[House Hearing, 116 Congress] [From the U.S. Government Publishing Office] THE IMPORTANCE OF TRAUMA-INFORMED PRACTICES IN EDUCATION TO ASSIST STUDENTS IMPACTED BY GUN VIOLENCE AND OTHER ADVERSITIES ======================================================================= HEARING before the SUBCOMMITTEE EARLY CHILDHOOD, ELEMENTARY, AND SECONDARY EDUCATION COMMITTEE ON EDUCATION AND LABOR U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED SIXTEENTH CONGRESS FIRST SESSION __________ HEARING HELD IN WASHINGTON, DC, SEPTEMBER 11, 2019 __________ Serial No. 116-38 __________ Printed for the use of the Committee on Education and Labor [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Available via the World Wide Web: www.govinfo.gov or Committee address: https://edlabor.house.gov ______ U.S. GOVERNMENT PUBLISHING OFFICE 37-855 PDF WASHINGTON : 2021 COMMITTEE ON EDUCATION AND LABOR ROBERT C. ``BOBBY'' SCOTT, Virginia, Chairman Susan A. Davis, California Virginia Foxx, North Carolina, Raul M. Grijalva, Arizona Ranking Member Joe Courtney, Connecticut David P. Roe, Tennessee Marcia L. Fudge, Ohio Glenn Thompson, Pennsylvania Gregorio Kilili Camacho Sablan, Tim Walberg, Michigan Northern Mariana Islands Brett Guthrie, Kentucky Frederica S. Wilson, Florida Bradley Byrne, Alabama Suzanne Bonamici, Oregon Glenn Grothman, Wisconsin Mark Takano, California Elise M. Stefanik, New York Alma S. Adams, North Carolina Rick W. Allen, Georgia Mark DeSaulnier, California Lloyd Smucker, Pennsylvania Donald Norcross, New Jersey Jim Banks, Indiana Pramila Jayapal, Washington Mark Walker, North Carolina Joseph D. Morelle, New York James Comer, Kentucky Susan Wild, Pennsylvania Ben Cline, Virginia Josh Harder, California Russ Fulcher, Idaho Lucy McBath, Georgia Van Taylor, Texas Kim Schrier, Washington Steve Watkins, Kansas Lauren Underwood, Illinois Ron Wright, Texas Jahana Hayes, Connecticut Daniel Meuser, Pennsylvania Donna E. Shalala, Florida William R. Timmons, IV, South Andy Levin, Michigan* Carolina Ilhan Omar, Minnesota Dusty Johnson, South Dakota David J. Trone, Maryland Fred Keller, Pennsylvania Haley M. Stevens, Michigan Susie Lee, Nevada Lori Trahan, Massachusetts Joaquin Castro, Texas * Vice-Chair Veronique Pluviose, Staff Director Brandon Renz, Minority Staff Director ------ SUBCOMMITTEE EARLY CHILDHOOD, ELEMENTARY, AND SECONDARY EDUCATION GREGORIO KILILI CAMACHO SABLAN, Northern Mariana Islands, Chairman Kim Schrier, Washington Rick W. Allen, Georgia, Jahana Hayes, Connecticut Ranking Member Donna E. Shalala, Florida Glenn ``GT'' Thompson, Susan A. Davis, California Pennsylvania Frederica S. Wilson, Florida Glenn Grothman, Wisconsin Mark DeSaulnier, California Van Taylor, Texas Joseph D. Morelle, New York William R. Timmons, IV, South Carolina C O N T E N T S ---------- Page Hearing held on September 11, 2019............................... 1 Statement of Members: Allen, Hon. Rick W., Ranking Member, Subcommittee Early Childhood, Elementary, and Secondary Education............. 5 Prepared statement of.................................... 6 Sablan, Hon. Gregorio Kilili Camacho, Chairman, Subcommittee Early Childhood, Elementary, and Secondary Education....... 1 Prepared statement of.................................... 4 Statement of Witnesses: Barker, Dr. Ingrida, ED.D., Associate Superintendent, McDowell County Schools, Welch, WV......................... 22 Prepared statement of.................................... 24 Burke Harris, Dr. Nadine, MD, MPH, FAAP, California Surgeon General, State of California, San Francisco, CA............ 9 Prepared statement of.................................... 11 Hofmeister, Ms. Joy, Oklahoma State Superintendent of Public Instruction, Oklahoma State Department of Education, Oklahoma, OK............................................... 28 Prepared statement of.................................... 30 Jackson, Dr. Janice K., ED.D., CEO, Chicago Public Schools, Chicago IL................................................. 33 Prepared statement of.................................... 36 Additional Submissions: Chairman Sablan:............................................. Research Article: Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults........................................ 116 Report: Children Affected By Trauma...................... 130 Report: Creating, Supporting, and Sustaining Trauma- Informed Schools: A System Framework................... 174 Article: The Association Between Adverse Childhood Experience (ACE) and School Success in Elementary School Children........................................ 187 Article: Helping Children Cope with Violence and Trauma.. 197 Article: The Impact of Gun Violence on Children and Teens 204 Fact Sheet: Ten Things to Know About Trauma and Learning. 211 Policy Statement: The Impact of Racism on Child and Adolescent Health...................................... 213 Prepared statement of the National Association of Secondary School Principals (NASSP).................... 229 Prepared statement of the Alliance For Excellent Education.............................................. 233 Letter dated September 10, 2019 from the American Federation of Teachers (AFT)........................... 239 Prepared statement of Binghamton University Community Schools (BUCS)......................................... 241 Prepared statement of the National Indian Education Association............................................ 244 Letter from the National Association of School Psychologists (NASP)................................... 246 Letter dated September 10, 2019 from National Education Association (NEA)...................................... 257 Shalala, Hon. Donna E., a Representative in Congress from the State of Florida:.......................................... Report: Care Provider Facilities Described Challenges Addressing Mental Health Needs of Children in HHS Custody................................................ 52 Questions submitted for the record by: Morelle, Hon. Joseph D., a Representative in Congress from the State of New York............................. 262 Omar, Hon. Ilhan, a Representative in Congress from the State of Minnesota..................................... 262 Scott, Hon. Robert C. ``Bobby'', a Representative in Congress from the State of Virginia.................... 261 Dr. Barker's response to questions submitted for the record.. 263 THE IMPORTANCE OF TRAUMA-INFORMED PRACTICES IN EDUCATION TO ASSIST STUDENTS IMPACTED BY GUN VIOLENCE AND OTHER ADVERSITIES ---------- Wednesday, September 11, 2019 House of Representatives, Subcommittee on Early Childhood, Elementary, and Secondary Education, Committee on Education and Labor, Washington, DC ---------- The subcommittee met, pursuant to call, at 10:18 a.m., in Room 2175, Rayburn House Office Building, Hon. Gregorio Kilili Camacho Sablan (Chairman of the subcommittee) presiding. Present: Representatives Sablan, Schrier, Hayes, Shalala, Davis, DeSaulnier, Morelle, Scott, Allen, Thompson, Grothman, Taylor, Timmons, and Foxx. Also Present: Representatives McBath, Bonamici, Wild, Trone, and Lee. Staff Present: Tylease Alli, Chief Clerk; Ramon Carranza, Education Policy Fellow; Emma Eatman, Press Assistant; Mishawn Freeman, Staff Assistant; Christian Haines, General Counsel; Stephanie Lalle, Deputy Communications Director; Andre Lindsay, Staff Assistant; Jaria Martin, Clerk/Assistant to the Staff Director; Max Moore, Office Aide; Jacque Mosley, Director of Education Policy; Veronique Pluviose, Staff Director; Lakeisha Steele, Professional Staff; Loredana Valtierra, Education Policy Counsel; Joshua Weisz, Communications Director; Ashley White, Education Policy Fellow; Cyrus Artz, Minority Parliamentarian; Kelsey Avino, Minority Fellow; Courtney Butcher, Minority Director of Member Services and Coalitions; Bridget Handy, Minority Communications Assistant; Dean Johnson, Minority Staff Assistant; Amy Raaf Jones, Minority Director of Education and Human Resources Policy; Hannah Matesic, Minority Director of Operations; Audra McGeorge, Minority Communications Director; Carlton Norwood, Minority Press Secretary; Brandon Renz, Minority Staff Director; Chance Russell, Minority Legislative Assistant; Mandy Schaumburg, Minority Chief Counsel and Deputy Director of Education Policy; and Brad Thomas, Minority Senior Education Policy Advisor. Chairman Sablan. Good morning. The Committee on Education and Labor will come to order. Welcome, everyone. I note that a quorum is present. The committee is meeting today in a legislative hearing to hear testimony on the importance of trauma-informed practices in education to assist students impacted by gun violence and other adversities. I note for the subcommittee that Ms. Bonamici of Oregon, Mrs. McBath of Georgia, Ms. Omar of Minnesota, Mr. Trone of Maryland, Mrs. Lee of Nevada, Ms. Wild of Pennsylvania and Mr. Castro of Texas are permitted to participate in today's hearing, with the understanding that their questions will come only after all Members of the subcommittee on both sides of the aisle who are present have had an opportunity to question the witnesses. Pursuant to Committee Rule 7(c), opening statements are limited to the Chair and the Ranking Member. This allows us to hear from our witnesses sooner and provides all Members with adequate time to ask questions. Can you hear me? Can you hear me all right? I recognize myself now for the purpose of making an opening statement. I want to begin by acknowledging that this morning marks 18 years since the terrorist attacks that struck New York, Pennsylvania, and the Pentagon on September 11, 2001. Let us please take a moment to remember the 2,977 lives lost in those attacks. [Moment of silence.] Chairman Sablan. Thank you. This morning, we are here to discuss the Federal Government's responsibility to ensure that every child from the Marianas to Maine has a nurturing learning environment. Today, many children are prevented from reaching their full potential because they are suffering from the significant long- term effects of trauma. In fact, 34 million children, or 45 percent of children, have endured an adverse childhood experience that can hinder their ability to learn and grow. Extensive research show that children who have experienced trauma and toxic stress are more likely to be forced into fight or flight mode. In school, this can often manifest in trouble, paying attention, an impulse to fight and depression or anger. These challenges can be further compounded by harsh school discipline instead of helpful support if a school is unaware of the science of trauma and toxic stress. My third grade teacher should have known this. But seriously, the trauma and stress of natural disasters have also affected student learning and well-being. For the over 950 Hopwood Middle School students in my district who lost their campus to Super-Typhoon Yutu, starting the new school year in FEMA-built tents is certainly not an ideal learning environment, especially when the students themselves have their homes lost or damaged. Damages from the storm have also forced schools to send their students to attend half-day sessions at other school campuses, robbing them of a full day of learning and the emotional security of having a campus community of their own. While we do not yet fully understand how the students will fare over time under these circumstances, studies show that over a lifetime, victims of trauma can face a higher risk of drug and alcohol abuse, greater risk of suicide, and shorter lifespan. Dr. Robert Block, a former president of the American Academy of Pediatrics, has been widely quoted as saying, quote: ``Adverse childhood experiences are the single greatest unaddressed public health threat facing our Nation today,'' end quote. Children across the world experience trauma; the United States is not unique in that regard. But there are specific preventable forms of trauma that our children experience more frequently than anywhere else in the world. The most notable example is gun violence. America's gun homicide rate for 15- to 24-year-olds is nearly 50 times higher than in other high- income countries, 50 times. According to a database maintained by the Washington Post, 228,000 students have experienced gun violence at school since the Colombine tragedy in 1999, 228,000 students. Americans, of course, are not 50 times more violent than citizens of other developed countries, of course not. But what distinguishes us from other developed nations is that we have failed to pass basic gun violence prevention laws that are supported by an overwhelming share of our constituents. The consequences of that failure are felt in communities like Odessa, El Paso, Dayton, and Virginia Beach, which have all experienced mass shootings in the past 3 months. They are also felt by residents in Chicago, St. Louis, Detroit, and other cities where families live under the constant threat of gun violence. And while this hearing is about implementing trauma- informed school practices, we cannot ignore the reality that most of this trauma is preventable. Reducing gun violence, ending family separations, improving access to mental healthcare, quickly rebuilding schools lost to natural disasters, addressing poverty are some of the many challenges we can make to improve the quality of life for children across the country. But given that we have shown little ability to address these issues, the very least we can do is help schools educate children who shoulder the burden of our inaction. More than 70 percent of children who need mental health services do not receive the appropriate care. Low-income students of color, who are more likely to experience trauma, are often concentrated in segregated public schools that cannot afford critical mental health resources; and as a result, children of color disproportionately suffer the physical and emotional effects of trauma. In addition, the report by the Government Accountability Office found that States are facing numerous issues supporting children affected by trauma, including funding challenges. And to make matters worse, President Trump and the congressional Republicans are further restricting mental healthcare at schools by repeatedly moving to slash funding for K to 12 education. This includes the elimination of Title II funding for teachers' professional development and the critical Title IV-A program, which is designed to improve school conditions for student learning. The experts here today will broaden our understanding of how trauma-informed care can be integrated into learning practices, student discipline, and support services, to improve graduation rates, student achievement, and school climate. They will also help us understand how Congress can support trauma- informed practices that are proven to help students succeed. Today's discussion is an important step towards addressing a pervasive public health issue that is affecting communities throughout and across the country. Thank you to all the witnesses for being here. I now yield to the Ranking Member, Mr. Allen, for his opening statement. [The statement of Chairman Sablan follows:] Prepared Statement of Hon. Gregorio Kilili Camacho Sablan, Chairman, Subcommittee Early Childhood, Elementary, and Secondary Education I want to begin by acknowledging that this morning marks eighteen years since the terrorist attacks that struck New York, Pennsylvania, and the Pentagon on September 11, 2001. Let us please take a moment to remember the nearly 3,000 lives lost in those attacks. Thank you. This morning, we are here to discuss the federal government's responsibility to ensure that every child--from the Marianas to Maine-- has a nurturing learning environment. Today, many children are prevented from reaching their full potential because they are suffering from the significant, long-term effects of trauma. In fact, 34 million children, or 45 percent of children, have endured an adverse childhood experience that can hinder their ability to learn and grow. Extensive research shows that children who have experienced trauma and toxic stress are more likely to be forced into ``fight-or-flight'' mode. In school, this can often manifest in trouble paying attention, an impulse to fight, and depression or anger. These challenges can be further compounded by harsh school discipline, instead of helpful support, if a school is unaware of the science of trauma and toxic stress. The trauma and stress of natural disasters has also affected student learning and well-being. For the over 950 Hopwood Middle School students in my district who lost their campus to Super Typhoon Yutu, starting the new school year in FEMA-built tents is certainly not an ideal learning environment especially when the students themselves had their homes lost or damaged. Damage from the storm has also forced schools to send their students to attend half-day sessions at other schools, robbing them of a full day of learning and the emotional security of having a campus community of their own. While we do not yet fully understand how these students will fare over time under these circumstances, studies show that over a lifetime, victims of trauma can face a higher risk of drug and alcohol abuse, greater risk of suicide, and shorter lifespan. Dr. Robert Block, former president of the American Academy of Pediatrics, has been widely quoted as saying, ``Adverse childhood experiences are the single greatest unaddressed public health threat facing our nation today.'' Children across the world experience trauma; the United States is not unique in that regard. But there are specific, preventable forms of trauma that our children experience more frequently than anywhere else in the world. The most notable example is gun violence. America's gun homicide rate for 15-24-year-olds is nearly 50 times higher than in other high- income countries. According to a database maintained by the Washington Post, 228,000 students have experienced gun violence at school since the Columbine tragedy in 1999. 