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Recognizing and Responding to Child Traumatic Stress in Schoolage Children

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Title: Recognizing and Responding to Child Traumatic Stress in Schoolage Children


1
Recognizing and Responding toChild
Traumatic Stress in School-age Children
  • Douglas W. Walker, PhD
  • Clinical Director - Mercy Family Center
  • Project Director - Project Fleur-de-Lis
  • New Orleans, Louisiana
  • USA

2
Background
3
(No Transcript)
4
Learning Objectives
  • Participants will appreciate the body of
    literature supporting the impact of trauma on
    child development and learning.
  • Participants will be able to recognize the signs
    and symptoms of CTS in their everyday lives as
    parents, educators and administrators.
  • Participants will be given a CTS response tool
    kit to use when assisting children and their
    families who have undergone extremely stressful
    or traumatic events

5
Overview
  • Impact of Trauma on Youth
  • Introduction to Trauma Informed Systems
  • Why a trauma program in schools?
  • Third Culture Students Stress Trauma
  • Your toolkit to manage stress and trauma Support
    for Students Exposed to Trauma (SSET)
  • Small group/Individual Consultation

6
Impact of Trauma on Youth
7
Consequences of trauma exposure Traditional
Concept of PTSD
  • Re-experiencing
  • Numbing/Avoidance
  • Hyperarousal

8
Evolving Understanding of Trauma and Youth
PTSD
9
Evolving Understanding of Trauma and Youth
Traumatic Stress
PTSD
10
Defining Trauma
  • Not an event itself but rather a response to a
    stressful experience in which a persons ability
    to cope is dramatically undermined
  • Traumatic events cause overwhelming anxiety or
    distress and include experiencing, witnessing, or
    being confronted with physical, verbal, and
    emotional abuse, or another event that involved
    actual or threatened death or serious injury to
    oneself or someone else

11
Defining Trauma Traumatic Stress
  • Traumatic events overwhelm the ordinary human
    adaptations to lifethey confront human beings
    with the extremities of helplessness and terror
  • Judith Herman

12
Child Traumatic Stress
13
Individual
Family
Trauma
School
Community
14
Trauma TypesNational Child Traumatic Stress
Network
  • Physical Abuse Neglect
  • Sexual Abuse
  • Traumatic Grief
  • Domestic Violence
  • Community / School Violence
  • Complex Trauma
  • Medical Trauma

15
Trauma TypesNational Child Traumatic Stress
Network
  • Refugee Trauma
  • Natural Disasters
  • Hurricane
  • Epidemics
  • Floods
  • Fires
  • Earthquakes

16
Trauma TypesNational Child Traumatic Stress
Network
  • Terrorism
  • Biological
  • Chemical
  • Radiological

17
Trauma TypesNational Child Traumatic Stress
Network
  • Physical Abuse and Neglect
  • Causing physical pain or injury (physical abuse
    or maltreatment)
  • Failing to give a child the care it needs
    according to its age (child neglect)
  • Causing psychological injury (psychological
    maltreatment)

18
Trauma TypesNational Child Traumatic Stress
Network
  • Sexual Abuse
  • Wide range of sexual behaviors that take place
    between a child and an older person. May also
    include non-contact abuse which includes genital
    exposure, verbal pressure for sex, and
    exploitation via prostitution and pornography

19
Trauma TypesNational Child Traumatic Stress
Network
  • Traumatic Grief
  • Occurs following the death of a loved one when
    the child objectively or subjectively perceives
    the experience as traumatic

20
Trauma TypesNational Child Traumatic Stress
Network
  • Domestic Violence
  • Actual or threatened physical or sexual violence
    or emotional abuse between adults that occurs in
    a childs home environment

21
Trauma TypesNational Child Traumatic Stress
Network
  • Community and School Violence
  • Predatory violence and violence that comes from
    personal conflicts between people who are not
    family members.
  • Robbery
  • Shootings
  • Rapes
  • Stabbings
  • Beatings

