 know that brick went really fast, didn't it? All right, welcome to this next session. We are going to talk, we're going to turn it over now to Pamela Dipasquale and her team from Cleveland Playhouse and we are talking about trauma-informed care. I'm turning it over to Pamela. Hello everybody, thank you for coming over and joining our circle. My name is Pamela Dipasquale and I'm just going to introduce my colleagues really quickly or let them introduce themselves. Hi, I'm Colleen. I am the Associate Director of the Care Program at Cleveland Playhouse. Hi, I'm Cassie Pai. I am a Care Coordinator for Cleveland Playhouse. Good, and before we get started we just wanted to sort of walk you through what we're doing so you're not worried I'm in a circle, what am I going to do, what's going to happen to me and so forth. So the first thing we're going to do is we're just going to do a very simple restorative circle exercise followed by a theater game that most of you will recognize. We'll do debrief after that game and then for the sake of howl around in our non-president audience members we are going to ask everybody to transition back over here. Lori has counted the seats so there's enough seats for everyone on this side. And then we are going to talk about the definition of trauma, trauma's effects on memory, some adverse childhood experience, understanding, revisit components of trauma-informed care, talk about self-care for those of you who are working with students who have experienced chronic trauma, and then we'll finish with a restorative circle exercise that we will do it over there so you don't have to move here again. Okay? Great. So we are going to join in in this circle and because we are aware that the microphone is necessary for this first exercise, we're going to just pass the microphone around. So what I'm going to ask you to do is just introduce yourself, let us know the pronouns you prefer and then just share one word about how you're feeling right now. So my name is Pamela, I prefer she, her, hers, and I am feeling just a little bit nervous. My name is Natalie, she, her, hers, and I'm feeling happy to be here. My name is Abby, she, her, hers, I'm feeling light. Jenny, she, her, hers, and I am feeling inspired. Sarah, she, her, hers, and I'm feeling open. My name is Amy, she, her, hers, and I am feeling scattered. My name is Laurie, she, her, hers, and I'm feeling enlightened. Cheney, he, him, sluggish. My name is Marita, she, her, hers, and I'm feeling gratitude. Johamy Morales, she, her, hers, energized. Faye Hargate, she, her, hers, they, them, light. Simone Emmett, she, her, hers, and I'm feeling inquisitive. Rachel, she, her, hers, can, that, she, her, hers, I was trying to find a word for that. So I'll say Gumby. Yeah. Like, stretched. Joanne, she, her, hers, intrigued. Tim, he, him, his, feeling really engaged. Laurie, she, her, hers, I'm feeling responsible and excited to see it coming to life. Nubra, she, her, hers, I'm feeling calm. Nikki Tombs, she, her, hers, the truth is scattered. But what I will put in the atmosphere is energized. Yes, and my name is Tamara, Carol, they, them, and Eager, Eager slash like anxious to go, like go, like go time. Hey, I'm Jared Bellot. I use he, him, his pronouns, and I'm feeling like good, like good. Mara Stern, I use she, her, hers. I'm feeling caffeinated. Mary, she, her, hers, excited. Gary, he, him, his, and I'm feeling open. And she, her, hers, I'm feeling creaky. Amanda, she, her, hers, I'm ready. Let's do this. Alma, she, her, hers, also ready. Victoria, she, her, hers. Sassy for us. Jenny, she, her, hers, caffeinated also. I'm gonna grab that one. Yep. Katie, she, her, hers, hot. Evelyn, she, her, hers, and I'm feeling a little awestruck. Rachel, she, her, hers, joyful. Cati, she, her, hers, curious. Skip, he, him, his, curious. Curious how that happened. Colleen, she, her, hers, full. Suzanne, she, her, hers, grateful. Cassie, she, her, hers, and excited. Jade, she, her, hers, and like a sponge. Has anyone just joined the circle who didn't get an opportunity? Hi, I'm Rebecca. She, her, hers catching up. Anyone else? Because she, her, hers, and synergized. Excellent. All right. So as promised, theater game time. Okay. So what I need you to do first is pretend like this is the first time you've ever played this. Be excited. All right. So it's when blows West. If you're familiar, can I get a hand? All right. So we're, for those of you who are not familiar, I'll give you a brief set of instructions. The person in the middle is going to say something that is true about themselves. If it is also true for you, you will stand up and find a new seat. If you didn't move quick enough and you find yourself in the middle, then you are the person who delivers the next. The wind blows West and say something that is true about yourself. Easy. We'll practice a little bit. One thing I'm going to ask is that you clear the floor. So if you have the packets, if you just tuck it all underneath, I see a lot of flip flops and things. So let's not do this linebacker style. Let's move with energy, but with safety. Yes, I've seen things happen in this game. I enjoy. All right. So I'll go first. I'll say, well, we need a space. See, that's an accident about to happen there. See, it'll come on in. There we go. Yes. Because I need, you know, access to the chairs. It gets serious. Okay. All right. So I'm going to say something that's true about myself. And if it is also true for you, stand up, find a new seat. And I should probably stay here with the microphone. That's going to be interesting. The wind blows West. If this is your first TCG conference, the wind blows West. If you love working with youth, the wind blows West. If you are from the Midwest, the wind blows West. If you've been in your position for over seven years. All right. So we're going to add a theme to it. No, come is still you. Good luck with that. Okay, your turn. All right. So now we want you to say the wind blows West and have it be something related to family, whatever that means to you. The wind blows West on people whose parents were not born in this country. Who's going to find it? The wind blows West. If you grew up with a single mom grew up with a single mom. Oh, I saw what you did there. Uh huh. See but her shoes shoes wind blows West if your grandmother was like your second mom. The wind blows West if both of your parents have now passed away. It's okay. You can go twice. All right. So here's the next one we're going to transition to. Isn't that so nice? Nice to meet you. Come on back. All right. So the next topic we are going to switch to is strengths. So something that you strengths, however you interpret that, but we're going to add a twist to it that we do with some of our older students. When you get up, you are going to stand and instead of running to find a seat, you're going to stay standing. The person in the middle who now has this thing in common with you will acknowledge you in some way. It could be a physical could be a not you just acknowledge everyone that is standing and then you say and go and then you go find your new seat. Okay. The wind blows West if one of your strengths is that you make connections and wonderful and I thank you for all the work that you do. Go. The wind blows West if you have a very large heart. It's okay if you don't and go. Large heart. The wind blows West if you draw strength out from outside of your theater walls reconsidering. Okay. I'll keep turning. Okay. Go. All right. Last one struggles. So this time when you stand up to be acknowledged, you want to stay there in the person in the middle wants to actually come around and have some either type of physical high five fist bump or at least eye to eye acknowledgement with the people who they share this with. So we're thinking struggle parents who are divorced and I'm going to come around and do a little fist bump if you're okay with that and go. The wind blows West if you are a working parent and it's hard and go. The wind blows West if there's not enough time in the day for you for self care. I'm going to fist bump too. Too many of