responding to trauma in the school setting school crisis response & crisis preparedness...
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Responding To Trauma In The School Setting
School Crisis Response & Crisis Preparedness Conference
St. Charles County Crisis Response TeamOctober 10, 2003
Ally Burr-Harris, Ph.D. and Matt Kliethermes, Ph.D.The Greater St. Louis Child Traumatic Stress Program
National Child Traumatic Stress Network (NCTSN)
Greater St. Louis Child Traumatic Stress Program Member of National Child Traumatic Stress Network
(NCTSN) - www.nctsnet.org Services provided by Children’s Advocacy Center
and Center for Trauma Recovery at UMSL Free assessment and treatment of children and
adolescents who have experienced a trauma Consultation and training of education, mental health,
and medical professionals in the area of child trauma School-based group therapy for children and
adolescents exposed to violence
What is a Traumatic Event?
Involves actual or threatened death or serious injury, or a threat to the person’s physical integrity
Involves feelings of intense fear, helplessness or horror (children may show disorganized or agitated behavior instead)
Types of Traumas
Natural disasters Kidnapping School violence Community Violence Terrorism/War Homicide Physical Abuse
Sexual Abuse Domestic violence Medical procedures Victim of crime Accidents Suicide of loved one Extreme Neglect
How Common are Traumatic Experiences? 69% of the general U.S. population report
exposure to one or more traumatic events 14 to 43% of children/adolescents report having
experienced a traumatic event 23% of national sample of adolescents report
being victim or witness of violence Up to 91% of African American youth in urban
settings report violence exposure Among refugee children, rates of trauma exposure
approach 100% Large-scale traumas in schools are very rare but
highly publicized
Effects of Trauma on Children and Adolescents Most people experience posttraumatic stress
symptoms during a trauma and in the weeks that follow.
Approximately 20% of youths exposed to serious trauma have persistent PTSD
Rates much higher for severe, chronic, or interpersonal trauma
77% of youths who witnessed school shooting reported PTSD symptoms
Effects of Violence Exposureon School Functioning Decreased school performance Decreased school attendance Increased concentration problems Decreased academic and cognitive scores Linked to aggression, conduct problems,
social deficits, substance abuse, delinquency, and psychiatric problems
In A Moment,
In a Heartbeat
…Everything Changes…
Paducah, Kentucky
Be prepared for a crisis
Expect the unexpected– Be ready to implement crisis plan
Learn about common trauma reactions Know yourself (strengths, limitations) Know your students
– Risk factors– Level of dependency (e.g., child with disability,
younger child) Build supportive relationships with students
before a crisis
Immediate Reactions To A Trauma Or Crisis Intense longing/concern for caregivers or loved ones Emotionally labile Extreme emotions (rage, fear) Tearful, crying Excited Clinging to caregivers Shock, numbness Denial, inability to acknowledge situation Dazed, feelings of unreality, dissociation Confused, disorganized Difficulty making decisions Suggestible Fight or flight mode, physical symptoms
Trauma Symptoms inElementary School Children Sadness, crying, irritability, aggression Increased activity level Poor frustration tolerance Safety-related fears Generalized fear Unable to verbalize distress Nightmares Trauma themes in play/art/conversation School avoidance; decline in school performance
Trauma Symptoms in Elementary School Students Physical complaints Poor concentration Regressive behavior (e.g., clingy, wetting
bed, babytalking) Eating/sleeping disturbances Attention-seeking behavior Withdrawal Magical thinking related to trauma/death
Trauma Symptoms in Middle and High School Students DepressionDepression Feelings of shame/guiltFeelings of shame/guilt Detachment, denial of feelingsDetachment, denial of feelings Avoidance of trauma cuesAvoidance of trauma cues Intrusive images, thoughts, memoriesIntrusive images, thoughts, memories Withdrawal from peers and/or familyWithdrawal from peers and/or family Low energy, loss of interestLow energy, loss of interest Appetite/sleep disturbanceAppetite/sleep disturbance Generalized anxiety, safety fearsGeneralized anxiety, safety fears Foreshortened futureForeshortened future