22
Trauma TypesNational Child Traumatic Stress
Network
  • Complex Trauma
  • The cumulative problem of a childs exposure to
    multiple or prolonged traumatic events and the
    impact of this exposure on their development
  • Usually begins in early childhood and occurs
    within the primary care-giving environment

23
Trauma TypesNational Child Traumatic Stress
Network
  • Medical Trauma
  • Associated with injury or accident, chronic or
    life-threatening illness, or painful or invasive
    medical procedures

24
Trauma TypesNational Child Traumatic Stress
Network
  • Refugee and War Zone Trauma
  • Exposure to war, political violence or torture
  • Can also occur from living in a region affected
    by bombing, shooting or looting, as well as
    forced displacement due to political reasons

25
Trauma TypesNational Child Traumatic Stress
Network
  • Natural Disasters
  • Any natural catastrophe that causes enough damage
    that local, state or federal agencies and
    disaster relief organizations are called into
    action

26
Trauma TypesNational Child Traumatic Stress
Network
  • Terrorism
  • Intent to inflict psychological damage on an
    adversary
  • US Department of Defense the calculated use of
    violence or the threat of violence to inculcate
    fear, intended to coerce or to intimidate
    governments or societies in the pursuit of goals
    that are generally political, religious, or
    ideological

27
Child Traumatic Stress
  • Children and Adolescents experience trauma as a
    result of two unique types of situations
  • Acute Traumatic Events
  • Chronic Traumatic Environments

28
Acute Traumatic Events
  • These types of trauma include
  • When a child experiences a serious injury to
    themselves or witnesses a serious injury or death
    of someone else
  • When children are faced with imminent threats of
    serious injury or death for themselves or others
  • When children experience a significant violation
    of personal physical integrity.

29
Acute Traumatic Events
  • Specific Examples
  • School shootings
  • Gang-related violence in the childs neighborhood
  • Terrorist attacks
  • Natural Disasters (Tsunami, hurricane,
    earthquake)
  • Serious accidents (motor vehicle)
  • Sudden and/or violent loss of loved one
  • Physical or sexual assault

30
Chronic Traumatic Environs
  • Exposure to trauma occurs repeatedly over long
    periods of time.
  • This exposure to the toxic environment can bring
    about a large range of emotional responses
    including fear, mistrust, compromised feelings of
    safety, guilt and shame.

31
Chronic Traumatic Environs
  • Specific Examples
  • Some types of physical abuse
  • Long-term sexual abuse
  • Domestic violence
  • Wars and other forms of political violence and
    unrest

32
Child Traumatic Stress
  • The dynamic nature of child development causes
    children to respond to traumatic stress in
    different ways

33
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34
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35
Child Traumatic StressChildren Under Age Three
  • Change in their personality that involves being
    clingy, irritable or tearful
  • Loss of energy or interest in play
  • Regression or change in daily routines of eating,
    sleeping or toileting

36
Child Traumatic StressPreschool Age Children
  • Fear of being alone
  • Nightmares, fear of the dark
  • Clinginess
  • Changes in speech (baby talk or stuttering)
  • Defiance

37
Child Traumatic StressSchool-Age Children
  • Irritable, whiney
  • Aggression toward peers
  • School avoidance
  • Headaches or other physical complaints
  • Disturbances in sleeping or eating habits

38
Child Traumatic StressTeenagers
  • Headaches or other physical complaints
  • Disturbances in sleeping or eating habits
  • Withdrawal from family and/or friends

39
Child Traumatic Stress Outcomes
  • Many children recover naturally and completely on
    their own after experiencing Child Traumatic
    Stress
  • Other children may go on to develop such
    psychiatric conditions as posttraumatic stress
    disorder, depression, and anxiety

40
Child Traumatic Stress Outcomes
  • Significant disruption of child or adolescent
    development
  • Repeated exposure to traumatic events are
    associated with
  • Atypical brain and nervous system development
  • Increase risk of poor academic performance
  • Engaging in high-risk behaviors
  • Compromised peer and family relationships

41
Child Traumatic Stress Outcomes
  • Repeated exposure to traumatic events are
    associated with
  • Increased use of health mental health services
  • Increase involvement with the child welfare and
    juvenile justice system
  • Adult survivors may experience difficulty in
    establishing intimate relationships and healthy
    employment histories

