Session 3: Trauma Informed Care in Education

Rachel Alt is an award-winning speaker and consultant for trauma-informed care, as well as a licensed speech-language pathologist. She collaborates with service providers, SLPs, doctors, PT, OT, etc., parents, businesses such as schools, hospitals, universities, and rehab, and communities to incorporate trauma-informed care into their setting. In 2018, Rachel was an SLP at Marjorie Stoneman Douglas High School in Parkland, Florida, when an internationally publicized traumatic event happened at her workplace. After wondering how she could better work with her students and self who had undergone trauma, she found trauma-informed care. Her lived experience of trauma in combination with her profession allow her to bridge the gap for SLPs and other service providers who want to learn about and implement trauma-informed care in any setting. Rachel is a neurodivergent SLP, PTSD and ADHD, and, and advocates for mental health trainings for SLPs. Rachel uses her unique journey to help put a face to trauma for healthcare providers, parents, and universities. Welcome, Rachel.

Thank you so much for having me. You all can hear me. Um, I'm really excited to be here tonight. Um, I'm on the East Coast in South Florida, so I don't know what time it is wherever you all are, but, um, I'm in my cozy sweatshirt even though it's like 90 degrees outside. But this is nighttime, so this is our nighttime presentation. So we're going to be talking about trauma-informed care in education. And I just— a little bit about myself. Um, so I'm an SLP program specialist for Broward County Public Schools. And for those of you that are not familiar with Broward County, it's in Florida. It is the 6th largest school district in the country. It is 230,000 students. And my role as the program specialist is I support all of the high schools, which is about 44 high schools and non-traditional schools, and all of the SLPs at those schools. So that could be anywhere from 1 to 5 speech pathologists. Like Corinne said, um, before that I was an SLP at Marjory Stoneman Douglas High School from 2016 to 2021. And I don't want you to stress about hearing something that you may not be ready for. I don't talk about anything that happened at that school. All I want you to know is that as someone who underwent trauma, my community, my students, I found trauma-informed care through that experience and used it after the fact with students successfully to build back our relationships. I'm the creator of PTSD SLP on Instagram. Please feel free to follow me, message me, tag me in this presentation. If you have any questions after, we definitely have a Q&A, but you can also feel free to message me. I am the co-host of the Speech Science Podcast. We've been on a little hiatus for the last year, so hopefully we get back to recording soon, but there's plenty of episodes to choose from. And I'm the owner of PTSD SLP LLC, which allows me to present to you all, and I've been doing this for 5 years now, which I love doing. So I just have my financial and non-financial disclosures here. I'll keep them up here for a second. I'm also going to be presenting at ASHA in Seattle this December, so if any of you are planning on going, I would I would love to see you. Please feel free to come up to me. I'm an ASHA member, FLASHA member, and CHAT advisory board member. So we're gonna get right into it because I have a lot of information to tell you all today. So what we're gonna learn is we're gonna recall the 6 pillars of trauma-informed care, describe 3 ways trauma impacts the brain and body, and identify when students or yourself might be dysregulated. So how this presentation is broken up, we're gonna do a little intro. What is trauma? What is trauma-informed care? And then how can we be trauma-informed? And then I've got some examples at the end. All right, so we're getting into it. What is trauma? This is one of my favorite quotes by my friend Addison Duane. She goes by Dr. Duane on Instagram. It is not our job as educators, scholars, or humans to name what counts as trauma for another. So one of the things that I notice, especially when speech pathologists or related professions, healthcare educators, They get trained in trauma-informed care, and sometimes those presentations go a little too hard into what the— your role is supposed to be. And sometimes it goes over the line of what our role is supposed to be. We are not supposed to be trauma detectives. We are not trying to investigate the traumas that all of our students have gone through. It is also not our job to decide what is trauma for another. So an example might be the word divorce. We might have a student come to us that their parents are going through a divorce, and it is not our job to say, well, that doesn't count as trauma because I went through a divorce, or my best friend went through a divorce, and that was fine for them, or their child was fine from that. Trauma is an individual's experience. So we really have to prevent ourselves from using our lived experience or not our lived experiences To try to determine what counts and doesn't count, because that is a bias that we're putting on someone else. Trauma is an individual's perspective. So what does trauma actually mean? So there are many definitions of trauma out there. And you'll excuse me, I am sick for like the 3rd week in a row. So that's why I have a lot of makeup on and my voice is cracking. So hang, hang with me. Trauma overwhelms the ordinary systems of care that give people a sense of control, connection, and meaning. So all of the definitions out there of trauma, the word that comes up in all of the definitions is overwhelms because it's not rational. I could tell you all day, every day that, oh, what I went through isn't traumatic, but my brain and my body will tell you Yes, it was, Rachel. Yes, it was. It is not our job to tell someone else, one of our students, whoever our clients are, that what they went through is not traumatic because it very much what may be. Again, it gives people a sense of control, connection, and meaning. Trauma overwhelms that ability to stay safe. So we are now coming up on our first trauma. So what is trauma? Based on this definition of trauma, how many people agree that trauma is pervasive in the neurodiverse community? So one of the options, I don't think it's common in this population. I think sometimes people might experience big traumas. And then I think more people than we realize experience traumas. I'd love to hear what you all think. Give you a couple seconds for that. And it doesn't allow me to vote, unfortunately. Give