THE ARC FRAMEWORK IN A SCHOOL SETTING Running head: THE ARC FRAMEWORK IN A SCHOOL SETTING

The Attachment, Self-Regulation, and Competency Framework: Intervention within a Specialized School Setting Apsy 605 Letter of Intent Rhonda D. Williams University of Calgary

THE ARC FRAMEWORK IN A SCHOOL SETTING Problem Children and adolescents who have experienced complex trauma (trauma that occurs repeatedly and cumulatively, usually over a period of time) in their lives become

deeply affected by their experiences, impacting their ability to effectively function within their home and school settings (Courtois, 2004; Cook et al., 2005; Kinniburgh, Baustein, Spinazzola & van der Kolk, 2005; van der Kolk, Roth, Pelcovitz, Sunday, & Spinazzola, 2005). Complex trauma symptoms include difficulty regulating extreme emotional states, dissociation, medically unexplained bodily stress, and profoundly negative cognitions about themselves, others, relationships and their world views (Gleiser, Ford, & Fosha, 2008). Children and adolescents with affect regulation impairments often have difficulty with emotional self-regulation, labelling and expressing feelings, problems knowing and describing internal states and communicating wishes and needs (van der Kolk et al., 2005). Exposure to trauma impairs development, severely impacting children and adolescents. Treatment intervention should focus on building normative competencies and establish connections to external resources that support resiliency building (Kinniburgh et al., 2005). This project will consist of a literature review on complex trauma and treatment approaches. Specifically, the goal of this project is to investigate how the implementation of the attachment, self-regulation, and competency (ARC) framework will reduce incidents of aggression and self harm within a specialized school setting for middle school students (grades 5-9) over the 2010-2011 school year. Rationale The possession of strengths builds resiliency in youth and has a positive effect of their ability to cope with the impact of complex trauma (Griffin, Martinovich, Gawron &

THE ARC FRAMEWORK IN A SCHOOL SETTING Lyons, 2009). Children and youth possessing strengths and resources tend to have a higher level of functioning and are less likely to engage in high-risk behaviours. The development of secure attachments in relationships with caregivers builds a safe and stable base for youth, resulting in positive social, emotional and behavioural skills, and coping mechanisms. Secure attachments can still be formed even after a child experiences complex trauma. This allows the child to build resiliency and gain

competency with each success achieved in a variety of domains (Kinniburgh et al., 2005). This project is important because the ARC framework provides a trauma-informed practice that helps support impacted youth by creating consistent, trusting and caring relationships, resulting in a safe and more predictable environment while addressing the students social, emotional, and behavioural needs (Kinniburgh et al., 2005). It is the hope of this author that this will translate into reduced incidents of aggression or self harm behaviours among middle school students within the specialized school setting during the scope of this project. Through the use of the 10 building blocks identified by the ARC framework, teachers and educational child and youth care workers are able to teach youth ways to learn affect self-regulation and competency skills adapted to the individualized developmental levels of each student. These skills can be transferred to help support the youth with relationships and self esteem throughout their lifetime. Also, many complex trauma-impacted youth have been diagnosed through co-morbid disorders and are often responded to in a behavioural approach (Cloitre et al., 2009; Griffin et al., 2009). The ARC framework helps caregivers shift their lens, focusing on why a student may be acting a particular way rather than only addressing the presenting behaviour. This allows

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for a more compassionate and understanding approach when challenging behaviours arise (Kinniburgh et al., 2005). Because of the flexibility within the ARC framework, it can be adapted for numerous different settings and personal counselling styles while still creating a common language for caregivers to use when working with complex trauma children and adolescents. Support from the Literature Children and youth with complex trauma related symptoms have been traditionally viewed as mentally ill and categorized by their co-morbid conditions rather than classifying their actions and cognitions as responses to the traumatic events (Courtois, 2004; Griffin et al., 2009). Children exposed to abuse, loss of a caregiver or maltreatment tend to be diagnosed with a variety of psychological disorders such as Attention Deficit Hyperactivity Disorder, Anxiety Disorders, Eating Disorders, Communication Disorders, Oppositional Defiant Disorder, Conduct Disorder, Reactive Attachment Disorder and Separation Anxiety Disorder. However, each of these disorders only capture a limited aspect of the relational and self-regulation deficits these children exhibit (Cook et al., 2005). When working with children and youth who have experienced complex trauma, attachment is a significant predictor of resiliency among high-risk populations. However, the majority of maltreated and abused youth have insecure attachment patterns. Youth who receive inconsistent, neglectful, or rejecting caregiving tend to manage overwhelming experiences using maladaptive coping strategies such as dissociation, aggression and avoidance. These youth fail to acquire more sophisticated emotional management skills (Kinniburgh et al., 2005). Youth with unresolved attachment states

