Creating a "Healing Environment" for Mr. Small Small

By Tony Rothfork | Posted on 11.14.2013 | 0 comments
One of the many wonderful things I get to do as a Self‐Contained ED Teacher in a public elementary school is to help kids recover from trauma. It seems that every year there is that one special kid in my class that touches my heart more than any of the others. Mr. Small Small has been that kid all year. 
I got Mr. Small Small when he was six years old, victim of type 2 or complex trauma resulting from extended exposure to traumatizing situations repeatedly early in life. The doctor said he was suffering from post‐traumatic stress disorder and his behavior was characterized by hyper‐arousal, hyper‐vigilance, problems with concentration and focus, and exaggerated startle response. 
His behavior challenged our best efforts in teaching him academics for any length of time. Instead, we focused on what Howard Bath calls “The Three Pillars of Trauma‐Informed Care” in the Journal of Safe Management of Disruptive and Assaultive Behavior, Volume XVII/ Issue I, March, 2009, published by Crisis Prevention Institute, Inc.
In his article, Bath states that “The brain‐based stress response systems of these children appear to become permanently changed as they focus attention on the need to ensure safety rather than on the many growth‐promoting interests and activities that secure children find attractive and stimulating.”
Bruce Perry (2006) has observed that traumatized children reset their normal level of arousal. Even when no external threats exist, they are in a constant state of alarm. In particular, such children come to view adults as potential sources of threat rather than sources of comfort and support.
In school settings such children are often described as hyper‐vigilant because they constantly scan the environment for potential sources of danger. Clearly Mr. Small Small’s brain had become re‐tuned to the possibility of harm as we learned how to best support his efforts to recover from the life altering trauma that occurred to him. Howard Bath goes on to explain that at the core of traumatic stress is a breakdown in the capacity to regulate internal states including fear, anger and sexual impulses. He says that one does not need to be a therapist to help address three crucial elements of healing: the development of safety, the promotion of healing relationships, and the teaching of self‐management and coping skills. That is exactly what I and my two aides did every day all year long with Mr. Small Small.
And how did Mr. Small Small get his name?
"Early in the year we told him big boys don't cry. Big boys don't pee in their pants. Big boys don't pick their nose. He responded with, 'I'm not a big boy; I'm a small boy. Small boys eat baby food, and wear diapers, and suck their thumb.' I think he never had a chance to be a baby when he was baby, so earlier this year he wanted to be one. His infant days were miserable for him and he remembers. He used to say, 'I don't want to be Nick; nobody loves Nick; Nick is bad; Nick gets thrown against the wall; people are mean to Nick. I'm Mr. Rothfork or I'm Mr. Crooks; I'm Mr. Small Small.'

—Tony Rothfork, Mr. Small Smalls' teacher
We constantly worked on creating that primary survival need of safety characterized by consistency, reliability, predictability, availability, honesty, and transparency to create a safe environment. We consciously developed a comfortable connection with Mr. Small Small and he gradually learned that it was ok to drop his guard around us and allow us to positively interact with him for gradually increasing periods of time among several school environments. Lastly, we continue to work with him in helping him learn how to regulate his emotions and impulses. 
Bath says that “These children may need adults who are willing to “co‐regulate” with them when their emotions run wild  . . .” and that’s exactly what we did on a daily basis. We sat with him, talked with him and were always there to comfort and reassure him that he was safe and that it wasn’t necessary to try to run away or hit others reacting to that urge to fight or flight.
Mr. Small Small has calmed down and matured immensely in a year’s time in our “Healing Environment” and continues to make remarkable improvements to self‐regulate. Today, a year later, he rarely wets himself, or throws chairs or lashes out and hits an adult or another student acting out his feelings of anger and frustration. Today Mr. Small Small can sit calmly with another adult while learning the sounds of syllables and listening to a story being read about “Paint it Purple”.   
Today Mr. Small Small told us that he doesn’t want to be called Mr. Small Small any more. Today he wants to be called Mr. Big Big.
Perry, B. (2006). Applying principles of neurodevelopment to clinical work with maltreated and traumatized children. In N. Webb (Ed.), Working with traumatized youth in child welfare (pp. 27‐52). New York: The Guilford Press.
About the Author
At the time of this article, Anthony Rothfork was the president of the South Carolina Council for Children with Behavioral Disorders. Rothfork has moved on to become an Assistant Professor at Northeastern State University, teaching the next generation of special education teachers.
Reprinted with permission from Anthony Rothfork from the SC Council for Children with Behavioral Disorders, Volume 15, No. 3, Spring, 2009 newsletter.

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