Trauma-Informed Classroom Management in Music Education: A Literature Review

Abstract

Students who have experienced trauma may be especially likely to present challenging behaviors in the classroom. With an increase of trauma-affected students in music classrooms, it is important for music educators to consider classroom management (CM) practices that support trauma-affected students’ healing without triggering students’ trauma responses. In this review of literature, I discuss childhood trauma and trauma-informed positive education (TIPE), research-supported CM strategies in music education, and the ways in which these CM practices do or do not support the trauma-informed approach outlined by TIPE. In addition, I provide my own definition for trauma-informed CM in music education and suggest implications for the music education field.

Keywords

classroom management teacher–student relationship trauma trauma-informed

Trauma, as defined by the Substance Abuse and Mental Health Services Administration (SAMHSA),

results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being. (SAMHSA, 2014, p. 7)

Over two thirds of children under the age of 16 have experienced at least one traumatic event (SAMHSA, 2019), and current rates of childhood trauma may be even higher due to the personal and collective traumas experienced during the COVID-19 pandemic (Bryant et al., 2020; McManus & Ball, 2020). It is important for music educators to understand the prevalence of students with trauma so they can work to meet the needs of these students (Bradley & Hess, 2022).

Trauma-affected children often demonstrate a variety of challenging behaviors in school, such as aggression, withdrawal, or difficulty focusing (Jennings, 2019). In music classrooms, this may include throwing instruments, intentionally making noise instead of music, or withdrawing from music activities entirely (Price, 2022). Educators often use a combination of reactive and preventive classroom management (CM) strategies to respond to and anticipate challenging behaviors (Clunies-Ross et al., 2008). However, some commonly used CM strategies, such as punitive punishments, confinement, and zero tolerance policies, may be triggering to trauma-affected students (Jennings, 2019). Although a trauma-informed approach to CM may support the specific needs of trauma-informed students (Brunzell et al., 2016), the authoritarian approach historically used by many music educators, particularly in the ensemble setting (Allsup & Benedict, 2008), may not be conducive to trauma-informed CM.

In this literature review, I provide background information on childhood trauma, trauma-informed positive education (TIPE; Brunzell et al., 2016), and CM in general; review recent literature on CM in music education; and examine ways in which CM practices do or do not support the TIPE model. In addition, I provide my own definition for trauma-informed CM in music education and suggest implications for the field of music education. This definition may provide music educators with goals to strive for in creating classroom environments that support their trauma-affected students’ needs.

Trauma

Trauma can stem from one’s lived experiences (SAMHSA, 2014) or from witnessing or hearing about another’s traumatic experience (Jennings, 2019). The Centers for Disease Control and Prevention (n.d.) note that any event that causes a person significant stress may be considered a trauma. Simple trauma refers to a single life-altering event that threatens one’s life or safety, such as a tragic accident or natural disaster (Brunzell et al., 2016). Conversely, complex trauma occurs when there are repeated traumatic events or a prolonged threat to one’s safety. Complex trauma often stems from adverse childhood experiences, which can include psychological, physical, and sexual abuse as well as exposure to various household dysfunctions, such as substance abuse, mental illness, violence toward mother, and criminal behavior (Felitti et al., 1998). The severity of the trauma may not always be indicative of the severity of one’s trauma response; responses may vary depending on a variety of factors (Jennings, 2019).

Effects of Trauma

Those who experience trauma can develop a variety of emotional (e.g., fear, grief, depression) or physical (e.g., nausea, dizziness, changes in eating or sleeping habits) symptoms in response to their trauma (Centers for Disease Control and Prevention, n.d.; Felitti et al., 1998; van der Kolk, 2015). When these symptoms last for longer than a month, individuals may be diagnosed with post-traumatic stress disorder (PTSD). Children with PTSD may experience physical health issues relating to the cardiovascular system and metabolism (Jennings, 2019). In addition, Felitti et al. (1998) found a strong relationship between adverse childhood experiences and negative health outcomes in adulthood, such as heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. Those who have experienced trauma may also have negative behavioral or mental health outcomes (van der Kolk, 2015).