THE ARC FRAMEWORK IN A SCHOOL SETTING (disorganized attachment) are at greater risk for deficiencies in certain cognitive processes (specifically areas of broad attention, cognitive efficiency, and working memory) compared to peers with resolved attachments (Webster, Hackett, & Joubert, 2009). The Complex Trauma Workgroup of the National Child Traumatic Stress

Network has identified six core components intervention should focus on when designing an individualized program for a child or adolescent with complex trauma histories (van der Kolk et al., 2005). Good treatment should adapt to the individual needs of each child (e.g. developmental level, age, gender, etc.). The core components emphasize internal and environmental safety, self-regulation (affect, physiological, cognition, and behavioural), self-reflective information processing (executive functioning), traumatic experiences integration, relational engagement, and positive affect enhancement (van der Kolk et al., 2005). Although evidence-based treatments such as trauma-focused cognitive behavioural therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) have been successful in treating children and youth with complex trauma symptoms within a clinical counselling setting, they only engage the individual 1-2 hours a week (Ahmad & Sundelin-Wahlsten, 2008; Cohen, Mannarino & Deblinger, 2006; Griffin et al., 2009). The attachment, self-regulation, and competency (ARC) framework approaches the issues associated with complex trauma differently. Rather than utilizing short therapy sessions, the ARC framework is flexible to the current environment of the child. This allows for a more extensive approach to help build secure attachments, selfregulatory skills, and competency in a wide variety of domains. The exposure to a

THE ARC FRAMEWORK IN A SCHOOL SETTING therapeutic approach is much longer compared to individual or group therapy sessions once or twice a week. In fact, these therapy sessions could be integrated within the ARC framework (trauma experience integration block) as part of the psychoeducational component. The ARC framework works on building supports and resources around a

trauma-impacted youth in a variety of settings (e.g. school, home, or residential settings). The ARC framework has found success in the residential care settings by increasing the overall functioning and resiliency of youth (Kinniburgh et al., 2005). This proposed research is very important because it will be the first of its kind to incorporate the ARC framework within a school setting. Attachment, Self-Regulation, and Competency The attachment, self-regulation, and competency (ARC) framework is a component-based framework focusing on the treatment of complex trauma with children and adolescents addressing individual developmental needs within their social context (Kinniburgh et al., 2005). ARC is not a prescribed manualized treatment protocol, but rather a guide to trauma-informed treatment practices that is individualized and flexible to the needs of each person. Although it is important to process traumatic memories and experiences, ARC focuses on the developmental skill deficits associated with exposure to traumatic events. ARC also focuses on building resiliency in youth by strengthening trust and security within the caregiving system, building skills, and stabilizing internal distress (Kinniburgh et al., 2005). The ARC framework consists of 10 building blocks focusing on the individual needs of complex trauma-impacted youth: 1) caregiver affect management, 2) attunement, 3) consistent response, 4) routines and rituals, 5) affect identification, 6)

THE ARC FRAMEWORK IN A SCHOOL SETTING affect modulation, 7) affect expression, 8) executive functions, 9) self development and identity, and 10) trauma experience integration. In the ARC framework, the attachment