us and go. All right. Our last one. Okay. Let's do this. It's because I'm got an ankle brace spine. The wind blows West if you've never thanked yourself. Never been never written a thank you letter to yourself for everything you've done. It's gonna make eye contact because I see you and I'm thankful for you. Thank you guys so much. All right, so we just want to take a couple minutes. I'm probably gonna sit because I feel very formal standing outside the circle. We wanted to debrief just this experience. So I guess to start. Does anyone have any comments about what this experience was like for them? Any changes they saw from the time they first started in the circle to the space that it holds now any minds really short. I just love the sense of the trust being built. I just love that sense of finding out someone becomes by a word or phrase. The story begins to be built and then trust begins to happen and it comes out of the vulnerability from before that. Great. Thank you. I just had two things. One, I love the fact that you made us slow down a little bit and I really appreciate that moment. Even as someone that was watching, maybe I wasn't necessarily participating, but to be able to watch and witness to people connect, that was beautiful. And then also I think for me, it reminded me again, I had this beautiful experience when I went to India and I realized the power of just eye contact and human contact that I felt so close to a group of artists who didn't speak my language and I didn't speak their language. And so this exercise just reminded me of that moment of going back to just being present and slowing down. So thank you. It was notable to me that I'm very accustomed to playing these games with my students, but I forget what it's like to be on the other side sometimes. I feel more awake and just like I think that the leveling up, we were able to just keep moving through it, moving through it and kind of caught in the opportunity to be vulnerable, which was appreciate it. Yeah, just going off of the vulnerability, it was surprising to me how vulnerable I felt in the circle. I think that like it's a good reminder for like when we do these games with students that that's probably how they're feeling too. Yeah, on the vulnerability thing, because I feel like I'm most of the time feel pretty brave, but that one about the parents, both parents being dead and there was only like a couple of people that stood up and I was like, okay, if there's not going to be a chair for me after this, that's going to be really hard. And it just made me think about students in a similar situation that may be in that. Thank you. Yeah, we hope that I mean, we can see the shift from when we first came in, we're like, what's going on? We all get an opportunity to really speak our name into the circle to have a voice in this space and really collaborate and create what this space is going to be, which in turn makes it safe to be vulnerable or feel like, oh, we're all in this together. So I can also step up and be vulnerable. And that was just with, you know, a traditional theater game that we all are very accustomed to playing with just some adaptation. So I think we are going to shift over here so we can move on and talk about trauma and the rest of the presentation. Thank you so much for playing. Oh, yes, and please take your packets that you found under your chairs. All right, so we're gonna, I know everyone's still getting settled, but we want to make sure we use all of our time because we have a lot of good stuff to talk about. And we're talking about trauma, we need to understand what it is. There's some misconceptions around what trauma is. And so we want to just dive into really what that is. As performers, we're taught through classes and schooling that behavior is communication that as acting, we learn that acting is reacting, right? It's all in the behavior and the play. And we also know that there's a lot of characters behaviors, if we're referring to a play or a piece of text, that their behavior that we may be witnessing cannot be understood just from externally looking, we got to dive a little deeper to that subtext to that backstory to the emotions and things that are kind of motivating them to behave in such a way and what that behavior is trying to say. So remembering that always behavior is communication, right? And so when we look at trauma, just a blanket definition for trauma is that trauma is the freezing and storage of unresolved emotions triggered by an adverse event. So it's important to note that trauma isn't the actual event, it's the emotional reaction to the event. That's what trauma is. And so what that's saying is that it's your response to a really disturbing or distressing situation. And so that chronic stress, the anxiety, the grief from those situations tend to get stored within our body's cellular memory. And trauma and something will speak Pamela will speak a bit more on a little later. When trauma is stored in our memory, it's stored as a sensory memory. So the brain has a really hard time trying to understand and make sense because we're storytellers brains want to categorize things with language and words because it's a lot neater and nicer for it to understand. And so trauma gets stuck in this very feeling sensory memory that's hard to put words to it. So when we have trauma and all of this energy kind of stored within our body, that's when it can be challenging as new stimuli kind of enters our world. And we're reacting with other people to be able to keep up and kind of process. It's kind of this barrier. And that's where you get flashbacks and triggers because you're stuck with this energy that is stored in your body in a way that your brain doesn't know how to process it clearly. And so really the central there's a central dialogue within trauma that's kind of this one side of wanting to hide and not share this really unspeakable, unfortunate event. And on the other side really wanting to share because that's how we process things we share we talk we put language to. And so this this conflict internally just creates a lot of dissonance. And it's important to know that it can affect not only the person who has experienced the traumatic event, but also anyone who's witnessed the traumatic event can feel these very same very real feelings from trauma and trauma symptoms. And for a long time traumatic events were believed to be really uncommon with the DSM. And for those who don't know that's just the diagnostic manual that clinicians use to make mental health diagnosis. And it wasn't until 1980 that PTSD was even put within that book up until that point clinicians would classify these traumatic events as just things outside the realm of normal life. And we really learned that this these descriptions are just not accurate. And Colleen will share more about this we get a lot of data from the ACE study that really showcases how much trauma that people and children specifically are experiencing. So traumatic events are not extraordinary because they happen rarely they're extraordinary because they overwhelm the ordinary human adaptations to life. So they really confront humans with extremities of helplessness and terror. And the ordinary response to fear is already kind of a complex system. It arouses your sympathetic nervous system that's when you get the high heart rate, you're overwhelmed you're on this high alert. And that is kind of where you're stuck when you're experiencing chronic trauma. And so threats evoke these intense feelings of fear and anger and all of these biological and chemical changes are there for a reason because they are meant to help protect you your brain is trying hard to protect you by saying like you need to do something and it mobilizes the person to act. And so those symptoms are categorized in three areas. And that's where we get the fight flight and freeze. So hyper arousal is that flight mode where you're on edge, you're always aware of what's going on, you're ready to just kind of take off at a moment's notice. Intrusion is the fight mode. It's a lot of reliving that experience over and