228,000 students. Americans, of course, are not 50 times more violent than citizens of other developed nations. What distinguishes us from other developed nations is that we have failed to pass basic gun violence prevention laws that are supported by an overwhelming share of our constituents. The consequences of that failure are felt in communities like Odessa, El Paso, Dayton, and Virginia Beach, which have all experienced mass shootings in the past three months. They are also felt by residents in Chicago, St. Louis, Detroit, and other cities where families live under the constant threat of gun violence. While this hearing is about implementing trauma-informed school practices, we cannot ignore the reality that much of this trauma is preventable. Reducing gun violence, ending family separations, improving access to mental health care, quickly rebuilding schools lost to natural disasters addressing poverty, are some of the many changes we can make to improve the quality of life for children across the country. But - given that we have shown little ability to address these issues - the very least, we can do is help schools educate children who shoulder the burden of our inaction. More than 70% of children who need mental health services do not receive the appropriate care. Low-income students of color, who are more likely to experience trauma, are often concentrated at segregated public schools that cannot afford critical mental health resources. As a result, children of color disproportionally suffer the physical and emotional effects of trauma. A recent report by the Government Accountability Office found that states are facing numerous issues supporting children affected by trauma, including funding challenges. To make matters worse, President Trump and Congressional Republicans are further restricting mental healthcare at schools by repeatedly moving to slash funding for K-12 education. This includes the elimination of Title II funding for teachers' professional development and the critical Title IV- A program, which is designed to improve school conditions for student learning. The experts here today will broaden our understanding of how trauma-informed care can be integrated into learning practices, student discipline, and support services to improve graduation rates, student achievement, and school climate. They will also help us understand how Congress can support trauma- informed practices that are proven to help students succeed. Today's discussion is an important step towards addressing a pervasive public health issue that is affecting communities across the country. Thank you to all the witnesses for being here. I now yield to the Ranking Member, Mr. Allen, for his opening statement. ______ Mr. Allen. Thank you, Mr. Chairman, and thank you for recognizing the anniversary of 9/11, and note that this discussion is particularly poignant, given this day. Sadly, far too many children are affected by trauma. Because of their age and reliance on adults to keep them safe, children are more vulnerable to trauma. Studies show that 26 percent of children in the United States will witness or experience a traumatic event before they turn four, and more than two-thirds of children reported at least one traumatic event by age 16. Even more disturbing are the statistics surrounding children in the welfare system. Ninety-five percent of children reported psychological and physical abuse, and 99 percent reported psychological and sexual abuse. This is absolutely heart-breaking. Trauma can include any variety of frightening event, such as physical and sexual abuse, cyberbullying, bullying, or the death of a loved one. These can be caused by events at home, in the community, or around the world. Children that face more than two traumatic experiences in their life can develop reactions that negatively impact their daily life. In fact, trauma can affect a child's education and impair their learning. Research shows that there is a correlation between traumatic events and cognitive and behavioral issues. A study of more than 1,000 children from 20 large cities in the United States found that traumatic events in early childhood were associated with below-average academic and literacy skills. In fact, I have been told in my district that if a child isn't reading at the level of third grade by the time they finish the third grade, he is more likely to drop out of school and he has an 85 percent chance of being incarcerated. Educators and school staff can serve as a critical support system for traumatized children and their families. If a student is acting out, failing tests, or having difficulty concentrating, it may be a sign of trauma. If teachers understand what is a traumatized student and what they are facing, they can better accommodate and address those child's needs in the classroom. However, teachers in the education system are no replacement for family and faith. Moms and dads and grandpas and grandmas cannot be replaced in the life of a child. Faith cannot be replaced in the life of a child. Education is just one piece of supporting and shaping children. All of us in this room today want to see our Nation's children and make sure that they are loved, happy, safe and successful. In fact, my goal when I ran for office, it is time to quit losing our children. There is not a person here that does not care deeply about their futures. That is why we shouldn't turn any kind of trauma experienced by a child into a political platform. Instead, we should focus on equipping families, schools, and communities with the tools they need to shape young Americans to be successful leaders. After all, we have a vested and sincere interest in the well-being of our Nation's children. They are our future. This hearing will examine the effects of trauma on school children and how to identify and address them and, most importantly, how we can help students have access to a safe, supportive, and healthy learning environment. I had as a point of personal privilege, I had the opportunity while we were on our district work period to visit with many school officials. I will not name the superintendent, but had the opportunity to visit with him as tears came to his eyes and he described three suicides of young people in that school system last year. And I asked him why. And he said, they are without hope. Where is the hope? It is interesting too that I was given a book at a meeting two weekends ago. It is called Death on Hold. I never thought somebody on death row would teach me what this gentleman, Mitch, taught me in reading this book about what he went through as a child, what he experienced in the streets, why he was on death row, and why now he is making an impact on so many lives, particularly young people who are making bad choices. I highly recommend this book. It is required reading for Members of Congress, because I think they will see where the real problem lies. Thank you, Mr. Chairman, and I look forward to hearing our witnesses today. [The statement of Mr. Allen follows:] Prepared Statement of Hon. Rick W. Allen, Ranking Member, Subcommittee Early Childhood, Elementary, and Secondary Education Thank you for yielding. Sadly, far too many children are affected by trauma. Because of their age and reliance on adults to keep them safe, children are more vulnerable to trauma. Studies show that 26 percent of children in the United States will witness or experience a traumatic event before they turn four, and more than two thirds of children reported at least one traumatic event by age 16. Even more disturbing are the statistics surrounding children in the welfare system. Ninety-five percent of children reported psychological and physical abuse, and 99 percent reported psychological and sexual abuse. This is absolutely heartbreaking. Trauma can include any variety of frightening events such as physical and sexual abuse, cyber bullying, or the death of a loved one. These can be caused by events at home, in the community, or around the world. Children that face more than two traumatic experiences in their life can develop reactions that negatively impact their daily life. In fact, trauma can affect a child's education and impair their learning. Research shows that there is a correlation between traumatic events and cognitive and behavioral issues. A study of more than 1000 children from 20 large cities in the United States found that traumatic events in early childhood were associated with below-average academic and literacy skills. In fact, I have been told in my district that if a child isn't reading at level by third grade, he is more likely to drop out of high school and be incarcerated. Educators and school staff can serve as a critical support system for traumatized children and their families. If a student is acting out, failing tests, or having difficulty concentrating it may be a sign of trauma. If teachers understand what a traumatized student is facing, they can better accommodate and address those child's needs in the classroom. However, teachers and the education system are no replacement for family and faith. Moms' and dads' and grandmas' and grandpas' cannot be replaced in the life of a child. Faith cannot be replaced in the life of a child. Education is just one piece of supporting and shaping children. All of us in this room today want to see our nation's children are loved, happy, safe, and successful. There's not a person here who doesn't care deeply about their futures. Which is why we shouldn't turn any kind of trauma experienced by a child into a political platform. Instead we should focus on equipping families, schools, and communities with the tools they need to shape young Americans to be successful leaders. After all, we have a vested and sincere interest in the wellbeing of our nation's children - they are our future. This hearing will examine the effects of trauma on school children, how to identify and address them, and most importantly, how we can help students have access to a safe, supportive, and healthy learning environment. I look forward to hearing from our witnesses today. I yield back. ______ Chairman Sablan. Thank you very much, Ranking Member Allen. Without objection, all other Members who wish to insert written statements into the record may do so by submitting them to the Committee Clerk electronically in Microsoft Word format by 5 p.m. on September 25th. I will now introduce our witnesses. Dr. Nadine Burke Harris is the surgeon general of California. She is also an award- winning physician, researcher, and advocate dedicated to changing the way our society responds to one of the most serious, expensive, and widespread public health crises of our time: Childhood trauma. Previously, she founded the Center for Youth Wellness and subsequently grew the organization to be a national leader in the effort to advance pediatric medicine, raise public awareness, and transform the way society responds to children exposed to adverse childhood experiences and the toxic stress. She also founded the Bay Area Research Consortium on Toxic Stress and Health, to advance scientific screening and treatment of toxic stress. Dr. Nadine Burke Harris has published academic articles on adverse childhood experiences and trauma. She also published a book entitled The Deepest Well: Healing the Long-Term Effects of Childhood Adversity. Wow, you've been busy, Dr. Harris. Next, Dr. Ingrida Barker is the associate superintendent of McDowell County Schools in West Virginia. She is in her 16th year as an educator, 6 of which were dedicated to teaching at Sandy River Middle School, and 3 spent as a high school administrator in charge of the curriculum and instructions at River View High School. Two of my youngest happen to be public school teachers, so Dr. Barker. Currently, Dr. Barker works as an associate superintendent in McDowell County Schools. She also serves as the county's testing and Title IX coordinator and works extensively to support the development of comprehensive student supports in the county. Dr. Barker earned her Bachelor of Arts degree from Latvia in English and French, and completed a Master of Arts degree from West Virginia University in secondary education. And Dr. Barker received a doctoral degree in leadership studies at Marshall University. Ms. Joy Hofmeister--I got that right? Ms. Hofmeister is the State Superintendent of Public Instruction in Oklahoma. She was originally elected to serve as State Superintendent of Public Instruction in November 2014, and began her second term as Oklahoma State Superintendent in January of this year. Since taking office, the State has repealed its ineffective State exams, released a more meaningful and new user-friendly accountability system, and bolstered student safety. With an emphasis on collaboration and a focus on ensuring Oklahoma students have access to opportunities to achieve academic success, Hofmeister has strengthened academic standards and testing, revamped teacher evaluation, and brought statewide attention to the need for trauma-informed instructional practices that meet children where they are. And finally, but not the least, Dr. Janice Jackson is the chief executive officer of Chicago's Public School system. Archer. She has been immersed in CPS her entire life, as a former student, teacher, principal, network chief, chief education officer, and now as a parent to CPS students. As CEO of the third largest school district in the country, Dr. Jackson is a forward-thinking educator who is focused on improving excellence, equity, and access in all CPS schools. Her efforts, along with those of Chicago's dedicated teachers and principals, have propelled CPS students to record-breaking academic gains, and education experts from across the country regard Chicago as a national leader in urban education. She holds a master's degree in leadership and administration and a doctorate in urban school leadership from the University of Illinois at Chicago. Welcome, all of you. We appreciate all the witnesses for being here today and look forward to your testimony. Let me just remind the witnesses that we have read your written statements, and they will appear in full in the hearing records. Pursuant to Committee Rule 7(d) and committee practice, each of you is asked to limit your oral presentation to a five- minute summary of your written statement. Let me remind the witnesses that, pursuant to Title 18 of the U.S. Code, Section 1001, it is illegal to knowingly and willfully falsify any statement, representation, writing, document, or material fact presented to Congress or otherwise conceal or cover up a material fact. Before you begin your testimony, please remember to press the button on the microphone--we ourselves forget doing that once in a while--the microphone in front of you, so that it will turn on and the Members can hear you. And as you begin to speak, the light in front of you will turn green. After 4 minutes, the light will turn yellow to signal that you have 1 minute remaining. When the light turns red, your five minutes have expired and we ask that you please wrap up. We will let the entire panel make their presentations before we move to Member questions. When answering a question, please remember to once again turn your microphone on. I will first recognize Dr. Nadine Burke Harris. You have five minutes. STATEMENT OF NADINE BURKE HARRIS, MD, MPH, FAAP, CALIFORNIA SURGEON GENERAL, STATE OF CALIFORNIA, SAN FRANCISCO, CA Dr. Burke Harris. Good morning and thank you for the opportunity to participate in this hearing on trauma-informed practices. A robust body of literature demonstrates that adverse childhood experiences, or ACEs, are highly prevalent, strongly associated with poor childhood and adult health, mental health, behavioral and social outcomes, and demonstrate a pattern of high rates of intergenerational transmission. High levels of adversity, without the buffering protections of a trusted caregiver and safe, stable environments, lead to overactivity of the biological stress response and changes in brain structure and function, how genes are read, the functioning of the immune and inflammatory systems, and changes in growth and development. These changes are what comprise what is now known as a toxic stress response. Sixty-two percent of American adults have experienced at least one ACE and 15 percent have experienced four or more. Those with four or more face double the risk of seven out of ten of the leading causes of death in the United States, including heart disease, stroke, and cancer. And the original CDC research was done in a population