"The Purple Book" is available from Massachusetts Advocates for Children. by jestevens

Editor's note: This is No. 9 out of 10 in a series of posts that accompany questions from the simple version of the ACE Study questionnaire developed by the Centers for Disease Control and Prevention. There are 10 questions on the simple ACE Study questionnaire; we posted the first five in polls last week and we're posting the rest this week. Today is the ninth question. Last week focused on the chronic diseases that show up in the lives of adults who experienced childhood trauma. This week focuses on how physicians, individuals, schools, and others are using the knowledge to heal or prevent child trauma.

Susan Cole is senior project director of the Trauma and Learning Policy Initiative at Massachusetts Advocates for Children and on the faculty of Harvard Law School. But before all this, she was a special education teacher. And she became concerned when she saw kids assigned to her classroom who she thought didn't belong. On some days they could learn without a problem, and the next day not be able to focus at all.

It turns out that in the 1990s, Boston schools were shunting thousands of kids into special education classes by classifying them as mentally retarded or just expelling them from school, when they were actually suffering from trauma. Unable to concentrate or participate appropriately, and under such severe stress that they walked through life with hair-trigger emotions, they often got into trouble. A task force was put together to investigate the impact of domestic violence on education, family law and other matters, and this led to creating the Trauma and Learning Policy Initiative at Massachusetts Advocates for Children.

Long-story-short, Cole went to law school because she felt she could have more impact on improving children's lives. She directs Harvard's Education Law Clinic, which is part of the Trauma and Learning Policy Initiative.

The goal of the Education Law Clinic is to help "children impacted by family violence and other adverse childhood experiences succeed in school", according to its website. Law students work with individual families and on policy issues. But Cole and others she worked with realized that trauma prevention needed to be incorporated into schools, starting at the first grade.

With five others, Cole wrote "Helping Traumatized Children Learn," also known as "The Purple Book", which has been downloaded tens of thousands of times. "We translated the ACE Study and neurobiological research into language that educators can understand," she said. "It helps people be kinder to kids who may be difficult." It also helps teachers, principals and other school staff develop a language that they can share to describe the low-achieving, non-disabled children.

"If one in four kids is sexually abused, we’re saying that we have to accept that any classroom is chock full of these kids," she says. Rather than turn a blind eye to children who are experiencing all types of trauma and acting out because of it, Cole wanted to help schools create an environment that helps children, and is comfortable enough for kids to talk about their problems if they want to.

"Kids spend most of their time at school," she said. "Where else can they have their underlying needs addressed, not feeling stigmatized by their ACEs, go on to achieve, become citizens and not feel marginalized? We think that place is school. You can’t fix a kid in a little room. They want to feel normalized in a group. They need validation and support."

Cole isn't interested in giving kids ACE scores. "We don't want to define kids by ACEs," she said. If children who are experiencing trauma and the neurobiological, psychological and social challenges associated with trauma, focusing on three things will help them be successful, said Cole:

• A strong relationship with a parent, or surrogate care-giver, who can be a teacher.
• Good cognitive skills
• An ability to self-regulate attention, emotions and behaviors.

The best way to do that is to create a classroom that teaches children about emotions and how to control them, she said. This creates an environment that is more conducive to learning so that kids can develop No. 2 on the list -- good cognitive skills. East Street Elementary in Ludlow, a town of 20,000 in Western Massachusetts, was one of the first schools to set up a pilot trauma-sensitive classroom....with a bunch of first-graders. I talked with Cole in 2008, toward the end of the first year it was put in place.

There's an incredible amount of work that goes into creating a trauma-sensitive classroom, and if you'd like more details, check out the keynote address for a 2009 trauma sensitive schools state conference that the East Street Elementary principal, Brett Bishop, presented.

Very briefly:

Bishop chose the best, most-motivated first grade teacher and paired her up with a consultant to set up the trauma-sensitive classroom. It's a calm place, said Cole. The colors are calm. They created a special place lined with pillows for kids to go if they felt bad or needed to vent. During transitions, the kids listened to classical music. They brought in an intern from a mental health center to teach self-calming techniques, including breathing and exercise. In other words, the six- and seven-year-olds were taught to understand their own emotions as well as their classmates' emotions. And they were taught to regulate them, and help each other. "So rather than hitting somebody on the head, they knew to go in and hit pillows instead," said Cole.

Even with all this, a child would occasionally be so stressed out that he or she couldn't stay in the classroom. In that case, the child was sent to meet with Bishop. Instead of expelling or taking a punitive approach, he listened to the child express as best as possible, his or her frustrations, anger and sadness. And then he'd say, "You know, I've had days just like that. Let's go out and get an ice cream," said Cole.

"Our public policy revolves around taking kids out of school," she said -- which further traumatizes them. (To this point, a survey of several hundred juvenile probationers in Spokane, WA, found that the average age of their first expulsion from school was seven to eight years old.)

Although not without its hiccups, the pilot program was so successful that the goal was to make every classroom at East Street School a trauma-sensitive classroom.