42
Consequences of Trauma Exposure
  • Posttraumatic Stress Disorder (PTSD)
  • Re-experiencing
  • Numbing/Avoidance
  • Hyperarousal

43
Consequences of Trauma Exposure
  • Posttraumatic Stress Disorder (PTSD)
  • Prevalence in adolescents
  • 4 of boys
  • 6 of girls
  • 75 of those with PTSD have additional mental
    health problems
  • Breslau et al., 1991 Kilpatrick 2003, Horowitz,
    Weine Jekel, 1995

44
Consequences of Trauma Exposure
  • Depression
  • Anxiety
  • Substance Abuse
  • Behavioral Problems
  • Poor School Performance

45
How can Child Traumatic Stress impair childs
ability to learn?
  • Single exposure to traumatic events may cause
  • Jumpiness
  • Intrusive thoughts
  • Interrupted sleep nightmares
  • Anger and moodiness
  • Social withdrawal
  • Concentration and memory difficulties

46
Chronic exposure to traumatic events
  • Especially during a childs early years
  • Brain changes that impact attention, memory and
    cognition
  • The overdevelopment of certain regions involved
    in anxiety and fear responses which result in the
    underdevelopment of other regions of the brain
    necessary for complex thought and learning
  • Reduction in a students ability to focus,
    organize, and process information
  • Difficulty with effective problem solving

47
Impact of trauma on learning
  • Decreased IQ and reading ability
    (Delaney-Black et al., 2003)
  • Lower grade-point average (Hurt et al., 2001)
  • More days of school absence (Hurt et al., 2001)
  • Decreased rates of high school graduation
    (Grogger, 1997)
  • Increased expulsions and suspensions (LAUSD
    Survey)
  • Students and Trauma DVD

48
Introduction to Trauma Informed Systems
49
The Trauma Lens
  • A shift in perspective from
  • Whats wrong with you?
  • to
  • What happened to you?

50
Attempts to cope may lead to behaviors that
undermine healthy relationships
  • Aggressive or sexualized behaviors
  • Sleeping, eating, elimination problems
  • High activity level, irritability, acting out
  • Emotional detachment, unresponsiveness, distance,
    or numbness
  • Hyper-vigilance or feeling that danger is
    present, even when it isnt
  • Under/over controlled behavior

(Developmental Trauma Disorder)
51
High-risk or destructive behaviors as an attempt
to cope
  • Aggressive or disruptive behavior
  • Sleep disturbances
  • Drug and alcohol as a coping mechanism to deal
    with stress
  • Over-or under-estimation of danger
  • Expectations of maltreatment or abandonment
  • Difficulties with trust
  • Leading to an increased risk of re-victimization

(Developmental Trauma Disorder)
52
Protective Factors that Increase Resilency
  • Caring supportive relationships
  • High expectations for success
  • Opportunities for meaningful participation
  • Clear and consistent boundaries
  • Life Skills (e.g., identifying internal states)

53
Resilience and Recovery from Trauma
  • Resilience describes the phenomenon that most
    children adolescents can bounce back from
    family or community problems or losses if the
    right combination of internal and external
    protective factors are in place.
  • Most youth recover over time, yet 25-30 will
    withdraw from teachers, friends family or act
    out with increased negative behavior.

54
Resilience and Recovery from Trauma
  • These youth are in need of more specialized
    support from a Mental Health Professional.

55
Why a trauma program in schools?
56
Trauma School DVD
57
Trauma Screening Activity
58
Why a program for traumatized students?
  • One night several years ago, I saw men shooting
    at each other, people running to hide. I was
    scared and I thought I was going to die. After
    this happened, I started to have nightmares. I
    felt scared all the time. I couldnt concentrate
    in class like before. I had thoughts that
    something bad could happen to me. I started to
    get in a lot of fights at school and with my
    siblings.
  • Martin, 6th grader

