Following the Sept 11, 2001 terrorist attacks on the World Trade Center in New York, Dr Pamela Cantor, a child psychiatrist specialising in trauma, was enlisted by the city's education board to study if the attacks had traumatised the city's public school children.
Dr Cantor and her team found that many of the children in the city schools had, indeed, suffered trauma and were doing poorly in school. But when they drilled down to the cause, they found that the trauma had not been caused by 9/11, not even for those who attended schools clustered around ground zero at the World Trade Center.
Instead, the symptoms of trauma were concentrated in schools with a high concentration of poor children.
"The students' sense of insecurity stemmed not so much from the 9/11 incident, but from what was happening in their homes and their neighbourhoods... from their exposure to violence, loss and adversity," explained Dr Cantor in an interview with The Straits Times.
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In addition, she also found that many schools in these troubled neighbourhoods were ill-equipped to meet the needs of their traumatised students.
The schools that they visited were chaotic and unsafe.
"In the classrooms, there were lots of kids suffering stress. One child acting out can set off other kids and shut down the learning environment for everyone," she said.
In the classrooms, there were lots of kids suffering stress. One child acting out can set off other kids and shut down the learning environment for everyone... We also saw teachers who had given up, as they had not been trained to cope with at-risk students, and administrators who were overwhelmed.
DR PAMELA CANTOR, a child psychiatrist specialising in trauma, on the schools her team visited.
"We also saw teachers who had given up, as they had not been trained to cope with at-risk students, and administrators who were overwhelmed."
Dr Cantor, who studied medicine at Cornell University, was all too aware of the studies that have detailed the effects of stress on learning.
Neurological research shows that traumatic experiences, such as being abused, witnessing a violent crime or even living in a neighbourhood where crime is pervasive, can transform the developing brain. They alter the chemical balance, making it more difficult for children to concentrate and build trusting relationships - all fundamental skills for performing well in school.
Thankfully, she says, this can be mitigated.
Much of the research suggests that this should be done early on in life, even before children start Primary 1 at the age of seven - which is the target group of the Circle of Care programme run by philanthropic group Lien Foundation and welfare organisation Care Corner in Singapore.
The scheme, which is available in 10 pre-schools and two primary schools, brings together teachers, social workers, education therapists and, more recently, health professionals, to identify the root causes of a child's difficulties and provides help on different fronts. It has resulted in higher school attendance rates and has seen the children improve their reading and numeracy skills.
From child psychiatry to Turnaround
Dr Pamela Cantor is the president and chief executive of Turnaround for Children, a non-profit organisation that connects the dots between science, adversity and school performance to catalyse healthy student development and academic achievement.
Dr Cantor practised child psychiatry for nearly two decades, specialising in trauma. She founded Turnaround after co-authoring a study on the impact of the 9/11 attacks on schoolchildren.
Before that, she co-organised the National Summit for Children Exposed to Violence, and served as co-director for the Eastern European Child Abuse and Child Mental Health Project.
Dr Cantor's work has been highlighted in The New York Times, The Atlantic and The Washington Post.
A visiting scholar in education at Harvard University and an Ashoka Fellow, she was awarded the 2014 Purpose Prize for Intergenerational Impact.
Dr Cantor received a medical degree from Cornell University Medical College.
Dr Cantor added that recent research has shown that children can also be helped in their later years. Research done by experts such as Dr Dan Siegel, a clinical professor of psychiatry at the University of California, Los Angeles School of Medicine, shows that children can be helped even in their teenage years.
"It is a period of tremendous growth. The brains of teenagers are malleable," said Dr Cantor, adding that although the research into how adversity impacts the development of the brain and learning is sobering, it also points to the ways in which children can be helped.
"The science shows that we can do something to help these children suffering from poverty-related stress. We can design environments to both correct for that negative impact and, more importantly, to set development on a healthy course.
"Adults can take specific actions to buffer stress for children and help them develop the skills that they need to succeed in school and in life. Much of it boils down to creating trusting relationships and encouraging environments."
Dr Cantor went on to set up an organisation called Turnaround for Children, which focuses on helping public schools in high-poverty areas lay a core foundation that will allow for academic growth.
The group now works with 10 schools in New York City, Newark and Washington, and has worked with 88 over the past decade.
Turnaround sends out teams of three - consisting of a social work consultant, an instructional coach and a programme director - to its partner schools.
Teams are embedded for three to five years in a small group of schools and work hand in hand with school heads, teachers and mental health professionals in the surrounding community.
The team starts by establishing practices and processes through which teachers and school staff can identify the students most at risk - typically about 15 per cent of students - and refer them to immediate mental health services where they can be helped in a variety of ways, from psychiatric evaluation to individual or family counselling.
Meanwhile, the instructional coach trains teachers in a variety of proven techniques such as using positive discipline techniques to reinforce good behaviour rather than punish bad behaviour.
The team also works closely with the principal to create a safe, positive environment and build a culture of high expectations.
Turnaround's programmes have been shown to be effective.
Schools that were once in crisis have grown measurably calmer and safer, and have experienced improved teacher retention and gains in student performance.
Turnaround reports that between 2014 and this year, the percentage of children in all Turnaround partner schools referred to mental health providers to receive help climbed from 31 per cent to 73 per cent.
Schools have seen significant reductions in suspensions, severe behavioural incidents and absenteeism.
But Dr Cantor is not one to rest on her laurels.
Not when the official estimate is that currently, 51 per cent of students in public schools in the United States come from low-income households - the highest figure since the National Centre for Education Statistics began tracking the figure.
To reach more schools and more children, she is turning her organisation's attention to embedding Turnaround's strategies, tools and practices into districts, states and federal policy through a combination of direct partnership, training programmes, guided learning and consulting, research and development and targeted advocacy.
She is also delving even more deeply into the scientific literature about the science of learning and development to illustrate the transformational opportunities before educators, policymakers and parents to influence the trajectory of children's lives.
She explained what keeps her going: "My vision and the vision of my organisation is that one day, all children in the United States will attend schools that prepare them for the lives they choose.
"Instead of asking children to beat the odds, let's use science to change the odds for many more children."