over. So a lot of being triggered. And even within your present moment where you may be safe, but you're still being triggered and reliving those events. And then constriction. And so constriction is feeling so powerful that your system of self defense actually shuts down completely. And that's where we get the freeze. And so allows the person to escape not by action, but by altering by changing their state of consciousness. So they're just kind of stuck without action or anything. So in the classroom, we see symptoms of trauma play out a lot in many different ways. And I know for us, we can have students who share personal trauma experiences with us through writing or theater exercises. But more often than not, it's a lot of behavior because again, the brain doesn't have a language to put to this, this event, especially with children who aren't developmentally at a place where their language is fully kind of developed and processed to be able to even find words to describe what they've been through. So just some examples of what these behaviors can look like. It's a lot of students struggling to focus for a long period of time. It's students who fight for no apparent reason. I mean, yelling, screaming or just start physically fighting for no reason that we can really understand. And then it's also students and I think this one is one that's important because we focus a lot on the extreme behaviors that kind of create the chaos. But the students who are very quiet and distant and withdrawal and isolated, like those are also very important to look in, even though they don't create havoc in your class, they're still showcasing the same intensity of experiences, but just in a very different way. So it's important to check in on those students. And traditionally, we'll look at these students and label them problem child or behavioral issues or whatever we want to call. And we want to raise our voice. We want to reinstate the order because it makes our jobs as educators a lot easier when the class runs how we plan it to run. And so we tend to get into this compliance center, especially that we see in our school systems. And it's very punitive and it's very compliance centered. And that's a very us centered approach as adults and educators. And so knowing that trauma is so prevalent and knowing that these symptoms are very persistent, we know that we have to turn to trauma informed practices in order to meet the children and the students where they are, and to help direct our methods in the classroom. And so briefly, and we'll come back to it a little later, just introducing trauma informed care. And there is a worksheet. It's like a three circle graph there that just breaks down the three main components of trauma informed care, which are safe environment, building relationships, and then teaching emotional regulation. And so these are really important when trying to shift a class or a program to be trauma informed. And the first and key part of that is the safe environment. And safe environment. And it's just important to note that until there is a safe environment established, no other work can be done. No other things can be processed, which is why even in our circle, you could kind of see that we slowly built up to create a slightly safer. We know each other a little bit more. We're building that so that we can feel more comfortable to be vulnerable. And our students need the same thing because trauma really robs an individual of their sense of power and control. And so we need to help them reestablish that power and control. And this can be different. It's hard to come in and say that we've created a safe environment and maybe not see the rewards of that as quickly as we would like to as educators, but just understanding that for a child who's maybe experienced more acute trauma that that could take days to weeks, but someone who has experienced chronic trauma that can take months, years. It's a lot of rebuilding of that trust and understanding that they can be safe. And processing all that their body and brain are kind of telling them is going on that's not really happening. There's a lot of research that shows the impact trauma has on our brain and development. And one major way that we know trauma impacts the brain is with self regulation. So when we're young, our brains create these narrow pathways that develop. And that's how we're able to self regulate. So it's a learned behavior. So without these pathways developing, we cannot be expected to self regulate. And so those students who have experienced trauma at a younger age, and maybe didn't have the ability to model that self regulation, they are not capable. They don't have the tools yet, just on a developmental level, let alone a skill level. And so the good news is, when the trauma impacts the brain, we know that the brain is really malleable, and it can be changed over time. But we know that it's going to take a lot of repetition and practice, and it needs to happen in a safe environment in order for them to master those skills. And to learn to self regulate their behaviors and emotions and attentions. And the last part, with the relationship building, we know that people who have experienced trauma tend to feel very isolated, whether that's in regards to just feeling kind of ashamed of what they've been through. Again, that that dialogue of like, wanting to hide the really unspeakable thing and not share it out. And also living in a lot of fear that disconnects them from wanting to have a relationship with people, or feel like they could trust people in the first place. And so those relationships and being able to practice those relationships with a safe person are really important. And we'll talk a little bit more about how we can do that later on. But for right now, I'm going to turn it over to Pamela, who will speak about how trauma impacts memory. Great. So there are two different kinds of memory. One is implicit memory. And this is the memory that has no awareness of language regarding how that memory exists. It's like learning how to ride a bike. Once you learn, you just know how to do it. So every time you get on that bike, you don't really have to think about riding the bike. You can just ride. The other one is explicit memory. And it involves the conscious recognition, like the story around how you learned to ride that bike. So my story is my dad taught me when I was seven, and he held on to the back of that seat and ran behind me until I could do it without the training wheels. So these two types of memories are like train tracks running alongside each other from the base of the brainstem moving up through the amygdala process in the hippocampus and then into that cortex area. And human beings are storytellers as well. So as we have this need to fill in that missing information about those memories, and it's a fundamental need to develop a narrative that is consistent with ourselves. So I know my dad really loved me. So he ran miles behind me, right? Because he was going to do whatever it took to get me to ride that bike. That might not be the true memory, you know, what happened, but my memory says that it is. So trauma can interfere with how that memory system works. So a traumatic incident, perhaps like getting hit while I was riding that bike by a car, creates something like a flashball memory, where the implicit and explicit memory travel together through the brain and sear the feelings in the language right there together at your cortex. This might cause a problem like I might close my eyes and see that accident over and over again, or I have nightmares about it. And I have to sort of work through in a relaxed state how I can be safe, that bike I'm not going to get hit again and again and again. That's not really happening to me, even though my whole body has all of those same things happen when I close my eyes and picture that. But then there's another kind of trauma. So chronic trauma. So what if I when I ride my bike to school every day, I ride through a very dangerous neighborhood from my home to my school, and I witness a number of violent or unsavory events