59
Why a program for traumatized students?
  • While walking we saw people crying because they
    had no food and water. We saw bodies in the
    street. They had an old man dead in a chair. I
    was so scared I thought I was going to die. We
    were walking on the bridge, and the army men
    started to shoot in the air, and I just started
    to cry I was so scared. It started to rain and
    everyone started to cry, saying, I hope another
    hurricane dont pass by.
  • Keoka, 10th grade

60
Why a program for traumatized students?
  • More and more youth are experiencing traumatic
    events
  • Community violence
  • Natural and technological disasters
  • Terrorism
  • Family and interpersonal violence
  • Most youth with mental health needs do not seek
    treatment
  • Many internalizing disorders in children go
    undetected

61
Events of the Generation That Have Changed
Education
  • 1990-2009 School Shootings 600
  • 1995-Oklahoma City
  • 2001-9/11 Terrorist Attacks NYC/DC
  • 2001-Present The War on Terrorism
  • Iraq War/Afghanistan/Middle East
  • 2005 Hurricanes Katrina / Rita

62
Traumatic Events in Society
  • Child abuse and maltreatment
  • Domestic violence
  • Community violence
  • Criminal victimization
  • Medical trauma
  • Traumatic loss
  • Accidents and fires
  • Natural Disasters (hurricanes, earthquakes,
    tornados, sunamis, wildfires)

63
Traumatic Events in Schools
  • School related violence
  • Bullying
  • Gang violence and threat
  • Internet sources of information, values,
    instruction

64
LAUSD 6th Grade StudentsPrevalence of Past Year
Violence, 2004
Gun or knife violence (40)
Non-weapon related violence(54)
No violence (6)
(N28,882)
No Violence (6)
65
National Survey of Adolescents Prevalence of
Violence History
Assault Witness (23)
Witness Only (48)
No violence (27)
(N1,245 Kilpatrick et al, 1995)
Direct Assault Only (2)
(N28,882)
No Violence (6)
66
Evidence-Based Practice A Dynamic Interplay
Best Clinical Experience
Best Research Evidence
EBP
Consistent with Family / Client Values
67
Bringing Evidence-Based Treatment to Schools
  • Kids are in schools (removes obstacles such as
    transportation, stigma, etc.)
  • CBT in school setting
  • Acceptable
  • Feasible
  • Amenable to group structure
  • Focus on building skill
  • Empowering

68
Gaining support from school community
  • Liaison with teachers and administration
  • Find ideal time for group
  • Present education about trauma and respond to any
    concerns about program
  • Students and Trauma DVD
  • Trauma Awareness Powerpoint Slides
  • Trauma Factsheets for Educators
  • Outreach to parents
  • Depending on community and school issues,
    consider working with parent leaders to engage
    parents in process
  • Develop parent component depending on needs of
    parents

69
Third Culture Students Stress Trauma
70
Third Culture Students Stress Trauma
Stress
Trauma
71
Third Culture Students Stress Trauma
Not an event itself but rather a response to a
stressful experience in which a persons ability
to cope is dramatically undermined
72
Third Culture Students Stress Trauma
Open Agenda Discussion
73
Overview of AISA Trauma Response Program
74
Children of War DVD
75
Your toolkit to manage stress and trauma
Support for Students Exposed to Trauma (SSET)
76
  • Who implements SSET?
  • teachers,
  • school counselors
  • school social workers
  • What age group benefits from SSET?
  • designed for middle school children/ grades
    4th-9th

77
Goals of the SSET Program
  • Reduce symptoms of PTSD and other related
    problems
  • Build resilience
  • Build peer and parent support

78
Theory behind SSET
79
Getting Started
  • Screening
  • Permission from parents
  • Space
  • Time of day
  • Time of year (10 continuous weeks are optimal)
  • of kids 6-10, gender mixed usually
  • Group schedule

80
Lesson One
  • Introduction

81
Goals and Objectives
  • Build trust and group cohesion.
  • Cover expectations of group.
  • Students will verbalize why they are
    participating in group.
  • Increase students comfort level within group.

82
Materials
  • Bag of MMs or other multicolored candy.
  • Confidentiality statement to be signed by group
    members.
  • Index cards
  • Copies of the Why I am Here worksheet.
  • Copies of the Goals worksheet.
  • Copies of the Letters to Parents with leaders
    name and contact information.
  • Return to Class slips.