(interactions and relationship) between the child and the caregiver has a major impact on the development of identity, early working models of self and others, and emotional regulation (Kinniburgh et al., 2005). ARC focuses on two overarching goals for attachment-focused intervention: building healthy attachments with caregivers and forming a safe environment for healthy recovery. These goals are achieved in the first level of the framework through four core principles focusing on creating a consistent and structured environment through the use of routines and rituals, increasing the caregivers ability to manage intense emotions (caregiver affect management), improving childcaregiver emotional attunement, and increasing the use of praise and reinforcement to create a strength-based approach rather than focusing on deficits (Kinniburgh et al., 2005). The second level of the ARC framework focuses on three primary regulatory skills for complex trauma. These skills are the acquisition of affect knowledge and the ability to accurately identify ones own feelings and read the emotional cues of others, the ability to safely express and communicate emotions, and the ability to modulate and shift within an emotional experience and return to a comfortable state of arousal (Kinniburgh et al., 2005). In the third and fourth levels of the framework, the final component of ARC emphasizes four general principles in developmental competency. Caregivers and treatment staff should focus on creating opportunities for mastery, connections with

THE ARC FRAMEWORK IN A SCHOOL SETTING peers, adults, and the community, build on strengths to promote a positive self-concept, and teach the child to evaluate outcomes to foster a sense of control and self-efficacy. Methods and Procedures This letter of intent is proposing a project to explore if the implementation of the

ARC framework into a specialized school setting will reduce incidents of aggression and self harm in youth over the 2010-2011 school year. A literature review was conducted through a search of Medline, Psychology and Behavioral Sciences Collection, and PsycInfo for journal articles published between 2004 and 2010 examining the definition, symptomatology and treatment of complex trauma and complex posttraumatic stress. The search terms and keywords used were: complex trauma and adolescents, complex trauma and children, complex PTSD and children and adolescents, cognitive behavioral therapy, EMDR and attachment and trauma. Participants Participants in this study will consist of 50 middle school students (grades 5-9) who attend a specialized school setting in Calgary, Alberta. Students have been enrolled in this specialized setting school due to severe social, emotional, and behavioural concerns within the school settings in the Calgary Board of Education. Students included in the student have histories of complex trauma and are diagnosed with at least one of the following co-morbid disorders: Attention Deficit Hyperactivity Disorder, Anxiety Disorders, Eating Disorders, Communication Disorders, Oppositional Defiant Disorder, Conduct Disorder, Reactive Attachment Disorder and Separation Anxiety Disorder. Students excluded from this study are youth diagnosed with Pervasive Developmental Disorder, Asperger's Syndrome, or Autism.

THE ARC FRAMEWORK IN A SCHOOL SETTING Design Prior to student involvement in the study, school staff (teachers and child and youth care counsellors) will participate in four training sessions (each approximately

three hours long) at the beginning of the school year before students arrived. The focus of the training sessions is complex trauma and the 10 building blocks of the ARC framework. Once classes begin, school staff will be involved in bi-weekly meetings throughout the 2010-2011 school year, focusing on a more in-depth view of each block of the ARC framework as well as case discussions about specific students (e.g. progress, struggles, approaches used). This training will be lead by three school administrators (principal, assistant principal, and program coordinator) who attended a 16 hour training session with Dr. Margaret Blaustein. Dr. Blaustein is one of the co-developers of the ARC framework and is the Director of Training and Education at the Trauma Center at Justice Resource Institute. The administrators are also part of the Calgary Board of Education(CBE) team of ARC coaches, developing curriculum around the 10 building blocks to be taught in various school settings throughout the board. This project is being implemented through a partnership between Dr. Blaustein, the CBE, and Hull Child and Family Services. Prior to involvement in this study, all participants/guardians will receive an information letter describing the purpose of the project and a list of potential benefits and risks of the study. If both the student and their caregiver would like to participate in the project, the guarding will complete a Written Informed Consent Form (Appendix B). Once consent has been given, students will be administered the Trauma Symptom Checklist for Children (Briere, 1996) to measure six different scales: anxiety, depression,

THE ARC FRAMEWORK IN A SCHOOL SETTING posttraumatic stress, sexual concerns, dissociation, and anger. The participant will