you a little bit longer so I can see what the answers are as they come in. Awesome. All right. Wow. Okay. So 94% said, I think more people than we realize experience trauma. No one said, I don't think it's common in this population. And 6% said, I think some people might experience big traumas. So I think that's great that no one picked the first option. We're gonna talk about a little bit who is experiencing trauma and what are the possibilities of trauma, and what does that mean for us as providers in this presentation. All right. So in general, there are a few types of trauma. So acute trauma results from a single incident like what happened at my school. That's the only time I'll talk about it in this presentation. Chronic trauma is repeated and prolonged, such as domestic violence or abuse. And complex trauma is exposure to varied and multiple traumatic events, often of an invasive and interpersonal nature. So you might have clients that have experienced an acute trauma. So that could be like a car accident or something. Um, you also might have clients that had a reason that they are now coming to you. So again, as someone who lives in Florida, I have a lot of students in the school system that survived drowning incidents. So that was from an acute trauma, but that is now creating different levels of trauma after that fact. You might have students who experience chronic trauma, and you might have students who experience complex trauma. It is our job to acknowledge that trauma exists. Like so many of you put in the poll, I'm so happy to see that many of you Believe it exists, and it exists more often than we think. Because the reality is our students are experiencing trauma, and it is our job to help support them, keep them well regulated, and help support them with any symptoms of like trauma or stressors that they are showing. All right. So I know that this like graphic is a little blurry and I don't know why I did that. But anyway, we're going to be talking about the polyvagal theory. So those of you that are speech pathologists, I love talking about the polyvagal theory, even though this is just one theory of trauma. This is not the end-all be-all. This is the reason for trauma, or this is what trauma is from. It's a theory. So many of you, most of you, when we are walking around a grocery store, I think most of us assume that people are in that window of tolerance. That's that middle area. That's the optimal arousal. You're calm, connected. But the reality is people are bouncing up and down. They're hyperarousal, hypoarousal. So in the window of tolerance, that's your parasympathetic nervous system. You can feel feelings of safety, curiosity. You're able to regulate your emotional state. You can simultaneously think and feel. You can learn new things. That is the optimal area in which our students learn. We have to recognize though, our students are not always in that window of tolerance. They may be in hyperarousal, which is the sympathetic nervous system. That's too much arousal to integrate. That's the fight or flight response. Some of you might have heard of fight, flight, freeze. In that hyperarousal area, you might feel unsafe, defensive, emotionally overwhelmed, reactive, impulsive, and poor judgment. In that section, you cannot register consequences. So I've seen over the almost 10 years as a speech pathologist, I'll go into a teacher's And they'll start counting down for a kid to do something. They'll say, 5, 4, 3, 2, 1, you need to move or recess is gone. If someone is truly in that hyperarousal state, it is impossible for them because their brain has taken over. It overwhelms their ability to stay safe, and it's trying to do its best to stay safe even when something feels threatening. On the opposite side of that spectrum, we have hypoarousal, which is the sympathetic nervous system again, but too little arousal to integrate And you're in that freeze response. So I often, when I'm scared or I'm overwhelmed, I go into the freeze response. That might look like feeling numb, hopeless, flat affect, no energy, dissociated, passive. We get a lot of kids on our caseloads that we're told, oh, they're always daydreaming or they're never here. Where are they? In their head. The reason that I'm showing you this slide Is because our students are all over this. They're— I'm trying to think of back in those math days, which I never tried to. I blocked that out purposefully. I think of like a scatter plot. If you were to have 100 students on your caseload, which for me in Florida, we've got no caseload cap. So I started with 130 students in a high school. They are all over this. They're in the hyperarousal window of tolerance and hypoarousal. They're all over it. So what is our job? Our job is to try to help bring those students in hypoarousal and hyperarousal back into that window of tolerance. And how do we do that? We can do that by providing the 6 pillars of trauma-informed care, which we will talk about very, very shortly. But the last thing I want to mention on this slide is all the way on the right side, you see no new learning on both the bottom and the top. We cannot expect any goals to be achieved, any learning to be met, if our students are stuck in hyperarousal or hypoarousal. Learning can only happen in that window of tolerance. All right, so what is trauma-informed care? Another one of my favorite quotes is, trauma-informed care is a mindset, not a prescriptive therapy technique. So As a speech pathologist, we do a lot with, here's a step-by-step guide of here's, here's how you fix the R sound. Here's how you do this. Trauma-informed care is not that. Trauma-informed care is truly a mindset shift. When I started implementing trauma-informed care in my day-to-day practice, at school, at work, I also was able to implement it in my personal life. And a lot of people always ask me, you know, isn't it exhausting to have your brain on trauma-informed all the, all the time? And at first I feel like maybe it was like I had to think about it more often, but now my brain is on trauma-informed autopilot all the time. I am always thinking, how can I be trauma-informed in this moment? And let's talk about what that means. So what is trauma-informed care? You might have heard trauma-informed care, trauma-informed education, trauma-informed practice. I always like to default to care because care happens at the education level. It happens in the medical setting. It happens for you all who are teletherapy providers. It happens everywhere. So there's a bunch of definitions of trauma-informed care. However, a bunch of models have 3 to 4 key elements, which would