83
Leader Preparation
  • Interview each student privately to confirm
    trauma and desire to attend group.
  • Obtain permission slips.
  • Discuss with each student on how he or she will
    present trauma have permission to present for
    student if it is to hard for them.
  • Locate place and time to hold group sessions.

84
Preparation cont
  • Review Disclosure by Group Members.
  • Troubleshoot Why we are here exercise.
  • Review the Dos and Donts of the MM game.
  • Have introductory questions on index cards and
    ready for MM game.
  • Personalize the Letter to Parents.

85
Session
  • Welcome students and review agenda for the
    meeting.
  • Review group schedules and hand out written
    copies for students to have.
  • Discuss importance of being on time, showing
    respect and completing between-lesson activities.
  • Review and discuss Confidentiality.

86
Activities
  • Play the MM game.
  • Explanation of SSET.
  • Go over Stress/Trauma/Violence Triangle.
  • Have group members share stories.
  • Go over at home assignment with students.
  • Troubleshoot problems they might have in
    practice.
  • Review what happened in group.

87
Parent Calls
  • Call parents to introduce yourself and provide
    information on group expectations.
  • Letters are sent home after session one in case
    phone calls are not possible.

88
Lesson Two Common Reactions to Trauma and
Strategies for Relaxation
89
Goals and Objectives
  • Teach students about normal or common problems
    that we have after a traumatic experience.
  • Teach relaxation exercise to calm anxiety.
  • Students increase understanding about negative
    thoughts ,feelings, and actions that result from
    trauma.
  • Students feel more normal as result of
    understanding.
  • Students feel a sense of support form peers in
    group.

90
Goals and Objectives cont
  • Students establish a sense of hope that the group
    will help reduce negative thoughts, feelings and
    actions associated to their experience.
  • Children experience increased communication and
    support from parents.
  • Students learn how to relax their bodies.

91
Materials
  • Copies of the List of Problems People have After
    Stress worksheet.
  • Copies of the Information About Common
    Reactions to Stress or Trauma worksheet.
  • Copies of the Activities worksheet.
  • Highlighters
  • Return to Class slips.

92
Session
  • Introduce agenda for session.
  • Review practice from previous session.
  • Education about common reactions to Trauma.
  • Relaxation training to combat anxiety.
  • Homework assignment.
  • Review session

93
Education on common reactions to trauma
  • Deliver information and lead discussion on
    traumatic stress.
  • Normalize problems.
  • Explain how group can offer support.
  • Build support among group members.

94
Relaxation
  • Have group members decline in chairs or lie on
    floor.
  • Encourage focus and silence during activity
  • Lead students in guided imagery and relaxation
    activity.

95
Lesson Three Thoughts and Feelings
96
Goals and Objectives
  • Teach students a common language to describe
    feelings.
  • Teach students that thoughts directly effect
    feelings.
  • Introduce skill that challenges unrealistic
    thoughts.
  • Students observe and increase ability to
    challenge thoughts.
  • Students begin experiencing less anxiety by
    decreasing negative thoughts.

97
Overview
  • Introduce Agenda for session
  • Review homework.
  • Introduce fear Thermometer.
  • Examples of thoughts affecting feelings.
  • Linkage between thoughts and feelings.
  • Assign homework.
  • Review session.

98
Materials
  • Copies of fear thermometers worksheet.
  • Comic strips, video clips or other examples that
    demonstrate how thoughts affect feelings.
  • Copies of the Noticing Your Thoughts and
    Feelings worksheet.
  • Return to class slips.

99
Fear Thermometer
  • Introduce fear thermometer concept for students
    to talk about how anxious or nervous they feel.
  • Give examples to demonstrate different levels of
    feelings.
  • Distribute blank thermometers, allow children to
    think of different situations and provide fear
    rankings using the fear thermometer.

100
Linkage between thoughts and feelings
  • This lesson shows that thoughts can cause and
    fuel feelings.
  • Make certain group members understand the way
    that thoughts and feelings are linked.
  • Engagement activity use example from group to
    demonstrate concept.

