugs among foster children so first with regard to placing children in appropriate settings federal law requires that foster children be placed in the least restrictive that is the most and like studying that's available in the inner gates but pashya work has shown that states have faced challenges in meeting this requirement in 2016 we looked at state efforts to place children and family based at settings rather than in congregate care which includes group homes and institutions and we found in the states that we looked at that there was clear progress in reducing institutionalization a decline of 47 percent between 2004 and 2014 and this is the direct result of say efforts to address this concern there was more oversight of decisions in place children recovery care and an increased emphasis on recruiting and retaining austere care of families including the use of an emerging model called therapeutic foster care where families that are provided with additional specialized training on to deal with the mental and emotional concerns that children who have experienced trauma faced however in some states up to a third of children we found who is still being placed in congregate care settings so with regard to maintaining stability and continuity we did some work looking at the fostering connections Act which is federal legislation that aims to maintain family connections as much as possible for foster children through efforts such as requirements to notify grandparents or other adult relatives when a child's face in foster care to the extent possible keeping siblings together when they're placed in foster care and and if possible keep in the same school that they were attending before they were placed in foster care we found that states were using various strategies to implement these requirements but they really did face challenges particularly in having sufficient licence to allow them to keep the siblings together and to keep kids in the same schools so now I'm going to turn to health mental health services over the past several years Gao has issued a number of reports looking at the use of psychotropic drugs among children and foster Canada psychotropics are medications that affect mood thought or behavior and can be used to treat conditions like depression and ADHD but they also can include antipsychotics there have been long-standing concerns that the overuse of these drugs especially because of that potentially harmful side effects a GAO found that foster children were being prescribed to these types of medications at rates that were 2 and a half to four and a half times higher than other children on Medicaid some of this might be explained by the fact that foster children have greater needs but when we looked at the patterns of prescriptions there were some habits that were very concerning for example we found children who were being prescribed five or more medications at the same time we found children that were being prescribed dosages of psychotropics that were much higher than recommended doses and we found doctors prescribing psychotropic drugs to infants who are under the age of 1 so last January we issued a new report where we looked at how states were overseeing the use of psychotropic drugs in the foster care system and we found that states were moving in the right direction in reducing their use of psychedelics they were taking steps like developing that are the guidelines for doctors monitoring kids were taking more than one medication and also involving another adults about a caseworker or a foster parent in the decision to prescribe psychotropics and making sure they understand the risks that were involved and that they agreed with the meet so despite these efforts we also found that states face continuing challenges in meeting the mental health needs of foster children we found that 30 percent of foster children who needed mental health services did not receive them and to give just one example we talked to the county official in Ohio who said that they were sharing to child psychiatrists across six counties to meet the needs of mental health needs of all of the foster children in that area even when mental health providers are available they don't always have the expertise to deal with its who have experienced trauma so I'm going to talk just briefly about policy implications so at the federal level there are various agencies including Samsung on the CDC the administration on children and families who've all played a role in disseminating best practices and offering technical assistance and in funding important studies so just useless psychotropic drugs but in all of the work that we've done in this area we've concluded that much more remains to be done to improve the outcomes for children in foster care who experience trauma with risk are with regard to placing foster children in appropriate settings we've recommended that HHS do more to support state efforts to reduce congregate care and with respect to the psychotropic drugs we recommended that HHS do more to promote collaboration between child welfare agencies Medicaid agencies and other stakeholders and consider ways to better share information on medication oversight I want to say thank you for everyone for this special opportunity today I thank you special to the congressmen senators representatives and the staff for being here and of course Tyrone was unearthed Danny Davis because I was here with him for shadow day and his continuous work as something that's refreshing to see on Capitol Hill because he's fighting for children who he serves I get emotional just excuse me but in an end-of-course for my husband's unconditional love and support my story is unfortunately the same as everyone else's in foster care I entered here at the age of 14 and I remained in care till I was 21 I'm 23 today I endured nine years of physical sexual and emotional abuse prior to entering care I walked into foster care with a trash bag of my belongings and I've written a total of 18 placements at 17 my father to cancer and I never knew who my mother was till he died I was petrified when I entered care I struggled in school and I was reminded everyday by the lack of quality education I had that I would never be successful in life I struggled with on and off medication and more than the desire to want to know why my life was so better I wanted to ask the doctor who gave me my first handful of psychotropic pills at the age of 14 do you know what you pre destined me for as I tried to salvage as much as I can to normalcy the journey of foster care left me battling with on and off medication roller roller coaster rides in multiple failed suicide attempts and of fear as I