be realizing the prevalence of trauma, recognizing how trauma affects all individuals involved with the program, organization, or system, including its own workforce, which is you all. And then responding by putting this knowledge into practice. So these are known as the 3 Rs of trauma-informed care. There's also a 4th R, which is called resisting retraumatization. So at the bottom here, I have what happens if we don't use trauma-informed care. The reality is we could possibly cause harm. We could possibly cause retraumatization. We could possibly traumatize. So by realizing the prevalence of trauma, recognizing how trauma affects all individuals, and responding, we can reduce our chance of causing harm, retraumatization, or traumatization. And that is where we need to focus. So I've been talking about these 6 pillars of trauma-informed care. Depending on where you look, you're gonna see anywhere from 3 to 12 pillars of trauma-informed care. However, the ones that are on this slide are from SAMHSA. SAMHSA, which is the Substance Abuse Mental Health Association. I always forget one letter every single time. I need to get it like tattooed on me or something. So these 6 pillars are from SAMHSA: safety, choice, collaboration and mutuality, trust and transparency, empowerment, and cultural, historical, and gender issues. I want you to just briefly scan these words. Safety, choice, collaboration, mutuality, trust and transparency, empowerment, cultural, historical, and gender issues. How I use this in my practice, and we'll be talking about it as we move forward in this presentation, is I always ask myself, how can I provide more safety to this student? How can I provide more choice to this student? How can I collaborate with this student and family? How can I provide trust and transparency? How can I provide empowerment? And then cultural, historical, and gender issues. We want to be cultural, historical, and gender issues, gender humility. So we want to recognize what our biases so that we can ensure that we don't cause harm in those ways. And let me just see what's on the next slide, because I don't remember, and I want— okay. So for safety, for an example of safety, this not only includes physical and emotional safety. And one thing I hear from educators a lot is, I'm my student's safe person. And I want you to kind of get away from saying that. I used to be someone who would say that, but the reality is there are possibly some students who do not feel safe with you. So the question should actually be, Which students don't think I am their safe person, and why is that? It's more so a self-reflection. How can I provide more safety for that student? Is my version of safety the same as theirs? Probably not. Choice. This goes into choice of participation in speech or language therapy. You know, we all learned in school about, hey, we we have three activities or five activities, and we put three on the table, and they get to choose which one. But they're all activities. That we chose, right? But where else can we provide choice to that student? That's something to always look at. Where else can we add choices? And my, my preferred age is the high school level. I love working with high school. We also have to consider their choice in being in speech or language therapy. That is a completely valid perspective. Collaboration. I always think of myself as an authoritative figure to my students, not authoritarian. And the difference is authoritarian is that power differential, that I'm above you, I have the master's, I'm an adult, I'm the speech pathologist. When authoritative is still an authority figure in a way, but we are working shoulder to shoulder, we are sharing, um, the decision-making process. We are saying What would you like to do in speech therapy? What are your goals for speech and language therapy? Trust and transparency. This is a big one, and I see this at a very, very small level being broken. For example, when you have an SLP working with a client and they're trying to do 100 trials of an R sound and you're doing these slides, you have the kids going down the list of words, all the Rs, and they stop and they say, how much more do we have to do? And you say, don't worry about it. Let's just move on, or just a few more to go, just 2 more to go, however you say it. But then you start going for 50 more R sounds. Whether you like that or not, that is taking away the trust that they feel in you that, oh, Miss A said that we're going to do 2 more and we just did 50 more. I'm exhausted. I'm tired. That's breaking down the trust. Transparency. What are we doing in speech therapy? Why are we doing this? Those are important aspects to even answer to a 2-year-old, to a 3-year-old. They need to have buy-in to what they are doing. Empowerment. We are always advocating for the self-advocacy of our students. We want them to be empowered in our sessions and outside of our sessions. And then cultural, historical, and gender issues. We want to make sure that we are not causing any additional harm. Based on not knowing the culture of our specific client. In my area, we have a lot of Jehovah's Witnesses, and we can say, oh, well, come on, just participate in Halloween. Oh, it's your birthday. Let's have a celebration. When we are able to say, hey, what do I know about this population? What do I know about this religion? That there is no celebrating this. There is no this. We have to make sure that we are not causing additional harm. Based on what we think is right or wrong, we have to make sure that we are not causing bias in that way. So how can we be trauma-informed and embrace neurodiversity? So this self-reflection, if you gain nothing from this presentation except for this slide, this is something I want you to reflect on for this session, your sessions in school. And your entire career. So on the easier side, starting at the top, do you know what your stressors are? What stresses you out? So for me, something that stresses me out and affects me is noises, loud noises, not even loud noises, repetitive noises. Something that always really stressed me out at the school was the lawnmower. And I hate it at my apartment as well, that I can tell that, oh, I'm really tense right now. I'm Not in a good mood. Oh, there's a lawn mower outside that's just been for hours. Drives me. Hate it. So do you know your stressors? Do you know that loud noises or repetitive noises? I don't know if any of you have misophonia like I do. What stresses you out? Because are you bringing that into the session? Do you know what you look like when you're stressed? So do you know that your body tenses