Environment

A Home Away from Home: Schools and Students after Trauma

NPR recently discussed some of the challenges and opportunities facing teachers of students who may have been exposed to trauma. In New Orleans, where public schools have largely been replaced by charter schools after Hurricane Katrina, schoolteachers have become accustomed to having students who may have experienced abuse or neglect, have absent or jailed parents, or have witnessed crimes. School discipline policies that previously only focused on a child’s errant behavior are now undergoing an update that takes these environmental factors into account.

 

There are currently five charter schools in New Orleans that are seeking to become “more trauma-informed.” In other words, these schools are starting to incorporate knowledge about their students’ lives outside of school in order to address their social, emotional, behavioral, and development needs. These changes are bound to have an impact, considering the fact that children in New Orleans screen for post-traumatic stress disorder (PTSD) at three times the national rate. Mental health experts and workers have only recently begun to understand that trauma dramatically changes the brain and intensifies the fight-or-flight response in young children.

 

Children with exposure to trauma might be disruptive in school, or they may be withdrawn and inattentive. Teachers are learning to look for signs of both ends of the spectrum and everything in between. They are also engineering new ways to resolve conflict instead of resorting to detention or suspension since sending a child back to a damaging home environment is not the best way to solve problems in the long run.

 

For example, some teachers begin classes with social-emotional learning, and students in disagreement are invited to use group discussion to resolve their problems. Another way teachers are approaching disruptive students is by renaming “time out” as “wellness centers”, and multiple teachers collaborate with each other to work the same students over the course of a day. The article also details the moving stories of students who have seen real change with this type of support that they cannot find at home.

 

Certain statistics aside, this story is not unique to New Orleans. In many urban areas, when children experience poverty and hardship, and there are desperate consequences at home and in their daily lives, teachers everywhere can be heroes that foster a “home away from home” in their classroom. However, these New Orleans teachers and schools have ventured into an unknown space in their mission to understand each of their students, and to address a holistic approach to health. By addressing issues, and not punishing students, a very challenging method, teachers play a vital role in the health and well-being of their students.

 

Economics, Doctors, and Us: A New Kind of Medicine?

A physician wrote a piece in the New York Times recently that is very relevant to our mission and work here at CHIL. Dr. Khullar writes that years of medical and scientific education often do not influence his decisions as much as his patients’ habits and environmental cues. If anything, a decade of diverse and intense training has made him more attuned to noticing subtle “nudges” and cues that incentivizes him to provide the best care he can, or incentivize his patients to be proactive about their health care.

 

According to Dr. Khullar, the field of behavioral economics holds that “human decision-making [often] departs” from what might be expected if agents behaved “rationally.” This description seems to characterize medical care as well, where all sorts of factors (emotions and uncertainties, for example) can complicate medical decisions. Despite this connection, Dr. Khullar says that members of the medical community have “only recently” begun exploring how behavioral economics can improve health. This is a crucial change, since medical experts bear an enormous responsibility in how they present care options to patients and how they encourage patients to pursue treatment options. For example, the framing of default options as opt-in or opt-out can have a huge impact on how healthcare is delivered to patients.

 

Pioneers in linking behavioral economics, decision-making, and medical care are focusing on designing randomized trials or applications to tackle some of the basic, and difficult, challenges in healthcare. Dr. Khullar names some of these challenges as encouraging doctors to provide evidence-based care, incentivizing patients to take their medications (a form of preventative care), and aiding consumers in choosing better health plans that were more comprehensive for their needs. Innovators are also using these challenges as opportunities to create applications to, for example, reward patients for submitting pictures of themselves taking medications each day. These designers create program infrastructures that reward patients for weight loss goals they establish by entering them into lotteries or deposit contracts. Health insurers are jumping onto this wagon as well, and researching goals for patients and doctors to meet when it comes to diseases like diabetes management.

 

The title of the New York Times piece is “How Behavioral Economics Can Produce Better Health Care.” This title leaves out some crucial actors in the study and delivery of a marriage between behavioral economics and health research. Doctors, patients, and economists each play a distinct role in identifying and acting on potential improvements in healthcare delivery. Projects like the ones we have at CHIL are designed with students as patients in mind - behavioral economics isn’t only for economists! We can all use a project-oriented approach to improve our health.