that was 70 percent Caucasian, 70 percent college-educated. There is no sociodemographic or geographic group that is spared. The higher the ACE score, the more likely an individual is to also struggle with depression, PTSD, sleep and eating disorders and substance abuse. A national study of more than 35,000 adults found that even after adjusting for the impact of sociodemographics and substance use, ACEs are independently associated with as much as four times the risk of incarceration. Similarly, research has indicated that a common factor among individuals committing mass shootings is a history of multiple ACEs. Among the most notable and perhaps well-studied effect of ACEs are the impact on learning and behavior. Compared to children with no ACEs, kids with four or more ACEs are as much as 32 times as likely to experience learning and behavior problems and are 3 times as likely to repeat a grade. The science is clear; adverse childhood experiences are a public health crisis that require coordinated, cross-sector response. Scientific consensus supports two core principles: One, early detection and early intervention improves outcomes; and two, safe, stable, and nurturing relationships and environments are healing. Schools and our educators are a critical part of an ecological and public health response to ACEs and toxic stress. Trauma-informed practices in schools involves ensuring that all personnel are trained to understand that disruptive behaviors may be possible symptoms of toxic stress and respond with compassionate buffering care. In addition, trauma-informed training and practices and policies include establishing systems that enable safety, including predictable routines and social interactions, a calm physical environment, transparent and predictable rules, having clear nonpunitive consequences for violating rules, teaching social and emotional skills, participatory decision-making by students in school policies, and explicit family and community involvement, including support for families who are managing stress. Restorative disciplinary practices and programs to prevent retraumatization should be the norm. Programs to support vulnerable children and youth can align with the six pillars of mitigating the toxic stress physiology, which include promoting healthy nutrition, physical exercise, mindfulness, mental health, sleep hygiene, and supportive relationships. In addition, prevention of vicarious traumatization and supports for educator well-being are essential elements for trauma-informed educational environments. Important elements also include workforce training, dissemination of best practices, data reporting and rigorous evaluation. As noted by authors in a recent commentary in the journal Pediatrics, both the World Health Organization and the Centers for Disease Control and Prevention recognize that schools are not only places to transmit academic knowledge, but also a place for vulnerable children to connect with supportive adults and peers outside of their families. Supportive relationships with peers, teachers, and coaches as well as school connectedness and belonging have been shown to protect against depression, substance use, and other risky behaviors and also support and promote academic success. The opportunity ahead of us is about the true intersection of healthcare and education. Thank you for this opportunity to share the science, and I urge you to use this information to inform your actions on behalf of the American people. [The statement of Ms. Burke Harris follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT Chairman Sablan. Thank you very much, Dr. Burke Harris. I would like to now recognize Dr. Barker for five minutes, please. STATEMENT OF INGRIDA BARKER, ED.D., ASSOCIATE SUPERINTENDENT, MCDOWELL COUNTY SCHOOLS, WELCH, WV Ms. Barker. Good morning. I work in one of the poorest districts in the United States. According to the 2019 Kids Count data, we face the highest rates of children living in poverty, low birth weight babies, and children in kinship care or children living with grandparents. These numbers alongside mounting drug overdose rates create the perfect storm of issues that impedes our students' well-being and subsequently their academic achievement. Besides battling the issues associated with drug misuse, we face the challenges brought to us by generational poverty, ranging from kinship care issues to generational trauma our students' families face. The schools see the adverse impact of these challenges on student attendance, behavior, and academics. For many students whose main focus is on survival and managing their basic needs, all the mental capacity is used up on managing the stress in their lives. Instead of thinking about reading or doing math, they need to think about their physical and emotional health needs. Stability and social structures lack in many of our students' lives, and that is why our schools face increasingly challenging behaviors and have to use a variety of resources to provide continuous learning opportunities for all of our students. Hence, the importance of trauma-informed practices and health supports in our schools. The need to help our students overcome trauma and focus on learning is immediate, overwhelming, and complex. It is known that students who are born to low socioeconomic status tends to lag behind academically when they enter our schools. They also come to us with several ACE scores. Many of our kids witness abuse, parent drug overdose, parent incarceration and violence early on. Schools can break the cycle of chronic stress and trauma by helping provide protective factors, such as strengthening social connections, providing concrete support in the time of need, and helping children develop social and emotional competence. We as educators have a choice: Wait for somebody else to come and help our families and children, or we can do something now while we have our kids in our schools. In McDowell County Schools, we choose the latter. Of course, the school staff cannot do the job alone. We have degrees in education, not in mental health, psychiatry, or social work. Therefore, we are applying community school strategy to leverage and coordinate resources with the school and the community providers to help our kids. School community strategy is also an equity strategy. It creates collaborative partnerships with various community organizations to meet the unique needs of the whole child, including family and kinship supports. Of course, building and maintaining so many partnerships requires the full-time position of the community schools coordinator, as the principals or central office staff struggle to find time to do this in addition to their direct instructional duties. Southside K8 in our district has been using community school strategy for several years, and now we see that we can keep our teachers. Instead of having a 40 percent turnover every year, we have very few teachers leaving. So it contributes to that stable environment and great culture in the school. As a district, we have an emphasis on securing collaborative partnership on a district level, because we are so remote and the schools frequently don't have the opportunities to get on the partnerships themselves. But funding for all these positions in addition to the graduation coaches, nurses, social workers is a challenge for a rural county with a diminishing tax base. Therefore, increases in the funding formula for education, like Title I and IDEA as well as Title IV, is needed. When faced with choices of directing these funds to meet students' needs, we should not have to choose between helping students to learn and do math and hiring nurses, mental health therapists and social workers. Both types of services are vital for our students to succeed, as the schools have become hubs of community and, therefore, have to meet the needs of the whole child instead of engaging in a piecemeal approach, having to choose between funding academics or social and emotional supports. The implementation of trauma-focused practices and wraparound services serves as a solid strategy to prevent students from engaging in destructive behaviors of drug misuse, violence, and risky behavior. These practices also can break the cycle of generational poverty and generational trauma in our students' lives, because their parents often coped with that trauma themselves and cannot help our students as much as they could. Thank you so much for your time to listen to my statement. [The statement of Ms. Barker follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Chairman Sablan. Thank you very much, Dr. Barker. Now I recognize Ms. Hofmeister for five minutes, please. STATEMENT OF JOY HOFMEISTER. OKLAHOMA STATE SUPERINTENDENT OF PUBLIC INSTRUCTION, OKLAHOMA STATE DEPARTMENT OF EDUCATION, OKLAHOMA, OK Ms. Hofmeister. Good morning. Thank you, Chairman Sablan, Ranking Member Allen, and Members of the committee. My name is Joy Hofmeister. I was elected State Superintendent of Public Instruction in 2014 by the good people of Oklahoma and reelected in 2018. Thank you for the opportunity to appear before you to discuss the effects of childhood trauma on student academic performance and the social-emotional growth of our school children. Oklahoma has made tremendous strides in various fronts in public education: Academic standards, national comparability, accountability and more. But these improvements cannot remedy every challenge. There are, of course, the stark realities of poverty, childhood hunger, domestic strife and more. The world outside the classroom has an undeniable impact on the world inside the classroom. A recent national survey of children's health reports that Oklahoma's youngest children suffer more trauma than those in any other State. According to the Annie E. Casey Foundation, Oklahoma ranks 42nd in the Nation in child well-being. Seventy- five percent of our students suffer moderate or serious depression and a growing number admit to a low commitment to school and a high risk for drug abuse. Bearing this in mind, how can we equip teachers to move students toward resilience and a bright future? We believe the key is trauma-sensitive instruction. Recent work on the science of hope makes clear that the connection with a stable, caring adult is a common factor in moving our children from trauma to hope. In October 2018 and February 2019, through grant assistance, Title IV funding, and community and agency partners, the Oklahoma State Department of Education held two statewide trauma summits. Both were heavily attended. Next February, we will hold another trauma-focused opportunity for all educators in the State. With approximately 42,000 classroom teachers, we expect to serve 10,000 at that event. Providing increased support to address the implications of trauma among our State's youth is a priority of our State agency. The agency provides professional development opportunities for educators to better understand the connection between trauma, the science of the brain, and the negative impact on student performance. In addition, we began a more cross-agency collaboration to address trauma and its connectedness to student academic performance, chronic absenteeism, and behavior. Our Office of Student Support provides on-site interventions and professional development to schools and districts. Developed last spring, it consists of directors of social-emotional counseling, academic counseling, prevention services, college and career readiness, work-based learning, family and community engagement, and suicide prevention. We will soon add a specialist devoted to bullying prevention and a statewide crisis response team. Since July, our student support team has provided educational opportunities and classroom interventions for more than 4,000 Oklahoma educators. Through our work toward college and career readiness, a new focus on Individual Career Academic Planning, or ICAP, we are learning that students who intentionally plan for their future are more hopeful and resilient. The results can mitigate the negative implications of trauma. ICAP is required statewide beginning this school year, but already students in our ICAP pilot study tell us that their friends are coming to school more, feeling more purposeful in their work and more optimistic about life after high school. Through heightened trauma awareness among our educators, we see rich learning environments and increased trust and support between teachers and students. Trauma-informed instruction is working. One teacher said, ``After attending trauma-informed instruction professional development, our school brought back classroom intervention strategies. We started implementing them in a few of our classrooms and noticed that student discipline referrals went to zero with these teachers. We are already seeing the change in our student behaviors and test scores.'' Such results are hardly surprising. When we ask students what they need from their teachers, their message is consistent: Get to know us. Connect with us. Care about us as people. When we empower teachers with evidence-based strategies and greater awareness of trauma, we allow them to harness their creativity to develop positive connections with students. In closing, the trauma expert Peter A. Levine said: Trauma is a fact of life; it doesn't have to be a life sentence. And we believe we can move our children from trauma to hope. [The statement of Ms. Hofmeister follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Chairman Sablan. Thank you very much, Ms. Hofmeister. And now I would like to recognize Dr. Jackson for five minutes. STATEMENT OF JANICE K. JACKSON, ED.D., CEO, CHICAGO PUBLIC SCHOOLS, CHICAGO, IL Ms. Jackson. Good morning, Chairman Sablan, Ranking Member Allen, and Members of the committee. My name is Janice K. Jackson and I am the Chief Executive Officer for Chicago Public Schools, which serves 361,000 students and is the third largest school district in our Nation. I am grateful for this invitation today to talk about one of the greatest challenges that we face in Chicago. Many of our students are growing up in communities that struggle under the weight of poverty and have been significantly impacted by violence. The purpose of my testimony today is to explain how exposure to violence and poverty creates trauma for Chicago's children, and more importantly, to share the steps that CPS is taking to combat the damaging effects of trauma. First, I would like to tell you about two students, Rodney and Kimyatta. These are children who live in a world where trust is scarce and anger is overly abundant. They describe their communities in their own words as places where no one can be trusted. For these children, navigating violence and poverty is a way of life. This can mean that they are exposed to gun violence, gang activity, substance abuse, incarceration of a loved one and loss of loved ones. And because of that, they are far more likely than their peers to experience multiple traumas during their formative years. This repeated exposure to trauma can have far-reaching effects on youth. Like teachers all over the country, Chicago educators also feel the pain and uncertainty right alongside the students that they serve every day, and this is referred to as secondary trauma. For both students and teachers, trauma becomes a form of toxic stress in their brains when it is left untreated. For students, it can lead to behavior problems, poor mental health, drug and alcohol abuse, and unhealthy sexual behavior, not to mention constant struggles in the classroom. Children exposed to this type of trauma are at risk for lower grades, poor attendance, behavior issues and an increased likelihood of dropping out of school. This sobering fate could easily have befallen Rodney and Kimyatta, but thanks to one of the many programs that CPS and the City of Chicago has invested in, their situation is changing. This summer, CPS and the City launched a first-of-its-kind program called Summer for Change, targeting students exactly like the ones mentioned before, students from underserved urban communities who are at risk for being impacted by violence. During the 6-week program, 430 youth participated in enrichment opportunities and were given access to mentoring and trauma- informed therapy that they needed. The program gave these students access to something that they were missing: Caring and trustworthy adults who they could open up to. Not one of the 430 students who participated in the Summer for Change program was a victim of violence this summer. We also saw an overall reduction of almost 50 percent in gun violence victimization among students who are enrolled in our alternative school systems during the summer of 2018. We hope that the Summer for Change program and programs just like it contribute to this type of success, and that we can continue to provide students in Chicago with a safe haven to avoid some of the outcomes we discussed earlier. Summer for Change is one of many initiatives that CPS has launched around social-emotional learning. Others include restorative discipline practices that are moving us away from suspensions and expulsions and toward uncovering the root cause of negative behavior while keeping kids in school where they belong. This has