Trauma Symptoms in Middle and High School Students Physical ailments/complaintsPhysical ailments/complaints Increased anger, irritability, aggressionIncreased anger, irritability, aggression AgitationAgitation Peer problems (e.g., fighting)Peer problems (e.g., fighting) Decreased interest in opposite sexDecreased interest in opposite sex Increased risk-taking, rebellious behaviorsIncreased risk-taking, rebellious behaviors ““Pseudomature” behaviorsPseudomature” behaviors Substance abuseSubstance abuse Decline in school performance/attendanceDecline in school performance/attendance
Risk Factors for Post-Trauma Adjustment Problems
Previous trauma exposure Severity of trauma Extent of exposure Proximity of trauma Understanding and personal significance Interpersonal violence Parent distress, parent psychopathology Separation from caregiver Previous psychological functioning Genetic predisposition Lack of material/social resources
Protective Factors for Post-Trauma Adjustment Strong academic and social skills Active coping, self-confidence Social support Family cohesion, adaptability, hardiness High neighborhood/school quality Strong religious beliefs, cultural identity Effective coping and support by parents
During the Crisis
Implement school crisis response plan Ensure safety and support of students Remain with students if possible Use calming techniques Model adaptive coping Provide developmentally appropriate
information to students Provide realistic, concrete reassurance
Stress Reduction During Crisis
Distraction Disruption Diffusion Running Commentary (to self) Separate from situation briefly Progressive muscle relaxation Breathing techniques Positive self-talk Visualization
Psychological First AidDuring and After the Crisis
First week after trauma Triage/ Risk Screening Classroom Crisis Intervention
– Crisis debriefing– Psychoeducational– Skill-building– Support-oriented– Regain sense of control/mastery – Plan for gradual return of normal activities
Triage and Risk Screening
Physical exposure– Direct: victims, eyewitnesses– Perimeter: close to chaos (sights, smells,
sounds)– Campus: no direct exposure; may be
affected by others’ reactions– Off Campus: not at school during incident
Triage and Risk Screening
Reactivity to trauma reminders Previous trauma exposure Subjective appraisal of threat during trauma Emotional exposure
– Relationship with victim – Personal significance of trauma– Loved one within physical proximity– Past history of serious emotional problems
Classroom Crisis Intervention
Designed to assist staff/ students in coping with trauma
Structured session(s) 24 to 72 hours after trauma Facilitators: Trained counselors, classroom teacher Effective in reducing distress, establishing
connections, reducing isolation, accelerating normal recovery, and helping to identify those most at risk
Not effective at reducing risk for PTSD for high-risk students
Problematic if varied exposure levels or too soon after trauma
Classroom Crisis Intervention:Components Provide accurate, developmentally appropriate
information Share thoughts, feelings, and needs for safety or
resolution related to trauma Nonverbal sharing exercise allows for individualized
attention Teaching phase:
– stress reduction– coping strategies– normalization of reactions– recovery predictions
Comforting Traumatized Children
Reinforce ideas of safety and security Allow them to be more dependent temporarily if
needed Follow their lead (hugs, listening, supporting) Use typical soothing behaviors (rest, comfort, food,
hugs, stuffed animal, music) Use security items and goodbye rituals to ease
separation with younger children Distract with pleasurable activities* Let the child know you care *normally occurring
Controlling Child’s Environment
Maintain normal routines as much as possible Reduce class workload as needed Avoid exposing children to unnecessary
trauma reminders (e.g., media) Minimize contact with others who upset child Guide other children in supporting child Give trauma cues positive change
Discussing the Trauma with Children Encourage children to express their traumatic experience but
don’t pressure Be an active listener Remain calm when answering questions and use simple,
direct terms Don’t “soften” the information you give to children Help children develop a realistic understanding of what
happened Gently correct trauma-related distortions Be willing to repeat yourself Normalize “bad” feelings
Intervening with Traumatized Children