strands within myself that this is what my life is like and the neverending answer to the question am I crazy after in foster care I was afraid of being myself if I cry I was given a pill if I screamed I was pushed to these quiet rooms rooms I were supposed to be a place for kids to calm down but it was just as good a solitary confinement and when we were in there all we thought about was the trauma the less there's the first place if I had a bad day and I told anyone the ward was somehow traveled to my psychiatrist who would then push for more pills for me to take and get this if I refused my medication I was punished to it to my room for 72 hour room confinement under guards are prohibited and if you're going to take a shower be prepared to take it without privacy I was 14 it's called suicide watch and I was conditioned that if I refused the drug I will be punished during school date and I remember in instance that I was never told when my treatment team meetings will be I will be randomly pulled out of class and I had to hear that no foster care you know there's there's no cluster homes available at the time and you're also going to have an ultimate set of medication because you can't seem to cope with your environment so after hearing that I was pushed back into the classroom expected to carry the day as is do your schoolwork listen dear teacher and try not to cause a ruckus and when I did it happened all over again I mean I had every time I had a needed social worker the translation of my care would change so it was a new introduction which means a new telling of my story telling my story which means reliving what led me into foster care I'm not the only person who's gone through this thousands in foster care until today are still undergoing this horrendous cycle it is redrawn enticing us and there's something horribly wrong in the system and is costing our life as we go by trying to find a solution medications are not the problem I'll make that perfectly clear however the problem lies within what I like to call medication without representation when I was a minor I had little to no say on how many medications made me feel and of course I didn't have pants to speak up for me there are repercussions on how to care for false views and they refused to take their medication have to be have to be reviewed reprimanding children who have already begun under God an immense amount of trauma is not the answer it teaches us that without the medicine we are incapable of recovering from our trauma and the result is addiction I hope that through my testimony you get a glimpse of what it's like to be in foster care and it's pretty scary it's pretty hard and I've been through it and there's a lot of people they're still going to it and the Sun that's too and there's somebody as young as him going through it children who enter care just as I enter care with nothing but they have a whole lot of trauma I hope that after hearing my story every child is given a bag of hygiene and clothing essentials to assist them in their transitions children in foster care system should have designated weeks of a month designed for treatment team meetings and psychiatric evaluation because simply pulling kids out of the school day and expecting them to carry on as is what the news they heard it's not acceptable upon leaving Karen all you should be taught the life skill on how to properly their psychiatric needs the Independent Living Program should be revised and become structured for cases of child who suffer from trauma we should implement goals regarding psychiatric care improvement and preventative actions that they can take leaving out in foster care I I did not I don't mind not only knew how to prepare for myself but I came to psychiatric need I had to confront a world that was foreign to what I just aged out of I couldn't hand somebody a binder and say this is me help me there is there has to be a better care for children leaving the system children as young as two have gone through what I shared children who have undergone trauma should be protected I have faith and I have hoped that with you all coming here today and the team that will find a way that we came together better take care of your children because it's happening right before our eyes thank you I want to thank those who supported you clearly Whitney you suffered greatly on your own but there are also some supports that had to be there somewhere in your points of life yes to get you to being here today yes and I think that while we wouldn't want to dismiss your experience I think it's also important for us to think about what what are those things that are so important that help you to be the person that you are today despite all of that could you share a little bit of that assess so there's the definitely my TL was a big role having bright recruiters to take an appeal and explain to them that your job is to advocate for the foster kids is number one because sometimes the social workers like everyone mentioned they do the best that they can to help the children but it's the system is so broken and it's hard for them to do their job so the helman betrayal I was finally able to be placed in a foster home and that family that foster family founded the grandparents of my staff and the Independent Living Program was something that helped me because they were able to give me a stipend at the end of the month but that I should be continuously funded and even better yet reviewed you know more hands-on or children who's undergone trauma and when I was in a public school setting my I had I had a panel of other foster kids who designed it's calling me foster youth advisory panel and what they were able to do is they're able to hold a training for teachers on how to you know if you have a if your foster kids in a publishable system how do you do and this came up because one day when I first entered a public school setting a teacher gave me a pamphlet of how to say no to drugs and you know it was like I thought there's something wrong with me so having the proper funding and training for teachers to get the help that they need so that they're not constantly battling with this another table of your problem okay we'll probably so not so overworked and tired and they know exactly how to handle it thank you so much I think what you talk about here on what you point out is giving people to help that they eat right and so we heard that across this panel here identifying those things that are working so not just putting those shutting the light we certainly are here to just show that it looks wrong on this broken because it's obvious there's a lot of pieces that are broken but there are also similarly a