Essay: Impact on student well-being and behaviors of children exposed to trauma and neglect

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  • Impact on student well-being and behaviors of children exposed to trauma and neglect
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Chapter 1: Introduction

1.1 General

Contextually, the Australian Government’s recently released paper, entitled ‘Australia’s Welfare 2015’ helps to set the scene for this study.

Adverse experiences in childhood, including poverty, child abuse and neglect, family violence, parental substance use, early mental health problems, poor health and nutrition, and growing up in a family dependent on welfare, have a negative impact on the social and cognitive development of children, with lasting health and welfare impacts in adulthood (p 76).

This research study is an evaluation of the effectiveness a series of four focused workshops had on both enhancing the knowledge and understanding of teachers regarding the impact on student well-being and behaviors of children exposed to trauma and neglect, along with the contribution and role of play therapy as a counselling tool to support these vulnerable students.  This research was prompted by the number of students with this background referred to the school counsellor (Guidance Officer) for social-emotional and behavioral difficulties, with teachers expressing frustration that ‘universal teaching and behavior strategies’ for classroom management did not appear to work consistently for these students (Safeschoolshub.edu.au, 2016). Many teachers indicated they were unclear about the role of the school counsellor, along with the presenting difficulties these students may exhibit, that would be appropriate for referral. Teachers may not be aware of the pervasive effects of trauma and neglect on a child’s well-being that may appear as emotional, behavioral, social, cognitive and physical difficulties. Teachers may also not be aware of how interventions, such as play therapy, can be used to support students as part of a whole school approach (Axline, 1989; Streeck-Fischer & van der Kolk, 2000).

The aim of this study is to raise awareness of this complex issue of trauma and neglect, identify topics teachers’ believe to be important in increasing their own understanding, and develop an understanding of the role and benefits of play therapy as a counselling tool. It is hoped that this will lead to a more cohesive approach to supporting these students at a whole school level which will impact positively on the well-being of all students and staff.

Working with the teachers in my current institution has led to my belief that to develop a whole school approach to working with such troubled children needs to include better education for teachers and administrators as to what play therapy is, and how it might help these students. The researcher believes there is a sense of urgency to enhance understanding at a whole school level, in an attempt to lessen the impact trauma and neglect may have.  ‘Disparities widen and trajectories become more firmly established if the cumulative risks impacting on some children are not addressed'(www.whealth.com.au).

With children at school for many hours,   teachers and schools have a primary role and opportunity to support students who may have suffered these adverse experiences by providing a supportive environment for children to learn. The damaging impact of abuse and neglect on some children’s ability to learn and navigate the social world of school has been described by researchers (Perry, 2006; Streeck-Fischer & van der Kolk 2000).  In addition to the demands faced by teachers on a daily basis focusing on teaching the curriculum and differentiating for academic differences, teachers are faced with challenges relating to behaviours that don’t appear to respond to strategies that form part of the ‘essential skills of classroom management’ that they are trained in (Education.qld.gov.au, 2016). To further develop capacity, teachers need both professional development specific to the academic and behavioural challenges they encounter with the multitude of diverse needs in their classrooms, and a clear pathway for whole school support from administrators and specialists to support both their students and themselves. In schools, Guidance Counsellors (school counsellors) have the role of specialists supporting children with mental health difficulties.  The role of the school counsellor is complex, and includes proactive prevention programming, assessment and program planning, collaboration with a range of stakeholders and interventions that include both group and individual counselling (Campbell & Colmar, 2014). Teachers’ understanding of the school counsellor’s role often comes from their experience in previous institutions, where the counsellor may have focused more on assessment and collaboration than intervention, though their role is critical in developing school support (Sawyer, 2000).  As such, many teachers are unaware of the breadth of counselling techniques, such as play therapy, that may be used with students, and this may contribute to teachers’ uncertainty of who would benefit from referral to the school counsellor and why.