Behaviors of Trauma-Affected Students

Trauma-affected students can demonstrate a variety of perceived misbehaviors, often affecting how they learn and act in school (Jennings, 2019). Addressing such behaviors in a safe and supportive way is an essential element of TIPE (Brunzell et al., 2016). Some trauma-affected children exist in a state of constant hyperarousal or hypervigilance, as if danger might occur at any moment. This is common among children who live in abusive homes, as they may have a legitimate reason to fear an abusive adult (Ludy-Dobson & Perry, 2010). In school, hyperaroused or hypervigilant students might overreact to seemingly innocuous situations or respond aggressively to nonaggressive behaviors (Jennings, 2019). Teachers might assume these students are aggressive or short-tempered when more likely the students are unable to regulate their emotional responses due to their trauma.

Other students respond to their trauma history by dissociating (Jennings, 2019; van der Kolk, 2015). In these cases, students might attempt to protect themselves from physical or emotional pain by separating their thoughts and feelings from their reality. These students may appear as if they are in a trance or shutting down and can often lose track of time. Teachers might assume these students are not paying attention or that they do not care about school, but again, these perceived misbehaviors are often a result of the students’ trauma experiences.

Physical and emotional trauma responses can be triggered by any situation that reminds children of their original trauma experiences, whether they are consciously aware of the association or not (Jennings, 2019). When triggered, students’ bodies and brains react as if they are reliving the trauma, even if they are safe in the present. Although triggers can vary greatly based on the individual’s unique experience, Jennings (2019) identified several common triggers that occur in schools. Some students may become triggered when overwhelmed by loud, chaotic classrooms, whereas others may find extremely quiet spaces to be triggering. In some cases, punishment itself can be a trigger for trauma-affected students, especially if they are severely punished by an abusive adult at home. For example, isolating students by giving them timeouts or detentions might replicate confinement punishments experienced at home. Knowing about these potential triggers might help teachers to avoid them and to instead implement trauma-informed practices (Jennings, 2019).

A Need for Trauma-Informed Education

Trauma-affected students typically require treatment from mental health professionals (van der Kolk, 2015). Although teachers are not mental health professionals, they can also support trauma-affected students by providing supportive, trauma-informed environments in which these students can learn and heal (Jennings, 2019). Understanding trauma and its effects on student behavior can help teachers respond to trauma-driven behaviors without the frustration or confusion that might occur if teachers lacked such an awareness (see foreword written by Daniel J. Siegal in Jennings, 2019). Therefore, trauma-informed education occurs when educators understand the ways in which trauma may affect their students and use this understanding to create learning environments in which the students’ needs are prioritized with an emphasis on healing and recovery (Carello & Butler, 2015).

Trauma-Informed Positive Education

TIPE is a strength-based model for teachers working with trauma-affected students (Brunzell et al., 2016). TIPE combines a focus on repairing trauma-affected students’ deficiencies with elements of positive education (Seligman et al., 2009), emphasizing the development of students’ well-being in addition to repairing deficits.

The three domains of TIPE are (a) repairing regulatory abilities, (b) repairing disrupted attachment, and (c) increasing psychological resources (Brunzell et al., 2016). Strategies for repairing regulatory abilities include sensory integration, rhythm and repetition, and mindfulness exercises. Similarly, teachers might help repair disrupted attachment by building positive teacher–student relationships, supporting emotional intelligence instruction, and engaging in play and fun with students. To increase students’ psychological resources, teachers following this model might encourage students’ positive emotion, positive engagement, positive relationships, positive meaning, and positive accomplishment. By engaging in these practices, teachers may be able to provide a classroom space that supports the needs of trauma-affected students.

Trauma-Informed Music Education

Although Brunzell and colleagues’ (2016) model has not yet been documented in a music education setting, researchers have provided ideas about the emerging field of trauma-informed music education (Bailey, 2022; Ryals, 2022). Bailey (2022) defined trauma-informed music education as “the aesthetic development of musical skills in a trauma-informed classroom that considers the physical, social, communicative, emotional, intellectual, and spiritual health and wellbeing [sic] of each individual student” (p. 20). Bailey (2022) added that music educators who engage in such a practice must “show that they care; create a safe learning environment; offer students time and space to process; allow cooperative learning and opportunities for students to participate in their educational journey; utilize SEL strategies; and keep clear, honest and consistent communication” (p. 126).

