This article is part of State of Health, a series examining integrated care and its potential to improve Michiganders' health. It is made possible with funding from the Michigan Health Endowment Fund.

Divorce, a parent's death or imprisonment, domestic violence, sexual abuse, and the daily experience of racism. They're all sadly common events, known as adverse childhood experiences or ACEs. But the increasingly common practice of trauma-informed education aims to ensure that educators identify ACEs and compassionately foster resilience in kids who experience them.

"We need to pay attention to the social and emotional needs of students. When we begin to look through this lens, we come to the understanding that most of the population — some 60% — have had trauma," says Alison Arnold, director of the Interdisciplinary Center for Community Health and Wellness at Central Michigan University (CMU).

Alison Arnold.

Experiencing four or more ACEs puts children at higher risk for academic failure and behavioral problems as well as mental illness, substance abuse, and physical disease as adults.

"Over the lifetime, we now know all kinds of chronic illnesses stem from trauma, for example, asthma, heart disease, and diabetes," Arnold says. "These chronic conditions have an early root cause in trauma and adversity. If we are going to take down these serious illnesses, we have to go way upstream and find where they are rooted."

Arnold notes that trauma releases stress hormones that not only impact a child's brain but also directly affect the metabolism and other body systems. That impact is more severe when the trauma occurs during key developmental stages, especially when a child does not have other supports to buffer the trauma and provide some feeling of safety.

"We've come to understand that trauma and adversity, which is historic in some of our cultures, is generational, not just culturally, but physiologically. Some kinds of trauma actually change the way our DNA is expressed," Arnold says. "Because the brain and body aren't developing in a normal sequence when impaired by a flush of stress hormones, these children may never develop fully. This affects children's ability to focus and to respond in social and emotional ways that are developmentally appropriate."

When a traumatized child goes to school, they may act out or withdraw. When they act out, adding more trauma via harsh verbal reprimands, punitive consequences, or expulsions that send kids home to an unsafe environment does not fix the problem. Within a trauma-informed school environment, teachers do not ask "Why is this kid giving me such a hard time?" but "What's really going on with this kid?"

Trauma-informed training shifts the way schools operate to create a safer environment for everyone: students, teachers, staff, parents, and administrators. Approximately 15,000 Michigan school staff members have completed training so far. The approach is especially relevant in areas lacking access to behavioral health services. Arnold cites a new report compiled by healthcare research nonprofit Altarum and funded by the Michigan Health Endowment Fund, which she says "paints a stark picture of the lack of services for all kinds of mental health issues."

"Some parts of our state have no access," she says. "Some counties do not have a psychiatrist, psychologist, or recovery treatment option. One thing that is working is integrated models where the school becomes the health home."

Building resilience with mindfulness

In Traverse City, licensed clinical social workers Linda Smith and Stephanie Berger are partners in Mindful Life Practice, where they utilize trauma-focused cognitive behavioral therapy and mindfulness techniques. They consider mindfulness an important tool for the trauma-informed classroom.

"Mindfulness can benefit all students, not just those who have experienced trauma. If we can find ways to integrate it throughout the day through informal and formal practices, overall it will help kids manage stress," Berger says. "Kids with trauma have chronic stress and bring it into the classroom. A trauma-informed school environment creates an atmosphere that resets that stress level throughout the day."

Stephanie Berger.

Grounding techniques and meditation help children escape downward-spiraling thoughts and return to the here-and-now of the classroom. For example, the teacher might lead students in identifying five things they can see, touch, and smell. Smith and Berger also recommend resources offered by the National Child Traumatic Stress Network and the Calm app, which offers a Calm Schools Initiative as one of its resources.

"If you have a child that is dysregulated, the ability for the teacher to pause with that student, sit with them, and do this helps them make that cognitive shift," Berger says.

"Simple breathing techniques can also be taught to all students — slow breathing in and out. This calms your mind and your entire body, including your nervous system," Smith adds.

Linda Smith.

Many teachers bring their own experiences of trauma to school or experience secondary trauma as they become involved with children going through it. These techniques help them to also recognize and deal with triggering situations and practice self-care.

"When you have schools that are trauma-informed from the top down, they are responding to situations instead of reacting to specific behaviors," Berger says. "(They are) focusing more on prevention and care on the front end instead of punishment or consequences."

In trauma-informed schools, children develop resiliency that empowers them to overcome, succeed, and grow up to be healthier adults.

Empathy guides trauma-informed care

Jim Henry is the founder and director of the Children's Trauma Assessment Center at Western Michigan University, where he and his colleagues have helped more than 5,000 traumatized children. He says empathy is a key element in trauma-informed care.

"Our goal is to understand what it's like to be that child. We say to kids, 'You're the expert of you. What is it like to be you? Help us know. Teach us,'" Henry says. "Frequently, kids have anger and the potential for violence when they understand the world as being dangerous and unsafe. We work on creating safety for kids as soon as they walk in the door."

An eight-year-old girl he recently counseled met with teachers, her principal, social workers, and therapists for more than five months. Even though those professionals knew the girl's mother had committed suicide, they were unable to help the girl change her behavior. Using a trauma-informed approach, Henry discovered that the girl not only missed her mom, but felt totally responsible for her death. This discovery opened the door to the girl's recovery.

"When school personnel, especially the teacher and principal, have the willingness to go the extra mile to be supportive rather than punitive, that shifts kids dramatically," Henry says. "Teachers can be essential for children to build resilience to overcome the trauma and adversities that they have had. I often say to teachers, 'You are the key to a child's resilience.'"

Henry explains that when children experience ACEs, the trauma rewires their brains to seek safety through primitive fight-or-flight responses rather than higher-ordered self-regulation skills. The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study, which took place from 1995 to 1997 and involved 17,000 subjects, found that children with four or more ACEs are 32 times more likely to have problems in school. (When they experience six or more ACEs, they are at three times the normal risk for heart disease and lung cancer and experience a 20-year reduction in life expectancy.)

"In order for our kids to be more successful, they need to develop resiliency and self-regulation skills. When their brains are compromised by trauma, they can't get to that executive brain functioning. They become impulsive and that makes behavior difficult — they can't think it through in the moment," Henry says. "When we teach kids to breathe (and) name their stress, they can calm. When they calm, they can begin to know that they can manage it."

As trauma-informed education models are logically extended to healthcare, human services, law enforcement, and court settings, communities can expect to experience tremendous change as well. The U.S. Centers for Disease Control and Prevention estimates the lifetime costs of ACE-induced illness costs the country $124 billion a year. Communities will also gain healthier, happier residents whose generational legacy will be wellness and compassion rather than fight-or-flight.

Arnold believes that trauma-informed education creates a way of working with children that comes without judgement and opens a door for understanding and healing.

"Many parents are waiting for that door to open so they can heal themselves and support their children," she says.

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media, communications manager for Our Kitchen Table, and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at [email protected] or www.constellations.biz.

Alison Arnold photos by Adam Bird. CMU photos by Kriti Gopal. All other photos courtesy of the subjects.