In Australia, and in particularly Queensland, the terms ‘Play Therapy’ and ‘Play Therapist’ are not well known. Despite play therapy being acknowledged within the mental health domain in America in 1982, it is only in recent years that training through university affiliated organizations has been offered in Australia. In Queensland, where this research study took place, Expressive Therapies (ET), of which Emotional Release Counselling (ERC) and sand play are a part, are better known terms. Mark Pearson (2003), credited with bringing the training of Expressive Therapies to school counsellors in Queensland, describes the ‘activity base’ in expressive therapy methods as ‘closely echoing play therapy approaches’.  Malchiodi (2013) concurs that play therapy is one of the individual approaches within the expressive therapies,  however, differentiates it as ‘the systematic use of a theoretical model to establish an interpersonal process wherein trained play therapists use the therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development’ (p.3).

It is the researcher’s belief that the profiles of ‘Play Therapy’ and ‘Play Therapist’ must be raised in Australia, particularly in Queensland. Research demonstrates play therapy as effective for a number of presenting concerns, including behavioural difficulties and social adjustment (Bratton et al, 2005; Landreth, 2002) academic difficulties  (Blanco & Ray, 2010; Lamont et al 2010), self-esteem (Bratton et al, 2005), and family change, grief and trauma (Landreth, 2002; Kot & Tyndall-Lind, 2005). Although play therapy is currently used by the researcher/ school counsellor in her current school, increasing staff understanding of the theoretical grounding and application of play therapy as a counselling tool may assist in timely referrals and better understanding of some of the difficulties reported by students and staff, and observed by the researcher, in transitioning from the play therapy session back into the classroom.

The expectation that children should re-enter the classroom with an ‘academic attitude’ is cited as a common difficulty with the transition (Drewes, 2010; Ray, 2011). The researcher’s observations of this when returning students to class is that students need some transition time moving between the ‘safe space’ of the play therapy room and the regular activities of the classroom.

The researcher has also observed this to be difficult for teachers, who are often focusing on the competing demands of the curriculum, large classes, managing behaviour and needs of a multitude of diverse learners. They may find the interruption in the child’s school day to attend play therapy to be frustrating, especially if they know little about it. Drewes (2010) argues that barriers to successful play therapy in schools can be overcome with strategies, including clear definitions of the role of play therapist and play therapy, building relationships with staff, and participating in every opportunity to develop staff understanding about play therapy, and the benefits for children.   Drewes also argues that whilst there are many studies demonstrating the efficacy of play therapy, further research is needed to investigate the therapeutic factors that produce desired change in clients.  The researcher’s belief is that a therapeutic factor should include the role of the teacher. Brown (2000) concurs that due to the amount of time a child spends in class, and the established relationship between teacher and student, the teacher is important therapeutic factor, and  can positively impact and support children in overcoming adverse early experiences, as are in daily contact with their students (Dwyer et al. 2010; Perry, 2002; White et al., 2007).

1.2 Research Aim and Objectives

Research questions:

•    To what extent can school based workshops improve the knowledge and understanding of teachers on the impact of trauma and neglect on the behaviors of their students?

•     What, if any, school-based workshops do teachers find most helpful in improving their understanding of the role of play therapy with children suffering from trauma and neglect as part of a whole school strategy

Firstly, the dissertation will explore the literature on mental health, with a focus on Australia and school contexts. The study will then discuss trauma and possible effects, and the role of play therapy which research has found to be an effective counselling tool for children exposed to trauma and neglect (Landreth, 2002; Kot & Tyndall-Lind, 2005). The study will then investigate the role of inter-professional communication and teacher education.

