The ‘Silent Epidemic’ of Child Trauma

As director of the School Mental Health unit at the Los Angeles Unified School District (LAUSD), Pia Escudero supervises more than 300 psychiatric social workers, clinical psychologists and other mental health professionals. She has also worked to create trauma-informed systems and therapeutic approaches in schools. Escudero was part of a team that helped developed the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program, an intervention aimed at reducing the symptoms of post-traumatic stress disorder (PTSD) and behavioral problems. The School Mental Health team has successfully deployed CBITS in several schools, but the need for more trauma-informed resources is high at LAUSD, where the student population numbers more than 650,000.

Over the past two years, Escudero and her team have introduced a universal prevention curriculum in partnership with the Nathanson Family Resilience Center at the University of California, Los Angeles. Originally designed for children in military schools facing family disruption issues as a result of deployment, the Families OverComing Under Stress School-Based Skill Building Groups (FOCUS-SBG, or FOCUS) is designed to complement CBITS and the school district’s other mental health resources. Last week, she presented on her work with FOCUS at Echo Parenting and Education’s conference on creating trauma-informed schools. 

The Imprint: You’ve described child trauma as a “silent epidemic.” Why is this the case and how did you come to see it this way?

Pia Escudero: Silent epidemic seemed like a compelling and accurate way to describe it. Consistently every time we’ve screened for trauma throughout the years at LAUSD, the rates are extremely high. When we first started doing targeted screening of sixth and ninth graders in 2000, our RAND partners would tell us to do it again. ‘The rates are really high.’ But we know that traumatic events are common here, and today, when we’ve screened, about 98 percent of our children have had at least one traumatic event. The average is between six and eight events. Trauma is common in our children’s lives, but multiple traumas are also very common.

With our partnership with the Nathanson Family Resilience Center over the past two years, we’ve adapted the curriculum they developed for students in military schools dealing with the issues of deployment and family disruption, but for our schools in an urban setting in Los Angeles. With the FOCUS pre-test, there are resiliency questions and skills, but also four trauma-related questions: If they answer two or more, they’ve been exposed to a traumatic event, and they could be in the range of needing clinical support or further intervention. What we’ve found is that when we have conducted universal screening on resiliency skills and trauma in a South Los Angeles elementary school, the average exposure to trauma of all fifth graders is 73 percent.

An epidemic occurs when the rate of disease substantially exceeds what is expected. In the general population, rates of PTSD average 7 to 12 percent and a little higher for military. Across LAUSD, trauma screenings have identified over 50 percent of students reporting moderate to severe traumatic stress symptoms. So if the common rates are 7 to 12 percent, this is something that’s really masked and been under the radar in our classrooms.

The Imprint: So how should school districts be approaching child trauma/adverse childhood experiences (ACEs) and what can they do to deal with students’ mental health needs that arise through the screening process?

Pia Escudero: As we’ve been doing this work more and more, we’re very careful about screening because when you screen there’s a huge ethical commitment to treat because you will find something. You can’t just screen and walk away and not treat the matter. We only screen when we are going to have a therapeutic approach to align with that approach.

With FOCUS, the encouraging news is that once children get this curriculum–children who have core treatments like problem solving and relaxation techniques–they dramatically improved. Some students will demonstrate the need for further intervention, which calls for possibly group or individual therapy or further resources.

The concept of doing curriculum-based teaching in the classroom early on and in middle school is something that’s brand new for us. Based on the high numbers of children who have been exposed to trauma, we now know there has to be a universal approach and it has to be something that really is available to all children, not just a select few. It really calls for a systems lens.

The Imprint: How important is the process of trauma screening as it relates to trauma-informed schools?

Pia Escudero: It’s critical. I think the way our educational system is set up is to really support the teacher, to be the best teacher possible with the best instructional materials or technology. If we focus entirely on that, and there’s trauma in the classroom and the teacher’s not prepared to deal with that barrier or is not aware of the barrier, it doesn’t matter how good of a teacher she or he is or what type of instructional material they have. This really addresses the need for looking at attachment or regulation activities. That’s why we have a big miss academically. Our children are coming with these high rates of exposure to trauma and our teachers sign up to teach, and they’re not able to do this effectively. And it leads to burnout.

Untreated trauma is so costly to our society. These are the kids who drop out of school, end up in the juvenile justice system, early death and with very maladapted behaviors that cost us. But the fact that we can see children bounce back, learn skills and get some support is critical. 

The Imprint: Why are schools a good place to address mental health challenges?

One of the reasons I’m so passionate about being in the schools is that people feel that schools are extensions of the family and they come. When we refer children out, we know that they’re very unlikely to get that treatment. Our partners in RAND have done some work of tracking services, and they’ve found that services rendered at schools are much more likely to be completed and more effective versus [seeking treatment outside the school]. Families in L.A. have long work hours, plus getting on a bus or traveling somewhere else with the transportation, and then we also lose a day of school.

That’s why we set up our school wellness centers. It’s a new model. We just launched them about a couple years ago. They’re attached to schools and students and their parents can get health and mental care, and students don’t have to miss a day of school. We have 14 of these new-model wellness centers and seven of them are co-located with school mental health staff. Our school mental health staff are trained on individual trauma-focused therapy but then if we have a school-based social worker at the school, they’re doing all the macro work, student campaigns, doing presentations in class, and surveying children in the center. It’s really a public mental health model. Teachers and administrators really appreciate it. These children come with such a load of barriers. It’s not just being homeless or just child abuse. They’re homeless, they’ve experienced trauma and they’re living in a community with violence and they might have a parent who is incarcerated. It’s usually multiple issues facing their lives when they come into the classroom.

This interview has been edited and condensed for clarity.

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