resulted in a sharp decline in out-of-school suspensions and expulsions in CPS and has led to the lowest ever dropout rate in our district's history. Other targeted trauma-informed intervention support our students in everything from coping with anxiety and depression to managing their emotions and taking responsibility for their choices. And this helps them ensure that they are prepared for success after high school. One other example that I would like to share is for a student whom I will call Cara. She is growing up without her mother and any other female adult in her home. She struggles with isolation and was constantly getting into conflicts with the peers in her school. Cara was recruited to join a Structured Psychotherapy for Adolescents Responding to Chronic Stress program, otherwise known as SPARCS, and things have started to turn around. She is learning to talk through her emotions and make better decisions, and this is helping her to develop the coping skills necessary to better manage her stress. Chicago has been fortunate to receive Federal grant support to manage the needs of children exposed to trauma. The impact of this funding is significant, particularly as our students continue coping with the stress of poverty and violence. But to keep this vitally important work going, CPS and other school districts around the country need additional support. There is a serious need for increased Federal funding to combat the effects of trauma on our youth. Only when our country's leaders unite behind this cause can the range of quality treatment services for these students begin to fully meet their needs and put them on the road to recovery and a productive and fulfilling life. I thank you for listening to my testimony and your time and look forward to your questions. [The statement of Ms. Jackson follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Chairman Sablan. Thank you very much, Dr. Jackson. Oh, God, how much you four make me miss my grandmother growing up. But under Committee Rule 8(a), we will now question witnesses under the five-minute rule. As Chair, I have decided to go at the end, so I will yield to the next senior Member on our side, the Majority side, who will be followed by the Ranking Member or his designee, and I would recognize. And so let's start with Ms. Schrier. You have five minutes. Ms. Schrier. Thank you, Mr. Chairman. And thank you to all of our witnesses today. I was thrilled to read all of your testimonies last night and then hear them today, and I am so grateful that we are talking about this. I am also a pediatrician, and so I come at this with a little bit different perspective. And I have been thinking about kind of how we can really address this, because ACEs are a particularly difficult problem because so many of the adverse childhood events happen at home. And so when a patient comes into the office, we try to partner with parents to make things better. But when there is so much dysfunction at home, whether it is hunger or parents are separated or abuse or a parent is sick with a horrible chronic disease or drug abuse, that makes it much harder to solve in the exam room. And so a lot of it really ends up being left, of course, to the schools, which is the other safe place for kids. So I wanted to talk--I have a couple questions. One is going to be for you, Dr. Jackson, about the difference between expulsion/suspension, kind of traditional responses to misbehavior in school, and then how that contrasts with now. But I wanted to first talk with you, Dr. Burke Harris, about what we can do to help these families and sort of catch things upstream. And in Washington State, there's a couple really exemplary programs that meet families where they are. So it addresses these exact situations to help them build their children's health. One of them is called the triple P program or Washington State's Positive Parenting Program, and it aims to assist parents in preventing a lot of the serious behavioral and emotional problems that we are seeing in kids. The other one is the Guiding Good Choices program that helps parents of kids 9 to 14-year-old, who are just entering a really turbulent period, to make good choices through adolescence. And the triple P's positive outcomes on reducing child abuse and neglect, limiting out-of-home placements of children, and academic success are outstanding and result overall in taxpayer savings of about $1,400 per participant. And the Guiding Good Choices program demonstrates increases in the number of positive interactions between parents and children, lower rates of substance abuse, lower rates of delinquency, and effects that last even 40 years out. And so I was going to ask if there are some other programs that you really like and would recommend, and then maybe even add what some of the challenges are, other resources in rural communities. Dr. Burke Harris. Thank you. So we recognize that when we are talking about addressing adverse childhood experiences, we have to break the intergenerational cycle, right? Kids who have ACEs have parents who have ACEs. In California, we are implementing universal screening for adverse childhood experiences in children and adults and responding with trauma-informed care, and our governor has allocated $40 million to reimburse providers for doing that and $60 million over 3 years to train providers on how to do that and how to respond to trauma-informed care. So ensuring that adults also have access to mental health services and supports for vulnerable families who are under stress, it has to be a two-generation approach. Ms. Schrier. Thank you very much. And are there particular programs that I should look into to bring home to my State of Washington? I love that you are implementing the screening program, so we in Washington will be learning from you in California. Dr. Burke Harris. One program I also recommend is CPP, Child-Parent Psychotherapy, which is a clinical intervention that I have used in my clinical practice, and as well as any trauma-focused therapy that can be used for kids and adults. Ms. Schrier. Thank you. Then I still have time so, Dr. Jackson, I just wondered if you could paint a picture for my colleagues about what it would look like traditionally if you had a child who was misbehaving so much in school that they would be sent home--of course, then being sent to a home where there is drugs or neglect or a sick parent or whatever else-- versus how you handle that in a school that is focused on trauma-informed behavior modification and education. Ms. Jackson. Thank you. In short, in Chicago Public Schools, we first started by looking at the policies that led to not only outrageous numbers of students being suspended and expelled from school, but the disparity between African American students and their peers. And we changed the policy to make teachers, principals, and administrators have to go deeper to identify the root cause and also show an effort to address those root causes through other practices, such as restorative justice, in some cases giving students access to mental health professionals, either in the school or outside of the community. And what this has resulted in, unlike some of the skepticism that we heard in the beginning, is fewer students being suspended and expelled from school resulted in higher attendance rates, which also had a direct impact on student achievement, which has been addressed here today. And I am happy to say that, you know, we have been engaged in this work for about 6 or 7 years now and now we have the data to show that when we invest in our students and look underneath to figure out what is going on and provide them with the trusted adult or individual, we can really change the pathway for our students. So I would recommend those folks listening to think about the policies first and then make sure that there is an investment in training for the educators who are working with students every single day so that they can implement them with fidelity and care for students. Ms. Schrier. Thank you. Chairman Sablan. Thank you very much, Dr. Shrier. At this time, the designee of the Ranking Member, Mr. GT Thompson of Pennsylvania, is recognized for five minutes, sir. Mr. Thompson. Chairman, thank you so much. Chairman, Ranking Member, thank you for really hosting this critical hearing on a topic that is extremely important to me. Trauma is such a destructive force from so many different perspectives of how it impacts a human being when it comes to impacting our children, who, quite frankly, maybe have not developed the resiliency, the strategy, the skills to be able to prevent the real destructive force of trauma long term. I want to thank each of the Members of this panel for bringing your professional expertise, your passion--very obvious to me, from what I have heard and what I have read--to this hearing today. And thank you for bringing your best practices too. I have already heard a lot of information that gives me hope. And the fact is I love that it was framed the science of hope. That really is what you all are all about. It is about building and establishing resiliency within our kids. It is sad what they have to experience. And I would argue that there are so many different forms of trauma, and what has really made it present in absolutely every school district, I think in every school in the Nation is the number one public health crisis of our lifetime, which has been substance abuse and the trauma, the loss of loved ones, you know, what that does. And so thank you for being here and sharing. Ms. Hofmeister, in your testimony you mentioned the importance of professional development and teacher preparation programs focusing on trauma-informed instruction. Can you provide some specific examples as to what this looks like? Ms. Hofmeister. Yes. It is based on the science of hope. Dr. Chan Hellman at the University of Oklahoma has done many studies related to this. And we teach and work with our teachers through professional development that it is about relationships. It is about building and fostering trust, trust and respect between the student and the teacher, between families and the school. And when we give our teachers more information to better understand behavior, recognizing that all behavior has meaning, sometimes I think teachers have viewed the behavior as something else when it could be an expression of trauma. And having new eyes to see that, instead of a child that is sleeping at the back of the classroom in middle school and a teacher might ask maybe in the past, what is wrong with that kid, we want to ask, what has happened and what can we do to give them confidence and build that relationship? And when our kids have that strong strengthened relationship with their teachers, they are going to be able to be more engaged and also have that one caring adult that we know is paramount for moving beyond trauma to hope and a brighter future. Mr. Thompson. I appreciate those observation skills. It is a world I come out of in healthcare for 28 years and it is a method I use here, root cause analysis, really finding out what is at the root cause of the behavior that you are seeing versus just condemning the behavior. And I am heartened by the fact that I have heard that this committee, working in a bipartisan way, and past Congresses, with the Every Student Succeeds Act, we have recognized the need. We have authorized programs. I have heard those mentioned a few times, how they have been helpful. I think there is obviously more left to be done. You mentioned a few examples of how this helped your students and faculty. Can you discuss that in more detail for us, and specifically what impacts has this had on students, both in performance outcomes and their overall classroom experience? Ms. Hofmeister. What we are seeing is that our students are more engaged, and we know that student engagement is key for academic success. This is something, of course, that starts and begins with teachers, but we also know that there is a collective impact when there is a strong relationship, and that community that is created in a classroom that starts with teachers engaging students. And it can be as simple as the difference when a teacher greets children at the door, knows their name, is there to support them as people, not just teaching a subject. And our students tell us this makes all the difference in the world. One of our students on our Student Advisory Council that we have at the State level told us that she accidentally got in a classroom that did not have an interest for her and was a mistake on the schedule, but the teacher was so engaging and cared and communicated that care about her as an individual that it was something she actually stayed in, didn't change. And it helped her at a time in her life when she needed an adult who would be there for her. This is something teachers can do. Teachers can foster hope, and that builds resiliency. But without hope, we do not have that ability to bounce back. Mr. Thompson. Thank you. Thank you, Chairman. Chairman Sablan. Thank you. Thank you, Mr. Thompson. We alternate sides in questioning, so I would like to now recognize the Chairman of the full committee, Mr. Scott of Virginia, for five minutes. Mr. Scott. Thank you, Mr. Chairman. And I want to thank all of our witnesses for your testimony. Dr. Harris, you mentioned that early detection could improve outcomes. When you have someone showing up with multiple ACEs, what do you do? Dr. Burke Harris. So several things. First of all, what the science shows, the safe, stable, and nurturing relationships and environments are key, and so those nurturing relationships are absolutely critical. And the opportunity in trauma-informed educational systems is for everyone, every adult in that child's educational environment to be a dose of a buffering relationship, if you will. In clinical practice, what we see, sleep, exercise, nutrition, mindfulness, mental health and healthy relationships are the clinical pillars for addressing a toxic stress physiology, and that is what we see improves both health and also mental health and behavioral outcomes. Mr. Scott. Thank you. Dr. Jackson, if a child is subject to trauma, does it have an effect on achievement and how do you measure that? Ms. Jackson. I had the mike on the whole time. Thank you for that question. There is definitely a correlation between students' exposure to traumatic events and their readiness and achievement and proficiency in the school system. I think that a few things we have been able to measure after changing policies around keeping students in school and reducing the amount of time that they are excluded from school is that we were able to see the correlation between increases in student attendance, access to healthcare professionals in the school and outside the school, resulting in students achieving higher on standardized assessments that they were taking. We have also been able to track our students over time and look at graduation rates, where we have experienced about a 20 percent increase in the past 8 years. Much of that can be attributed to the changes that we have made around addressing the root cause analysis of what is going on with our students and making sure that we are intervening early and appropriately to keep them on track for schooling. I think some of the other ways that we try to measure this is that in Chicago Public Schools we have a Safe School Certification, which is a deep analysis of the practices as well as the data in schools where we look at the amount of time students have been suspended, access to resources that they have, and also the interventions and supports that they have received at three different tier levels. And because that information is tracked and made publicly available, parents are able to see that and they are able to use that to make determinations about schools, for example. It has really incentivized the educators within those buildings to really make sure they have organized their schools to be safe and supportive environments for students. And just to give you a quick data point, since we have instituted the Safe and Supportive School Strategy five years ago, we went from having a third of our schools receiving kind of the seal of approval on that certification to now having close to 75 percent of our schools meet that. And our goal is obviously 100 percent, but that is pretty dramatic progress in a five-year period. Mr. Scott. That is what happens if you intervene. What happens if you do not intervene and a child is subject to trauma? Ms. Jackson. I think a lot of that has been covered today, but just to reiterate, students that have been exposed are more likely to repeat the behaviors that they have either experienced or, you know, been exposed to. One of the things that we have also focused on in addition to gun violence and the effect of poverty and some of the other things that have been talked about a lot today is also looking at some of the challenges that many of our LGBTQ students experience. Many of them have a higher likelihood of being exposed to traumatic incidents in their lives, and so this has become a bigger priority here in CPS. What we tend to see if this is untreated is students drop out of school. Students are at a higher