up? Do you know if you're very quick? Do you know if you yell like? What happens to you when you are stressed? Are you able to identify when you're stressed? Can you do it in the moment, or can you do it after the fact? Can you do it at all? After the fact being, ooh, I was really tense in that session earlier today. I might have snapped at this student verbally. Didn't mean to do that. You have to be able to identify it. So that you can stop it and regulate yourself. So on the other side, we have how do you regulate yourself when stressed? Are you a person that has zero coping strategies and is just stressed throughout the entire day? I know many people like this, that they had one bad thing happen to them in the morning, or one inconvenient thing happened to them in the morning, and they are a nightmare to be with the rest of the day because they have no coping strategies and they take it out on everyone they come in contact with. Is my dysregulation negatively impacting a client? Is my emotional regulation impacting a session? And finally, am I causing harm? And that is a really hard one to reflect on because none of us go into this profession to cause harm. We go into this profession to help, but we have to acknowledge that somewhere along the way we potentially might have caused harm, and that is a much healthier way and responsive way to think about it than Rather than saying, I've never caused harm and I've not— I never will, because that's not true. So we are now on our second poll, which is regulation. So have you ever reflected on your emotional regulation skills? Nope, I'm not sure how to. I haven't considered it within my work conditions. Yes, I have, and coping strategies are in place. So I really am excited to see the results of this. And Be as honest as you can, please. I'm excited to see what the results are here. I know this is a hard one to reflect on, but it's very important. I think we'll give you just a few more seconds. All right, let's see. Okay, so 14%, I'm not sure how to. And remember, the question is, have you ever reflected on your emotional regulation skills? I'm not sure how to. So that slide that we just went over about reflecting on it, that's how you that's how you reflect on it. That would be the best way again to think about how you react to things. What things stress you out? Thirty-four percent said I had it. I haven't considered it within my work conditions. Some of you might know your home stressors. Someone talking back at you. Whatever. Think about it. In terms of your work location? And then 52% said yes, and I have coping strategies in place. That's awesome. I'm so glad to hear that. Thank you for answering that. I really appreciate that. And I think that speaks to how much you are interested in understanding your coping strategies. It's really important. All right. So we talked about it very early on. The first poll was about the prevalence of trauma. So we're actually going to go into the statistics. 674,000 children were affected by some sort of maltreatment in 2017. There's a growing body of research that pertains to the prevalence and exposure to adverse events and trauma in children with ASD and the consequences in terms of physical and mental health. That's really important to know for our population because we also know that students with learning disabilities are arrested at higher levels. They are taken advantage of in many different situations at higher levels than the typical population. Research indicates that when a person is subjected to any conditions, situations, or events that produce high levels of stress, trauma is more likely to occur, and the risk of PTSD is higher for groups who are more likely to be exposed to traumatic events. Research indicates that autistic people may be more likely to experience traumatic life events, particularly interpersonal traumas such as bullying, physical and sexual abuse. In the general population, exposure to interpersonal traumas and a lack of social support increases the risk of PTSD. So I know that one of these examples had the word stress in it. And one thing that I've had to explain to my coworkers as well, when I've said, you know, A highly toxic work environment is traumatic. And my coworkers would fight back about that. When I put it in terms of stress, how high your stress is, trauma is likely to occur. That was eye-opening for them that, wow, I'm so stressed and that is causing trauma. So some of you might be working in stressful work environments, toxic work environments. And although that's not one of these specific traumas, the high stress level is causing trauma. So I also want to mention potential traumas for neurodiverse individuals. So number one, not being able to communicate or not having any— someone understand. So I work at the high school level. You wouldn't believe how many students are just getting an AAC device. as a 9th grader, 10th grader, 12th grader. And can you imagine not being able to communicate for that long? Not being told their diagnosis. This is a really hard one. And I've had several students that I'm not allowed to say what their diagnosis is, which we know what the research shows about that. The research shows that having that identification, that cultural group of autism or deafness or whatever it is, It's so important for the mental health and understanding of what is happening to them. Not presuming competence, sensory differences or challenges. I know for me, I'm someone who really is affected by fluorescent lights. And I think now to being in school, high school, when I was so drained all the time. That's really difficult to have the entire day with these big lights on you and burning you out, and your teachers are like, what? We need the lights on. And then you go into some other teacher's room and they've got a little lamp on and you can still see, but it's easier. Anyway, expectation of masking, burnout from masking. Pragmatic therapy has changed over the past decade. We were essentially teaching kids you need to mask to please the neurotypical population. Now we're teaching everyone else like, hey, you need to be mindful of everyone else and not expecting them to mask for you. Then traumas from therapy. We have heard from autistic individuals certain therapies or things that are done in therapy that could cause trauma. We want to make sure that we are not one of those reasons. So one thing that we can do, and these are practical strategies, is altering our language. So number one, removing toxic positivity. Toxic positivity is something like, everything will be okay, or don't worry about it, everything's all right, something