Ryals (2022) suggested that

An effective trauma-informed music education should include (a) music teachers who develop an affirmative and proactive perspective on student growth through individualized instruction and foster a positive student-teacher relationship; (b) classroom experiences that balance students’ self-selected activities and activities that pose encouraging and empowering challenges to students; and (c) curriculum design emphasizing students’ preferences and lived experiences, incorporating opportunities for students to connect with each other in a safe learning environment. (p. 112)

Both Ryals (2022) and Bailey (2022) call upon the need for a safe learning environment, caring teachers, and student agency in their music education experience. I posit that CM can be implemented in a way that supports these ideas about trauma-informed music education as well as TIPE.

Classroom Management

The concept of CM has evolved drastically over the past few decades. CM, as defined by Brophy (2006), “refers to actions taken to create and maintain a learning environment conducive to successful instruction” (p. 17). In this definition, Brophy (2006) assumed that the purpose of school is to provide students with a place to learn predetermined curricular goals. Evertson and Weinstein (2006) wrote, however, that the purpose of CM is “to create an environment that supports and facilitates both academic and social-emotional learning” (p. 4), suggesting that social-emotional learning is of equal importance to academic learning. Along with this, Evertson and Weinstein (2006) emphasized the importance of teacher–student relationships as an integral part of meaningful CM. Wubbels et al. (2015) expanded upon Evertson and Weinstein’s (2006) definition, prioritizing relationships and social-emotional learning above all else. The idea that CM has evolved to prioritize teacher–student relationships aligns with the previously discussed viewpoints on trauma-informed music education and TIPE.

Classroom Management Strategies

In an analysis of over 150 CM studies, Greenberg et al. (2014) identified the five most common research-supported strategies for CM as rules, routines, engagement, praise, and responding to misbehavior. They, like Evertson and Weinstein (2006), highlighted the importance of teacher–student relationships being “just as essential for a functional, productive classroom as anything mentioned above” (p. 5). Similarly, when describing CM strategies, Brophy (2006) mentioned the preventive strategies of creating an appropriate physical environment, implementing rules and routines, and engaging students in learning activities. To address misbehavior, Brophy (2006) used a different term entirely: disciplinary intervention. By separating disciplinary intervention from CM, Brophy (2006) suggested that CM might exist without reactive CM strategies, some of which may be damaging to trauma-affected students.

Classroom Management in Music Education

Classroom management in music education can be challenging due to large class sizes (Gordon, 2002) as well as the noisy nature of music instruction and pressures related to time management (Byo & Sims, 2015). Elementary music teachers typically see their students once or twice per week, which allows for minimal time to implement consistent CM protocols (Byo & Sims, 2015) or to build the teacher–student relationships that can be important in CM (Evertson & Weinstein, 2006). In addition, ensemble teachers often face the expectation of public performances, and these teachers might feel pressure to prioritize their ensembles’ musical achievement over supporting individual student behaviors to present high-quality performances (Byo & Sims, 2015). Music educators have reported that dealing with challenging behaviors is one of the most difficult parts of the job (Gordon, 2002), and they often feel unprepared by their preservice teacher programs to do so (Gee, 2022). For these reasons, it may be especially important for music educators to develop effective CM skills before entering the field. Due to the likely presence of trauma-affected students in their classes, a trauma-informed approach to CM may be beneficial to music educators and students alike.

Method

For this literature review, I selected empirical studies that included the keywords “classroom management,” “discipline,” or a specific CM strategy, such as “rules,” “routines,” “engagement,” “praise,” “addressing misbehavior,” and “teacher-student relationships,” as identified by Brophy (2006) and Greenberg et al. (2014). I focused on studies within music education and excluded studies from general education. In addition to searching Google Scholar and databases provided by my university’s library website, I drew sources from the reference lists of other articles, dissertations, or book chapters on CM and related topics. I identified the main CM strategy or strategies addressed in each study and then organized the literature thematically according to how each strategy supported one of the three domains of TIPE: (a) repairing regulatory abilities, (b) repairing disrupted attachment, and (c) increasing psychological resources. After discussing the literature according to these themes, I conclude with a new definition for trauma-informed CM in music education and implications for music educators.