risk for unproductive behaviors. They are also at a higher risk for suicide and some other things that can be really traumatic. And so one of our goals is to really intervene as soon as possible to try to reverse some of those negative outcomes. Mr. Scott. Very quickly, can you tell me the importance of Title IV-A student support services under ESEA? Ms. Jackson. I think the importance, we talked a lot about this today. Projects like the Project Prevention funding and others that the district has been able to apply for really provide us with additional funding and support, or could provide us with additional funding and support so that this is sustained. We now know better, so it is incumbent upon us to do better. And I think that our educators need training, they need support in order to do this. And I would even say once we get to a place where we have really reached a utopia, if you will, we will be providing support for the educators who work with our students as well. I talked a little bit about secondary trauma earlier, and I really want to lift that up. We have a teacher shortage in the country, and we know that is even greater in some of our more challenging schools where there is a higher rate of students who have experienced traumatic episodes and incidents. And if we do not adequately train the teachers who work with them every single day, we will continue to see turnover and we will continue to see these cycles persist. Mr. Sablan. Thank you, Dr. Jackson. Thank you very much. Thank you, Mr. Scott. And as we alternate sides again, this time I recognize Mr. Timmons for five minutes. Mr. Timmons. Thank you, Mr. Chairman. And I want to thank all of the witnesses for coming to testify before the committee today. Ms. Hofmeister, it is often the case that children struggling with trauma do not communicate with teachers the stress and other trauma-related problems they face. In your experience, what have you found to be common indicators of a child struggling with trauma or traumatic stress? Ms. Hofmeister. You know, often a child who appears disengaged, as I mentioned earlier, does have a story behind that. And that is something that, as teachers begin to foster the connection, they begin to understand a little deep--more deeply what is occurring. So that could be an older sibling that is in middle school that is taking care of the younger children who got them to school on time. Or there could be barriers that occur that we can see as we dive a little deeper about those who are chronically absent. So it is incumbent upon us in schools to meet our kids where they are and to look for ways to remove barriers, first identify those and remove them so that our students are able to be successful. I think we focused a lot in the last number of years on student achievement, and we want and have set a high bar for student achievement. But we also have not had the expansive conversation we are having now about all aspects of the student, thinking about the whole child. And that is something that we are doing differently. And those types of indications that a student is having struggles can look different for every child. We need teachers and educators and school leaders and school board members to have new eyes, a new lens to view the students that they are serving and then act on evidence to create trauma-sensitive school policy. Mr. Timmons. Thank you. You talk about removing barriers to getting children help. What can be done to encourage kids to actively seek help? Ms. Hofmeister. Well, I think it is about being sensitive to where our kids are. It can look different in different settings. I am thinking of an example just this start of the school year. You have tornado drills. And I was reaching out. And one of my school superintendents mentioned how they had, in El Reno, a very significant tornado that had devastation throughout that community just in May. So an example of what can we do was what they did. And it was a trauma-informed policy. What they had--the new eyes to see kids that were going to go through that tornado drill. And there were 15 of them that were very affected and impacted by that May event. And they had a caring adult holding their hand through that entire exercise. And they just were there for them through the rest of the day. And it is a small thing, but it made a great difference in those children's lives. And it also allowed them to at least stay as focused as possible on learning that day. But the superintendent told me learning was not taking place for them that day. It brings back triggers. And as we think about those triggers, we can't make assumptions about what those will be. Students who have endured abuse at home or they have witnessed violence in the home. Oklahoma has a high level of incarcerated men and women. In fact, the largest incarcerated population in the world per capita in our State. And this is something that impacts families, of course, and means many of our children have a high incidence of adverse childhood experiences. So having eyes to see the child where they are and being willing to not try to use more of a blanket cookie cutter approach to trauma is the call. We want simply to build a relationship. And it unfolds from there. Mr. Timmons. Thank you. What role does the family play in this process? Ms. Hofmeister. A significant role. We believe that strong families make strong communities and make strong schools. We want to strengthen families. And we also, as educators, want to reach out to families to meet them where they are. We want to find ways to include them where, perhaps, they also had a negative experience in school and don't want to come to school. They don't want to be as engaged as we know that they need to be and that it will, in fact, benefit their children. So we will meet them where they are in a more welcoming way intentionally welcoming of our families and finding new ways to do that. When you are homeless, when you are a mother who is homeless and has a child who is in school and you are moving from district to district or school to school as the trauma, means that you have to be more fleeing, for example, we still have to have a way to connect. And those are some of the examples. Mr. Sablan. Thank you. Mr. Timmons. Thank you for your testimony. Mr. Chairman, I yield back. Mr. Sablan. Thank you, Mr. Timmons. I will now recognize Mrs. Hayes for five minutes. Ms. Hayes. Good morning, everyone. And thank you so much for being here for this very important hearing. I taught in and I now represent a congressional district that has been defined by tragedy. Newtown Sandy Hook is in my district. And in my own school district, the Waterbury Public School System, we did extensive work on trauma training all of our social workers on adverse childhood experiences and hosting a series of symposiums for trauma in early childhood. All of our teachers and faculty members went through professional development on social and emotional learning. One of the presenters, I remember this very clearly, told us as a group that our children were scoring just as high as veterans on the trauma scale. And I know personally that once educators begin to see children through a trauma-informed lens, they can shift from blaming them for the behavior to beginning to understand the root causes of those behaviors. But what I want to talk about today is the fact that trauma extends beyond the point of impact. Grief counseling happens, you know, the day after something happens at a school. But the grief resulting from those tragedies extends into our communities. And I see that every day in Connecticut 5. Just this spring, one of the parents of the students at Sandy Hook tragically took his own life. So I ask you, if the parents are still struggling or if adults are still struggling, imagine what children are going through. We recently did a study in Connecticut, and the results were astonishing. Ninety percent of kindergartners reported experiencing ACE events, but only 23 percent were currently displaying symptoms. What this tells us is that 67 percent of students are experiencing ACEs but are unidentified and untreated allowing them to worsen over time. So I cringe to think that these children are coming of age and they have all of these experiences that they do not know how to address. Actually, Mr. Chair, I would like to introduce this testimony that I just cited into the record. Thank you. Mrs. Hayes. So my question today--I have two questions. First for Dr. Burke Harris. What can we do post trauma for families to make sure that they have the supports that they need, you know, 2 years, 5 years down the road to make sure, especially in communities that have polarizing targeted issues that we can identify? Because I think the one thing that we can all agree on is that it is not the children's fault, the families that they come from. And then my next question, if you could follow up, is for Dr. Jackson. What do you think the impact of secondary trauma is on the educators who have to, year after year, stand in front of children. You know, oftentimes we think of events like the one I just described, but we have children with prolonged trauma as a result of their daily interactions, and teachers who see this year after year. And it is kind of hard to feed hope into someone when you are just repeating the cycle every single year. So Dr. Burke Harris. Dr. Burke Harris. Thank you. Those are excellent questions. I think there are a couple of critical pieces. Number one, a recognition that trauma in our communities, right, is so common that a true public health approach involves universal precaution, if you will. This is why trauma-informed care in our educational systems is so critical, because we have to be providing these supports and services routinely as part of our way of doing business in education in order to respond to the endemic levels of trauma that we are seeing. Another piece is the role of screening and partnership, cross-sector partnerships. The prevalence of trauma is so high that--you know, I hear educators saying, okay, what can we do? I hear doctors saying what can we do? I hear law enforcement saying what can we do? How can we be part of the solution? And when each of us takes our little piece, right, there is a tremendous amount that we can do to support resilience and buffering across our communities and increasing that cumulative dose of buffering making sure that every adult in the environment understands not only how they are managing their own history of adversity, because as you mentioned, it is not just vicarious trauma for educators but the fact that educators are-- Mrs. Hayes. I am sorry. I don't mean to cut you off, but I cannot let my time expire without speaking to what happens to teachers. Dr. Burke Harris. Absolutely. Ms. Jackson. Sorry. I will be quick, but I feel just as passionate. Teachers--we see higher turnover rates and burnout. We also see depression. We have had teachers report depression as a result of some of the things that they have been able to hear. And not because--not only because the stories are so challenging but because, in some cases, it is feeling of hopelessness. When we don't have the resources, when we don't have a place to point students and families to, when they have the courage to share with us what is going on, teachers feel hopeless in that regard. And that can contribute to some of the depression and things that have been reported. Mrs. Hayes. Thank you. Mr. Chair, with that, I yield back. Mr. Sablan. Thank you, Mrs. Hayes. And at this time, I am going to recognize the Ranking Member of the full committee, Dr. Foxx, for five minutes please. Ms. Foxx. Thank you, Mr. Chairman. And I want to thank our witnesses for being here today. Ms. Hofmeister, in your testimony, you discussed the State's working conducting cross agency collaboration to help address the needs of students experiencing trauma. Can you, please, explain in more depth why this collaboration--what this collaboration looks like and why it is a critical component in helping these students? Ms. Hofmeister. Thank you very much, Representative. Yes, this is essential. We are working in Oklahoma in the Department of Education to work with our partners in the Department of Mental Health and Substance Abuse Services. With that work, for example, we are able to be--have more of our students participate in the Oklahoma prevention needs assessment survey. Actually, just for the last reported school year that we have data from, we had 47,940 students participate in the grades of 6th, 8th, 10th, and 12th grades. That is one example. From that we were able to learn a lot about the evidence that they are providing us with input and then develop strategies to meet needs. And as we have partnerships, it goes beyond just one or two agencies. Actually, it is across the board. We are working with the Department of Corrections. I want to see those parents engaged that are able to be engaged in the lives of their children even through something unique with parent conferences virtually where that is appropriate. We are grappling with health issues, and we are working with other entities within the State agency to work with Department--DHS and with the Health Department as well to work on battling the physical aspects of health as well. So it is paramount. Ms. Foxx. You mentioned in response to Representative Timmons' questions about the family, that you have the largest per capita incarceration rate in Oklahoma in the country. I would assume from that there are a lot of single-parent families in Oklahoma. Have you done anything to look at the impact of single-parent families on what is happening with students and how to deal with that as trauma? Ms. Hofmeister. Yes. Thank you as well, Representative, for that question. What we know on the ACE index, having a divorce within the family impacts children as an adverse childhood experience. So it does contribute. And in Oklahoma we have, among States, the leading and very high divorce rate as well. We also have, because of the high incarceration rate, many children in foster care. Again, at the top of the list, we are wanting to reverse. But all of that said, it is about strengthening families. And we see in Oklahoma the need for loving family members, parents, grandparents, extended family. And where we don't have that we see community stepping in to bridge that gap for students. And this is part of this work as we think about trauma-informed practices in communities. Ms. Foxx. Thank you. Ms. Hofmeister, in your testimony, it says that 75 percent of your students suffer moderate or serious depression. That is a staggering number. Is the work you are doing around trauma-informed instruction developed to address this issue? And how much does the data about student needs drive the development of the instruction program? Ms. Hofmeister. Thank you again. And, yes, this is that needs assessment where we did receive that very compelling information from students. And we also know that it doesn't have to simply be a program about mental health. We see crossover impact with our career pathway work and post-secondary planning with the individual career academic planning which is now State law, it is a requirement for graduation. But it starts early, 6th grade, 7th grade, 8th grade, as our student tell us as we have spent 2 years piloting this, that those students who engaged in this had purpose and an awareness of a future beyond the tassel and graduation. That it is about something more. And teachers who now aren't just delivering tests at the end of a course but are looking beyond that at the student and their strengths. This actually has had an impact on hope and on trauma-informed practice that was unexpected, and we are studying with our researchers. Ms. Foxx. Thank you, Mr. Chairman. I yield back. Mr. Sablan. Thank you, Dr. Foxx. I am going to be more strict on time, because we do have Members in line for questioning. At this time I would like to recognize Mr. Morelle for five minutes, please. Mr. Morelle. Thank you, Mr. Chairman. Mr. Sablan. I am sorry, Mr. Morelle. I am really sorry. I need to--Dr. Shalala, please. I apologize, Mr. Morelle. Take it out on me later on. Dr. Shalala, please. Ms. Shalala. Thank you. Madam Surgeon General, last week HHS's office of the inspector general published a report, which I will submit for the record, following an investigation of immigrant children in detention centers. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Ms. Shalala. What the report outlined was how this administration's child separation policy makes worse the trauma that immigrant children have already experienced on their journey to this country. The investigators found that separated children exhibited more heightened symptoms of anxiety, fear of abandonment, and post-traumatic stress disorder than children who had not been separated from their parents. The report goes so far as to say, and I quote, ``some separated children expressed acute grief that caused them to cry inconsolably.'' Many of these children will eventually attend our schools once released from custody. Some of them will stay in detention centers in which--for example, in the Homestead facility, which had over a thousand children, the teachers had no training in trauma. Could you tell us what the science says about the effects of separating young children from their parents and placing them in inadequate conditions. Dr. Burke Harris. The science on that is unequivocal, that this is a harmful practice and that it increases children's both physical health risks as well as their mental, psychological, and developmental risks. Ms. Shalala. Thank you. Perhaps the executive director from Chicago could comment, because you have had a lot of immigrant children that have come through and who are in your school system on your own experience with these children that have been separated from their families for some period of time. Ms. Jackson. Yes. I would just extend some of the comments that Dr. Burke Harris made. In particular at the school system, CPS,--Chicago is a welcoming city, a sanctuary city, so we have a lot of students who emigrate to the United States and end up setting up a home in Chicago. We do our best to support those students when they disclose their status. And with that comes additional resources and support, in particular around navigating the school process, making sure that they don't have any barriers to enrollment, but also working with our students to make sure that there is the stability in their home life and that they have access to resources or know how to access those resources should they need them. I would count this as an area where we could definitely be doing more. Earlier there was a comment made just about our students and their families and how they feel or trust the school system or any type of government agency. I think the more we show an awareness around the need to support our students and families, they will disclose to us their status and ask for that support and thereby making it easier for us to identify students who may have experienced trauma. You know, they would disclose that so that we can support them. But I do still see a huge disconnect, if you will, because many of our families, in particular our immigrant families or undocumented families, do not trust the government agencies enough to disclose their status. Ms. Shalala. Ms. Hofmeister, what advice--particularly in the large facilities that we now have that are holding children that have been separated from their parents, we have not thought about or at least invested in training the teachers that are working with those children. What advice would you give to us on insisting that if we are going to hold unaccompanied children that we ought to be training the teachers? Ms. Hofmeister. Well, we definitely agree that our teachers need and actually want professional development support. Students of all kinds of trauma are arriving at our school doors and coming from the school bus. Teachers, though, are telling us that they want more specifics, more clinical and practical advice as well. But it is something that we are addressing again with a State-level trauma summit that is coming up, because the demand has been so great called Bridges to Hope, Teaching in the Shadow of Trauma. You know, trauma is trauma. We open our arms wide in public school for any child who comes through that door. And our teachers deserve to have the training needed. And we are using our Title 2 dollars, our Title 4 dollars as well that are afforded to us under the flexibility of ESSA, and we are grateful for that. Ms. Shalala. Thank you. I yield back. Mr. Sablan. Thank you very much, Dr. Shalala. At this time, I am going to recognize Mr. Grothman for five minutes, please. Mr. Grothman. Thank you. First of all, I want to respond a little bit to Congresswoman Shalala's comments. I have been down on the border three times. And I know in--or at least we were told, in May alone, 15,000 children came into this country unaccompanied by their parents. I think--we should all agree that it is better for children to be with their parents. And right now, apparently under American law, we have to accept most of these children, or do try to accept them or find foster care. I would be happy to work with her and, A, make sure that these children are not allowed in this country but sent back to their countries of origin where they can be reunited with their parents. And, secondly, I know one the things that bothers the border guards is even when children come with a parent, frequently it is only one parent, and the other parent is back in Central America or, whatever. And I know this bothers some of the courts in Central America. I know in our courts, even if, you know, parents are separated, we try to keep them in the same area as the children. So I would be happy to also work with you. And if a parent shows up with children in this country but the other parent remains in another country to again send those people immediately back to their country of origin where the children could be with both parents. Ms. Shalala. Mr. Chairman, if I might respond. The point is, if they are here, if they are being incarcerated by us in a facility and we are offering educational services, whatever services we are offering-- Mr. Grothman. Yeah. I think--right. Well, that is the problem. We have too many people around here who don't want to address the problem. Mr. Sablan. Do you yield? Mr. Grothman. Okay. Now, Ms. Hofmeister, just because some of these statistics they throw out, I almost question. You are telling us that 75 percent of the children in Oklahoma suffer moderate or serious depression? I mean, if I look out at a class of 28 kids, 21 are suffering from depression. Are you sure that is right or somebody isn't kind of exaggerating? 21 out of 28, if I look in a class in Oklahoma. Ms. Hofmeister. That is what the data tells us. And that is based on the students' voice. Again, we have surveyed 47,900-- Mr. Grothman. That is okay. I just encourage you, because I just find that hard to believe. I will ask Ms. Jackson. I wasn't aware you had so many immigrants in the Chicago schools. Of the immigrants that you invite into your sanctuary city, how many come with immigrant children? How many come with both parents? How many one parent and how many no parent? Ms. Jackson. I don't have that information. I don't want to make up any numbers. Mr. Grothman. Why don't you--that is very relevant. Why don't you--because you collect all sorts of other data. Why don't you--can you get that information for us? Because I kind of would like to know what we are getting here. Ms. Jackson. Just for the record, we do not collect that information as a school district. We have removed every barrier for students to enroll, so that is not information that we even collect. Mr. Grothman. You mean you don't know if, say, Johnny breaks his arm or something. You don't know whether no parents are at home, one parent is at home, or two parents at home? You don't even keep track? Ms. Jackson. Yes. We know, for every student, who is the parent or guardian of record. What I am saying is we don't know initially a student status, whether they--we don't ask them that information when they enroll in school in Chicago. It doesn't matter. Our door is open to all students. Mr. Grothman. That is not the point. I am just kind of stunned. That is not the purpose of this hearing, but it seems to me, if something horrible happens, say a health crisis, whatever crisis, I think the parent should know. You know, if both--if their mom and dad--both mom and dad should know. If just one parent is there, they should know. If there are no parents and we just deal with a guardian or a foster parent, we should know. Ms. Jackson. We do. We do have the information for the guardians and the parents of record. Mr. Grothman. Okay. So you cannot tell us the percentage of immigrants in Chicago who have a guardian and not a parent of the people who came here who are of a different citizenship? Ms. Jackson. No, sir. As I stated earlier, that is not information that we collect. Mr. Grothman. Okay. Well, next question. And I am going to kind of follow up on Congresswoman Foxx's comments. You have all sorts of statistics that you break down by race as far as people getting in trouble at school or being removed. Do you adjust that for, again, parents at home? I mean, we have had a dramatic change in the last 50 years in this country. Many, many less children raised with both parents at home, and I think that is a--some absolutely wonderful parents. Wonderful parents I know in that situation doing a great job. But I think overall it might be better sometimes both parents there. Do you have on how well your children are doing? Could you adjust it for parental situation at home? Ms. Jackson. No. Typically when we disaggregate the data, we look at race, socioeconomic class, gender. I think those are the--and then ability, whether or not the student is a special needs student or not. We do not disaggregate the data based on their family status. Mr. Grothman. That stuns me. I mean, if we are going to--I mean, that is something we can change people's behavior on, right, in the future? You are not going to change your race. You are not going to change any of these other things. Mr. Sablan. I hate to interrupt, but I said I was going to be stricter on time. Mr. Grothman. You have been very patient. Thank you very much. Mr. Sablan. Thank you, Mr. Grothman. And now Mr. Morelle, please, your five minutes. Mr. Morelle. Good morning. Thank you, Mr. Chairman. This is truly an important topic, and I appreciate each of the witnesses and their testimony. I think this is a really, really important topic. And I had some prepared remarks, which I am going to largely dispense with and just talk about my district for a moment, which is in Upstate New York, Rochester, New York. Rochester has, over the last several years, been identified as either number two or three in terms of childhood poverty in the United States among cities. So it is something that is distressing, the impacts of poverty. And I have been working on a number of initiatives that I am going to touch on briefly. But in the context of some of the work that I have been doing around poverty, several years ago I would admit to the fact that I thought, when people would talk about trauma, that it was generally regarded as physical kinds of trauma, domestic violence, gang-related violence, neighborhood violence. And it has really become clear to me over the years, I have become sensitized to the fact that it is housing and food insecurities and things that you don't necessarily see easily. And so that has led me to lead an effort in Rochester over the last several years, with significant State and philanthropic support, to not only have trauma-informed care in our community but to do it in an interdisciplinary way. I think Dr. Schrier talked about how, in the medical community, pediatricians and nurse practitioners see trauma. Classroom teachers and educators see trauma. In Rochester, we are trying to break down the silos between education, health, and human services so that those professionals can all speak to one another, identify trauma. So something I am very engaged in, very optimistic about. But I wanted to just ask a couple questions. I think you have all done a great job of just sort of identifying the impacts of trauma on development and on future success in life for children. And I think you have talked a great deal about the types of things you are doing. One of the things that I would like to ask you to talk a little more detail about, and perhaps let's start with Dr. Burke Harris, but any panelist who wants to comment, is--you talk about screening. I am just curious what the research tells you about how to identify trauma in children. I am sure there is screening questions you could ask. There is probably some obvious things about children who are withdrawn. But I suspect that some children carry the impacts of trauma that are harder to see. And I am just curious as what research tells you and what you are doing to try to become more sensitive to or more aware of traumas that don't have sort of an easily outward identifiable manifestation, if that is a fair question. I would just be curious what the research tells you and what you are doing in sort innovation around that. Dr. Burke Harris. Absolutely. You are right that some children will demonstrate behavioral or learning difficulties, but many children will not. For many children, there are no outward signs. And that is why, number one, screening is so important, and that is why California has moved toward universal screening for adverse childhood experiences for children and adults. Mr. Morelle. May I ask you? Could you just; talk a little about what that screening consists of? I hated to be really granular, but just sort of trying to get at that. Dr. Burke Harris. Sure. The screening actually consists of the ten criteria that were in the adverse childhood experiences questionnaire, which, for example, don't include poverty or community violence. Although the screening that we are using in California, the pediatric adverse and related life events screening the PERIL's tool does include other social determinants of health like food insecurity, housing insecurity, community violence, et cetera. So that is what is being used for kids. And then the traditional adverse childhood experiences for adults. Mr. Morelle. Sure. And may I ask you--and I am sorry. These five minutes go by so quickly. So when you are looking at food insecurities, is it done through an interview with the child, or do you get data from other sources that you somehow integrate? How is that--how do you get to that? Dr. Burke Harris. The screening is done in the primary care home. It is a questionnaire that families fill out. And, actually, the way that we do it in California is we use a de- identified screen. So we actually say don't necessarily tell us which ones of these your child has experienced, only how many. So that allows the primary care clinician to rapidly, in that very short 15-minute pediatric visit, identify who needs additional services. And then they can receive those services from a social worker. Mr. Morelle. And do you find that there is--that people-- the respondents still feel stigmatized in some way about being truthful about what the environment is that their child is living in? Is there sort of an embarrassment? Is it getting easier to get to that? Dr. Burke Harris. We find that the de-identified screen actually makes it more much easier. That is higher disclosure rates. Mr. Morelle. Well, I am sorry I have run out of time, Mr. Chair. But I appreciate it. And I will have to get further information from the panelists. Thanks. Mr. Sablan. Thank you. Now I recognize Mr. Taylor for five minutes. Mr. Taylor. Thank you, Mr. Chairman. I am going to yield 2 minutes to my colleague from Rochester to continue his line of questioning. I think he was asking some good questions. Mr. Sablan. Mr. Morelle, you have 2 minutes. Mr. Morelle. Mr. Taylor, thank you. You are quite a gentleman. So I am troubled by--not troubled by it. I understand it. So the ability to sort of drill down and really identify is partly self-identification by a parent or guardian. Is there any verification you do? Or how do you sort of get to--I guess I am--I know this is really granular, but to really sort of identify things that are hard to identify. Dr. Burke Harris. So we have 88,000 providers, primary care providers in California who see Medicaid patients. And in order for those 88,000 to be able to identify ACEs rapidly in primary care, that is why we use the de-identified screen. And then when that de-identified screen shows that a family needs more services for whatever reason, then they are referred to someone who can unpack that and do an identified screen. And that is the verification. So it is a two-step process, and that allows us to be able to more thoroughly identify. Mr. Morelle. And that is primarily done through the health side? That is a primary care provider or social worker? Dr. Burke Harris. Yes, on the health side through the primary care provider. Mr. Morelle. Do you match that data, then, with anything that you get out the classroom so that--so that in other words, if you had one or two risk factors on the social side, one or two factors on the health side, and one or two on the school, can you aggregate that data and get a profile and say, gee, we wouldn't have normally thought that child was suffering from trauma. And maybe by looking at one piece or one dimension we wouldn't have--but when we combine this, there is a troubling pattern here that tells us that we ought to do X. Dr. Burke Harris. Those are the systems that we are hoping to put in place. And I look forward to leading in my role as surgeon general of California. Mr. Morelle. Thank you, Mr. Taylor, for extending that courtesy to me. I don't know if anyone else had a comment about sort of that aggregating information. But if I might continue to borrow my time from Mr. Taylor? He has been very kind. Mr. Taylor. I did have one question. Mr. Morelle. You said 2 minutes, so I probably used them both up. So I will yield back. I appreciate both Mr. Taylor's indulgence and the panelists. Mr. Taylor. Thank you, Congressman Morelle. Ms. Hofmeister, this is a question for you. When we think about child trauma, where is that coming from? What are the--I