as I'm going. So that trauma is there every day and I'm experiencing over and over again. So now what's happening is my while I'm trying to process all of that. My amygdala is on like that overload. It's living in that flight or flight over and over and over again. So as those train tracks of memories try and go through my hippocampus, they can't get processed correctly. So in children who experience a lot of chronic trauma, they're actually their hippocampus region develops. It's larger than children who are not experience a lot of chronic trauma, but their frontal cortex doesn't develop as much because that amygdala is sending up so much, you know, information there that it can't process. And then those train tracks go the sideways, right? So they're not parallel anymore. And what happens is I have that fear of having to ride that bike through that neighborhood every day, but I no longer have the language to go along with what that story is to get there. And then because I don't have the language, I'm having difficulty processing that. So what it does is it starts to disorganize my memories. So they're not they're not in a parallel track anymore. I get little bursts of things. I'm struggling now with a persistent fear. My neuron pathways are starting to break down. And I start overreacting to things that are non threatening because I spend every day riding that bike over and over again. And now I can't call everything is a threat to me now. Not just the bike in the car, right? Now everything feels threatening. My emotional attachment is disrupted. And I'm confused because I no longer have the narrative about how I can feel safe. And it actually disrupts my ability to learn. So it's not our job as theater educators to help the child create, put their own narratives back together, right? That's for a child psychiatrist. So what we want to do is write those train tracks again. But we can't do it by saying, okay, let's sit down and talk about your ride to school. Let's try and piece that story back together. We're not trained to do that. So that's not our job. But what we can do as theater artists is start giving them narratives again, help them with some some narrative pieces. So even if it's not their story, it's a story that might feel similar to them. It might help take some of those little bits in pieces and dissociated pieces of memory and give them a longer story and teach them how to take those little pieces of memories and build and try and put their own stories back together. So I'm going to invite Colleen up for a moment. One of the things we've done is commission a number of monologues that we share with our sixth through eighth grade students. And Colleen is going to share one of those monologues written by George Brands. Sorry. Suitcase stuffed with clothes, couple of kitchen chairs, trash bag full of soap, Christmas cards and a space heater. All sitting out on the curb. All of it just sitting in the snow on the curb where they left it. Landlord's crew came and moved it today. They changed the locks on me. I knew some of them. I mean we recognized each other but it was like we had this deal. I just pretended I was somebody else and so did they. They needed the money I suppose. You know we all need the money. They're gone now and it's just me and my house on the curb. Can't do it again. I cannot drag my junk around and try and look for someplace smaller and cheaper. I just I don't think I have it in me to do it again. I just sit in one of my kitchen chairs. Sitting shiver for a minute and just stare at my house on the curb. Stare at my house on the curb for the garbage men come and take it away. Just staring at that space heater. I can't stop staring at the space heater. A space heater sitting out on the curb. Now where am I going to plug it in? How is it going to heat up the whole outside? How's it going to heat up my world? I'll show that monologue to students and then I'm just going to walk you through the process. So the playwright didn't give that character a name but let's go ahead and name her. Who'd like to name her? Diane. Good. What's the first part of Diane's story? What's the beginning that we heard? Suitcase. What about that suitcase? So she's moving. She's moving. What's the middle part of that story? It's going on in the middle of Diane's story. Yeah. Yeah. She knows the people who are locking her out. Do those people, does she acknowledge the people and they acknowledge back? No. Why not do you think? She helps us understand. They need the money so she's forgiving them for doing something terrible because she knows they need the money. Why does Diane not want to recognize them or acknowledge them? How do you, she's embarrassed. She might be feeling very very embarrassed that they have to move her out because what do we, what do we know? If she can't be in that apartment, what has she done? She wasn't able to pay her rent, correct? Or that's at least what we assume. What's the end of Diane's story? She's waiting. For what? Mm-hmm. Mm-hmm. She's feeling lost. Somebody else. She, she feels like she's run out of options. We, we know she's done it before, right? Because she talks about how I can't do it again. So we know she's resilient. Nowhere to plug in her space heater, right? Right. She's worried about being cold. She might have kids. I don't know as if she, she referenced them in the context. Great. If we were to write a little monologue for Diane that happened right before we just met her, what would that monologue reference do you think? Maybe she's worried. Maybe it's a monologue about her worried that she can't, that she can't pay her rents. Excellent. If we were to write a monologue right after we leave Diane, what do you think would happen? What's in that monologue? Somebody might come up to her and what happens when that, when that someone comes up. Mm-hmm. Do you think that they'll help her? They're attempting to help her. Do you think that Diane sits on that curb forever or never? No. Because what's in, what, what is Diane? Exactly. So let's talk about real use. That's one of the teaching tools we use in our program and it's touching because it allows us to, and it allows our students to help us tell stories that they don't necessarily directly relate to, but it gives them an emotional distance to be able to share what they want to, to be able to empathize or sympathize with their peers, because when you're 10 or 11 going through an experience like that or watching your parents go through it, it always surprises me how alone they feel. And then they get into a room with half the people might be familiar or have had a similar experience and then all of a sudden there's this kind of breath they get to take. It's interesting to watch children do that and feel a little bit more comfortable to be a little bit more free even if for just that moment in that space talking about that particular topic. And so instances like that, and the reason why we commissioned writers and we gave them a list of topics that came from our students is because as we went forward in our study we knew it was important for us to take into consideration adverse childhood experiences. And so in this trauma work that's like buzzy. Everybody says it. So just raise your hands if you have some familiarity with adverse childhood experiences. Great. So in the interest of time I'm going to move swiftly through this piece, but I just want us to talk about it a little bit so we understand why we do it and how important it is. Yeah. Okay, great. In your packet there's some information about adverse childhood experiences. We won't talk about each sheet directly but I will reference them from time to time. So adverse childhood experience is the way we define them now. They're defined as stressful or traumatic events that children experience before age 18 such as violence at home, neglect, abuse, or having a parent with mental illness or substance dependence. So this study, while it's wildly popular now, it started in 1985 and it's something that I found really interesting. There is a doctor Vincent Feliti who was the chief of Kaiser Permanente's