education

Trauma, challenging behaviour and restrictive practice in schools.

This is a record of the #SENexchange Discussion in January 2020. We examined the findings and content of Centre for Mental Health briefing on Trauma, challenging behaviour and restrictive practice in schools.

To give you context as to my potential bias in choosing and responding to these questions I am a special education teacher. This means I have a huge amount of flexibility and support when supporting children with a range of additional needs. I do not generally support reward or sanction based behavioural interventions. I strongly believe that as adults we must reflect on how our actions will shape the wellbeing of the children we teach. And in turn their interactions with us.

Ever since I became involved in behaviour there has been debate around appropriate responses and approaches. Currently there is a debate around the use of isolation, booths and exclusion that can at times be highly divisive. As a school leader I am always aware of the need for a safe learning and working environment for all and the challenges of balancing this with potentially extreme manifestations of distress from some pupils.

A PROFESSIONAL DISCUSSION around BEhaviour

The current move towards trauma informed practice is positive but I worry that the training and awareness if often too simplistic. Training programmes can easily fall into the trap of generalisation without providing practical solutions. This often also fails to relate to the context the child finds themselves in. The report also touches on PBS or positive behaviour support. I have been a lead trainer for a PBS system and am a strong believer in much of the approach. However I spent my time developing a curriculum that moved away from the theory and behaviourist leanings of pure PBS. Recently I have become more and more interested in relational behaviour approaches and how we can modify our organisational systems, training and pedagogy to meet the needs of all children.  

Trauma, Challenging Behaviour and Restrictive Practice.

Below is an edited summary narrative of the questions and responses around the topic. for a full transcript of the discussion including the tweets download the PDF by clicking below

Q1 – A Trauma informed school seeks to maximise the healing potential of the school environment. How can we do this? 

I was very excited to read this statement in the briefing. Schools are places that children go to learn new skills and knowledge. “Trauma informed” is starting to become a buzzword for schools that have undertaken training and maybe made a few adjustments. The concept of the school as a healing environment is a real influence of how school leaders value their investment in Pastoral support. Schools can become healing environments by ensuring the interactions are positive, supportive and non-judgemental. High quality bespoke staff training and support is required for all. 

Flipping the narrative around SEND

Looking at schools as healing environments requires us to reframe our view. Starting with looking at whose behaviour is challenging who? As professionals, parents, carers, specialists we bring a range of values and beliefs to our teams. It is essential we remain reflective about what we bring to the table. Stay curious. One of the movements most influential on behaviour approaches in SEND is the #flipthenarrative campaign started by Elly Chapple. This seeks to turn everything we think we know about SEND around. Make it truly about the human at the centre of our discussions. Move away from boxes, labels, war stories, interventions and strategies; make a human connection and celebrate the differences.

Utilising staff skill sets is important is important for any team. It is suggested that staff need as much support as possible both within the organisation and from external agencies. The common factor in this is the knowledge and input of parents and carers. (Harry Empsall)

Suggestions for appropriate training to support schools becoming trauma aware include Emotion coaching, trusted adult training, low arousal approach, Restorative practice, (@devschsenco). One of the studies suggested for Emotion coaching is downloadable here. 

Human interactions behaviour SEND education

Trauma: Flexibility and Adaptations

A common feature of trauma informed approaches is recognising the demand placed on a student by tasks which may otherwise be considered simple. Accepting a child’s limitations are more important than pushing your own teaching agenda. (@MissSTaylor2). The timetable should not be a set of deadlines. For children and staff under time pressure a minor issue can quickly escalate. From my own experience a child’s ability to complete tasks can be impaired by multiple factors including hunger, lack of sleep or stress. A child experiencing trauma will have a varying level of tolerance to stimuli. For example a tired child who has been caring for a sibling or parent may be much more sensitive to noise and less able to concentrate. This may lead to a more negative reaction to pressure than usual. Triggers are not static or always obvious.  

So what can we do to support our children through this. Only by reflecting on our own behaviours and recognising sometimes we may be triggering the child’s behaviour (@SusanGriffiths5) can we adjust our approach and reactions.

This is why at all times when supporting children, whether trauma or SEND, schools need to ensure they look at skill development and empowerment not control and coercion. A child with more control over their day has less to push back against and is more likely to look to staff for support rather than expect a confrontation.