like that. What the research actually shows, the best way to help someone cope is by validating emotions instead. So that might sound like instead of everything will be okay, Is, that sounds really hard. Sounds like you're having a hard day. Thank you for sharing with me. That's validating emotions. Recognizing our own bias. So we talked a little bit about that in terms of the cultural— let me just take a drink for a second— the cultural, historical, and gender issues. But we also need to recognize other biases that we might have against the student, against the parents. We need to acknowledge that these things do happen. We can add inclusive language, acknowledge that providers and therapies might have contributed to possible trauma and harm, asking for consent through the session. So many of us are trained in prompt therapy, or we're doing some articulation stuff, we're grabbing onto people. We need to make sure, is it okay if I touch your face? Is it okay if I use your hand to touch your face instead of just grabbing onto someone? Because as a person with PTSD and ADHD, I'm not a person who likes touch, and someone just grabbing my face would be an automatic cause for me to punch them. And that's my body taking over and saying, unsafe, unsafe. It's not because I would like to punch someone in the face. Sometimes I do. But anyway, moving inappropriate use of mental health phrases. So that might be, oh my gosh, the weather's so bipolar today. Oh, that guy's schizophrenic in some way. We're using these terms inappropriately. And although we have maybe a student's IEP that says autistic, And OHI and whatever other categories, we don't have their mental health records. We don't know if they're bipolar. We don't know if their parents are. And those little words that we're doing, that we're using, we want to show that we are safe. And that might be a reason that someone says Miss A isn't safe because she used that word bipolar in a negative way. What does she think of me as? Someone with bipolar disorder? Does she think less of me? Oh, I can't tell her that I'm bipolar because she used it that way. And then removing violent language. So we don't know all of the traumas or any of the traumas that people have gone through. There is a big likelihood that they have been through a violent trauma, whether that's like domestic abuse, something like that. If we remove violent language phrases, which could be just like, shoot me a text, shoot me an email. You wouldn't believe how many violent phrases are used in our day-to-day life. And after this presentation, you're gonna start clocking it. You're gonna start saying, oh my gosh, I didn't realize that was— that's a violent term that we use. You're gonna start seeing it now. And that is what trauma-informed care is. That's what that mindset shift is, that you're like, oh, I'm hearing it now. I hear the things that I can adjust. So I always choose to be more direct. Instead of saying, shoot me a text, shoot me an email, I say, send me a text, send me an email. And that way, if someone has gone through a violent experience, I can prevent myself from causing them a memory or distraction or sending them into fight or flight when I want them in that area of tolerance. So speaking of language changes, we have identity-first and person-first. So many of us in grad school were told about only use person-first language, which is a person with autism. The neurodiversity movement has changed things in the last like 20 years, but especially I see a difference in the last 5 years. It is our job as SLPs to know that 2 schools of thought exist: identity-first and person-first. Identity-first being autistic person. Both are correct. It is our job to inform our clients, hey, did you know that both of these schools of thought exist? Which one do you go by? Which one would you like to use? That's providing that aspect, that pillar of choice. Um, non-speaking, nonverbal— there are different phrases, um, and we need to get clarification on what that student is. Are they non-speaking or are they nonverbal? Red flags, change to signs. Um, red flags has a negative connotation. Signs is neutral. Removing ableist language, and then we're not using high functioning versus low functioning, rather high support versus low support, and name the areas in which they require support. Also, Asperger's is not used at all. Um, so for session considerations, so we can try our best to be as predictable as possible, um, flexible as possible, empower our clients, and create connections. These are our goals as a trauma-informed provider, how to Make sure that we can provide safety, choice, collaboration, mutuality, trust, transparency. All of the pillars can be done if we can be predictable, if we could be flexible, empower, and create connections. So I think this is our final poll. Provide 6 pillars. So who remembers the 6 pillars of trauma-informed care? I do. I know I need some help. I, I can't speak. I know some and I need help, please. So please rate this and please be honest so we know what else we need to talk about for the short part left of this presentation. And I hope you can't hear my dog drinking water like right under me. He chooses to eat and drink during my presentations. So the 6 pillars of trauma-informed care. I'm going to start wrapping up. All right, let's see. Okay, awesome. So I do, I know some, and I need help, please. So 13% said I need help, please. 70% said, I know some, and then the rest was, I do. So we'll go over that, I think, on the next slide and how to use these pillars. Okay. So I briefly mentioned about— is my mouse working? Yes, it's right there. Safety, choice, collaboration, mutuality, trust and transparency, empowerment, and cultural, historical, and gender issues. I went over a little bit on the top. Right here, kind of view this: common areas are welcoming, privacy is respected, individuals are provided a clear and appropriate message about their rights and responsibilities, individuals are provided a significant role in planning and evaluation services, respectful and professional boundaries are maintained, providing an atmosphere that allows individuals to feel validated and affirmed with each and every contact, and then recognizing and eliminating any potential cultural, racial, gender, or other bias. So please feel free, take a picture of this because we're We're gonna go over some situations to help you remember the 6 pillars of trauma-informed care. And I'm gonna have a couple situations that we're gonna talk about. We'll give you like 5 seconds to take a picture if you haven't already, so we can move on. All right.