Chapter 2 Literature Review

2.1 Contextual Background

An improved understanding of the benefits of play therapy, trauma theory and characteristics children may present with is important with ongoing concern worldwide about the number of children exposed to abuse and neglect. This may indicate an increased likelihood of classroom teachers working with children with mental health and developmental vulnerabilities as a result of this. The second national data collection of Mental Health Difficulties of children and adolescents in Australia was released in August 2015 (AIHW, 2015), with the publication of the second Child and Adolescent Mental Health and Wellbeing survey. In Australia, the incidence of mental health difficulties appears to be increasing. The inaugural survey, conducted in 1998 reported Mental Health Difficulties to be the third leading cause of disability in Australia, with fourteen percent of Australian children and adolescents aged fourteen to seventeen having mental health or behavioural problems (Sawyer et al., 2000). In 2003, mental health difficulties were reported to be the second highest cause of disability in Australia (Begg et al., 2007), and in 2012, the Australian Bureau of Statistics estimated that 25% of young people aged between twelve and twenty-six years’ experience mental health problems (ABS, 2012). However, Sawyer (2000) reports that only one in four young people with mental health difficulties receives professional support. Substantiated cases of abuse and neglect are also increasing in Australia with an increase from 26, 237 children aged 0-12 the subject of a substantiation of notification during the 2007-2008 calendar year, to 33, 561 cases during the 2013-2014 calendar year (AIHW, 2015). Statistics are similar in other western countries with childhood abuse and neglect in the United States a major public health problem, with ‘childhood exposure to interpersonal trauma described as a silent epidemic’ (Kaffman, 2009; Gibert et al., 2009).

The World Health Organization promotes schools as an ‘ideal environment’ to promote positive mental health with schools in recent years becoming primary providers of mental health services (Durlak et al., 2011; Burns et al., 1995; WHO, 2011). In Australia, the Health Promoting Schools (HPS) approach supports the Kids Matter Program (2012) in primary schools, and the Mind Matters Program (2010) in secondary schools. These programs use universal strategies to promote whole school positive mental health strategies, and use a three-tiered approach to prevention and intervention. Similarly, Positive Behavior for Learning (PBL) uses a school-wide universal design that targets behavior using a three-tiered approach. The aim of these three-tiered prevention programs is for all students to receive universal support at the first tier level, additional support if required at the second tier, and where needed the highest level of support at the third tier. Elias and Weissberg (2000) argue the importance of teacher training in these programs in order to support inter-professional communication, “if teachers lack the training, skills, and knowledge necessary to participate in an exchange of experiences and developments with external partners, and the ability to work across professional and institutional boundaries – there is little feasibility in implementing or sustaining a HPS approach” (p.8).

With a focus on supporting and building capacity of teachers through the development of skills and knowledge, this study considers several theoretical paradigms to demonstrate the impact of trauma on the development of the child. In addition to attachment theory and emotional self-regulation, an understanding of neuroscience and the impact of trauma and neglect on the developing brain will be explored.

2.2 Trauma Definitions:

There is not a standard definition of trauma in the literature. The National Child Traumatic Stress Network (NSTSN) lists 13 types of trauma: community violence, complex trauma, domestic violence, early childhood trauma, medical trauma, natural disasters, neglect, physical abuse, refugee and war zone trauma, school violence, sexual abuse, terrorism and traumatic grief. Complex traumatic events and experiences are defined by Courtois (2004) and summarized as stressors that are:

(1)    repetitive, prolonged, or cumulative

(2)    most often interpersonal, involving direct harm, exploitation, and maltreatment including neglect/abandonment/antipathy by primary caregivers or other ostensibly responsible adults, and

(3)    often occur at developmentally vulnerable times in the victim’s life, especially in early childhood or adolescence, but can also occur later in life and in conditions of vulnerability associated with disability/ disempowerment/dependency/age /infirmity, and so on (Recognizing complect trauma today).

The category of Developmental Trauma Disorder (DTD) was proposed by van der Kolk for inclusion under “Trauma and Stressor-Related Disorders” for inclusion in The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) but not accepted by the American Psychiatric Association (Polzin, 2014).For the purpose of this research study the definition of trauma as defined by Perry (2002) will be adopted. Perry describes trauma as a ‘psychologically distressing event that is outside the range of normal childhood experience and involves a sense of intense fear, terror and helplessness’ (p.23).