A supportive, positive, healing, aspirational culture and environment can have such a positive impact on students and families.

(@SMSAteaching)

Q2 – Exposure to Systemic trauma (bullying, institutional harm etc) Is higher for children with SEND – How can we ensure schools are safe spaces for children?

This graphic from the University of Buffalo outlines how organisations and systems can lead to retraumatisation through their policies and culture. Labelling, lack of self advocacy, and a culture where the children are being done to rather than with. Discrimination of any sought can lead to systematic trauma. With any deviation from the norm being treated differently or as a burden. 

The common thread through responses to this question was the requirement for schools to build trust. Safety and trust are intrinsically linked. Building relationships where the child feels they can trust you and feel safe with you (@SusanGriffiths5). This made me reflect on a presentation by Sarah Hendrixx around her thoughts on what happiness looked like for Autistic and Neurotypical people. Because ultimately we want our children to be happy at school and safety is essential as a first step. 

ACEs, PAces and Safety

It is our duty of care to ensure school environments for children are physically Safe. It should be the same for physiological safety. Schools need to strive to reduce restrictive practices of all types. These include limited choices of activities, food, or access to resources (@jw_teach). Another essential aspect of creating this psychological safety is by ensuring that our interactions with children who have experienced trauma are characterised by Dan Hughes’ care giving & relational formula of PACE – Playfulness, Acceptance, Curiosity & Empathy. Key adults can provide these therapeutic exchanges throughout the day (@EPInsight, @SendcoThe).

Again, whole school awareness, low arousal approaches that respond to need in the moment, de-escalate and reduce stress and anxiety, personalised approaches, taking sensory aspects into account By acknowledging our own mistakes; sometimes something so simple can cause trauma, if we’re not reflecting on our practice, we cannot be trying to ensure this doesn’t happen again (@MissSTaylor). Having a range of adults that the child trusts is absolutely instrumental; these children or young adults will have to work hard to trust you, make sure you work just as hard trying to earn it (@devschsenco). We need to ensure the good news stories and great practice are shared far and wide and have a greater influence on practice and policy (@SMSAteaching). 

Trauma Informed Approach: CONSISTENCY and Calmness

The two C’s are always worth bearing in mind when thinking about safe environments Consistency, Calmness. In addition all children need to feel they are liked, listened to and valued (@devschsenco).

To meet the admission criteria for the school I first worked at the child often had to be excluded or undertake a managed move, this meant that their experiences of school were often negative.  One of the challenges inclusive schools face is How to start to build trust with children who may have had negative experience of schools in the past?

To make schools safe places for children with compromised stress-response systems, we need to adopt a low arousal approach. We need to establish predictable routines, provide a sensory diet & reduce demands when necessary in order to prevent emotional dysregulation. Teaching more appropriate ways to manage their emotions. Every adult in the school needs to be approachable Pastoral/emotional support cannot be down to 1-2 people alone. Truly effective trauma informed practice needs to be a whole school ethos and approach.

Often children come to school with a complex history, complex needs and complex relational histories. Complex often means misunderstood. We need to work hard to stay curious and find out what lies at the root of these needs. Is the child hungry? Have they slept well? This means we will probably make mistakes, it can be so powerful if people at all levels of a school community put their hands up and can say I got it wrong / its ok to make mistakes. If leaders do this well it can create a great culture. Mistakes must be addressed and at times leaders need to reflect on how the school culture has led to this.

If a child is shown they have value, are given ownership and the development of self-advocacy skills are essential to any curriculum. they are more likely to thrive. Listen to them, look beyond the behaviour they are displaying and validate their feelings, show empathy to them, stay calm, etc. Lots of different ways on how to do this, just don’t focus on the behaviour, focus on the child

Having a range of positive & nurturing relationships is effective in creating an environment where the emphasis is not on managing behaviour (as the external manifestation of stress or frustration), but on the wellbeing of the child. How often could we prevent emotional dysregulation if the school secretary, caretaker, playground staff and canteen staff were all interacting with the child in a trauma-informed manner?

Q3 – Trauma can lead to poor stress regulation. This may lead to challenging behaviour. How can we break the cycle?  