All right.

So this is the tool that I use. And also, please feel free to take a picture of this while we go over the situations. So this is how I analyze my own sessions. Um, what might safety look like in this population? So there's many of you on this presentation. Um, I don't know what specific population setting, um, age group you're working with, developmental. All of that is gonna be different. So I want you to consider what does safety look like for that population? What does choice and empowerment, trust and transparency, Collaboration, mutuality, and cultural, historical, and gender issues of your population that you work with. So I have a brief video here of hand over hand. So this is kind of considering a trauma-informed perspective of hand over hand. Okay, I know that music is very dramatic for that, but basically it's saying, you know, hand over hand is not giving choice, it's not giving safety in some aspects. So this person, um, this creator on, on TikTok is saying that hand over hand might not be trauma-informed because it Doesn't have safety, choice, collaboration, mutuality. What a lot of people suggest instead is hand under hand, and some other opportunities for instructing and modeling is what this creator suggested. We already did that one. Okay, so now we are getting to the last part of this presentation. I have 5 scenarios here. We'll see what we get through. But basically, scenario 1, I want you to consider when a student is in a trauma response, and not just a trauma response. I also want you to think about it in terms of stress. So think about it in terms of your student is stressed. And remember that polyvagal theory we talked about a while ago? They're either in fight or flight, or in there, they're in freeze. So here's an example. The student was caught off guard by a loud walkie-talkie. I had this happen to me just this morning that I was In a room with a student who is autistic and the AP is in the room with their walkie-talkie on like 120%. I don't know why any administrator is always on that loud, loud version. Anyway, you automatically see this kid's hands go up and I'm not stressed out by it. Like, I kind of expect it, but the student is stressed and cannot concentrate on anything else until that's turned down. So we need to acknowledge as the provider, freezing up or shutting down, not speaking can be a trauma response. We can pause and wait to see, listen, clear other people if possible. Don't force them to talk or start doing a countdown for them to unfreeze. Try to observe the situation and figure out what happened or changed. Use direct language. Consider outside factors that might have reminded them of something. Try to explain what's happening. Help them make sense of what's going on. Validate. You can say, that was scary. That was really loud. Offer choices. Try to redirect their thinking to shift the vibe. So I know that this is happening in your sessions, not just the walkie-talkie, but I want you to think of a time that a student was stressed out by something that you're fine. How do you address it? Do you say, oh, it was nothing, and just move on? What happened in this situation was the student actually had been given some coping strategies that he had his hands over his ears, and he asked the assistant principal, can you please turn that down? Can you please turn that down? And the AP was like, no, like, and that was not a trauma response, trauma-informed response to me. I immediately was like trying to help out the situation. I said, oh, he could turn it down a little bit so that it's not so loud and that we can keep talking, right? And the administrator, you know, had to turn it down a little bit because I'm helping advocate for my student that I can see is stressed. After it was turned down, the hands come down again. We are trying to bring them back to that level of tolerance, level of tolerance. And if they are in that stressed position, we're not going to get any learning from happening, right? All right. Here's the second scenario. This is for when the SLP is triggered. So this is for when your student is totally fine, but you're stressed. Remember, we talked about trauma-informed care not only being for the student, But for all individuals in the organization. So you— so this happened to me as soon as I graduated from grad school. I was given an iPad by my family as a graduation gift. I was so excited. I brought it into the session without a case, without a screen protector, and the student just launched it at the wall and it broke, and I never had an iPad again. So the student broke my iPad. What do I do? First, I pause and breathe. I don't say anything. I focus on my own emotional regulation until I am ready to respond calmly. Number 2, ask questions, make basic observations out loud instead of focusing on correcting the behavior, or until you've processed the situation and are ready to respond. 3, simply just walk away or ask them to give you a minute to breathe and calm yourself. You do not always need to respond immediately in order to be effective. So this is a big deal. So like I told you, it was my fault that I too early brought my iPad in, even though I ordered the case, I ordered the screen protector because I know what is possible with this population and the kid threw it. So am I gonna waste my time yelling at the kid? No, because I have emotional regulation strategies that I'm stressed. I, I'll go cry outside for a second, but I'm using my coping strategies to make sure I'm not taking it out on someone when it was my fault for bringing it in the first place, not prepared for the possibilities. Um, also in trauma work, we know the longer you go from the action to the reaction, the better learning outcomes. So that's why we say pause and breathe. Don't say anything. Wait until you're— Emotionally regulated and ready to respond calmly. We need that gap in order to respond effectively. If we answer right in the moment, I would scream at the kid, right? But I know that that is not what I need or what the student needs. So now we're at student scenario 3. So student and the SLP are stressed, right? This happens a lot. Fire alarm went off when you were working with a student. For those of you working in the school system, you know how loud and like scary those fire alarm sounds are. So I'm stressed when it happens. My student is stressed when it happens. So first, regulate the adult emotion. A dysregulated adult cannot regulate another person, whether it's a student or a child. A dysregulated person cannot regulate another dysregulated person. So we have to work on our Regulation first, bring ourselves into that window of tolerance, and then help regulate. So get in non-threatening position, make eye contact if that is what they need, and validate the emotion. Show sympathy, offer affection. Once connected, offer teachable moment and explain why the child can't do the dangerous thing, that the intention is safety, not to keep from fun. Whatever the intention is, just explain. So That was scenario number 3, and I know that we are at 7:20, and I want to open it up to questions. I saw that some were coming in the chat. Let me pull them up.