Children who have experienced early, chronic trauma, can develop mental health problems due to the effect of trauma on the developing brain and subsequent cognitive, emotional, behavioural, and relationship difficulties causing barriers to learning and social relationships in schools. (Cole et al., 2005; Perry, 2001; Streeck-Fischer & van der Kolk, 2000). Social, emotional and behavioural difficulties impact on their ability to be successful at school, are likely to persist throughout schooling and are associated with later poor learning and mental health outcomes where no targeted intervention has occurred (Putnam, 1997; Reinke, Stormont, Herman, Puri & Goel, 2011; Darney, Reinke, Herman, Stormont, & Ialongo, 2013). The child’s complex difficulties with self-regulation and relational impairment may meet the diagnostic criteria for a range of other diagnoses (Perry, 2006, Cook et al., 2005).

2.3 Domains of Impairment Relating to the Impact of Trauma in the classroom:

Cooke et al. (2003), proposed a ‘phenomenologically based framework for the impact of complex trauma exposure’, based on his review of clinical and research literature.  The framework has seven domains of impairment. There is an overlap in observable symptoms between the domains as are all linked.

Table 1.

Domains of Impairment in Children Exposed to Complex Trauma

I. Attachment IV. Dissociation V11 Self Concept

• Problems with boundaries

• Distrust and Suspiciousness

• Social Isolation

• Interpersonal Difficulties

• Difficulty attuning to other people’s emotional states

• Difficulties with perspective taking • Distinct alterations in states of consciousness

• Amnesia

• Depersonalization and derealization

• Two or more distinct states of consciousness;

• Impaired memory for state-based events • Lack of a continuous, predictable sense of self

• Poor sense of separateness

• Disturbance of body image

• Low self-esteem.

• Shame and guilt

II. Biology V. Behavioral Control

• Sensorimotor developmental problems

• Analgesia

• Problems with coordination, balance, body tone

• Somatization

• Increased medical problems across a wide span • Poor modulation of impulses

• Self-destructive behavior

• Aggression towards others

• Pathological self-soothing behaviors

• Sleep disturbances

• Eating disorders

• Substance abuse

• Excessive compliance

• Oppositional behaviors

• Difficulty understanding and complying with rules

• Reenactment of trauma in behavior or play (e.g. aggressive or sexual)

III. Affect Regulation V1 Cognition

• Difficulties with emotional self-regulation

• Difficulty labelling and expressing feelings

• Problems knowing and describing internal states

• Difficulty communicating wishes and needs • Difficulties in attention, regulation and executive functioning

• Lack of sustained curiosity

• Problems with processing novel information

• Problems focusing on and completing tasks

• Problems with object constancy

• Difficulties with planning and anticipating

• Problems understanding responsibility

• Learning difficulties

• problems with language development

• Problems with orientation in time and space

Cooke et al. (2003)

The impact of the domains are expanded on in the following paragraphs, in relation to the school setting. The impact of attachment difficulties leading to interpersonal difficulties, including difficulties with relating to the emotions and perspectives of others, and difficulties in attuning to other’s emotional states as described by Cooke could impact on all relationships in the school environment.  Historically, the impact of trauma and neglect on attachment have been described by Bowlby and more recently, Perry as having lifelong effects, ‘Experiences during this early vulnerable period of life are critical in shaping the capacity to form intimate and emotionally healthy relationships’ (Perry 2001, p.1). Bowlby’s attachment theory describes the negative effects on mental health in the absence of a positive relationship with a primary caregiver, as may be the case with complex trauma, at a critical time during a child’s development, as this impacts on a biological need for safety and development (Bowlby, 1969). However, critics of Bowlby’s work refer to other contributing factors, including temperament, ‘Generally temperament and attachment constitute separate developmental domains, but aspects of both contribute to a range of interpersonal and intrapersonal developmental outcomes’ (Seifer et al., 1996; Vaughn et al. 2008 p 16). Ainsworth (1967) refers to attachment as having a neurobiological basis, in that ‘attachment is more than overt behavior; it is built into the nervous system, in the course and as a result of the infant’s experiences with the mother’. More recently Shore (2003 ) describes this neurological basis in that  ‘early abuse negatively impacts the developmental trajectory of the right brain, dominant for attachment, affect regulation, and stress modulation, thereby setting a template for the coping deficits of both mind and body that characterize PTSD symptomatology’. With research by Gottman et al. (2007) finding that children who can regulate their emotions and responses have fewer behavioral problems and can achieve more academically in schools, understanding the theoretical groundings of both attachment and self-regulation is critical for teachers working with these students. A secure relationship with a teacher was found to partially compensate for insecure relationship with the mother about the development of pro-social skills (Copeland et al., 1997).

