Readiness, Response and Recovery in Schools Building A Crisis Response System

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Readiness, Response and Recovery in
SchoolsBuilding A Crisis Response System

• Marleen Wong, Ph.D.
• Director, Crisis Counseling and Intervention
  Services
• Los Angeles Unified School District
• Director, Trauma Services Adaptation Center for
  Schools
• National Child Traumatic Stress Network/SAMHSA
• US Dept. of Health and Human Services

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The Three Rs of Crisis Team Development

• Readiness Preparedness Training
• Response- Assessment. Crisis Counseling and
  Intervention
• Recovery Long Term Issues

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Todays Agenda

• Welcome and Introductions
• What Is Child Trauma
• What We Have Learned From School Related Violent
  Incidents
• What We Have Learned From the Impact of Terrorism
• Establishing Partnerships with Mental Health and
  Social Service Agencies
• Restoring the Learning Environment

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What is TRAUMA?

• Trauma is an acute stress response that one
  experiences when confronted with sudden,
  unexpected, unusual human experience.
• Trauma occurs because the event poses a serious
  threat to the individuals life or physical
  integrity or to the life of a family member or
  close friend, or to ones surrounding
  environment.
• Individuals who may have witnessed the event are
  also at risk to develop a trauma stress response.

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Objectives of School Crisis Teams

• Restore the Learning Environment
• Re-establish Calm Routine
• Assist with Coping and Understanding of Reactions
  to Danger and Traumatic Stress
• Re-unite Students with Caregivers ASAP
• Support the Emotional Stabilization of Teachers
  and Parents

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An Interdisciplinary Crisis Recovery Team
Who Should be on the Crisis Team? - Principal
selects the School Crisis Team Members - Team
Members can be

• School Psychologist
• School Counselor
• School Nurse
• Psychiatric Social Worker
• Custodian

• Welfare and Attendance Counselor
• School Resource Officer
• Administrators
• Secretaries
• Other Support Staff

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Desirable Qualities for Crisis Team Members

• A sense of responsibility beyond routine
• Ability to establish rapport quickly
• Ability to listen to difficult feelings and
  experiences of others
• Clear about feelings thoughts biases
• Maintain confidentiality
• Aware of limitations
• Aware of the need for self care

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Terrorism in School and Community

• May 1927 Bath MI
• Jan 1979 San Diego CA
• Feb 1984 Los Angeles
• May 1992 Yuba CA
• Jan 1993 Grayson KY
• Jan 1993 Los Angeles
• Feb 1993 Los Angeles
• Apr1993 Sheridan WY

• Feb 1994 Fort Meyers FL
• May 1994 Union KY
• Jan 1995 Redlands CA
• Nov 1995 Lynnville TN
• Feb 1996MosesLakeWA
• Feb 1997Bethel Alaska
• Oct 1997 Pearl MS
• Dec 1997 Paducah KY

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Terrorism in School and Community

• May 1999 Conyers GA
• Aug 1999 Granada Hills, CA
• Valley Jewish Community Ctr
• Nov 1999 Deming NM
• Dec 1999 FortGibsonOK
• Feb 2000 West Palm Beach, FLA
• Jan 2001 Oxnard CA
• March 2001 Santee CA
• March 2001 El CajonCA
• March 2001Gary,Indiana

• Feb 1998 Hoboken NJ
• Mar 1998 Jonesboro AR
• Apr 1998 Edinboro PA
• Apr 1998 Pomona CA
• May 1998 Houston TX
• May1998 FayettevilleTN
• May1998 SpringfieldOR
• June1998 Richmond VA
• Apr 1999 Taber Canada

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Barry GibsonSurvivor, School Shooting

• Thurston High School
• Springfield, Oregon
• May 1998

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Barriers to LearningAfter Terror

• Physical Changes
• Emotional Changes
• Cognitive Changes
• Behavioral Changes
• Spiritual Changes

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Symptoms of Traumatic Stress

• Difficulty Concentrating
• Difficulty Sleeping or Staying Asleep
• Recurring Traumatic Images
• Hypervigilence
• Fear of Recurrence
• Avoidance of and Reactions to Traumatic Reminders

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Multi-Level Intervention Options

• Tier 1 General School-Based Interventions
• Psychoeducation
• Coping Skills
• Support
• Tier 2 Specialized School-Based Interventions
• Trauma / Grief - Focused Counseling
• Group, Individual, Family
• Short-Term
• Tier 3 Specialized Community-Based
  Interventions
• Referral to On or Off-Site MH Services

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Common Action Steps to School Recovery

• Provide Accurate Information/Psychoeducation
• Triage and Assess
• Make Individual and Group Crisis Counseling
  Available During the First Week After a Crisis
  Event
• Prepare for 3 levels of intervention
• Follow-Up Be Aware of Secondary Adversities

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Secondary Adversities Compound Trauma

• Loss of home, car, cherished belongings
• Loss of social, personal, or familial ties
• Loss of self-esteem, control over ones life
• Loss of resources such as food, money, physical
  abilities

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Grief and Trauma

• TRAUMA
• Generalized reaction TERROR
• Pain triggers tremendous terror, sense of
  powerlessness and loss of safety
• Guilt may focus on It was my fault. I could
  have prevented it. It should/could have been
  me.
• Dreams include the self as the potential victim
• Involves grief reactions mixed with trauma
  reactions flashbacks, startle reactions,
  hypervigilance, numbing, etc.

