Consider connecting individual resilience to community resilience. See the attachment for further details. See the links below as resources: https://youtu.be/0YK62vddjGw-This free web

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Trauma affects the brain in many ways, including impairing one’s ability to learn, creating psychological and emotional issues, and contributing to poorer health outcomes. This is not only true for children but for adults as well, contribut- ing to social issues such as erratic job performance, increase in homelessness rates, addiction rates, and higher rates of domestic violence and child abuse. We must be more effec- tive at preventing and treating trauma and promoting resil- iency in order to make the members of our societies as safe and productive as they can be. In Watauga County, North Carolina, an initiative is taking on that very challenge.

One out of every 4 children in the classroom has been exposed to trauma that can affect learning and

behavior [1]. In a classroom of 20 students, an average of 5 of those students have had traumatic experiences, which can impact their ability to focus, process, learn, and regu- late emotions. Every day, pediatricians treat children from trauma whose histories contribute negatively to their health, mental stability, and emotional well-being. Children from trauma are seen in the juvenile court systems and the foster care systems, and it is likely that communities will see issues with them as adults if changes are not made in how we pro- tect, nurture, and strengthen them. As commitment toward trauma-informed communities spreads throughout North Carolina, Watauga County agencies and organizations that partner with children and families are using best practices to more effectively prevent, recognize, and treat trauma, and build resiliency.

In 2015, with leadership from Watauga County Schools, multiple youth-serving agencies in Watauga County began engaging in regular work sessions to explore how to better serve youth and families. The superintendent and the direc- tor of student services fully supported the movement toward making classrooms and schools more sensitive and respon- sive to students impacted by trauma. In fall 2016, faculty at one school received a brief training in trauma, resiliency, and practical strategies for making classrooms more effective in teaching children from trauma. A Compassionate Care team was formed and implemented strategies from The Heart of

Learning and Teaching: Compassion, Resiliency, and Academic Success [2] in their classrooms.

Members from the Juvenile Crime Prevention Council, The Watauga Children’s Agenda, and the local Interagency Coordinating Council decided that the next best step would be to raise awareness and educate the community, and the “State of the Child Forum,” with themes of childhood trauma and trauma-informed communities, was held in May 2017. Over 350 people from the community attended, including representatives from the media, law enforcement, edu- cation systems, the medical community, and youth- and family-serving agencies, parents, foster parents, the faith community, Appalachian State University, and political fig- ures. Classroom teachers, administrators, psychologists, counselors, social workers, nurses, and other school staff attended as well. The forum focused on how trauma is seen and addressed in local agencies, answering the prompt: “In an ideal community, how could we more effectively prevent, recognize, and treat trauma?” in 14 sectors of the commu- nity, including education systems and medical arenas.

Later, in August 2017, action steps were initiated at the school where the first Compassionate Care team had been created. For example, a study at Harvard University found one of the most important factors to offset trauma and build resiliency is a positive relationship with a consistent, caring adult [3], so a Silent Mentor program was implemented in which nearly every adult in the building, including bus driv- ers and custodians, was assigned a student to speak to at least weekly. The students identified were at risk for low academic performance, had unmet emotional needs, or lacked a positive connection to school. The children were unaware of this assignment, but it created an opportunity for adults to monitor the well-being of the students while making them feel seen and welcome. There continues to be

Preventing and Treating Trauma, Building Resiliency: The Movement Toward Compassionate Schools in Watauga County, North Carolina

Denise Presnell

Electronically published March 19, 2018 Address correspondence to Denise Presnell, Watauga County Schools, PO Box 1790, Boone, NC 28607 ([email protected]). N C Med J. 2018;79(2):113-114. ©2018 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved. 0029-2559/2018/79209

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ongoing training for faculty on trauma, resiliency, and class- rooms strategies.

Meanwhile, interventions provided by school staff and referrals made to other agencies are confidentially recorded and made available to support staff so that they have a more accurate and broader picture of the issues a student may be facing. Teachers are also using mindfulness and ground- ing activities to build resiliency, and funds are being sought to purchase materials for Calm Corners, which are areas in classrooms where students can go prior to an emotional outburst to help themselves get re-focused, de-stress, and regulate their emotions. Additional copies of The Heart of Learning are being distributed to school staff throughout the county.

The Watauga County Schools system continues efforts toward becoming Compassionate Schools. The school dis- trict has offered professional development in the areas of trauma, resiliency, and practical classroom strategies. Principals are leading efforts to bring increased awareness to their school communities and have requested training on trauma and resiliency for their faculty and staff. School sys- tem employees are continuing to be involved in activities to make Watauga County a trauma-informed Community by attending Watauga Compassionate Community Initiative (WCCI) committee meetings, planning the “State of the Child, State of the Community Forum 2018,” and engaging in conversations to bring awareness of trauma and resiliency to those who live and work in our community.

The medical community too is becoming trauma- informed. Area health departments that were involved in the planning of the “State of the Child Forum 2017” con- tinue to be involved with monthly meetings of the Watauga Compassionate Community Initiative (WCCI), and the plan- ning of the “State of the Child, State of the Community 2018.” A local physician spoke at last May’s forum on the ways trauma is seen in their office and what steps they take to address it, including a postpartum depression screening for new mothers. The practice sponsored professional develop- ment on a well-known parenting method known as Love and Logic with the goal of reducing childhood trauma by giving professionals information to share with parents to help them parent more effectively. About 20 people from Watauga County Schools, the faith community, and other agencies

attended these weekly sessions throughout summer 2017. These partnerships are providing a strong foundation for future work. This pediatric practice remains committed to better understanding a child’s health issues in the context of the parent and family structure and looking at the “bigger picture” issues as they relate to a child’s health or behavior.

Conclusion

Ongoing goals include more connections and additional relationships and collaborations with staff from our area hospitals and medical practices, particularly partnerships with practices that provide obstetrical care. When discuss- ing “upstream” interventions and prevention, it is exciting to think about being involved in the life of an individual from cradle to grave in a community that offers nurturing, sup- portive, and safe spaces over the course of a lifespan.

In Watauga County, we are dependent on the energy, enthusiasm, and passion of people who have seen the effects of trauma on children in classrooms and the com- munity. These individuals are committed to preventing, rec- ognizing, and addressing trauma. They are stepping forward to help create communities and systems where children and families feel safe, heard, understood, and assisted in maxi- mizing their full potential.

Denise Presnell, MSW school social worker, Watauga County Schools, Watauga, North Carolina.

Acknowledgments Potential conflicts of interest. All authors have no relevant conflicts

of interest. With thanks to Scott Elliott, PhD, superintendent of schools,

Watauga County Schools, Boone, NC; and Paul Holden, PhD, director of student services, Watauga County Schools, Boone, NC.

References 1. National Child Traumatic Stress Network. Child Trauma Toolkit for Ed-

ucators. National Child Traumatic Stress Network; 2008. https://wm ich.edu/sites/default/files/attachments/u57/2013/child-trauma -toolkit.pdf. Accessed November 20, 2017.

2. Wolpow R, Johnson MM, Hertel R, Kincaid SO. The Heart of Learn- ing and Teaching: Compassion, Resiliency, and Academic Success. Washington State Office of Superintendent of Public Instruction (OSPI) Compassionate Schools; 2009.

3. Harvard University, Center on the Developing Child. Resilience. Cen- ter on the Developing Child website. https://developingchild.harva rd.edu/science/key-concepts/resilience/. Accessed November 20, 2017.

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