Biological impairments leading to sensorimotor developmental difficulties, such as with body tone, balance and coordination can impact on both social and academic progress. Many school activities, such as sport and handwriting are dependent on the ability to coordinate gross and fine motor movements.

Sensory reactions such as the fight or flight response are also described by other authors as occurring when the autonomic nervous system becomes aroused affecting the child’s ability to think clearly or attune to their emotional state (Ogden 2006, Van der Kolk, 2000). These are described as survival defenses which may be observed in the classroom as ‘excessive motoric activity which may make the child appear hyperactive, defensive or aggressive’ (Figley, 2002 p 132; Ogden, 2006; Siegel, 2012).  Children who have been exposed to trauma and neglect may perceive there to be similar threats at school, activating the fight/flight or freeze response. The child may be in a hyper-aroused state where he is over vigilant which in turn leads to this fight or flight reaction with emotional or physical outbursts. Cooke describes these as impairments of affect regulation, where a child has difficulty with emotional self-regulation including being in tune with their emotional states, and labelling and expressing these states. The child may also become hypo-aroused, described by Cooke as an impairment relating to dissociation. The child may appear inattentive and unfocussed, with alterations in attention and consciousness leading to both amnesias and dissociative episodes and depersonalization (Courtois, 2004), further impacting on memory and learning. The hypo-aroused child may have reduced capacity to feel the experience, whereas the hyper-aroused child may dissociate due to the overwhelming intensity of sensations and emotions.  Siegel (2012) describes the optimal arousal zone as a ‘window of tolerance’ where a person can contain and experience the affect, sense perceptions and thoughts and process effectively.

Behavioural control is a domain of impairment often cited by teachers when referring children to the school counsellor, describing these behaviors as oppositional, impulsive and aggressive. Stress-response systems if poorly regulated or abnormal, such as poor emotional self- regulation, including dissociation, anger and self-destructiveness, can cause dysfunction in all parts of the brain, further impacting on a child’s coping strategies in the classroom (Perry, 2006; Courtois, 2004). Poor modulation of impulses arises with the amygdala acting as a neural alarm to release neurochemicals and the stress hormones cortisol and norepinephrine, preparing the body for fight, flight, freeze responses before the neocortex or thinking brain has had the chance to analyze the information and respond rationally (Schore, 2001; Perry, 2006). This may appear as a ‘poor behavior choice’, whereas the response has not been in the child’s control.

Trauma disrupts the normal pattern of brain development (Perry & Pollard, 1998), resulting in cognitive impairments.  Brain development occurs in a sequential order during critical or sensitive periods and within each of these sensitive periods requires sufficient opportunity for exposure to patterned and repetitive stimulation to assist the neural systems of the brain to organize into proper structures and related regions (Perry, 2006, Montessori, 1967). If this does not occur, the neural systems may begin to organize into incorrect pathways, causing the brain to develop in maladaptive ways (Perry & Hambrick, 2008, Perry, 2006). Symptoms can results in all parts of the brain and be seen in the classroom as sleep and attention problems (brainstem), fine motor control and coordination (diencephalon and cortex), clear social and relational delays and deficits (limbic and cortex) and speech and language problems (cortex) (Perry, 2006). Axline’s observations of her student Dibs describe the confusing symptoms that teachers may see, “At one time, he seemed to be extremely retarded mentally. Another time he would quickly and quietly do something that indicated he might even have superior intelligence” (Axline, 1964 p.11).    Researchers such as Putman, Bucker and Perry have found deficits can be pervasive in school-aged children, with difficulties in complex visual attention, visual memory, language, verbal memory, planning, problem-solving, attention, and working memory consistent with Lower IQ and poorer performance in school.  (Putnam, 2006; Perry, 2006; Bucker, 2012;).