Department of Preventative Medicine in San Diego, California. And it resulted in a 25 year quest that involved researchers from the CDC, Centers for Disease Control and Prevention, and more than 17,000 members of Kaiser Permanente's self-care program, well, care program. And it revealed some things that we know now but that adverse childhood experiences are very common and that these experience can be linked to just about every major chronic illness and social problem in the United States and the billions of dollars we spend on them. So basically Dr. Feliti had an obesity clinic and over the course of five years, more than half of the people that were in it were dropping out. And he was trying to find out why this was happening because the people who were dropping out were successful. It wasn't like they weren't losing weight. They were losing weight and they were still dropping out. And it happened in over a five years time span. He said over more than 50% of the people dropped out. So he wanted to do some research and find out. He conducted a series of interviews where he asked the people who had dropped out some questions about just about their life, especially with their weight journey. And in one of those interviews he misspoke. He was asking them how old were you when you first became sexually active? And instead he said how much did you weigh when you first became sexually active? And the woman responded 40 pounds. And so he thought that he was hearing something wrong or said something wrong. So he asked it again and she said 40 pounds. I was four and it happened with my father and she broke down into tears. And so being embarrassed of course initially he thought you know he had been too invasive and this was too much information and he had made the person uncomfortable and he knew he misspoke because it was an uncomfortable question to have to ask people. But what he did was he and his colleagues and he asked them to help him with interviews. They added this to the interview questions. A question about sexual abuse. And out of the 200 and I believe 86 people they interviewed more than half of them. Actually he says in a study most of them had some type of sexual abuse. And so their obesity issues were attached in some way to that trauma. And it meant for some of them I think that he quoted there was a girl who was this is a lot of information but the where her father communicated to her and the reason why he was raping her and not her sister was that her sister was fat. So she gained weight as a shield. And other people who had experienced sexual abuse kept the weight on because it made them invisible or it made them in their minds unattractive or not a target for that kind of abuses. So these so what he discovered was that he could tie this directly to the issues that he found in his patients. So he connected with some people from the CDC Dr. Robert Anda. And they decided to do a study because he was studying the adverse childhood experiences in their relation to COPD. And so they decided to create a comprehensive list of questions that they could ask people. And they they were at Kaiser Permanente they had 26,000 people who were under the care in San Diego. They said they would they created a survey and asked them to voluntarily do it. And they got 17,421 who agreed. And over the 15 years they studied those 17,000 people that's how we got the adverse childhood experience information that we have right now. The questions that are on it. And their findings and discoveries were quite significant. One they realized that there is a direct link between childhood trauma and the adult onset of chronic disease and mental illness, doing time in prison, work issues such as absenteeism. They also realized that about two-thirds of the adults in the study had experienced one or more types of adverse childhood experiences. And of those 87% had experienced two or more. So they realized that ACEs don't usually happen in isolation. And that more adverse childhood experience resulted in higher risk of medical mental and social problems as an adult. They also realized that things started to get really serious around the A score of four compared with people who had an A score of zero. So just a couple of quick numbers. Those with four categories of ACEs had a 240% greater risk of hepatitis, were 390% more likely to have chronic obstructive pulmonary disease, and a 240% higher risk of a sexually transmitted disease. They were twice as likely to be smokers, 12 times more likely to have attempted suicide, seven times more likely to be alcoholic, and 10 times more likely to have injected street drugs. So after they concluded these studies over like a 15-year time, over 60 publications, a lot of people started to pick it up. Pediatricians, neuroscientists, take this and try and link it to what they found. And one of the people who has done it most famously is Dr. Nadine Burke Harris. And she is a pediatrician in San Francisco. And she found that her patients who had four or more categories of adverse childhood experiences, their odds of having learning and behavior problems in school were 32 times as high as kids who had no childhood, ever childhood experiences. And she summed it up this way. Children with toxic stress live much of their lives in fight, flight, or freeze, what Cassie talked about. They respond to the world as a place of constant danger. With their brains on overload, with stress hormones, and unable to function appropriately, they cannot focus on learning. They fall behind in school or fail to develop healthy relationships with peers, or they create problems with teachers and principals because they are unable to trust adults. So all of this is important because when we went into the schools and we were like we're excited, we have a theater program, they want us here, right? So while they were interested and they loved what we were doing, we were having behavior issues that were showing up. We were having difficulty with the student population or the parent population or the teacher population. Just a lot of difficulties, they had nothing to do with the curriculum, just something that hit us and it was really abrupt. So we started doing our research and in there the first set of data that you see is for Ohio. And one thing I really want to point out that's really important to focus on, you see the national average, then you see it by state, by county, and by city. So the national average, if you look on the, I believe the second sheet with the Ohio numbers, I don't have it in front of me, the national average, you see what that is, and then if you look at the Cuyahoga county average or percent, then look at the Cleveland percentage. And that's where our work is based on, in Cleveland. And when we look at the numbers, if we only looked at the Ohio percentage, we wouldn't realize how much work we needed to do in a specific area. So if you could go with me to where it says, it's this page right here. And you see in the middle where it says the national average, let's look at the extreme economic hardship. No, has been a victim of or witnessed neighborhood violence. The national average is 8.6 percent, Ohio is 12.5, Cuyahoga county 15.6, and Cleveland 23.5 percent. And that's where we were. We were in the Tamir Rice neighborhoods. A couple of my students found a dead body walking on their way to work. I mean their way to school. And they came in and they said, Ms. Jackson, they put us in the newspaper. We found a dead body. And the city council gave them a certificate for calling the police because it was a missing person who they found in this abandoned building, a naked girl, six graders walking through their neighborhood. And they called the police and they got a certificate. And they came to me to show me the certificate. They were so proud. And I asked them, I said, how are you sleeping? It was just an instinct that I had. And one of them said, I can't stop seeing it when I close my eyes. And the other brother was a set of brothers. And I asked them, I was like, we had a counselor on site. I said, you want me to let you talk to