Breaking the cycle of trauma -> stress->behaviour->restriction Takes a team passionate about change. Need to work with parents, carers, & child to identify how to make the child feel safe before working on emotional skills. Everything starts with relationships and how staff approach those interactions that have the potential to go wrong. This graphic from @EPInsight gives some clear, simple ways to reframe behaviour through a trauma lens. Takes the focus off of “managing” the child. 

trauma informed behaviour lens reframe
  • Stress regulation needs to be preventative.
  • Have a familiar key adult check in frequently with the child. 
  • Communicate routines using visual schedules
  • Break down tasks into small steps with opportunities for choice.
  • Provide movement breaks & proprioceptive input

The concept of coregulation, leading to eventual self regulation can help support this process. Making sure we do the restorative and/or problem solving aspects with children. If staff do not the skills or support to practice co-regulation there is the chance they will escalate with the child increasing stress and the potential for the situation to run out of control (@The_MrsCampbell). In training I have described this as the adult acting as the child’s emotional brakes.

We had this with a pupil that I worked with, we had to completely reduce all demand, build relationships with that child by doing activities that they enjoyed, and then slowly introduce them to the classroom setting. It look a long time, but was so, so worth it.

(@MissSTaylor2)

One of the most interesting developments in behaviour support in recent times is the focus on meeting sensory needs. A number of schools have been using the interoception curriculum which looks at developing the ‘feel good menu’ with a child where they explore and identify activities that makes their body feel good. This feel good menu is embedded into the child’s day & helps keep stress levels down (Susan Griffiths).

Trauma challenging behaviour and restrictive intervention cycle
Trauma challenging behaviour and restrictive intervention cycle

How the school supports staff to ensure induction processes emphasises the expected culture. In turn this determines how effective that culture will be. We need to support staff to understand that relationships are key to all in school. When the ethos is one of trust, all are empowered to share positive experience (@scatti1).

‘The opposite of anxiety isn’t calm – it’s trust’.

Prizant

Q4 – PBS is the most widely used approach for reducing Restrictive Practice. How do we ensure the plan reflects the child’s best interests? 

Get ready for the acronyms. Positive Behaviour Support must be part of a process. The school culture and environment must fully reflect the values of supporting the child not purely focusing on behaviour. Positive Behaviour Support must not be, but too often is a way to build restrictions/physical interventions into a “nice” package. A key element of PBS is the BSP or Behaviour Support plan. This may be referred to as a BIP, behaviour intervention plan. As you can see both of these drive the focus onto the behaviour and stopping it. This should be based on an ABC model. Antecedent, Behaviour, Consequence.

However this leaves the C being open to being interpreted as requiring a sanction based consequence rather than the planned reaction being de-escalation or natural result of the behaviour.  The antecedent (A) is too often described as “unknown” or “for no reason” This shows a lack of understanding of the driver of the behaviour. This can be key to being specific about what the often mentioned “unmet need” is. In a truly supportive, trauma informed setting the antecedent analysis will include an in depth reflection of the adult’s part in the behaviour. 

Behaviour support plans

Plans should outline how the child may present, what their triggers might be and how we can support them at each stage what works for them. ‘Stress response’ plans or ‘stress support’ plans rather than reward and consequence focused approaches (@EPInsight). Triggers are often found in the antecedent aspect.

Staff often expect triggers to be obvious and occurring immediately before the behaviour. This is often not the case, many children will have a tolerance level that reflects the stress they are taking on board. This is sometimes depicted as a cup filling up then spilling over, or a shaken coke bottle. A whole plethora of stimuli, stressors, interactions and frustrations may collectively trigger a behaviour. The focus is too often on explosive behaviours that impact others. It is also worth being mindful of the behaviours the child directs towards themselves, self injury, withdrawal, intrusive thoughts of failure leading to cripplingly low self esteem.

It is for these reasons that sanctions and punishments may enforce compliance on a child; but will never serve to manage behaviour. I went through distress plan as an option for our plans. Ultimately we settled on Wellbeing plan so we could focus on indicators such as withdrawal that indicate low wellbeing, low self esteem and other needs.

ChiLd Centered or Child LEd BSP?