Impairments in self-concept are also described by Cooke.  Children learn self-worth from relationships with others, and as such abuse, neglect and lack of predictability can affect self-esteem and leave a child with pervasive feelings of shame and guilt. This can impact on a child’s relationships with both teacher and peers (Schore, 2001; Streeck-Fischer, 2000). Trauma and neglect can occur at any age. Perry’s Neurosequential Model of Therapeutics (NMT) identifies the age that the brain may be affected through abuse and neglect to the stage of sequential development of the brain.

Table 2: Age and Brain Development

Age of Most Active Growth    ‘Sensitive Brain Area’    Critical functions formed

0-9 months    Brainstem    Regulation of arousal, sleep and fear states

6 months-2 years    Diencephalon    Integration of multiple sensory inputs: fine motor control

1-4 years    Limbic    Emotional states; social language; interpretation of non-verbal information

3-6 years    Cortex    Abstract cognitive functions; socio- emotional integration

Perry (2006, p. 41)

This understanding of neuroscience is important to both school counsellor and school staff. By understanding the critical functions that are formed at the stage of brain development when the impairment occurs, emotional and developmental skills that may have been affected can be replicated through the use of activities available in the play therapy room (Perry & Szalavitz, 2006; Perry, 2006, (Homeyer & Morrrison, 2008). Having discussed the impact of trauma and neglect on the developing brain, the literature review will now focus on play therapy, its history and potential contribution.

2.5    Play Therapy

Historically, the first documented case of therapeutic play was Sigmund Freud’s work in 1909 titled ‘Little Hans’, with Freud attributing Hans’s horse phobia to an emotional cause, through the father’s notes on Hans’s play. Psychoanalytic play therapy further developed with Hermine von Hug-Hellmuth, also in the early 1900’s being credited as being the first therapist to provide children with toys for therapy. Theoretical approaches were applied to play therapy during the mid-1900 by Melanie Klein (1955) and Anna Freud (1965), with Freud emphasizing the therapeutic relationship between therapist and child prior to analysis, and play as free expression. Also in the mid-1900’s, a second important historical influence was the development of  a more directive approach with structured play therapy  known as release therapy developed by   David Levy (1938), and  Gove Hambidge (1955) who extended this to introducing anxiety provoking events, playing them out and then allowing the child free play time to recover 9Landreth, 2002). A third major historical milestone is described as relationship therapy, attributed to the work of Jess Taft (1933) and Frederick Allen (1934) which emphasized the ‘powerful and curative relationship between therapist and child’, without emphasis or interpretation of past experiences. The fourth historical influence is attributed to Carl Rogers client-centered therapy (1951), and his student Virginia Axline’s expansion of this to the concept of child-centered play therapy, (1950) and it is this theoretical background that the researcher operates from as a play therapist. In the 1960’s play therapy began to be used as a counselling tool in schools by school counsellors, when Guidance and Counselling programs were introduced in elementary schools in America.

Research into play therapy over the past decade has found it to be an effective therapy for a range of presenting problems, including for children who have experienced abuse, domestic violence and post-traumatic stress (Baggerly, Ray & Bratton, 2010; Bratton et al., 2005; Landreth et al., 2010).  More recently, Gaskill and Perry (2014), have offered a neurodevelopmental perspective using Perry’s Neurosequential Model of Therapeutics (NMT) targeting traumatized children, using a developmentally sensitive sequence or somatosensory approach (Cook et al., 2005; Gaskill & Perry, 2014). The therapeutic aim is to help the child self-regulate, whilst providing developmentally and cognitively appropriate play experiences.

The authors emphasize that for the traumatized child to modulate and reorganize their regulatory neural networks, they need to be exposed to many positive and repetitive healthy interactions, more than the weekly play therapy session, thus calling for a whole of school support (Perry, 2009).