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complete this scale within the first month of school and complete it again the last month of school for a pre/post checklist comparison. The integration of the 10 building blocks within the ARC framework will be twofold; student participation in two 40 minutes lessons a week and individualized support and counselling on an ongoing basis within the classroom setting with trained school staff. The two lessons a week will focus on attunement, affect identification, selfregulation, positive social skills, effective communication skills, and anger management techniques. These themes will incorporate key concepts of the ARC framework into developmentally appropriate levels for each student to understand. For the first few months of the school year (August November) staff members will focus primarily on the first level of blocks: caregiver affect management, attunement, consistent response, and routines and rituals. In addition to the lessons, students will be engaged in the rest of the ARC blocks as needed on an individual basis. Staff need to be mindful of teachable moments as they occur to increase student engagement within the ARC framework. From December to June, levels two and three of the building blocks (affect identification, affect modulation, affect expression, executive functions, and self development and identity) will become the focus in the scheduled life skill classes. The skills developed through the building blocks of the ARC framework should help create stronger attachments, self-regulation, and feelings of competency for the middle school students involved in the project. It is hoped that as students acquire these skills, it is predicted there will be a decrease the in the number of incidents of aggression and self harm throughout the school year. Incidents of aggression such as severe property

THE ARC FRAMEWORK IN A SCHOOL SETTING destruction and physical aggression (e.g. hitting, kicking, punching, biting, scratching,

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spitting, and posturing) and incidents of self harm (e.g. cutting, biting, or hitting self) will be documented daily on critical incident forms. Details of the type of aggression, length, and any injuries will be documented within the critical incident form and kept within confidential individual files and stored within a locked filing cabinet. Ethical Considerations Participants will be treated in accordance with the University of Calgary Conjoint Faculties Research Ethics Board, research agreement between the CBE and the researcher, and Hull Child and Family Services Policies and Procedures. Prior to any involvement, informed consent will be obtained. Any information collected during the project will be stored in a locked cabinet where only staff members with direct contact with the student will be allowed access to the information. A monthly summary of all critical incidents will be categorized and tallied, removing any identifying information from the data. These forms are already a part of an established tracking system within Hull Child and Family Services and will remain within the agencys possession after the study is finished. All files are destroyed after 10 years of inactivity. A summary and review of the research findings will be conducted with participants, guardians, and research partners prior to the final report to ensure accuracy. The level of risk associated with the project is appropriate for youth within the specialized school setting and does not increase their risk level. There is a low student to adult ratio in every classroom (4:1) and individual work is utilized when required and physically possible. The scope of the project is realistic as it will track 50 students matching the criteria over the period of one school year. The partnership between the

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CBE and Hull Child and Family Services will be supplying the resources for the study as both organizations are focused on initiatives to improve trauma-informed practice and already have systems in place to support the project. Implications and Considerations The implications of using the ARC framework within a special education setting to support complex trauma-impacted youth are far-reaching. Teachers, child and youth care counsellors, students in the study, other classmates, and caregivers will all be impacted by the project. School staff (teachers, child and youth care counsellors) will benefit from the professional development opportunities provided through initial and ongoing training throughout the 2010-2011 school year. The ARC framework provides a common language to communicate about their work with complex trauma youth. This helps facilitate consistency between various settings for the children and adolescents engaged in the ARC framework. School staff will also have the opportunity to learn more about their own communication styles and ways they manage their own emotions and coping mechanisms (e.g. caregiver affect management block). Students with a history of complex trauma will benefit tremendously from the integration of the ARC framework into the school curriculum and their daily interactions with school staff through developing skills related to affect identification, affect management, increased executive functioning, and increased self development and identity within a safe and supportive environment. Once students feel a sense of belonging, they can begin to engage in the ARC framework in a genuine way. The skills developed within the framework are transferrable to any setting and throughout