Yeah, thank you, Rachel.

Of course.

Yeah, so we have a question actually going back to altering our language and that section where you were talking about different ways that we can change how we, we speak. There was a question requesting more examples of inclusive language, if you wouldn't mind sharing that first.

Okay, so one of my favorite ones to do is, especially in the school system, when I send home letters, which I know many of you do send letters home, instead of saying, dear parents, I'm gonna say I'm gonna be working with your student this year, I say, dear adults. That is just one inclusive language change, because 99.9% of your students are going to be living with an adult. They may not be living with a parent. They may be living with a family member. They might be living with an 18-year-old friend of a friend of a friend, but they may not be with family. And that is something that when they read it and they say, dear parents, oh, I don't have a parent, back in my backpack, never to see the light of day. So just opening up those spaces to say, dear adults, is one simple change that you can use to your letters home. So I know that some private practices do change that on their intake forms, that they— it doesn't say parent 1 and parent 2, just says adult 1, adult 2. Um, that way it's more inclusive for everyone. So that is one change that I would recommend.

I love that. I actually went through that this year where I was contemplating which name of the family should I put. And so I was really worried that I would be, um, upsetting folks, but that—

I love that.

Also, if you wouldn't mind giving us some examples of things that we might say in our phrases that would be taken as toxic positivity, and how would we replace those with validating emotions instead?

Sure. So one of those, I think I mentioned a couple, but one that I hear all the time is everything will be okay. And I do a lot of presentations also for like the medical setting. So would you say everything will be okay to like an ALS patient? Would you say that to a family member? Like, everything is not always going to be okay. And many of your students, they might be going through a breakup and something, and you say everything will be okay. They cannot consider that that is a possibility right now. So something that if I have a student that is telling me they just broke up, you know, it's the worst thing that's ever happened, I'd say that does sound tough. I'm sorry to hear that. Sounds like you had a hard day. We're validating the emotions that we are hearing from them. We are seeing how it is affecting them versus saying, don't worry about it. You're not going to remember that boyfriend in 20 years. You know, these are things that they're said toxic positivity at its core is a way to help people cope, but people don't always take it well. There are some people that like those certain phrases of, oh, you know, it'll be okay. But that's why it's so important to develop those relationships with your clients. to know what they would be validated from. Also, religious phrases can also be considered some of the toxic positivity phrases. That's why it's important to understand the cultural, historical, and gender issues that we are not putting our own bias and our own perspective, our own religions, our own culture on someone else and what they might like to hear.

That is really, really helpful. And then also, just before we kind of move on to the next topic, inappropriate use of mental health phrases, I think you gave an example of Of at least one. Uh, was there others that you could provide?

Um, so the bipolar one was what I was talking about. I hear that a lot in Florida. You know, we have sunshine one second and we have pouring rain the other, and we'll say, oh, you know, the weather's so bipolar today. I've seen that happen in real time, that someone automatically goes, oh, well, I'm bipolar. How, how does that make that person feel about me? I've tried to remove the word crazy from my popular, uh, my, my vocabulary. Insane. I tried it a stop because especially working at the high school, I know that these students are constantly analyzing. Am I crazy? Am I? Am I dumb? That's another one that I will not say, especially with the populations we work with. So we need to make sure that any of those phrases—crazy, dumb—the R word is one that should never be used, and I hear it way too much in education, unfortunately. But these are phrases. that if someone, if one of my students or clients hears being used by me, that they might go, Miss A is not safe. Miss Rachel is not safe. So we need to think of what things we're saying. Who could that harm? Who am I talking about? Who would be harmed by this is what I ask myself for everything I say.

Thank you. That, that was very, very helpful. We have another question here. So this is kind of a sensitive topic, of course, but hoping you could help us with this one. What can educators do if they are the victims of crimes by students with potential trauma? In my experience, administrators are not supportive since their primary client is the student. The crime goes undocumented or is ignored even as if it is documented, as if without meaning or consequence for the educator's life, and there are not any union protections for educators that are traumatized. So anyway, the question I think is, what can be done in a situation like this? If you have a few words for this.