• GRIEF
• Generalized reaction SADNESS
• Pain is the acknowledgement of the loss
• Guilt may focus on I wish I would/would not
  have
• Dreams tend to be of the deceased
• Generally grief reactions stand alone and do not
  involve trauma reactions

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Behavior is an Iceberg

• --------------------------------------------------
  ------
• Filters and Foundations

Behavior
Childs Crisis or Problem
Individuals Personality and Mental Health
Youth Culture
School and Community Environment
Child Development/Family Influences
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IOM Report - Defining Psychological Consequences
Preparing for the Psychological Consequences of
Terrorism

• Range of emotional, behavioral and cognitive
  effects
• e.g., Insomnia
• Sense of
• Vulnerability
• e.g., Change in Travel
• Patterns, Smoking,
• e.g., PTSD Alcohol Major
  Depression Consumption
• Anxiety Disorders

Distress Responses
Behavioral Changes
Psychiatric Illness
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On the World Trade Center Attack onNYC Public
School Students
Preliminary Report to theBoard of Education
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Gender and Ethnicity of NYC School Survey
Participants Grades 4-12 (N 8,266)
Gender
Ethnicity
8.1
12.3
28.2
46.9
53.1
13.5
37.9
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Numbers of NYC Students in Grades 4-12 Estimated
to Have a Probable Disorder with Impairment6
Months After the 9/11 Attack
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Link between Violence Exposure and Chronic PTSD
with

• Substance Abuse
• Reckless Behavior
• High-risk Sexual Behavior
• Gang Participation
• Disturbances in Academic Functioning

(Kilpatrick, Saunders Resick, 1998)
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Violence and Trauma affects School Performance

• Children with life threatening violence exposure
• Lower GPA
• More negative comments in permanent record
• More absences
• Children with Depression and Posttraumatic Stress
  Disorder
• Even Lower GPA
• More absences

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Important Facts

• Education Statistics
• 15,000 School Districts
• 100,000 Schools
• 70 Children k-12 in Schools
• 50 of Total US Population Connected to Schools
• Schools have become the de facto source of
  mental health, crisis response and recovery
  services for children

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Dr. Pamela Cantor, Childrens Mental Health
Alliance, New York

• The shock, trauma and complexity of our
  societies dont permit the establishment of
  working alliances within 60 days. This was the
  most significant limiting factor in mobilizing an
  effective response in New Yorkschools and
  communities (must) know that collaborative
  relationships need to be forged, meetings held,
  and procedures developed well before an event
  occurs and the immediate phase begins.  

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Dr. Mary Courtney, New York University

• It has been my experience that people typically
  fall back on the most familiar, over-learned,
  conceptual framework at times of stress and
  ambiguity. After 9/11, for example, most
  educators were primarily concerned with getting
  the educational process back on track, preferring
  to focus only on preset roles/structures, and
  freely admitting that they felt too overwhelmed
  to enter the unfamiliar territory of mental
  health. Safety officers tightened safety
  enforcement and did not feel able to address the
  mental health repercussions of either the
  disaster or their response to the disaster.
  Because of this completely human response to
  crises, it is necessary to build the mental
  health response system and the network of
  relationships that support it before any crisis
  occurs.

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From the Field of Brain Research

• In order for children to learn
• Eliminate Threat from the Environment
• Eliminate Threat from Childrens Hearts and Minds
• Enrich the Learning Environment

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Getting to KnowFellow Team Members

• Introduce yourself
• Your name
• Your Assignment District/Base
• Job title, job responsibilities
• Describe what you do in the school

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Getting to KnowFellow Team Members

• Fact Question
• What kinds of experiences have you had with
  crises in schools?

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• Thoughts/Feelings About Crises at School
• What was the most difficult school crisis youve
  had to deal with? What about the situation was
  especially difficult?

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Kinds of Crises that Affect a School

• Death of a student on the way to school
• Intruder on campus
• Gang violence
• Weapons
• Suicide attempts and suicides of students
• Homicides of students
• Homelessness
• Loss of a parent by student

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Kinds of Crises that Affect a School

• Car accidents
• Faculty member lost a child
• Racial issues
• Immigrant issues
• Gang violence

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Sometimes a Crisis Becomes an Opportunity to Make
Things Better

• What kinds of program and services could address
  some of the long term issues?
• Who are the community partners, including service
  agencies, faith based and self-help groups who
  might be able to support kids?
• What kinds of in-school programs and curricula
  could be enhanced to teach coping and problem
  solving skills to students?

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First and Most Important

• Every Adult on Campus Plays an Important
  Role
• Your Attitude and Actions Make All the
  Difference

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THANK YOU FOR YOUR WORK IN SCHOOLS AND FOR BEING
HERE TODAY
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Assessment Question

• As you think about the students and staff at your
  school
• What are next steps you can take to establish
  your schools crisis response system? What kind
  of help, support or training would help you right
  now?