Increasing attention in research and practice has focused on the physical and psychological impacts of trauma and violence, for example from living in conflict zones or experiencing family violence. In North America, such work has led to an increased understanding of the prevalence and impact of adverse childhood experiences (ACEs). These include childhood physical, sexual and emotional abuse; neglect; and childhood experiences of household disruption such as parental separation or divorce, exposure to family violence, living with someone with mental illness, substance misuse within the household, and having a family member incarcerated (Substance Abuse and Mental Health Services Administration, 2014). Research has found that between 50 and 60 percent of the population report at least one adverse child experience, with approximately 30 to 40 percent reporting two or more ACEs (Centers for Disease Control & Prevention, 2010; Dube, 2003; Felitti et al.,1998). As the number of ACEs an individual as experienced increases, so does the risk for negative health and social outcomes.

The impacts of trauma and violence can manifest in a range of physical, psychological, emotional and social symptoms (Anda et al 2006; Felitti, 1998; Irish, Kobayashi, & Delahanty, 2010). These include but are not limited to:

• An overactive stress response (related to the “fight or flight” response);
• Increased risk for chronic diseases (e.g. cardiovascular disease, cancer, diabetes);
• Higher rates of anxiety and depression;
• Increased behavioral difficulties (e.g., emotional outbursts, lack of focus, aggression);
• Difficulties in physiological and emotional self-regulation;
• Challenges in developing and maintaining relationships and social support systems; and/or
• Complications related to job stability and career progress.

Based on the prevalence of ACEs within the general population, sport organizations, coaches and program leaders are recognizing that a substantial proportion of athletes have ACEs. Within sport and physical activity, the impacts of these experiences can result in difficulty building positive relationships with teammates and coaches, inability to focus, difficulty abiding by the rules of play, aggressive behavior with opponents and teammates, lack of self-awareness, violent outbursts, and difficulty dealing with the pressure of competition (Bergholz et al., 2016).

What is a Trauma-Informed Sport Program?

When coaches and program leaders are trauma-informed it means that they recognize that anyone they interact with may have been impacted by trauma at some point in their lives, and understand that a variety of emotional (e.g., anxiety, depression, anger) and behavioral (e.g., substance use, self-harm, isolation) challenges may present themselves as a result of the traumatic experience(s) (Gutierres & Van Puymbroeck 2006; Nadew 2012; Schäfer & Fisher, 2011;).

The overall purpose of trauma-informed programming is to provide individuals experiencing such challenges with the opportunity to develop skills that will help them improve their ability to regulate their emotions and behaviors. Bergholz and colleagues identified a number of principles that are critical in the development of a trauma-informed sport program. The sport program must:

1. Place an emphasis on creating a physically and emotionally safe environment;
2. Be designed for long-term engagement, rather than short, one-off programs;
3. Create opportunities for the development of meaningful relationships with others;
4. Have a supportive structure (e.g., rules of play, planned predictable activities/schedule, reasonable ratio between coaches and athletes); and
5. Integrate local cultural practices (e.g. local practices for healing from trauma).

Trauma-informed sport programs are important given that a significant percentage of youth will be exposed to some form of trauma; sport is the most popular extra-curricular activity amongst youth in Canada and hence a great opportunity to reach large numbers of youth; and evidence suggests that physical movement is an important component of the healing process (Bergholz et al., 2016; D’Andrea, Bergholz, Fortunato & Spinazzola, 2013).

Bounce Back League

In Canada, these principles are being put into practice through a new project funded by the Government of Canada and being led by Boys and Girls Clubs of Canada. Boys and Girls Clubs of Canada is a national non-profit organization that serves over 200,000 youth annually in more than 700 small and large cities, rural and Indigenous communities across Canada. More than 70% of families served are living on low-incomes and are at higher risk of having or being exposed to trauma. The mission of the organization is “to provide a safe, supportive place where children and youth can experience new opportunities, overcome barriers, build positive relationships and develop confidence and skills for life.”

Bounce Back League (BBL) is a trauma-informed sport program that was designed by Edgework Consulting in collaboration with Boys and Girls Club of Canada. At the core of the program is a new curriculum that has been developed and piloted in three locations. Youth engage in a variety of sports and active games over the course of the year during three seasons of play (Fall, Winter and Spring).

Although aspects of the program delivery vary depending on the needs and interests of each location, there are three main foci of BBL:

1. Leaders help youth Come to Play, focused on developing self-awareness and being able to prepare oneself to make the most out of the challenges and opportunities that present themselves. Leaders focus on creating a welcoming, inclusive and safe space where youth feel they can fully participate. Each BBL sessions starts off with a welcome and a warm–up, and the youth learn how to check their pulse so they become aware of their body and how it responds to physical activity.
2. Leaders help youth Build My Team, which is all about learning the importance of and how to invest in people to help youth develop their own support system, and to help one another build skills together. After the warm-up, leaders engage the youth in drills related to the sport or activity of the day and then have the youth play. The drills and rules of play are specifically designed to emphasize teamwork and support the development of relationships.
3. Leaders help youth Play On, supporting youth in adapting to new situations and being able to persist and stay on a positive path when faced with adversity. A unique design feature of the BBL is a space called “The Zone” that is always available in any program session. Youth are encouraged to use The Zone to take breaks when needed – if they feel overwhelmed they can opt-out of play and then opt back in when they feel ready to play again.

These three foci are also reinforced at the end of every session during “Team Time” where the leaders debrief with the youth on the successes and challenges of the day.