Yeah, that's a tough one. Thank you for sharing, whoever wrote that. But one thing I want to mention is trauma-informed care is not just for us to the student to prevent harm. Trauma-informed care needs to be at all levels. So just from that question alone, I can tell that your bosses are not trauma-informed. They are not interested in making sure that you feel safe. You have choice. You feel empowered. They are not hitting any of those pillars. So I have to be my own advocate. You have to be your own advocate. I have filed police reports to protect myself at the school. I was scratched badly by a student my first year, and in my first year I was like, I guess that's just what happens. And it wasn't until an older, older SLP was like, you need to document that. You need to send an email. Explain the situation. You need to memorialize it. That's the word that we are using, memorialize it. We want everything in writing. And then after I sent that email, I got a response. My dog is on my lap right now. I got a response from my administrator saying, all right, now we need you to fill out a police report. That doesn't mean they go and arrest the kid necessarily, but it's just something that they need to have on record. So trauma-informed care is also about empowering you. And making sure that you are safe. So your safety is the priority. Whatever you need to do to make yourself feel safe, you, you absolutely can, can do. And it sounds to me that your administrators or whoever is your boss is not being trauma-informed. So I would also have a talk with them about what is trauma-informed care and how can the school or the setting that you're in also be trauma-informed for its employees. Which absolutely needs to be done. Trauma-informed care can only be as strong as the levels above you, which is something I talk about in longer presentations. But if I have a a boss that is not trauma-informed, I can't be 100% trauma-informed because it's not trauma-informed to me. So that is one thing to think about. But self-advocacy is absolutely one of the tenets of it, and I want you to feel empowered to. Do whatever you need to do to feel safe.

Thank you. And then I think just one last question here. I know we're coming up on time. Um, what are some ways we can incorporate predictability, flexibility, empowerment, and connectivity into our group sessions in the schools? There's, um, not a whole lot of control that we have over those group sessions.

Yes.

And also any thoughts on how we can do this remotely via telepractice?

Yeah. So it's funny that you actually said that, that we don't have control of it. And I definitely want to say, yes, we can only be as trauma-informed. We can only be as flexible and predictable as our school allows us to be, as our setting allows us to be. So I talk a lot about caseload caps and everything. In Florida, in my district, we do not have a caseload cap. So I cannot be trauma-informed, 100% trauma-informed. Because my caseload cap is so high, I cannot be as trauma-informed to my students as someone who has 50 students on their caseload. So we can try our best to be flexible, whether that's flexibility in what we are doing. We know that many of our students with autism like schedules. They like to know this, the, our sessions kind of go the same way each time, but we also have to teach them about flexibility as well, that some things happen that are not under our control. One thing that happens all the time is we get pulled for IEP meetings. Right? So we have a session, I have a student waiting outside, and I'm like, Johnny, I have an IEP meeting, I'm so sorry. That's something that we talk about in our sessions to say, hey, this is going to happen sometimes. However, the predictable part is I will pull you another time if I'm not able to catch you this time. I will pull you another time, so please expect that. That's something that we can work on within the sessions. But again, it comes down to our setting and advocating for ourselves and our students. So if there's something that keeps coming up, if IEP meeting is always scheduled or last minute scheduled, we can talk to our bosses and say, hey, I just want to let you know, I'm not able to be with these students each time because I keep getting pulled last minute for IEPs. We have to advocate for ourselves. So that's the empowerment on our level, the self-advocacy on our level as well. And I hope that answered the question. Teletherapy, I know that you're not face to face with them, but it ultimately should be Somewhat the same. Again, you don't have a little bit more control being at that setting, but we still need to prioritize where can we add predictability in this session? Where can we add flexibility? Where can we add connection? How can we build connections here? That is our priority in those in those settings.

Amazing. Thank you so much, Rachel. This has been very informative and. We thank you for being with us tonight, and this of course concludes the educational— excuse me, this concludes the educational portion of our webinar available for ASHA CEUs and NASP CPDs. If you— when I'm done with this part, if you could advance to the next slide as well. As a reminder, you will be receiving a survey tomorrow by email. Please be sure to answer all the questions and complete the survey by the deadline. And now, before we end, we have a few more special announcements about ways to partner with Parallel. We know it's not always easy being a provider, and that's why we'd like to raffle off our relaxation kit to anyone who may be interested in filling out or becoming a provider, refer a provider, or refer a district. And also, we are continuing to hire for the current school year. So if you know anyone that would be interested, interested, please do scan the QR code and participate and let them know about Parallel. Again, a special thank you and appreciation to all of our Parallel providers for all that you do to support our students. And again, if you are very happy with your position and you are at a school that definitely could use some help, we would also appreciate you spreading the word about our program and our services. And of course, we'd love it if you come and grow with us and join our amazing team. And again, thank you for being with us this evening. We will have another series beginning in 2025, so look out for the information on our socials coming up. And do follow us on Instagram, YouTube, and LinkedIn. I think there might be one more slide after this. For folks, if they want to. Yes. So this was our last one of the series, and do follow us on our socials. All right, and have a good evening, everybody. Thank you.