mean, do we have statistical data on what the sources are? What are the sources? Ms. Hofmeister. Yes. It is childhood abuse, neglect, and other forms of child malpractice. Those could be when we are thinking strictly about ACEs, or adverse childhood experiences, those are different events that have occurred in the life. Divorce of a parent, an incarcerated parent. Mr. Taylor. Do we have percentages for that? I mean those percentages? Ms. Hofmeister. Yes. So Oklahoma leads the Nation with ACE scores of two or higher. We know that this is also in our world in schools, we feel it is most important to be able to focus on learning. But we really can't learn until we have some of that connection and some of those other areas addressed. But we also know that it is a heavy burden for teachers. And that is not something that we are asking burden teachers more and more with new mandates or additional programs, necessarily, that they must bear. Instead, we would like to see an awareness created, practical applications of trauma-sensitive instruction that could be as simple as telling a child what to do instead of what not to do. A child that has cortisol washing over the brain that is in a constant fight-or-flight kind of mode is not going to know what to do when you say stop, quit, don't. But instead, a teacher can simply say it is time to open our book or it is time to walk in the hall. Those are practical examples of tools that teachers can use, and they don't have to know a child's history to be able to do that. Mr. Taylor. And just speaking of history, what protections have you put in place in terms of privacy? I mean, clearly there are things we have to think about. Privacy is something important to all of us. How do you think about privacy? Knowing about the trauma, how far out do you go? Who do you tell? How do you keep privacy? Ms. Hofmeister. I think privacy is very important. And thank you very much, Representative, for bringing that up. And that is, then, outside the scope of what we focus on in our public school right now. Our teachers, with a new awareness, are able to make connections regardless of the details that might have occurred. And I think that is a very important first step. There is a program that is being used right now between law enforcement and schools. It is called Handle With Care. And our law enforcement that are in the home and notice a child is there have connected with the school and let them know, handle this child with care. Mr. Sablan. I am sorry. Mr. Taylor. Thank you. I yield back, Mr. Chairman. Mr. Sablan. Thank you, Mr. Taylor. So now I would like to recognize Mrs. Davis for five--Mrs. Davis for five minutes. Mrs. Davis. All right. Thank you very much, Mr. Chairman. Thank you to all of you. I think this is a politically well-informed and inspirational panel today. And I want to thank you for that. We have just been talking about sources of trauma for students. Ms. Hofmeister, you mention abuse, neglect. One of the issues that hasn't come up is actually gun violence and the impact that has on students, certainly not the only source of trauma as we said, but it is one of those sources. And I know that we had a hearing here recently. And Mrs. Hayes, I believe, asked Secretary DeVos about the use of Federal money to arm teachers. And she stated that she lacks the authority--Secretary DeVos, that she lacks the authority to tell schools they cannot use Federal funding to arm teachers. But I am wondering where you all feel this comes in and whether you believe, maybe if you all want to have a show of hands, whether or not you think that arming teachers is part of the solution to addressing gun violence in schools. Anybody feels that it is part of the solution to addressing gun violence in schools? Okay. Ms. Hofmeister. So I can only speak to Oklahoma. And that is not something we have had requested of the State Department of Education. Of course, this is a conversation for the Federal and the State level. Mrs. Davis. Okay. Thank you. Just so the record shows that nobody raised their hands. But what I also wanted to know was if you feel that gun reform can be part of the solution to reducing trauma and how do you think that might be. We know that for many students, actually, even the act of lockdown drills can be traumatic for them. And, of course, we know that the homicide rate in our country for 15- to 24-year-olds is 49 times higher than in other high income countries. How could we move some of those reforms into being something that is helpful in schools? Ms. Hofmeister. You know, I think some of what we are talking about is also meeting the needs of students early. And how that is often--when that is unaddressed there are serious complications and issues that arise. So our focus in Oklahoma is on meeting our kids right where they are early. And we believe that is the best use of our funds and preparing teachers through training. That is the key. Mrs. Davis. Yeah. Thank you. I don't know if anybody else wants to comment. I do have another question that really speaks to the need for us to be more responsive to teachers. Dr. Jackson, did you want to-- Ms. Jackson. Yes. I think commonsense gun reform is extremely important. Many times when we see these acts of violence in school it is a manifestation of, you know, things that have gone unnoticed or missed in a way that I think can be better addressed with the right policies and supports in place in our schools. One other thing that I would like to add is that what we do in CPS is we take seriously any types of threats of violence and that we work directly with the families. And we have taken an approach where, even if it is something such as a student making a threat online, we address that, and we don't go in with a law enforcement mentality initially. I know that some other cities and schools have taken that approach. But instead to get to the real issue, why would a student post this information. And oftentimes what we find, except in a few rare occasions when it is just a prank, is that there is something going on that needs to be addressed. And so we spend a lot of time connecting them with the resources but, more importantly, following that student and keeping track of, like, are they getting the resources that they need. Do they, you know, still have these ideas. And I think that is one of the things that we have been pretty--proud isn't the right word, but we feel good that we have a good process in place to address these issues. But with that said, it is constantly on the back of everybody's mind that an event could happen. Mrs. Davis. Thank you. Thank you, Dr. Jackson. What I wanted to just mention really quickly--oh, so one of the issues is around Oklahoma on the teacher's can carry a weapon, and I just wanted to again, for the record, mention that. Really quickly, because we talk about secondary trauma and compassion fatigue on the part of teachers. Having put in language in Title 2 for social and emotional learning and for being able to get grants to teach that, what would it look like if we really did support teachers in this effort and we acknowledge that it does make a difference for them. It is a reason that a number of teachers leave school. What would that look like for you? What is the most important thing that we could do that really addresses that? Mr. Sablan. I am going to interrupt, Dr. Jackson, and ask you to please respond to her in writing. Mrs. Davis. Writing. Ms. Jackson. Oh, will do. Mrs. Davis. Thank you. Mr. Sablan. Thank you. I would like to now recognize the Ranking Member, Mr. Allen, for five minutes. Mr. Allen. Thank you, Mr. Chairman. And we know that the family is one of the seven cultural pillars in our society. Statistically, we know that the family has been under severe attack in this Nation. In 1950, 93 percent of households, both parents were there for those children. And today it is less than 60 percent. And, Ms. Hofmeister, I know we don't allow studying in trying to come to grips with what is the real problem here. Are we doing anything as far as reaching these young people to change this cycle? I mean, if this cycle continues, how does it get better? Have you got anything to offer with regard to that, or are we just trying to fix what problem we have and we are ignoring the real cure here? Ms. Hofmeister. Well, in a public school, again, we are there to serve children who come with a variety of backgrounds. And our educators are there to address their academic needs. And we recognize that we are not able to work on those without first building that connection and rapport and trust with the students. So getting to know families and reaching out to families, all families, is important. And this is what builds a strong school and a strong community. So our approach is different now than it perhaps was years back. We are needing to be more creative in how we make those connections. And we also recognize that it is important to have school counselors in place as there are need for academic counseling as well as those who can provide crisis counseling or referring students and families to receive support that is needed through other community resources. The most-- Mr. Allen. Do you have the flexibility? I know that, when I talk to teachers, they are pretty limited in some regards legally what they can do and what they can share with their students about their life experiences, which is one reason I think we are losing teachers, because they feel like they are just being observed and criticized every step. Yet it sounds like that they are actually becoming the family, the family unit. Ms. Hofmeister. This is very true. We actually know that in Oklahoma we are looking to teachers often to be kinship placement family for those that are being put in foster care. Mr. Allen. Are there limits to what a teacher can share with a student in Oklahoma? Ms. Hofmeister. Certainly there would be some limits, I suppose, that would be--I am not sure exactly how to answer that except I would say this: We just want our teachers to feel supported so that they can support our students. And having more of our school counselors, it is beyond the service to students is also to coach teachers, to provide the kind of training that I think many of us at this table are talking about now, perhaps. But in the classroom setting. Classroom management is what we call this where you are building that kind of---- Mr. Allen. So, for example, are you able to talk about the family and the importance of the family unit and, you know, the design of the family and those kind of things? The teachers, are they allowed to do that? Ms. Hofmeister. Well, in public school we support families. Mr. Allen. Okay. Ms. Hofmeister. And that is paramount in our agency at the State Department of Education in Oklahoma recognizing that family engagement is key to success for students, and we are making that a priority and a focus. Mr. Allen. Okay. Now, when these students leave school, what is their feeling toward the family? Do they realize that, hey, to fix this, the cure here is for us to, you know, not have children before we get married. And then we get married, and we have children, and we raise those children with a set of values that will give them the freedom to do the things that I was able to do because I had an amazing family. So, like, are they--do they understand how--you know, what really has to change there. Dr. Burke Harris. May I add something? Mr. Allen. Yes. Dr. Burke Harris. I think that one of the pieces that is critical about this work is reducing stigma and reducing blame and shame. That is critical for healing and a recognition I think for families of understanding how the experience that parents had, perhaps their own adversity can be handed down and recognizing the key of safe and stable relationships. Mr. Sablan. Again, I am sorry. Mr. Allen. I yield back, Chairman. Thank you, panel. Mr. Sablan. Thank you, Dr. Harris. So now I would like to recognize for five minutes Ms. Bonamici, please. Thank you. Ms. Bonamici. Thank you, Mr. Chairman. I am going to start with a series of sort of big-picture questions about prevention. And these are issues that this committee works on. And I want to know if they should be part of the solution. Ms. Bonamici. School-based health clinics, just yes or no? [All witnesses]: [Yes all around.] Ms. Bonamici. Paid family leave? [All witnesses]: [Nod their heads ``yes'' in agreement.] Ms. Bonamici. So yes all around. Ms. Bonamici. Affordable childcare, a real challenge. [All witnesses] [Witnesses said ``yes'' in agreement with Ms. Bonamici.] Ms. Bonamici.Thank you. I appreciate that. We need to look at prevention as well as how we address the serious issue. And thank you for your testimony. I thought it was all very, very enlightening. We know the growing awareness of the profound effects of ACEs, and some of them have been mentioned. I want to follow up on a couple of them. Representative Shalala talked about children of immigrant parents. And I have to tell you that when I talk to kids, they are afraid to go to school because they don't know if their parents are going to be home when they get back. So that is a concern I have. I had a young woman who is a high school student say to me at a townhall meeting that the first thing she does when she walks into a classroom is to figure out where she can hide or how she can escape. So you can understand why these kids are going through so much trauma with the threat of gun violence, with immigrant families. And, of course, thank you, Dr. Burke Harris for talking about trying to get rid of the stigma. We want to make sure that everyone gets the help they need. And, Dr. Jackson, I think you mentioned the LGBTQ students who are already facing discrimination, oftentimes, and higher suicide rates and the inability to do well in school if they are feeling that pressure. So we know that, you know, schools in Oregon and across the country are doing what they can to support these students, but they need extra resources. And I am glad several of you mentioned the student support and academic enrichment grant programs and Title 4A of the Every Student Succeeds Act. We need to make sure, and I have been a leader on getting that fully funded, make sure that the schools have the resources to support those students. Dr. Burke Harris, a 2018 report by Child Trends, children of color are disproportionately represented among children who have experienced trauma, specifically 61 percent of African- American children, 51 percent of Latino children have experienced at least one adverse childhood experience. African- American children are also disproportionately subject to severe discipline. That is a GAO report. So how does racial and historical trauma and early adversity affect these marginalized students, particularly African-American, Native American students? Dr. Burke Harris. Although discrimination is not one of the traditional adverse childhood experiences, what we understand now is that cumulative adversity is what leads to the toxic stress response which is what causes the harm. Experiences of discrimination based on race, national origin, or other forms of discrimination add to the cumulative adversity and put those individuals at greater risk of health and--mental health and behavioral social risks. Ms. Bonamici. Thank you. And, Dr. Jackson, evidence suggests that the opioid crisis is, you know, creating all these new challenges in protecting vulnerable children. In October of 2018, Congress passed the Support for Patients and Communities Act to address the opioid crisis. The bill included $50 million to support trauma- informed practices in schools. Unfortunately, that program has not yet been funded. But what would you do with funding to scale trauma-informed practices in your school district specifically with regard to the opioid crisis? Ms. Jackson. These resources would make a significant difference in Chicago. I know a lot of times, when we talk about the opioid addiction, you know, we focus on other areas. But this is something that we struggle with in the city as well. One thing that we would do is expand the work that we are doing in our parent universities. I know family has come up with a lot, and we do have engagement with many of our parents through a parent-university structure. And with additional support being able to help train them and, in some cases, help direct them to other resources again to break that cycle would be helpful to us. So I would say more awareness and language to address those issues and reducing barriers to getting the support. Ms. Bonamici. Do you have any recovery high schools? Portland is getting ready to open a recovery high school to high school students who are in recovery so they don't have all the peer pressure of the students who aren't struggling with-- Ms. Jackson. No, we don't. We have prioritized putting health clinics in some of our schools who do provide that support to both students and people in the community, but we don't yet have a recovery high school. Ms. Bonamici. Thank you. And in my remaining few seconds, just one quick anecdote that was really meaningful to me. I was visiting a small school on the Oregon coast, and the principal told us an example of implementation of trauma-informed practices. There was a student who used to go to school with his hood up, on his hoodie. And the teachers would tell him to put his hood down and sit up. When they let him keep his hood over-- Mr. Sablan. I am sorry, Ms. Bonamici. Ms. Bonamici.