Classroom Management and Trauma-Informed Positive Education

Although music educators are typically not trained mental health professionals (Edgar, 2017), they may be able to support their trauma-affected students’ healing by incorporating trauma-informed practices into their CM. As previously discussed, TIPE is a model for teachers to use when working with trauma-affected students (Brunzell et al., 2016). Music educators can support the three domains of TIPE—repairing regulatory abilities, repairing disrupted attachment, and increasing psychological resources—by implementing certain CM strategies while eliminating previously used strategies that might trigger trauma-affected students.

Repairing Regulatory Abilities through Rules and Routines

The first domain of TIPE focuses on helping trauma-affected students repair their regulatory abilities (Brunzell et al., 2016). This reparation is needed because trauma-affected students typically struggle to regulate their emotions (Jennings, 2019). Brunzell et al. (2016) suggest using sensory integration, rhythm and repetition, and mindfulness exercises as possible strategies for helping trauma-affected students heal their regulatory abilities. Rhythm and repetition in particular can be supported by the CM practices implemented by a music educator. Although rhythm in the musical sense has been suggested as a healing practice for those who have experienced trauma (van der Kolk, 2015), the connection between music-making and trauma, often seen in music therapy, is beyond the scope of this paper.¹ However, the repetitive, rhythmic structure of rules and routines in music classrooms can provide trauma-affected students with predictable, stable environments in which they can heal (Brunzell et al., 2016).

According to Greenberg et al. (2014), rules are a set of classroom expectations, and routines are procedures within a classroom, such as how the students might enter the classroom and take out their materials. Rules and routines are among the most common CM strategies valued and used by music educators (Kelley, 2020; Millican, 2009; Simon, 2012). Greenberg et al. (2014) suggested that rules and routines be taught, practiced, and applied. Although general rules and routines might be established at the beginning of the school year, it may be beneficial to explain context-specific expectations and procedures as they pertain to specific activities as those activities occur (Spicer, 2014). Establishing a predictable routine at the beginning of a class period can support the structural rhythm and repetition that trauma-affected students often crave (Brendell, 1996; Spicer, 2014).

In some cases, rules and routines are determined by schoolwide models, but music educators may be able to adapt schoolwide plans to suit their classroom contexts. Spicer (2014) described an approach to CM in a middle school general music class inspired by the school’s implementation of two CM programs: Response to Intervention (RTI) and Positive Behavioral Interventions and Supports (PBIS). Although neither program was designed for music education, the music educators at this school were able to create a CM program that aligned with RTI, PBIS, and the general music classroom. As a result, the music educators outlined rules and routines in the general music course syllabus along with rewards for abiding by them and consequences for failing to do so.

Being consistent and predictable with rules, routines, rewards, and consequences can create a “safe environment conducive to learning” (Spicer, 2014, p. 110). Such an environment supports the repetitive, rhythmic structure that so many trauma-affected students require (Brunzell et al., 2016). When students do not follow rules or routines, however, implementing certain punishments, such as detentions and time-outs, may be triggering to some trauma-affected students, as these punishments might resemble punishments they encounter at home (Jennings, 2019). To avoid triggering a trauma response in students, it may be beneficial to avoid yelling at or embarrassing them (Sandness, 2005) or giving them detentions (Spicer, 2014). Instead, teachers can reinforce the expected behavior in a compassionate yet firm manner, re-teaching the behavior entirely, if necessary, in the same way a teacher might re-teach an academic concept a student struggles to understand (Jennings, 2019). Spicer’s (2014) general music CM program led to a dramatic decrease in detentions for disruptive and defiant behavior, suggesting that the rules and routines, along with other elements of the program, improved student behavior so much that punishments were unnecessary.

Repairing Disrupted Attachment

Because trauma-affected students often lack healthy attachment with adults at home, these students can struggle to establish secure relationships with others (Ludy-Dobson & Perry, 2010). Therefore, repairing the disrupted attachment styles of trauma-affected students is imperative (Brunzell et al., 2016). Teachers who implement TIPE can help repair disrupted attachment by building positive relationships, supporting emotional intelligence instruction, and engaging in play and fun with students. Building positive teacher–student relationships and engaging in meaningful, enjoyable learning activities are hallmarks of CM as well (Evertson & Weinstein, 2006; Greenberg et al., 2014). Therefore, these CM strategies may support repairing disrupted attachment (Brunzell et al., 2016).