Identify triggers (e.g., trauma cues) that upset child and plan ahead Defuse anger Address acting out behaviors involving aggression or self-
destructive activities quickly and firmly Model/coach adaptive coping with upsetting feelings Set up behavior management plan reinforcing adaptive coping and
appropriate behavior Do not tolerate inappropriate negative behavior (harassment,
bullying, threats) Avoid traumatizing classmates during trauma
reenactments/discussions Be patient and calm
Facilitating Trauma Resolution
Use play, art, stories to assist with trauma resolution
Normalize symptoms/reactions Reinforce positive messages Positive reminiscing of deceased Encourage constructive activities
– Teach tolerance and respect– Recovery events
How to Talk (and Listen) to Traumatized Children Children need to have their feelings
accepted and respected Listen quietly and attentively Acknowledge their feelings with a word
or two Give their feelings a name Give them their wishes in fantasy Show empathy
Responses That ARE NOT So Helpful Denial of feelings Philosophical response Advice Too many questions Defense of the other person Pity Amateur Psychoanalysis
Common Trauma-Related Distortions in Youth Self-blame Guilt, survivor guilt Overgeneralization of danger/risk Shame/embarrassment b/c of trauma Shame over PTSD symptoms Hero fantasies related to trauma Omen formation Foreshortened future Magical thinking
Correcting Distorted Beliefs
Point out the child’s distorted belief by briefly summing it up
Label how you think they might feel Validate their feeling; show empathy Let them know how it makes you feel to
hear the distorted belief Suggest a healthier belief; keep it brief
Helping Grieving Children
Don’t be afraid to talk about the death Be prepared to discuss the same details over
and over again Be available, nurturing, reassuring and
predictable Assist youths in developing grieving rituals and
in finding meaning Help other students learn how to respond Anticipate need for extra support when child
faces loss reminders (e.g., holiday)
Helping Grieving Children
Assist younger children in understanding finality of death.
Use youth’s (family’s) own belief system when discussing afterlife
Share memories and talk about the person who died when appropriate
Gently remind children ALL feelings are okay. Use reminders like “you did not cause this” or
“it is not your fault.”
Helping Parents of Traumatized Children Communicate with parents frequently about child Encourage parents to listen to child closely Encourage parents to set aside special time for child Recommend maintenance of normal routine Encourage parents to remain calm and to get help for
themselves if needed Normalize child’s emotional/behavioral difficulties
after trauma Model soothing behaviors with younger children Assist in developing plan for behavior mgmt.
Group Exercise
Supportive listening techniques
When to Refer for Psychological Care
Appear depressed, withdrawn, noncommunicative Strong resistance to affection/support from caregivers Suicidal or homicidal ideation Dangerous behaviors to self/others Increased usage of alcohol or drugs Rapid weight gain or loss Significant behavioral changes or problems (e.g., sexual) Discontinue attending to hygienic needs Significant acute stress symptoms
When to Refer for Psychological CareShowing these changes for more than 1 month after trauma
Intense anxiety or avoidance behavior triggered by trauma reminders
Unable to regulate emotions (crying, angry outbursts) Poor academic performance and decreased
concentration Continued worry about event (primary focus) Excessive separation difficulties Physical complaints (nausea, headaches) Continued trauma themes in play Unable to grieve/mourn death of loved one
Taking Care of Yourself
Alleviate additional stress Request temporary relief from
classroom if needed Make sure your own family is safe Participate in staff debriefing sessions Schedule time away from work to talk
about your own experiences Limit exposure to media coverage
Taking Care of Yourself
Be aware of your limitations Pick your battles Prioritize where you are putting your energy Surround yourself with people who make you
feel good and on whom you have the same effect
Take care of yourself physically DON’T BE A SUPERHERO
Group Exercises
Case examples: – Identify and Discuss
• Risk factors • Symptoms• Supportive strategies
We’re done!
Email Ally Burr-Harris, Ph.D., at [email protected] for additional
questions, references, or referrals.