BBL Results to Date

The BBL project also has a robust intervention research design that uses a combination of quantitative (e.g., surveys and observations involving both youth and leaders) and qualitative methods (interviews with youth and leaders as well as art-based activities with the youth) to evaluate the impact of both the curriculum and associated staff training. The findings from the pilot year are promising. Leaders have reported improvements in their knowledge of trauma-informed principles and confidence in utilizing a trauma-informed approach. From analysis of the weekly logbooks completed by the leaders it was evident they were able to successfully implement the program structure and activities as planned in a progressive manner (Shaikh, Bean, Forneris, 2018). The youth who participated in the program also showed positive outcomes including increased wellbeing from pre-season to post-season; improvements in physical literacy; the development of friendships; as well as learning a number of life skills such as teamwork, respectful listening, perseverance, and putting forth your best effort (Shaikh, Bean, Forneris, 2018).

Getting started with a trauma-informed approach

The use of a trauma-informed approach will enhance outcomes for any team or program. A trauma-informed approach can help your athletes improve their ability to regulate their emotions and behavior, enhance their focus and teamwork, and thus improve their performance both on and off the field. Below are seven principles developed by Bergholz et al. (2016) that you can start with:

• Use C.L.E.A.R communication (using a Calming voice and tone, Listening deeply, Explaining the how and why of what you are doing, Asking engaging questions, and Reducing distractions);
• Focus in on one skill at a time, and focus on progress rather than performance;
• Encourage expression of emotions – both verbal and non-verbal;
• Offer opportunities for athletes to opt out and opt back in to play;
• Check in and debrief with the youth by reviewing and asking “looking back” questions;
• Engage athletes by inviting them for input; and
• Be available for informal time before and after practice.

Moving Beyond the Few to the Many

Research has shown the many benefits of using a trauma-informed approach, and as a result the number of programs and coaches adopting such an approach is growing. However, for long-lasting impact to occur in the lives of athletes who have experienced trauma and the associated emotional and behavioral challenges, changes in policy and practice are needed. Coach education programs should increase awareness about trauma and incorporate training to enhance capacity for integrating a trauma-informed approach. In addition, sport organizations should develop guidelines and policies to support their coaches in using a trauma-informed approach. These actions will go a long way to improve the environment and enhance support for athletes from the community to elite level.

Recommended Resources

Creating trauma-informed sports programming for traumatized youth: Core principles for an adjunctive therapeutic approach. By Bergholtz, L., Stafford, E. & D’Andrea, W. (2016). Journal of Infant, Child and Adolescent Psychotherapy, 15(3), 244-253.

Vital Connections: Harnessing the Power of Relationship to Impact the Lives of Young People. By Bergholtz, L. (2018). Lioncrest Publishing

Re-designing Youth Sport: Change the Game. By McCarthy, J., Bergholz, L., & Bartlett, M. (2016).Routledge.

The Boy Who Was Raised as a Dog: And Other Stories from a Child Psychiatrist’s Notebook–What Traumatized Children Can Teach Us About Loss, Love, and Healing. By Perry, B. D., & Szalavitz, M. (2017). Basic Books.

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About the Author(s)

Tanya Forneris is the Associate Director of the School of Health and Exercise Sciences at the University of British Columbia Okanagan. She obtained her undergraduate and Masters degrees at the University of New Brunswick and her PhD at Virginia Commonwealth University. Her area of expertise is the development, implementation and evaluation of community and sport-based programming to enhance the development of youth.

References

Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C. H., Perry, B. D., … & Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood. European archives of psychiatry and clinical neuroscience, 256(3), 174-186.

Bergholtz, L., Stafford, E. & D’Andrea, W. (2016) Creating trauma-informed sports programming for traumatized youth: Core principles for an adjunctive therapeutic approach. Journal of Infant, Child and Adolescent Psychotherapy, 15(3), 244-253.

Centers for Disease Control & Prevention (2010). Adverse Childhood Experiences Reported by Adults — Five States, 2009. (Morbidity and Mortality Weekly Report, Vol. 59, No. 49, pp.1609-1613). Washington, DC: U.S. Government Printing Office.

D’Andrea, W., Bergholz, L., Fortunato, A., & Spinazzola, J. (2013). Play to the whistle: A pilot investigation of a sports-based intervention for traumatized girls in residential treatment. Journal of family violence, 28(7), 739-749.

Dube, S. R., Felitti, V. J., Dong, M., Chapman, D. P., Giles, W. H. and Anda, R. F. (2003). Childhood abuse, neglect and household dysfunction and the risk of illicit drug use: The adverse childhood experiences study. Pediatrics, 111 (3), 564-572.

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 14(4), 245-258.

Gutierres, S. E., & Van Puymbroeck, C. (2006). Childhood and adult violence in the lives of women who misuse substances. Aggression and Violent Behavior, 11(5), 497-513.

Irish, L., Kobayashi, I., & Delahanty, D. L. (2010). Long-term physical health consequences of childhood sexual abuse: A meta-analytic review. Journal of Pediatric Psychology, 35, 450–461.

Nadew, G. T. (2012). Exposure to traumatic events, prevalence of posttraumatic stress disorder and alcohol abuse in Aboriginal communities. Rural & Remote Health, 12(4).

Schäfer, I., & Fisher, H. L. (2011). Childhood trauma and psychosis-what is the evidence?. Dialogues in clinical neuroscience, 13(3), 360.

Shaikh, M., Bean, C. & Forneris, T. (2018). BBL Evaluation Report: Results of the Pilot Implementation. Report prepared for the Boys and Girls Club of Canada.

Substance Abuse and Mental Health Services Administration (2014). TIP 57: Trauma-Informed Care in Behavioral Health Services. (HHS Publication No. (SMA) 14-4816). Washington, DC: U.S. Government Printing Office.

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The information presented in SIRC blogs and SIRCuit articles is accurate and reliable as of the date of publication. Developments that occur after the date of publication may impact the current accuracy of the information presented in a previously published blog or article.