Teacher–Student Relationships

Teachers can build positive, secure relationships with trauma-affected students to assist with students’ healing (Brunzell et al., 2016; Jennings, 2019). These relationships are also an essential component of CM (Evertson & Weinstein, 2006; Greenberg et al., 2014; Wubbels et al., 2015). Music educators are uniquely positioned to create such relationships with trauma-affected students because they often teach students for several consecutive years (Edgar, 2014–2015). Music educators and students often forge such connections through their shared experiences with the music itself (Hendricks, 2018).

Music educators value relationships with students as a crucial part of their work (Kelley, 2020; Millican, 2009; Sandness, 2005). When asked to rank 10 components of general pedagogical knowledge according to importance, band and orchestra teachers ranked developing relationships with their students among the top four items (Millican, 2009). In a qualitative study of novice music educators, nine out of the 12 surveyed described the positive effects of building relationships with their students on their CM (Kelley, 2020). Choral teachers noted that the ways in which they responded to non-participatory or disruptive students were often dependent on their relationships with those students and what they knew about their individual students’ personalities and backgrounds, suggesting that teacher–student relationships can affect other CM decisions (Sandness, 2005). Teacher–student relationships appear to be a key component of both CM in music education (Kelley, 2020; Millican, 2009; Sandness, 2005) and trauma-informed teaching (Brunzell et al., 2016; Ryals, 2022). For this reason, trauma-affected students may begin to heal when music educators prioritize building positive relationships as a central component of CM.

Engagement

Some may view engagement as an instructional strategy as opposed to a CM strategy; however, executing interesting lessons that maintain students’ focus may prevent challenging student behaviors from occurring (Greenberg et al., 2014). When trauma-affected students engage in fun and playful activities, they may feel increasingly connected to their teachers, leading to potential healing of disrupted attachment as discussed previously (Brunzell et al., 2016). Music classes can be especially enjoyable for trauma-affected students due to the fun atmosphere and pleasant experience of creating music with others (Adderley et al., 2003; Ryals, 2022).

When students are engaged in music-making, they are typically focused, attentive, and on-task (Brendell, 1996; Russell, 2000; Yarbrough & Price, 1981). In observing an elementary music teacher, Russell (2000) found that the use of varied activities, a mix of new and old material, and quick pacing left little need for the teacher to use any reactive CM strategies. In high school ensembles, students who were engaged in performance tasks were more likely to remain on-task than when they were not (Yarbrough & Price, 1981). Similarly, when examining the warm-up procedures of high school choral ensembles, Brendell (1996) found that students were more on-task during activities that required active participation, such as sight-singing, than during activities that were more passive, such as preparing materials.

Music students are more likely to engage in learning when the curricular content itself is appealing to them (Spicer, 2014). If students find the content to be too easy or too difficult, they may misbehave. Finding ways to make the curriculum accessible and appropriately challenging can be an act of preventive CM in itself. Trauma-affected students often struggle in school due to delayed executive function development, lack of impulse control, and difficulty remaining focused (Jennings, 2019). As a result, trauma-affected students may benefit from having certain activities and curricular content adapted to their individual needs. In addition, allowing for frequent student choices and even the right of refusal can be empowering to trauma-affected students and may ultimately encourage student engagement when they feel safe and ready to do so (Hess, 2022). When trauma-affected students feel supported by their teachers regarding their decisions about participation, they might feel strengthened relationships with their teachers, ultimately contributing to the goal of repairing disrupted attachment.

Increasing Psychological Resources through Praise

The third domain of TIPE is increasing psychological resources (Brunzell et al., 2016). This idea draws from positive education, the idea that happiness and emotional well-being can and should be taught in schools (Seligman et al., 2009). To increase students’ psychological resources, teachers following a TIPE model might encourage students’ positive emotion, engagement, relationships, meaning, and accomplishment. I have already addressed the benefits of engagement and relationships as they relate to CM strategies and TIPE. In this section, I focus on positive accomplishment, which can be achieved by encouraging a growth mindset (Dweck, 2007). Growth mindset is the idea that one’s intelligence or skill set is malleable and can improve with effort and education. When used appropriately, one CM strategy that can support development of growth mindset is praise.

