Responding To Trauma In The School Setting

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Responding To Trauma In The School Setting

• School Crisis Response
• Crisis Preparedness Conference
• St. Charles County Crisis Response Team
• October 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)

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Greater St. Louis Child Traumatic Stress Program

• Member of National Child Traumatic Stress Network
  (NCTSN) - www.nctsnet.org
• Services provided by Childrens 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

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What is a Traumatic Event?

• Involves actual or threatened death or serious
  injury, or a threat to the persons physical
  integrity
• Involves feelings of intense fear, helplessness
  or horror (children may show disorganized or
  agitated behavior instead)

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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

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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

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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

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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

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In A Moment, In a Heartbeat
Everything Changes
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Paducah, Kentucky
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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

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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

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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

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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

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Trauma Symptoms in Middle and High School
Students

• Depression
• Feelings of shame/guilt
• Detachment, denial of feelings
• Avoidance of trauma cues
• Intrusive images, thoughts, memories
• Withdrawal from peers and/or family
• Low energy, loss of interest
• Appetite/sleep disturbance
• Generalized anxiety, safety fears
• Foreshortened future

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Trauma Symptoms in Middle and High School
Students

• Physical ailments/complaints
• Increased anger, irritability, aggression
• Agitation
• Peer problems (e.g., fighting)
• Decreased interest in opposite sex
• Increased risk-taking, rebellious behaviors
• Pseudomature behaviors
• Substance abuse
• Decline in school performance/attendance

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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

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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

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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

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Stress Reduction During Crisis

• Distraction
• Disruption
• Diffusion
• Running Commentary (to self)
• Separate from situation briefly
• Progressive muscle relaxation
• Breathing techniques
• Positive self-talk
• Visualization

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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

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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

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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

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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

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Classroom Crisis InterventionComponents

• 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

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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

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Controlling Childs 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

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Discussing the Trauma with Children

• Encourage children to express their traumatic
  experience but dont pressure
• Be an active listener
• Remain calm when answering questions and use
  simple, direct terms
• Dont 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

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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

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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

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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

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Responses That ARE NOT So Helpful

• Denial of feelings
• Philosophical response
• Advice
• Too many questions
• Defense of the other person
• Pity
• Amateur Psychoanalysis

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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

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Correcting Distorted Beliefs

• Point out the childs 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

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Helping Grieving Children

• Dont 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)

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Helping Grieving Children

• Assist younger children in understanding finality
  of death.
• Use youths (familys) 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.

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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 childs emotional/behavioral
  difficulties after trauma
• Model soothing behaviors with younger children
• Assist in developing plan for behavior mgmt.

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Group Exercise

• Supportive listening techniques

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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

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When to Refer for Psychological Care

• Showing 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

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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

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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
• DONT BE A SUPERHERO

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Group Exercises

• Case examples
• Identify and Discuss
• Risk factors
• Symptoms
• Supportive strategies

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Were done!

• Email Ally Burr-Harris, Ph.D., at
  Burrharrisa_at_msx.umsl.edu for additional
  questions, references, or referrals.