July 19, 2012
By Patricia Yollin
Source: UCSF School of Medicine Public Website – Public Service
Photo: Anthony Asael
The story is very sad and way too familiar.
Ryan, a third-grader who lives in a San Francisco housing project, watched his father beat up his mother one night, something he’d witnessed since infancy. His dad was arrested, his mom was taken off in an ambulance and a neighbor brought the boy to school. A teacher asked for his homework, and canceled his recess when he said he hadn’t done it.
Shortly after, a classmate accidentally bumped Ryan -- who punched him in the stomach. The teacher yelled at Ryan to stop. Instead, he screamed, kicked chairs and hid under his desk. He ended up with a five-day suspension.
“He’s not a bad kid,” said Joyce Dorado, PhD, an associate clinical professor at UCSF and director of clinical research and evaluation for Child and Adolescent Services in the UCSF Department of Psychiatry/San Francisco General Hospital. “This is a scared kid in need of support.”
For Ryan, who Dorado evoked as a composite of several children, that support is available through a project she directs: UCSF HEARTS (Healthy Environments and Response to Trauma in Schools).
“He’s trying to survive an untenable situation,” she said. “His body has adapted to surviving it, and that adaptation gets him in tons of trouble in school. We can change the trajectory for a kid like Ryan.”
This fall marks the fourth year of collaboration with the San Francisco Unified School District, which is clamoring for HEARTS to expand. One school reported a 42 percent decrease in violent student incidents and a 32 percent drop in disciplinary office referrals after participating in the program for a year.
HEARTS, co-founded by Dorado and former UCSF psychologist Miriam Martinez in 2008, shows teachers and other school staff how to reframe the disruptive behavior they encounter by seeing it in the context of the trauma many youngsters experience. It can take the form of loss, child abuse or being a witness to violence -- or a victim of it -- in the home, school or community.
Unaddressed, this trauma can result in school absences, poor academic performance, attention deficits, difficulty in self-regulation and dropping out. It also can lead to prison, Dorado said, citing a Children’s Defense Fund study that found one in three African American boys and one in six Latino boys born in 2001 are at risk of imprisonment during their lifetimes. Children’s Defense Fund attributes these statistics to the “dangerous intersection between poverty and race.” Dorado believes that unaddressed trauma also contributes to this tragic statistic.
“The kids are developing these identities so early in their educational careers. By kindergarten, many kids are labeled and tagged as a major problem,” said Lynn Dolce, MFT, associate director of Child and Adolescent Services and an assistant clinical professor in the UCSF School of Nursing
HEARTS relies on prevention and intervention, and operates on three levels: student, caregiver and the school system.
Students receive individual and group psychotherapy in school as well as classroom presentations on how to calm down under stress. Caregivers, such as parents or guardians, can to go workshops and support groups, while school staff can get consultations and professional development training. On a system level, policies and procedures in the school district are examined through a trauma lens, which can mean, for instance, finding alternatives to suspension.
“We especially work on building relationships between the teachers and kids,” Dorado said. “Some of these kids are difficult to get close to. They push you away because they’re so scared you’re either going to leave them or hurt them. Because that’s what has happened to them in their lives.”
The students that HEARTS focuses on live in southeast San Francisco, where the program has been implemented in four elementary schools: Bret Harte in Bayview-Hunters Point, Paul Revere in Bernal Heights, El Dorado in Visitacion Valley, and George Washington Carver, also in Bayview-Hunters Point. The latter two will still be involved this fall. Given the demographic of these communities, students served are overwhelmingly African American and Latino.
"The UCSF HEARTS program does great work and we value what they do,” said Richard Carranza, superintendent of the San Francisco Unified School District. “They are making a real difference for some of our most at-risk students and for the teachers who work with them."
HEARTS has spent more than 6,000 hours in San Francisco public schools, had an impact on more than 3,600 students, administered more than 1,800 hours of training and consultation to SFUSD, and trained more than 800 SFUSD staff and affiliates. It has received glowing evaluations and repeated requests to scale up.
“It’s been tremendously effective,” said Kevin Truitt, associate superintendent of the Student, Family & Community Support Department in SFUSD. “Children who’ve experienced trauma are a sizable population in this city. They need someone to help them sort through it. If a person is shot in the middle of the road, how is a young child supposed to make sense of that?”
Nancy Milliken, MD, vice dean of the UCSF School of Medicine and a professor of clinical obstetrics, said HEARTS gives tools to children, parents, teachers and principals that can help break an intergenerational cycle of violence.
“The program is a wonderful example of a true academic-community partnership,” said Milliken, who is also the director of the UCSF National Center of Excellence in Women’s Health, which runs the project in collaboration with Child and Adolescent Services.
The goal is to create trauma-sensitive classrooms that are safe, nurturing and predictable -- a place where children acquire skills to regulate their behavior and emotions, where stretching and deep breathing are routine, and where there’s a “peace corner” when students get agitated. They can retreat there and listen to calming music through headphones, wrap themselves in a blanket or squeeze a stress ball.
“Basically, it’s a good investment,” said Delia Reid, vice president of programs at the Metta Fund, the first and biggest funder of HEARTS. “And for us to see the involvement of other funders is a stamp of approval.”
The program has also been supported by: the John and Lisa Pritzker Family Fund, the San Francisco Department of Children, Youth and Their Families; Lieff, Cabraser, Heimann & Bernstein law firm; the Mount Zion Health Fund; the Tipping Point Foundation; and SFUSD School Improvement Grant (SIG) funds.
To deepen its reach to all elementary, middle and high schools in the district, HEARTS began conducting Training of Trainers (TOT) sessions in 2011 for more than 80 medical and mental health personnel in Truitt’s department, focusing on strategies and coping mechanisms to deal with complex trauma and transform school cultures.
Feedback from the sessions is being used to refine a curriculum HEARTS is creating that can be used in any SFUSD school. Dolce said the broader and deeper approach reflects the fact that chronic trauma exposure is not just a mental health issue but also a public health problem: systemic, widespread and culturally defined.
“I’m really pleased at how the HEARTS program has been able to build on its success but also identify a way to transition to meet growing needs in a climate of dwindling resources,” Reid said.
Tai-Sun Schoeman, principal at El Dorado Elementary School for the first three years of the HEARTS program, said it has shifted the way students are disciplined.
“We are a lot more empathetic,” said Schoeman, who is moving to a different school in the fall. “... We take more time to allow kids to cool off … to have those meltdowns and then come back without being suspended or sent home.”
HEARTS, which uses the LINC (Living in a Nonviolent Community) program at UCSF as a backdrop, explains the science of brain development to those who deal with traumatized children, and often suffer vicarious trauma as a result. They learn how a student’s frontal lobe largely goes offline when he enters survival mode -- fight, flight or freeze -- and that the normal sense of consequence or rationality briefly disappears.
“The fact there is science behind it makes it much easier to digest and takes it out of the personal realm,” Dolce said.
For all those who work with HEARTS, the hours are long and the tasks are endless. But the stakes are high, which keeps everyone going.
“We can't afford to lose these kids,” Dorado said. “ If we can support them in healing from the injuries caused by trauma, these are kids who can change the world.”