Praise is verbal acknowledgment used to reinforce positive student behavior (Greenberg et al., 2014) and can be an important CM tool for music educators (Caldarella et al., 2017). In a sixth-grade general music class, when the praise-to-reprimand ratio increased, on-task student behavior increased and misbehaviors decreased (Caldarella et al., 2017). This suggests a relationship between praise and engagement.

Music educators might use praise for a variety of reasons, such as rewarding students for performing well, encouraging students to do better, gaining cooperation, or sending a message (Taylor, 1997). To support a trusting relationship between students and their music teacher as discussed previously, music educators must be honest when praising their students (Hendricks, 2018). When considering growth mindset, it is important to praise students for their efforts and the learning process rather than their intelligence or talent (Dweck, 2007). In a study of fourth-grade music students, they performed rhythm exercises and were given either no praise, talent-based praise, or effort-based praise (Droe, 2012). The students were then provided options for their next task: a performance-oriented goal or a learning-oriented goal. Of students who were praised for their effort on the first rhythm exercise, 90% chose the learning goal, whereas only 41% of students who were praised for their talent chose the learning goal. The findings of Droe (2012) are supported in previous literature (Dweck, 2007) about how the type of praise given can affect student attitudes toward learning. For music educators who want to support their trauma-affected students, it may be important to know how to use praise as a CM tool in such a way that supports a growth mindset.

Trauma-Informed Classroom Management in Music Education

Having reviewed various definitions of CM and trauma-informed education in music education as well as CM literature analyzed through the lens of TIPE, I propose the following as a definition for trauma-informed CM in music education: the choices a music educator makes to create and maintain an environment in which all students can, want to, and feel safe to learn. This environment is achieved by prioritizing caring teacher–student relationships and student well-being alongside musical engagements.

Implications for Music Educators

Music educators can implement trauma-informed CM by establishing rules and routines that provide predictability, structure, and stability; engaging their students in meaningful, enjoyable lessons; praising students frequently, honestly, and based on effort rather than achievement; and prioritizing positive teacher–student relationships built upon care and trust. In addition, avoiding punishments that might trigger trauma responses is critical. These strategies can be implemented by practicing music educators at all levels. However, preservice and inservice music educators may not know about the importance of these practices and strategies, so targeted coursework and professional development are imperative steps in implementing trauma-informed CM.

Music educators have reported a lack of coursework in CM during their preservice teacher programs (Gee, 2022), but when they do have the opportunity to practice CM skills in an interactive manner, preservice music educators become more confident and effective in their CM (Brand, 1977; Hedden, 2015). To prepare preservice music educators to use trauma-informed CM strategies, music teacher educators should include coursework dedicated to CM and strategies for addressing students’ trauma and mental health disorders. This coursework would be most effective if it included simulated classroom experiences in which preservice teachers could practice CM techniques in addition to traditional lecture-based instruction (Brand, 1977; Hedden, 2015).

Inservice music educators would also benefit from professional development on these topics. Because experienced music educators tend to feel more comfortable with CM, mentorship programs between experienced and novice music educators may increase confidence and skill level among new teachers in the area of CM (Potter, 2021). However, given the newness of the body of research on trauma-informed education, all inservice music educators would benefit from additional knowledge about the effects of trauma on student behavior and what practices might best support these students (Jennings, 2019). When teachers understand a certain CM strategy, they are more likely to use it (Moore et al., 2017). Therefore, teaching educators about trauma-informed CM practices may increase the likelihood that they would use them.

Although scholars have written about trauma-informed music education (Bailey, 2022; Bradley & Hess, 2022; Price, 2023; Ryals, 2022), my definition of trauma-informed CM in music education appears to be the first of its kind. Researchers may contribute further insights into this definition by exploring how the definition is used in practice. Given the significance of the teacher–student relationship to both CM (Wubbels et al., 2015) and TIPE (Brunzell et al., 2016), as well as the potential for music educators to establish these relationships (Edgar, 2014–2015; Hendricks, 2018), it would be valuable to learn more about how music educators establish relationships and incorporate them into their classroom environments. By doing so, music educators can engage in CM that supports trauma-affected students.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Betty Bauman-Field

Notes

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