somebody? And you know, the tough brother, no, no, I'm good. So I knew I needed to keep him close to me because he was not good. But the other one did want to see somebody. And we got him in right away. And he really liked it. But because it required parental permission for him to continue, and the parent did not agree, that stopped. Fast forward a year later, their brother was shot in the head and killed. And so, yes. So these are things that happen to them, but they're, they're expected to just keep going to school. When they are failing, nobody's thinking, oh, it's because they missed three weeks when their brother died, because they had to watch the baby sister. It's just, oh, they can't read. We're talking about eighth graders who read at a third and fourth grade level. Why? Because those brain things stop. They can't learn. They can't focus. They're in fight or flight all the time. But we want them to do math. And that, you understand what I'm saying? So when we look at these things, and we look at these scores, it gives us a little bit about what our children might be facing. But let's talk about what's not represented here. Actually, let's read the second one. Treated or judged unfairly due to race or ethnicity. And you see how low that percentage is? 3.9%. I grew up in Cleveland. And it's at least triple that. I know from my own personal experience. But when you're in a school when everybody looks like you, and you don't even understand how systemic racism puts you in extreme economic hardship, you don't know to connect those things, you don't even have the ability to score it properly. When I talk to my students about racism, and they don't think it affects them. They think it's something that expired with slavery until they go to the movies at 40 minutes outside of our neighborhood. Then they come back to school the next day and tell me about what happened to them at the movies. So adverse childhood experiences, while this data is really important, it's also important that we realize that the overall risk for ACEs is not shared equally by all children. Whether the data examined at a national level or by the country's major geographic divisions, inequities by race and ethnicity are evident. So if you look on the next three pages, they're maps that map out adverse child experience by race, ethnicity, and geographic location. And just a couple of the highlights. 60% of white non-Hispanic children have had no ACEs. And that's the case for only 49% of Hispanic children and 39% of black non-Hispanic children. In the United States as a whole, and in every sub-region, Asian non-Hispanic children have the lowest prevalence of ACEs. Nationally, more than three quarters of these children have had no ACEs. In every region except the Pacific, black non-Hispanic children are more likely than white non-Hispanic children to have had at least one ACE. And in every region except the West South Central and the East South Central, Hispanic children are more likely than white non-Hispanic children to have had at least one ACE. Nationally in the mountain region, black non-Hispanic children, non-Hispanic children of other races, and Hispanic children are more likely than white children to have experienced two or more ACEs. Nationally, one in three black non-Hispanic children have had experience two to eight aces compared to only one in five non-white children. So while it's individual and they're not in isolation it varies greatly. So what I encourage you I put a list there by state what you should do because it's available I just couldn't print them all out don't look at gesture state numbers find your community that your work is being done in because that will help you with programming and accessibility like we talked about and challenges things that might challenge their participation having that information is really really helpful and one of the most helpful things that I have done is find out what my a score was because we need to know as people who do this what we're walking around with how we enter these spaces so what we're handing out right now to you is the current ace quiz I'm gonna give you a couple of minutes to just take that quiz for yourself it's a series of ten questions it walks you through it so once everyone has it just take a minute find out your score I'm gonna ask that once you've completed your quiz if you just fold it over and just consider just sit in it for a second right and once you figure out what your score is it helps you to know it connects a lot of dots we've learned a lot about what aces can do how they show up but it affects how you show up in a room the similarities and differences you have from the people from your students from your peers it affects biases we might carry it also helps us to understand triggers if you find that you get upset about something and you really can't put language to it it could be tied to to this and that enlightenment can help us as we go through and now that we once we did this research and we found out what our students were dealing with we really broke down those three components of trauma-informed care now it's practical application and that's what Cassie will finish up so we've spoken a little bit about this already but we just wanted to take a couple minutes to reflect on specific goal specifically I'm just gonna make up words guys specific practices we can put into place and just kind of reflect back on things that we've been modeling throughout this presentation so just starting with creating that safe environment looking back to the very beginning when we had Pamela kind of start us off and introduce us and went through the structure of here's what we're doing first here's what we're doing next and providing that kind of routine and structure is huge for children who are struggling to feel safe because it's that predictability piece it's that okay I can tell my brain brain thank you for protecting me but I'm okay right now I know what's coming this next 50 minutes or whatever your class time may be and so providing that we also made sure to provide an outline I think it was your second page or first page in the packet so again how we can show a visual structure of whatever that class is going to be verbalize it at the beginning to just help them know it's okay they don't have to fight flight freeze during this time can be a huge help supporting and teaching social emotional regulation so one of the ways that we do that is with our monologues or the text that we use within the class one wonderful thing about providing a text to hard things that they're already struggling to find language not only do we get to give them language and a tool to be able to process and communicate their own experience but it also gives them that social or that emotional distance where they don't feel so vulnerable that they have to share every personal hard thing about themselves that they can talk about their hardships and their own experiences but through the lens of this character and kind of feel protected in a space until they are in control and feel like they want to share about their own personal thing and that they are able to process and heal a great deal just from talking about a character's experiences and relate that to themselves and just thinking of there's a variety of theater games that help teach impulse control all of that works into social or to self regulation so we play a lot of like stop and go and a lot of other games that help teach that impulse control and how do I stop give myself the space to choose how I'm going to react and practice practice those skills in a safe space and the last part with building relationships and connectedness again with the restorative circle we try to start all of our classes with a check-in of some kind it's a moment to say I see you I recognize you I'm glad that you're here and make sure that everyone's voice gets put into that space and it's this collaborative community effort and playing games like wind blows west where we get to take time to really get to know who's in the room not just you're my students I'm the teacher and you're you guys are