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Community & Behavioral Health | Recovery | Social Change


Changing the Conversation

The Number One Public Health Problem in the U.S.

06/10/15 01:17 PM | Kristen Paquette | Trauma, Youth

Just this past month, a landmark class action lawsuit was filed to address the pervasive public health problem of childhood trauma. Filed by Public Counsel, the lawsuit seeks to mandate the integration of trauma-informed practices in schools in Compton, CA.

In recent years, research supported by the Centers for Disease Control and Prevention (CDC) has documented the extent and impact of adverse childhood experiences (ACEs). About two-thirds of children experience at least one traumatic exposure each year (Finkelhor, Turner, Ormrod, & Hamby, 2009). These rates are higher in low-income and marginalized populations (Bassuk et al., 1996; Hayes et al., 2013). The exponential and lifelong impact of unresolved trauma is staggering. For example, the likelihood of illicit drug use and addiction increase seven to ten times among those with five or more ACEs compared to those with no ACEs (Dube et al., 2003). Additionally, a higher number of ACEs predicts risk of developing a depressive disorder later in life (Chapman et al., 2004).

Exposure to traumatic experiences leading to traumatic stress is often misunderstood. Traumatic stress is different from everyday life stress. Traumatic experiences occur outside the realm of expected daily experiences and can overwhelm a person’s ability to cope. Trauma can result in a range of adverse outcomes, including changes to the brain. These and other emotional and physiological responses can severely impact functioning, relationships, and most important for young people – learning.

“In my experience, kids have a hard time separating their personal lives from school. For a child dealing with trauma, this may manifest in various ways – inability to focus, lack of attention to school work, withdrawn behavior, peer issues, and acting out,” said Bethany Paquette, Special Education Lead Teacher K to 5 at Drew Charter School in Atlanta, GA.

Despite the fact that we know childhood trauma is pervasive and life changing, in the institutions with the most frequent and persistent reach into the lives of young people – schools - trauma remains largely unaddressed.

Over the years, conversations with educators have indicated that trauma is rarely discussed in undergraduate and continuing education, and that a focus on mental and emotional health is often crowded out in favor of professional development focused on testing standards. Further, children with extensive behavior problems tend to be referred for special education or to child welfare. Even when academic and behavioral issues do not rise to these thresholds of concern, assessment and intervention is typically focused on correcting the immediate problems rather than addressing the root causes.

In many ways, this mirrors the difficulties posed by other public systems of care. Similar to the mental health system, counselors are overloaded with excessively high student-to-counselor ratios. Triage takes the place of proactive, universal approaches to health and safety. Maladaptive behaviors are seen through the lens of disciplinary problems and deviance, rather than as survival skills needed to deal with family conflict, abuse, and loss. Parents may fight to qualify their children for special education programs or general education accommodations – only to set their child on an irreversible course of being labeled, separated, and blamed for being a problem.

What if school systems considered the question that is key to trauma-informed care:

What happened to you?

instead of

What’s wrong with you?

The concept of trauma-informed care (TIC) has gained traction in human service settings, and has become a guiding principle for good care. TIC informs engagement and service delivery approaches, organizational policies and procedures, and even the physical environment. TIC can be adapted to school settings in a way that promotes universal safety and recognizes how a young person’s family and social context influences his/her well-being on any given day. This includes staff training, an emphasis on mental health, community-based supports, sensory curricula, and predictable classroom routines.

Moving towards a fully trauma-informed school model may take time. However, teachers can incorporate trauma-informed principles any time. “Teachers need brief, accessible training tools to help them understand and appropriately respond to trauma experienced by children in their classrooms,” says Ms. Paquette. Educators and administrators need training and ongoing supports to help them separate a student’s trauma responses from their academic capacity. Professional learning communities and task forces can also help to implement school-wide trauma-informed initiatives.

On a personal note, the work I have done throughout my career has focused largely on homelessness – most often these are young families and older adults who suffer from the inevitable sickness brought on by years of abuse, violence, isolation, poverty, and failed attempts at seeking quality care. Many of these men and women are ghosts who surely slipped through the cracks and chasms of public school systems. What if someone had asked them “What happened to you?” Where would they be now? When will we start asking these questions?


Bethany Paquette is Special Education Lead Teacher K to 5 at Drew Charter School in Atlanta, GA. She currently leads the special education faculty, which includes managing all relevant state and federal compliance requirements. Over the last thirteen years, Ms. Paquette has won various awards including the distinguished Atlanta Families Award for Excellence in Education (2012) and Inman Middle School Teacher of the Year and Atlanta Public Schools Semi-Finalist for City Teacher of the Year (2006).



Bassuk, E. L., Weinreb, L. F., Buckner, J. C., Browne, A., Salomon, A., & Bassuk, S. S. (1996). The characteristics and needs of sheltered homeless and low-income housed mothers. Journal of the American Medical Association, 276(8), 640-646.

Chapman, D.P., Whitfield, C.L., Felitti, V.J., Dube, S.R., Edwards, V.J., & Anda, R.F. (2004). Adverse childhood experiences and the risk of depressive disorders in adulthood. J Affect Disord, 82(2):217-25. Retrieved June 5, 2015, from: http://www.ncbi.nlm.nih.gov/pubmed/12612237?dopt=Abstract

Dube, S.R., Felitti, V.J., Dong, M., Chapman, D.P., Giles, W.H., & Anda, R.F. (2003). Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics, 111(3):564-72. Retrieved June 5, 2015, from: http://www.ncbi.nlm.nih.gov/pubmed/15488250?dopt=Abstract

Finkelhor, D., Ormrod, R. K., Turner, H. A., & Hamby, S. L. (2005). Measuring poly-victimization using the Juvenile Victimization Questionnaire. Child Abuse & Neglect, 29(11), 1297-1312.

Hayes, M., Zonneville, M., & Bassuk, E. (2013). The SHIFT Study final report: Service and housing interventions for families in transition. Newton, MA: National Center on Family Homelessness. Available at: http://www.familyhomelessness.org/media/389.pdf

Image via U.S. Department of Education (CC BY 2.0)

Kristen Paquette

Written by Kristen Paquette

Kristen oversees the Center for Social Innovation's innovative programs in homelessness, trauma, recovery, and dissemination. She directs a project developing peer interventions to reduce youth substance use and leads activities to advance the availability of affordable, recovery-oriented housing.