--he did well in school because he was protecting himself-- Ms. Bonamici. Thank you, Mr. Chairman. I yield back. Mr. Sablan. Thank you. You are welcome. Thank you. I now recognize Ms. Wild for five minutes, please. Ms. Wild. Thank you, Mr. Chairman. It would be lovely if everyone had a perfect family. I don't think there is a definition of a perfect family. My own family of origin was flawed, and my current family that includes two children in their 20s who are doing fairly well was also flawed. So the--I am distressed by some of the comments we have heard today that seem to lay all of this at the feet of the family and the fact that there may be a number of children going to school without two-parent families. I don't think that anybody disagrees about the effects of ACEs. That is what I am hearing at least from all of you. And it seems to me that two things are just so important. First is awareness. And you are helping us with that. And I really appreciate it. I know we all do. We all need to understand this and know more about it. But the second and the most obvious elephant in the room is the funding for these kinds of programs. That includes, I might add, supporting teachers who have been put in the very unfortunate position of having to become counselors and pastors in addition to what they went in to teaching for, which is educating students. And, of course, the issue of secondary trauma is so important. So on that funding issue, it seems pretty clear to me that we still have a lot of work to do to convince our colleagues across the aisle that there is not only a place but a demand and a need for Federal funding to support these kinds of programs. So with that in mind, I would like to ask you a couple questions about why everybody should care about providing some additional Federal funding for this issue. We know that there are distressed school districts all over the country. In my district, which is the 7th District of Pennsylvania, we have one very severely distressed district. And, by the way, in that district, 3,000 Puerto Rican families came into the Allentown School District following Hurricane Maria. I might point out, they are citizens. They aren't immigrants. But it has very much contributed to the issues that are faced by that distressed school district that has trouble even affording textbooks and supplies. So we need to--we obviously have to do a job of convincing. So what I would like to know, and let me address this first to you, Dr. Jackson, what Federal programs or Federal funding are most important to supporting schools in creating and sustaining trauma induced-- trauma-informed care? Dr. Jackson. Funding to support programs like I talked about earlier, the SPARCS program, which allows us to work directly with students and their families doing psychotherapy, these are very powerful and impactful programs. They are also very expensive, and many school districts just simply can't afford to do this at scale. I would also say programming for trauma-informed practices to train all of the teachers as well as the other professionals in the district is something that is extremely helpful and can be impactful and, again, one of those things that we have trouble finding the necessary resources to support. I could go down the list, but I am sure my colleagues on the panel would like to get theirs in as well. Ms. Wild. Well, one of the things that I really wanted to ask you, Dr. Burke Harris, is about the issue of children in the United States currently getting the mental health and treatment services that they need. How can we in Congress and the Federal Government better support children who are experiencing ACEs? Dr. Burke Harris. I think that it is critical for us to certainly--I think the screening piece is absolutely critical, because early detection improves outcomes. The second piece, obviously, is the support for the responses, including mental healthcare, trauma-informed educational systems. And another critical piece is a public education campaign to raise awareness among families and everyday Americans. Ms. Wild. I am really struck by a quote that I read from Dr. Robert Block, former president of the American Academy of Pediatrics, who has been widely quoted as saying: Adverse childhood experiences are the single greatest unaddressed public health threat facing our Nation today. I think you made reference to that. Dr. Burke Harris. I want to also point out that ACEs don't just happen in low-income neighborhoods. The original study was done in a population 70 percent Caucasian, 70 percent college- educated, all middle class adults. And when we are looking at two-thirds of Americans have experienced ACEs, then we are really seeing that we cannot afford not to do early detection and early intervention. Ms. Wild. You get no argument from me. Thank you. Chairman Sablan. Thank you, Ms. Wild. And now I would like to recognize myself for five minutes. And I ask unanimous consent to insert into the record a letter from an eighth-grader whose school campus was destroyed by a super-typhoon, and it is entitled--and she shared her experience. It is entitled ``From Hopwood to Tarpwood.'' And having seen no objection, I insert this letter to get it for the record. Chairman Sablan. I do have questions that I may not be able to ask of you and submit it for your answers. But, Dr. Barker, how has McDowell County Schools changed its policies, procedures, and practices to align with being trauma-informed? Ms. Barker. We had to become more inclusive, and we had to create policies to work with our mental health providers and our school-based health clinics. As you know, you have FERPA and HIPAA regulations, and sometimes those don't communicate. So we had to really change those policies so that our mental health clinicians would be able to get information from our teachers to help them in their therapy sessions and, again, consequently be able to be back with the teachers and tell them not the diagnosis, but how can they help in the classroom. Because if we do all this therapy and work with our kids and it never translates into the classroom practices, it just cannot, you know, cannot be productive. So we had to include that. And we are also moving to restorative justices. Instead of just telling the kids, here, you go home for five days because you were fighting, what happened, you know, what happened at home the night before that kind of got you a little, you know, upset that you decided to take matters into your own hands? So we are working to be more open and change our privacy and confidentiality policies, just to make sure that we are communicating along the lines to help our kids. Chairman Sablan. So could I say then that teachers and staff have had to do things differently because of changes in policies, procedures, and practice? Ms. Barker. Yes. And we are using a lot of professional development. We have trained our service personnel and our professional personnel in Youth Mental Health First Aid, which is recognizing the signs and symptoms of certain behaviors and be able to refer and communicate with different therapists. Also with trauma-informed, we are providing the training. Let's take a look at the kid, you know, and just giving them scenarios. Here is Johnny. He did not bring homework to you. Here are the two scenarios: Teacher yells at you because, you know, Johnny, you did not do your work and you explode, or teacher actually asks Johnny and talks to him individually, what happened to you before? And just kind of looking at different scenarios. How do you react? How should you be reacting? So we are working with teachers to help them understand not everybody grew up with two parents and had, you know, place for homework at home. Kids are different and we should meet them as they are. Chairman Sablan. All right. And let me now turn to Dr. Burke Harris, if I may, because we have man-made climate change driving more severe weather, such as hurricanes, typhoons, fires that devastate entire communities, homes, and schools. This committee has heard testimony that students are experiencing post-traumatic stress disorder. What recommendations do you have for schools post natural disasters in caring for their students? And you have a minute and a half. Dr. Burke Harris. Yes. I would say, again, this just reiterates how important it is for all individuals in the educational environment to receive professional education and professional training about how to respond to a traumatic situation, whether that trauma is the result of a natural disaster or whether it is the result of community violence or violence or trauma that is happening at home. The responses, the fundamentals of the response and what the science shows us makes a difference in improving outcomes, are safe, stable, and nurturing relationships and environments, ensuring that all folks in the educational environment have that training; and more than just the knowledge, a set of tools and skills that they can apply in the educational environment to support children. Chairman Sablan. All right. Thank you. I am going to cut my 30 minutes. I will have records, I mean questions submitted of you and you will have time to respond. I remind my colleagues that pursuant to committee practice, materials for submission for the hearing record must be submitted to the Committee Clerk within 14 days following the last day of the hearing, preferably in Microsoft Word format. The material submitted must address the subject matter of the hearing. Only a Member of the committee or an invited witness may submit materials for inclusion in the hearing record. Documents are limited to 50 pages each. Documents longer than 50 pages will be incorporated into the record via an internet link that you must provide to the Committee Clerk within the required timeframe, but please do recognize that years from now that link may no longer work. And now, without objection, I would like to enter into the record the 1998 Regional Adverse Childhood Study By the Centers for Disease Control and Prevention and Kaiser Permanente; a 2019 report from the U.S. GAO, Government Accountability Office, regarding the approaches and challenges to supporting children affected by trauma; a report by the National Child Traumatic Stress Network on creating, supporting, and sustaining trauma-informed schools; a scholarly article written by researchers at Washington State University on the connection between adverse childhood experience and elementary school children; article by Rand on evidence-based practices that are effective in schools to support children affected by trauma. I am going to go through the list. An article by Everytown for Gun Safety on the impact of gun violence on children and teens; a fact sheet on ten things to know about trauma and learning by Alliance for Excellent Education; a policy statement by the American Academy of Pediatrics on the impact of racism on child and adolescents' health; a statement of Civil Rights Principles on Safe, Healthy, and Inclusive School Climates from the Leadership Conference; and five letters for the record from Alliance for Excellent Education, American Federation of Teachers, Binghamton University Community Schools, National Indian Education Association, National Association of School Psychologists, and National Education Association, in support of trauma-informed practices in schools. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Chairman Sablan. Again, I want to thank the witnesses for their participation today. What we have heard is very valuable. Members of the committee may have some additional questions for you, like I said, and we ask the witnesses to please respond to those questions in writing. The hearing record will be held open for 14 days in order to receive those responses. I remind my colleagues that pursuant to committee practice, witness questions for the hearing record must be submitted to the Majority Committee Staff or Committee Clerk within 7 days. The questions submitted must address the subject matter of the hearing. I now recognize the Ranking Member for his closing statement. Mr. Allen. Thank you, Mr. Chairman. I want to thank the witnesses for coming today. And I do want to clarify that, first, I am not talking about stigma or shaming. I am talking about the importance of faith and family in this culture. As we said in the beginning of the hearing, the testimony today makes it clear that trauma has a detrimental impact on student lives. We heard a lot of statistics about children suffering as a result of trauma. In fact, I am amazed at the numbers we are talking about here. But the bottom line is that each one of those numbers is a child, a child that needs to be helped and given the attention they need to succeed in life. I think Ms. Hofmeister shared some interesting information about projects she has undertaken in her State to help these students. One of the reasons I ran for Congress is an experience I had in my district. I supported a school there. I actually built the school. It is a great example of what it takes in children who have experienced trauma to transform their lives. I was proud to be a part of a local movement in Augusta, Georgia, which created the Heritage Academy. The Heritage Academy is a mission-based school that serves inner city school kids who have been labeled losers in the public school system. Their moms have no choice but to send these children to Heritage School. And they have been given up on by everybody but their mom. One of the key elements of this school is that kids are given a faith-based education. These children come from broken homes and through their education they learn their value and worth, taught by loving teachers, who are free to share their values so these students can learn the truth about what is right and what is wrong. These kids grow up to go to the best schools in Georgia and this Nation. I have never seen anything like it. It is a complete miracle. Heritage Academy is one of the many reasons that I believe families need options in education, options that help them connect with individuals who will care about them and help trauma not be a life sentence. It is not for everybody, but there are young people that need this. Considering what we have learned today about trauma, I believe this even more so. I did share earlier about this book, Death on Hold. This gentleman experienced everything that you described out there today. In fact, his life would be the capital T trauma. He was on death row. This man made a covenant with God, if God would let him live that he would make a difference. I ask you to read this book. It will tell you a lot about what is going on in this culture and what he says needs to be done to turn it around, because, like I said, he made a covenant to do that. And I encourage you to do that. In fact, he is now on life without parole, and I am going to do everything I can to get him pardoned, to get him out there talking to young people about his experiences and the consequences of those experiences. He is an amazing, amazing individual. Thank you again for being here today and helping us to learn more about this issue. And, with that, Mr. Chairman, I yield back. Chairman Sablan. Thank you very much, Mr. Allen. I now recognize myself for the purpose of making my closing statement. Again, thank you again to our distinguished witnesses for being with us. The insights and expertise you shared today make clear that childhood trauma is a pervasive public health crisis that demands our attention. Far too many children suffer from trauma that prevents them from healthy growth and success in school. Without adequate care, these child victims of trauma can become life-long victims. Yet, when a child struggling with toxic stress acts out in class, many of our schools resort to harsh discipline that not only fails to address the student's trauma but can even elevate it. Even schools that understand the care needed for traumatized children lack the resources and assistance to offer adequate student services. That is why Congress must invest in trauma-informed school practices that ensure children coping with trauma can look to their schools for support, not further harm. Before I close, let me reiterate again that our children's trauma can be prevented if we are able to recognize and address the root causes. If we can come together to stop the school shootings, end the separation of families at the border, and address widespread poverty, we can not only care for victims of trauma, but prevent children from becoming trauma victims in the first place. Only then can we truly ensure that all children have a chance at reaching their full potential. Thank you very much, again, to all of you. Thank you, Mr. Allen, for being with us today. And if there is no further business, without objection, the committee stands adjourned. Thank you. [Questions submitted for the record and their responses follow:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] [Whereupon, at 12:33 p.m., the subcommittee was adjourned.]