peers and maybe some of you are friends and some of you don't like the other ones but really break down all of those barriers to create and establish community and relationships and help them feel comfortable to practice what a healthy relationship is in that safe space so I think our next our last thing is talking a little bit about self-care because doing this work it's really important that you're taking care of yourself as well great so I supervise a department of 25 full-time staff 20 of those artists are out in the community every day working with students who reflect those ace numbers that you just saw so vicarious trauma is a very real thing and it can result from hearing children's trauma stories and bearing witness to their pain the their fear the horrors that they're surviving enduring and sharing with you it affects teachers the same way it affects students the same way so the brain emits a fear response it releases excessive cortisol and adrenaline that can increase heart rate blood pressure repetition the biological response can manifest itself in physical symptoms in caregivers so we can see anger we can see headaches we can see diminished workplace behavior like missing meetings or lateness or avoiding students are not teaching challenging classes so what are some of the things that we can do in practice one of them is to provide a space to talk it out or reduce professional isolation and allow and encourage educators to see each other and realize that they're struggling with the same issues so at Cleveland Playhouse none of my teaching artists are allowed to work in the field on Thursdays everybody has to come back to Cleveland Playhouse where they share stories they attend meetings they go on mandatory paired walk-in talks you know they're laughing at me but they have to do all of these things you know we schedule self-care afternoons where we might go bowling together or go to the local ice cream shop whatever we can do to make sure that we're finding that place for restorative healing on on those days we can build coping strategies that work specifically for the individual artists so anything from taking a deep breath having a ritual where you drink your coffee every morning reminding yourself to respond to a yelling child with a quiet voice so you don't start you know lifting your yourself up to scheduling walks around the building taking a quiet lunch and I'm gonna use Colleen as an example when Colleen was in the field she never had a moment to herself because the students loved her they were always in her drama classroom she could not have lunch without 18 kids sitting there asking Ms. Jackson for something and so we actually put a moratorium on that and we made Colleen close her classroom door and shut the lights off so she sat inside sort of behind a little screen every day because that was the only way the kids wouldn't come in right but if she kept trying to work at that pace every day while she was out in the field we wouldn't have Colleen you know working with us today she would have said peace out I'm going back to New York and pursuing my acting or something but she wouldn't be here so we have to sometimes help and remind our teachers to do those things we can always establish a coming home ritual so encouraging your your staff what do you do when you leave the building do you put on your favorite playlist or your radio station or do you go for a walk before you get in your car what is it that you do before you get home because I don't want you to take what you had home with you we want you to be able to just go home to put those boundaries around yourself and to let yourself regenerate so I'm just gonna in the last three weeks I have four staff members full-time staff members who work very closely together across two schools and in the last three weeks they have had to have staff members because there's also part-time staff there report three instances of child abuse to CPS they also actually had to release one of their community workers because a parent complained that that community worker was holding their child to you know like shaking the child so these staff members were really really struggling I started to see them fighting with each other they never fought but they would they they were at each other's throats to the point where another staff member from another department on Thursday came and said you might just want to check in on those two because I think they're a little upset so you know we have to go find them so they start fighting with each other they also started calling out a lot so excessive PTO days and one of them who goes between both schools tried not to like started scheduling herself at one school and not the other school because she just wanted to avoid that school so we know what it was we had to sit down we had to talk about it we had to put use all of the structures we had in place to say you know this is traumatic this is traumatic for you it's vicarious trauma it's for your whole teams back at at the schools so what do we have to do to write this because you don't hate each other you're not fighting because of that you're fighting because you're traumatized because of what you just had to do in the last three weeks but we were we were prepared we had an organizational structure in place including a resource that we can recommend them to go get treatment and emotional help and so forth if they chose to have it we have ability to help them sign up for a gym I mean all of those things what we've included in your packet and we don't have time to go through it right now but is an organizational checklist so you can go through and see does my organization do these things to help keep its staff healthy there's also an individual checklist for self-care that you can distribute to your artists and your educators and encourage them to do those same things and then there's just another packet that gives you more information about vicarious trauma and so forth so you have that those resources to be able to work through things great and with that it is time to give opportunity to ask questions so what we'll do is we'll get them on the mic and we'll come around to ask and we'll answer whatever questions you might have any questions I know that you have a unique model with your embedded teaching artists but a lot of us deal with classroom teachers who don't have these social emotional skills or training do you have any advice what what can we do to help them and often they need help themselves and how do you convince them of that and give them the tools that they need yeah well overstepping yeah I mean the biggest thing because we work across 17 schools and we we work with staff who who are not our own staff we work with all these classroom teachers and principals and so forth we get we we talk to the principal because it's his or her or their building right and we help them get invested in it and then we offer professional development we will go in anytime anywhere and provide this for free if you're if you're a partner we're coming in to help you and we'll give you all of the resources that we have all of the training that our staff has so we can help sometimes the principal isn't ready for that yet because they don't they don't have the trust in us or they think that their staff is overwhelmed or whatever so we model our teachers never just stay in the classroom they're always in the classroom when it's time to teach the students but when it's not there shut off the lights time or if it's not their classroom time they are out modeling what kind of positive adult role model what that looks like how that works how I'm gonna care for myself I'm gonna take care of the kids in the community at the same time but but yeah as much professional development as you can and offer it for free yes I keep coming back to this question not having any experience in this yet when we're talking about particularly students who are having impulse control and challenges and where that sits in the world of students with special needs and how we kind of are moving between the two which I know is not black and