lot of pieces that are working and how do we lift those things that are working I think it was really important that both Monica and Ola pointed out that some of those best practices that are in place that we can help through this piece of legislation such as this can help to lift up those programs you know we know that collocation ameno mental health providers does work we have the evidence that does working clearly our schools are on the front line of this issue but if Monica Portman and supports for educators such as Monica or are on the front lines doing the best that they can one of the things I wanted you to point out though when you talk about all those programs those aren't drunk necessarily drawing away from your academic programs correct you're finding how are you supporting those programs that's correct they're not drawing away from the academic programs at all we actually we're getting pretty creative because it's you know that teachers and educators we dig into our pockets and support our citizen kids always so there's a lot of that going on applying for grants and the partners locally you know talking to local agencies and partners in Cincinnati that share the same vision of mission and seeing how they can help us in a school setting thank you and so you know when you talk about it supporting children in the study you talk primary stairs and honey years of foster care that I also meant that you were probably bouncing around to multiple schools and I think that was one point that can be brought out was the fact that the key protective factor for our children are these supports that are familiar and familial so it's not one of the other but it really in spoken to schooled that the familiarity of a school and that school community your teachers it's just as important for these children so when we think about how we're operating and moving children our school to school culture to culture because the children at your school definitely benefit from a unique program that's not quite spread throughout since a public schools so we want to make sure that we're also thinking about the differences in the culture the differences in the treatment environments that would help to support our children so that continuity of placement as Kathy discussed clearly is important for us when we think about what's happening within the foster care crisis of how that overlaps with our education system so we are we kind of gone over time I do want to respect everyone's time but if there are we this is a rich panel are there any I could take maybe one or two questions yeah so everything that's being discussed in Congress is about Medicaid from gallery caps or stripping up the essential benefits how I think my answer you probably know which is you know we're very concerned you know a lot of the particularly the school-based and school rate programs and approaches that I that we very much promote and work towards enhancing are in the least resourced parts of the country because that's where the need is greatest and often we're talking about populations that are much more likely to be have Medicaid or public insurance and also for provider types that you know or we've already had difficulty before our current situation having Medicaid reimbursement for school-based services which not every state easily maneuver you know mean we're having some successes in figuring out the mechanisms and the levers to get that to happen you know my worry is a lot of that is stalled if not being reversed we're now you know going to have we are worried in them in the mental health community about essential about behavioral health and substance use disorders and the potential for some of that to really roll back I don't know what to say about what moving forward will be accepted I think that a lot we'll remind particularly locally and at the state level trying to figure out how to best advocate or what how we could come together with the dwindling resources and how we can be creative which is what we often do in all of our systems to figure out how to piece together the little bits we have to try to touch as many kids know great answer so one of the example one of the examples with regard to how are we creative and creating a little bit more access to services particularly for motor muscles are in populations is our partner in Portland Oregon they cut Bobby in school there and they've actually created for Kaiser Permanente through their community benefits to the show their program they've created a health clinic within the school so they will be able to serve those children there and where they are and so that is another one where we think about again what are some of the other existing avenues to support these programs and this is why healthcare obviously is a very important partner in this work you know working with them on creative use of Community Benefit dollars to support these variable normal populations yeah so I want it in my Anjali from representative Davis's office who wants to talk just a little bit about a general colleague letter thank you everyone and on behalf of congressman Davis I want to thank you for being here for hearing about our bill and supporting our efforts and in that support we did provide your colleague letter out in the front and for my separate colleagues in the room would love to take a look at that we are actively seeking additional co-sponsors for our bill and also wanted to let you know that we had partnered with Congressman Gallagher's office recently on a House Resolution creating a trauma trauma Awareness Month so in that bipartisan effort you know we were looking to not only create awareness but to really raise up HR 1757 so that in addition to awareness raising we can also you know put some hard and fast resources into expanding or trauma Florida informed efforts across all of these important and critical service systems as you heard today really need to work together to ensure that all of our children and families that are have been exposed to trauma can be successful thank you so just one parting thought here although you mentioned that port health is linked to poor education and vice versa so this is a to bidirectional pathway here and and so with that you know when we're thinking about how all of these are connected i we want to leave you with the thought that Monica said so eloquently and we cannot reach them we cannot teach them and I'm going to amend it a little bit and if we cannot teach them we cannot expect them to derive so go out go forth be productive continue championing this cause and I want to thank my panel thank you for taking your time today to show

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