That is why we must strive to develop the plan with the child! PBS if done well can be great but if not done well I.e. usually not in the child’s best interest it can backfire and cause more trauma for the child (@MissSTaylor2). If we tailor the plan to fit the child and review the impact of our responses to behaviour as well as adapt our approach and environment for the child it is more likely to succeed. For example in some circumstances a behaviourist approach isn’t appropriate, especially if a child cannot comprehend cause/effect. 

As professionals we have a responsibility to ensure everyone who is important to the child is involved where possible as well as the child themselves if they are developmentally able to contribute, in terms of communication skills strategies like talking mats can help gather the views of children. The child needs to be involved in the planning. It’s vital to include parents/carers so that strategies can be used from both home and school. By involving all, it builds the trusting relationships needed for successful mental health intervention (@RMG0988). The vast majority of the plan should focus on preventative measures. By being “proactive” we can prevent escalation first with environmental audit and staff skill development.

BEhaviour Plans: A Team Approach

Home-school communication is essential in understanding what motivates the child, what they like, what makes them laugh, etc. When the child is engaged and feels safe, this reduces the need to plan for consequences and shifts the focus away from compliance. Behaviour support plans can only reflect the child’s best interest if they are written as a team involving the child and focus on skill building rather than stopping behaviours. In terms of safeguarding we all have a duty to the child to move away from compliance. It makes the child vulnerable to adult control. This may serve to reflect the traumas experienced in the past or that currently affect them. 

PBS practices and the connotations of the name have become synonymous with Lovaas and the behaviourist approaches. So while we are practicing behaviour support in a positive way, some may misunderstand the approach and so we have been looking for other ways to describe the positive approach. Relational practices, supportive approaches, low arousal, when what we mean is – form positive bonds with them, listen to hear not to respond and interact accordingly (@scatti1). We need to push back from “if you don’t do this then I will take this away” threat based behaviour support. PBS maybe widely used but that does not mean it is the right approach. Often it places too much emphasis on the behaviour of the child rather than the needs of the child.

Q5 – Social and Emotional Learning (SEL) are interventions seeking to provide skills to manage their mental health. How have you approached this?

One school has developed a ‘Healthy mind, happy me‘ curriculum that runs from EYFS to Y6 and focuses on various areas of emotional wellbeing and mental health. This is really useful for focusing on the emotional needs of the child. I would like to make this the focus of further discussion. The bulk of SEL practice practice is around providing opportunities to learn through managed situations that may challenge them. So by allowing these children and young adults to (where appropriate) lose a game, talk to someone they dislike, share adult attention with another people, in a safe and controlled setting (@SandwellEdPsych).

Q6 – How do we promote the wellbeing of children who have experienced Trauma in schools.

“Restrictive interventions do not promote the wellbeing of young people who are subject to them

Centre for mental health 

I thought about the wording of this and whether to include this question but it important to recognise that schools can cause harm. It is unforgivable for schools to cause trauma to children in their care. We need to challenge the practices that lead to this – isolation from peers, restraint, control and lack of advocacy. Rebuild trust first

Restrictive interventions do not promote the wellbeing of young people who are subject to them

Our interactions as adults, carers and professionals can impact how successful any child is in education. Only If we are truly passionate for them to succeed do we meet our obligations to them. We first have to acknowledge the ways in which they have been failed, and carefully consider steps that we would take under similar circumstances, which would allow the child to feel safe. 

An Emphasis on Connection

  • Place the emphasis on connection.
  • Find time to talk about their interests
  • share a joke
  • deliver praise and warmth (verbally or non-verbally)
  • give reminders of their past success
  • empathise when things are hard.

When it comes to behaviour, “Connect & Redirect”. Any approach has to be personalised and it has to be flexible. Forcing children into situations that heighten their anxiety only escalates the situation and causes more trauma.

We need to #flipthenarrative because there is a better human way. When a system is creating stress for everyone, everyone suffers. Acknowledging the diversity of our being, will enable a wider view. Begin with being human. Recognise that everyone needs to be able to be within the space, with the relevant support. From strong leadership through a human lens to seeing difference as a strength, needing differing approaches. Trust, empathy and communication are key (@elly_chapple).

Trauma challenging behaviour and restrictive intervention in schools

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