The final component of the literature review discusses the role of inter-professional communication and delivery of teacher professional education.

2.6    Interprofessional  Communication

Bateman et al. (2013) argue that there is a need for systemic reform for Trauma-Informed Care and Practice (TICP) in Australia, with the implementation of strategic frameworks at both system and service levels, such as schools, to break the cycle of intergenerational abuse, and support the recovery process. Bateman et al. (2013) also argue that any systemic reform should include communication practices between agencies and professionals, especially that between school counsellors and teachers, school counsellors and outside agencies, and teachers and outside agencies.  As members of each professional group think in a specialized way inherent to their profession, the process of interprofessional communication is key, so that communication does not fail with the misunderstanding of key messages between stakeholders (Elias & Weisberg, 2000).

School communities benefit through a shared understanding that the behavioral challenges of children with trauma histories are complex in nature, often outside of the child’s capacity to choose the ‘appropriate’ response, and needing a whole school approach to supporting neuro-chemical reactions, sensory difficulties and relational impairments (Howard, 2013). However, barriers to building strong collaborative and supportive whole school approaches can occur due to the diversity of professionals, as each profession has a different value system which can create communication barriers between professions. Difficulties such as unfamiliar vocabulary, different approaches to problem-solving, and a lack of common understanding of issues and values can become problematic. Verhovsek et al. (2009) argue that lack of autonomy by different professionals, role confusion, territorial disputes and role overload are barriers that can impact on successful teams. Respect and a willingness to collaborate are key to successful interprofessional communication, with Ryan (2006) arguing that effective teamwork is not necessarily achieved by merely putting people to work together.

Desimone (2009) suggested a framework containing five core features that define the quality of teacher professional development: (a) focus on content knowledge, (b) opportunities for active learning; (c) coherence with other learning activities; (d) duration of the activity; and (e) collective participation of teachers from the same school, grade or subject. Research conducted by Meiers and Ingvarson (2005) concurred with findings that content, active learning and collective participation were most impactful on teacher development. Whilst agreeing with these essential components of teacher education, Opfer and Pedder (2011) argue that this does not adequately address the variety and complexity of the variety of different environments where teachers’ live and work. Whilst the framework of Desimone and colleagues has a purpose for planning and evaluation of workshops, the researcher concurs with Opfer and Pedder that where the complexity of the environment is as challenging as where the research project took place that this framework is somewhat simplistic. Thus the need to attend to a conceptual framework where interprofessional collaboration is paramount, such as professionals determining the professional activities needed,  is critical to any teacher professional development aimed at strengthening inter-professional  communication and practice. Collaboration with the leadership team prior to running the workshops as part of the process of ethical clearance for the research process utilized the ten ‘Key issues in planning interprofessional education/collaborative practice initiatives (Nasmith  et al., 2003).

1. What are the etc xx

2.

3. Chapter 3 Research Design and Methodology

4. This study aimed to evaluate how effective school-based workshops were in enhancing teachers’ knowledge and understanding about the contribution of play therapy for pupils exposed to trauma and neglect by encompassing the following aims and objectives:

5. •    To what extent can school based workshops improve the knowledge and understanding of teachers on the impact of trauma and neglect on the behaviours of their students?

6. •     What, if any, school-based workshops do teachers find most helpful in improving their understanding of the role of play therapy with children suffering from trauma and neglect as part of a whole school strategy?

7. 3.1 Inquiry paradigm

8. The difference between qualitative and quantitative research is traditionally seen as a methodological issue with advocates occasionally promoting one methodology as inferior to the other (Bryman, 1998). The two methods differ epistemologically. Walker and Evers (1988) state epistemology relates to how phenomena can be made known to the researcher.  Researchers who take a purist epistemological or strong paradigmatic view purport each method to be exclusively superior. Purists from a positivist perspective advocate that quantitative methodology is objective with researchers remaining emotionally detached and uninvolved with the objects of study.  Purists from a constructivist or interpretivist perspective reject this view and advocate qualitative approaches with its emphasis on research that is dependent on the interactions of people as part of a social system which, they state, is how meaning is constructed (Onwuegbuzie & Leech, 2004). Researchers with a weak paradigmatic view like situationalists, believe either quantitative or qualitative methods can be used, but not in the same research study. A third research approach is favored by pragmatists who advocate that a combination of the methods, or a mixed methods approach, can successfully be used to enhance understanding as there are both similarities and differences between quantitative and qualitative methodology.