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their lifetime. It allows students insight into how to process situations and effectively respond, communicating their needs in a more clear and productive way. Engaging in the learning through the ARC framework will help build resiliency for youth with a history of complex trauma because it not only teaches specific life skills, it allows the students the opportunities to develop relationships in their lives based on healthy attachments. Through participation in this project, students will most likely engage in less incidents of aggressive or self harm behaviours creating a safer, more stable environment for themselves, school staff, and other students. Levels of frustrations with others will decrease as students learn more effective ways to self-regulate and communicate their needs. Students will be more responsive to therapeutic interventions from school staff when presented using approaches identified within the ARC framework. Students will also increase on-task behaviour in class resulting in more learning opportunities and chances for academic success. Overall, students will experience a greater sense of competency and control in their lives fostering independence, mastery, and increased self-esteem. With increased social, emotional, behavioural, and academic success, students will progress towards requiring a less intensive support structure within their school placement. Ultimately, students will be able to transition from the specialized school setting to another less intrusive placement. In addition to the students participating in the project, other students and caregivers will benefit from the integration of the ARC framework into the specialized school setting. Other students not included in the study will benefit from

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increased stability and safety in the classroom environment. With this stability comes more learning opportunities. School staff will transfer newly acquired skills and knowledge regarding their therapeutic approach for all students in the class, creating more effective communication and affect regulation skills. Students not included in the study will also benefit from the curriculum developed for the two lessons a week, developing their knowledge around affect identification and management, effective communication, and social skills. Caregivers will benefit from increased skill development in social skills and self regulation acquired by their child at school. In addition, their children will experience more social, emotional, and academic success at school, resulting in positive reports home. This will allow the opportunity for more positive interactions at home about school and foster opportunities for relationship building at home. Caregivers will also be provided with information about the ARC framework through individual and group sessions presented by school staff. Despite all the positive implications related to the integration of the ARC framework into the specialized school setting, there are some limitations of the proposed project to consider. One of the limitations is around school staff and student participation in the project. Although children and youth have embraced the ARC framework in residential care settings, it is currently not known if this approach will be adopted by students and staff in the school setting and elicit participation. School staff will also require an in-depth understanding of ARC and have the ability to integrate the framework into the existing structure and culture within the school. There may also be some limitations regarding the ability to learn the content of ARC and retain the material for students with lower cognitive levels as some of the core

THE ARC FRAMEWORK IN A SCHOOL SETTING concepts of the building blocks within ARC may require more than a school year to learn. In addition, student enrolment within the specialized school setting can be

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transient at times. There may be some limitations around participant retention of the study in the 2010-2011 school year. Students meeting the inclusion criteria should also be considered around the stability of their placement whenever possible. Finally, there is a disproportionate representation of male students within the middle school age group in this specialized school setting. This can have implications regarding the ability to generalize findings of the study to female students. However, the population selection is characteristic of a naturalistic approach as it is representative of the current population within this and other similar specialized school settings. Further research should focus on the effectiveness of the ARC framework in the treatment of children and youth who have experienced complex trauma. Although it addresses all components identified for effective treatment of trauma-impacted youth, little empirical evidence has been published on its impact within residential settings and no current research exists regarding its implications within a school setting as this proposed project is the first attempt at infusing the ARC framework within the school environment according to the co-developer of ARC, Dr. Blaustein. Future research should also focus on longitudinal studies to investigate the long term implications of the ARC framework in the lives of trauma-impacted children and youth. Gender differences in response to complex trauma and the effectiveness of the ARC framework treatment should also be explored.

THE ARC FRAMEWORK IN A SCHOOL SETTING References

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Ahmad, A., & Sundelin-Wahlsten, V. (2008). Applying EMDR on children with PTSD. European Child and Adolescence Psychiatry, 17, 127-132. doi:10.1007/s00787077-0646-8 Blaustein, M, & Kinniburgh, K.J. (2010). Attachment, self-regulation, and competency: A framework for intervention with traumatized youth. Material presented at the Attachment, Self-Regulation, and Competency (ARC): A Comprehensive Framework for Intevention with Complexly Traumatized Youth workshop, Calgary, Alberta. Cloitre, M., Stolbach, B.C., Herman, J.L., van der Kolk, B., Pynoos, R., Wang, J., & Petkova, E. (2009). A developmental approach to complex PTSD: Childhood and adult cumulative trauma as predictors of symptom complexity. Journal of Traumatic Stress, 22(5), 399-408. doi:10.1002/jts.20444 Cohen, J.A., Mannarino, A.P., & Deblinger. E. (2006). Treating trauma and traumatic grief in children and adolescents. New York: The Guilford Press. Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., van der Kolk, B. (2005). Complex trauma in children and adolescents. Psychiatric Annals, 35(5), 390-398. Courtois, C.A. (2004). Complex trauma, complex reactions: Assessment and treatment. Psychotherapy: Theory, Research, Practice, Training, 41(4), 412-425. doi:10.1037/0033-3204.41.4.412