white by any means but where the research is or if it has started in this this area yet do you mean students with emotional and behavior disorders or artistic which yeah yeah it's really interesting I'll let Cassie talk more be in calling because they both do or did have classrooms with students with multiple issues but we are actually currently conducting a quasi-experimental long-term four-year program to understand how to work with students who have emotional and behavioral disorders within the theater classroom and how we can work with this to improve impulse control for those specific students but why don't I have you talk specifically about some differentiations in what you do with those students I know that we in our first programs we had mh classes which was what is caught in our district so multiple handicaps anywhere from autism cerebral palsy all that students in wheelchair nonverbal and then we also had our ED class which is what they call it there which we don't like and we're trying to get a change but it's what they emotionally disturbed is how they put it and it's where they put behavior but people who act out outlier in the behavior and what we found for differentiation you could be doing four different things within one classroom to get all of them doing the same thing especially your mh classes with differing abilities but in the ED classes specifically this work has been transformative most of the times the class sizes are smaller so instead of 32 I would have maybe seven sometimes smallest a group of four and they were really able to dive into the work and when they're a lot of what we do is kind of like the modeling so we would have the para who would say oh you can't come today there's a substitute or they would try to take the student out if they were being disruptive or being disrespectful and the ways that we work around it that restorative justice way of incorporating them back into it you know if they offended the group giving them an opportunity to self-regulate and then inviting them back in asking the class do you accept their apology you know making that conversation happen it instead of them being this bad child they had a moment and they see how they can be reintegrated into the classroom and not automatically eliminated from it and the teachers have and the principles of the buildings have said what a difference it makes in this ED behavior challenged population because most of the time they're not cognitively delayed in anyway they're usually advanced thinkers and really really smart and over it and not buying the bullshit is what they would say to our to their teachers faces and so we would say okay well that's not the way we communicate that but I agree with you you know like that kind of thing and giving them that platform for free discussion free just that freedom to say I don't I forgive you every time I come in here you can call me all these names you're gonna apologize and get your life together but we get a new start every week we come back together and all of our teachers have that special way we connect it's really about authenticity so we are differentiating our work to meet that need because that's what they're responding to that authenticness that ability to be reintegrated that less punitive and less compliant based how do you want to learn this because you're gonna do it so how do you want to do it and then having that asking them what they need instead of telling them what they're going to do because you're dealing with kids who have adult lives outside of it oftentimes so they come in and you want to treat me like I'm seven but I'm at home taking care of three kids until my mom and get off work like that kind of thing so realizing that and meeting them there so a lot of it is in the relationship building and the connectedness and we're that's why we have this study so that we can see how do we differentiate this curriculum make it so successful for them I think they found in our study that among middle school age black boys we had like this huge spike they were the ones who really really flourished and I think the first couple years of our study and everybody was like what something that works for them well yeah cuz things work and we were so excited and they were excited so we're still doing the research and we'll give it to you when we got it there is a lot of research outside theater education right that does show that students with with emotional and behavioral disorders thrive in very structured classrooms yeah all of the things that we've talked about are things that that fit back over with those that student population anything else could you talk a little bit about recruiting and onboarding teaching artists to do this work I sure can cuz we learned a lot so the first cohort of teaching artists I think that within we needed for teaching artists within the first three months we had gone through 10 so we learned a lot along the way one of the things is we changed what what we thought were the requirements right we had to so we thought oh well you know we have an MFA and an MA and in theater education so in acting so everybody has to have that what we found very quickly is no they didn't no they did it so we have drama therapists on our team Cassie is a as a trained social worker we have clinical counselors we have elementary school teachers we also have people who studied communication so so we stopped looking at what your degree was that we love having you here if you have a relatable field degree but we started looking at cultural competencies were you culturally competent could you understand what what was going on in that classroom and and how it related to you were you resilient were you like these kids were you gonna be resilient because if you weren't we couldn't have you in there cuz the kids needed to see you enough times and we had one more do you remember what it was as we were doing the interviews that we culturally competent resilient and just authentic I think it was just authentic work could you bring your own self into the room and if you could do those we found that you you could be successful but we have a three week intensive training period that includes trauma informed care restorative justice theater teach you know skills I mean it goes on and on and then you're mentored for the first six months for the first six months of your work and then of course you're still assigned to supervisor pass that to make sure you can make those transitions but we do a lot to make sure that they're they're able to go I don't want to cut it off is there any more are they for questions comments thoughts and if before we could go to lunch if we could just pass the microphone really quickly one word how you're feeling just so we can come to an end that would be lovely I think that's a great idea can we start with you Lori stunned overwhelmed heavy arrived digesting present inspired grateful inspired educated reflecting pondering bursting cautious more sad inspired wow reviewing proud inspired thinking grateful brokenhearted but hopeful grateful inspired strategizing search searching reflective purposeful seen and activated reflective processing for me I'm gonna say this has been extremely powerful and I'm hopeful because of you and all the work that you do and all the work that you all do so thank you I love the inspiration because it's pretty heavy stuff what you all are bringing to us but my guess is that you're all on the front lines dealing with this so thank you for bringing us on this journey today really I I'm gonna charge you as you go off to lunch to please think about because at the end of the day because there's been a lot of a lot of talking at you and there will be before the end of the day I we have a half an hour to reflect together so please be prepared to join in to some what do you want to bring forward what are you gonna take home to your theaters and if you were to have a convening again next year let's say what do you want to focus on so I'm gonna help facilitate that but if you could already start to think then we'll fill that space this afternoon some logistics