9. Historically, Creswell (2003) describes research approaches in the social science domain from late 19th century to the mid-20th century as being primarily quantitative.  Research methodologies used in social science for much of the 20th century was largely quantitative, with an increased interest in qualitative research towards the latter part of the century and in the mixed method approaches. Bryman (1988) argues that the decision to choose a specific methodology should be based on its suitability to answer the research questions, with both qualitative and quantitative methods having strengths and weaknesses. Lobe et al. (2008)  agrees that each researcher should consider the purpose of their study with no ‘ultimately preferred’ research method, be it solely qualitative, solely quantitative or using both methods, and that using more methods, as with the mixed methods approach,  doesn’t necessarily lead to more valid data.

10. The research methodology, therefore, should be determined by what the researcher is trying to learn. Brewerton & Millward, (2001), attest that quantitative researchers try to investigate phenomena without influencing or being influenced by it. This is in direct contrast to a qualitative approach to research which uses phenomenology to gather rich, layered information, using, for example, focus groups or structured, semi-structured or open-ended questions and interviews (Gall et al., 2003). The purpose of a phenomenological approach is to identify phenomena through how they are perceived by the participants in a given situation. Comprehensive information and perceptions are gathered through inductive, qualitative methods such as interviews, discussions, and participant observation and then represented from the perspective of the research participants.

11. The third method developed when researchers, frustrated by the opposing views and believing in a more pragmatic approach, advocated mixed methods which aim to integrate the strengths of quantitative and qualitative research. Advocates of the mixed-methods research argue that using two methods of data collection and analysis helps to gain a deeper understanding of a phenomena (Creswell, 2003, Robson, 2011). Critics of the mixed methods approach argue that mixed methods may result in a poorer quality of research and may compromise validity, and be merely conducted in parallel as opposed to being integrated (Bazely, 2004; Tashakkori & Teddlie, 2003). However, Creswell & Clark (2006) argue that “the use of quantitative and qualitative approaches in combination provides a better understanding…than either approach alone” (p. 5).

12. Historically, Teddlie and Tashakkori (2003) state that ‘multi-method’ studies have been in existence as far back as the  1930’s with the inclusion of interviews with empirical data. Interviewing has a variety of forms including structured, semi-structured or unstructured interviews, on a continuum with structured interviews using more closed question type of format, and unstructured being more conversational. Creswell (2003) suggests flexible techniques are suitable for small-scale research. Semi-structured interviews use a flexible technique, whereby the researcher maintains general structure by deciding in advance the focal topics and questions designed to cover the main aspects of the research question, but the participant has a degree of freedom to express their views in their way. This can provide more detail and depth than a standard survey but allow more focus than unstructured interviews, whilst still providing comparable qualitative data. Similarly, focus groups may be useful to use with a small sample group gain to insight and stimulate discussion. However, there is a lack of privacy, which may lead to some participants being unwilling to express their thoughts, feelings, and perceptions in a group, or one person dominating the group.

13. Having discussed research methodologies, the research paradigm for this empirical study was a mixed methods single case study design based on a pragmatic research theoretical perspective with a phenomenological emphasis in order to evaluate the effectiveness a series of focused workshops may have on enhancing the understanding of teachers working with children exposed to trauma and neglect and the role of play therapy. A phenomenological emphasis assisted in ascertaining the experiences and perceptions of teachers from their unique perspective. Creswell, (2003) states pragmatic researchers focus on the ‘what’ and ‘how’ of the research problem.

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