THE ARC FRAMEWORK IN A SCHOOL SETTING Gleiser, K., Ford, J.D., & Fosha, D. (2008). Contrasting exposure and experiential therapies for complex posttraumatic stress disorder. Psychotherapy Theory, Research, Practice, Training, 45(3), 340-360. doi:10.1037/a0013323 Griffin, G., Martinovich, Z., Gawron, T., & Lyons, J.S. (2009). Strengths moderate the impact of trauma on risk behaviors in child welfare. Residential Treatment for Children & Youth, 26, 105-228. doi:10.1080/08865710902872994 Kinniburgh, K.J., Blaustein, M., Spinazzola, J., & van der Kolk, B.A. (2005).

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Attachment, self-regulation, and competency. Psychiatric Annals, 35(5), 424-430. van der Kolk, B., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma. Journal of Traumatic Stress, 18(5), 389-399. doi:10.1002/jts.20047 Webster, L., Hackett, R.K., & Joubert, D. (2009). The association of unresolved attachment status and cognitive processes in maltreated adolescents. Child Abuse Review, 18, 6-23. doi: 10.1002/car.1053

THE ARC FRAMEWORK IN A SCHOOL SETTING Appendix A The ARC framework

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THE ARC FRAMEWORK IN A SCHOOL SETTING Appendix B

Consent to Participate in the ARC Framework Project Dear Parent/ Guardian,

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You child has been selected to participate in the ARC Framework Project at William Roper Hull School. The Attachment, Self-Regulation, and Competency (ARC) framework is an approach focusing on building skills in youth who have experienced various forms of trauma in their lives. This project emphasizes the development of skills for both school staff (teachers and child and youth care counsellors) and students in the areas of caregiver affect management, attunement, consistent responses, routines and rituals, affect identification, affect modulation, affect expression, executive functions, and self development and identity. For more information on the ARC framework, please attend our parent/caregiver information session (date and time will be announced soon) or contact any one of the administrators mentioned at the bottom of the letter at any time. Your child will participate in two, 45 minute lessons a week during the 2010-2011 school year focusing on the ARC framework in addition to individual support from school staff when required. Assessments will be completed by your child at the beginning and the end of the school year to help measure any growth and development made throughout the school year. Specifically, we will be tracking incidents of aggression, property destruction, and incidents or threats of self harm with all participants. Participation in
research is voluntary. If you choose to participate in this study you may withdraw at any time. As stated above, there are many areas of focus that can positively impact skills development in

youth through the participation in the project. Should you feel this project would not benefit your child, the student will not participate in the project and still receive therapeutic intervention from school staff while attending William Roper Hull School. Confidentiality will be respected and no information that discloses the identity of the participant will be released or published without consent unless required by law. This legal obligation includes a number of circumstances, such as suspected child abuse and infectious disease, expression of suicidal ideas where research documents are ordered to be produced by a court of law and where researchers are obliged to report to the appropriate authorities I agree that ___________________________________________________________(name of student) who is under my guardianship may take part in the ARC framework project at William Roper Hull School for the 2010-2011 school year during their enrolment. I am aware that participation in the project is voluntary and can be stopped at any time. Name of Guardian: ____________________________________________________

Signature of Guardian: _________________________________________________ Date: ________________________________________________________________ If you would agree to this request then please sign and return this form to the school. If you would like further information or have any questions about the project, please contact one of the following administrators: Kris Reinhardt Principal - 403-251-8022 Rhonda Williams Assistant Principal - 403-251-8024 Denise Manderson Program Coordinator 403-238-7995

Thank you for your consideration of participating in the ARC Framework Project. We look forward to working together in the future.