101
Lesson Four Helpful Thinking
102
Goals and Objectives
  • Teach students to challenge their negative
    thoughts and replace them with more-helpful
    thoughts.
  • Increase ability to challenge thoughts
  • Increase ability to generate helpful thoughts.
  • Students experience less anxiety as a result of
    mastering these skills.

103
Overview
  • Agenda for session.
  • Review of previous homework.
  • Hot Seat Check the Facts.
  • Hot Seat activity
  • Homework assignment
  • review

104
Materials
  • Chair for Hot Seat activity.
  • Copies of Questions you can use to argue
    against negative thoughts worksheet.
  • Copies of Hot Seat Exercise worksheet.
  • Return to Class slips.

105
Hot Seat Activity
  • Teach students to challenge negative thoughts
    and replace with positive thoughts.

106
Lesson Five Facing your Fears
107
Goals and objectives
  • Introduce concept of avoidance.
  • Students will be able to identify trauma-related
    avoidance.
  • Decrease anxiety and increase confidence by
    facing fears.
  • Increase skills by coping with anxiety.

108
Materials and Leader Preparation
  • Copies of Steps toward Facing your Fears,
    instruction worksheet, Facing your fears and
    Hot Seat Exercise
  • Copies of Letter to Parents.
  • Return to Class slips
  • Review students individual experience and
    progress.

109
Overview and Lesson
  • Review homework from previous session.
  • Introduction to facing your fears.
  • Working with students on fear.
  • Steps toward facing your fears.
  • Go over coping strategies
  • Assign homework.
  • Review of session.

110
Introduction to facing fears
  • Explain that avoidance is a form of coping with
    anxiety.
  • Avoidance often creates more problems than it
    solves.
  • Pick a safe fear for student to work on.
  • Work on steps to facing fears.

111
Other Coping Strategies
  • Introduce other ways of dealing with stress.
  • Thought stopping
  • Distraction
  • Positive Imagery

112
Lesson 6 Trauma Narrative Part 1
  • Overall Goal
  • Help students begin to process their traumatic
    experience through writing about it and sharing
    their story with the group
  • Materials
  • Writing a Newspaper Story worksheet
  • A Newspaper Picture worksheet
  • Facing Your Fears and Hot Seat Exercise
    Worksheets
  • Return to Class slips filled out
  • Leader Preparation
  • Review each students traumatic event
  • Review table 4, Common Misconceptions About
    Processing Trauma

113

114
Sharing their Stories
  • Confidentiality
  • Support
  • Paying attention
  • Positive feedback

115
Plan for Independent Practice
  • Handout the Newspaper Picture Worksheet
  • Ask students to draw a picture to accompany their
    news story
  • Explain Drawing a picture is another way of
    digesting what happened
  • Assignments
  • Facing your Fears
  • Hot Seat Exercise

116
Lesson Eight Problem Solving
117
Goals and Objectives
  • Teach students skills to problem solve.
  • Students learn the link between thoughts an
    actions.
  • Students learn to brainstorm solutions.
  • Students learn to evaluate pros and cons to
    solutions.
  • Students learn to apply skills to problems in
    their own lives.

118
Materials and Leader Preparation
  • Copies of worksheets
  • Problem Solving
  • Facing Your Fears
  • Hot Seat Exercise
  • List of real-life problems faced by students in
    group
  • Return to class slips.

119
Overview
  • Introduction
  • Review of homework from previous session
  • Social problem solving
  • Brainstorming Solutions
  • Decision Making
  • Homework assignment
  • Review

120
Social Problem Solving
  • Introduce that problem solving with others takes
    practice.
  • Teach students how thoughts influence behavior
    with family and friends.

121
Parts of a Problem
  • Physical
  • How others think and act
  • How you think
  • How you act or what you do

122
Brainstorming and Decision Making
  • Generate real-life solutions to real-life
    problems.
  • Seek social support
  • Try to get as much information about problem.
  • Decision making pros and cons
  • Evaluate possible actions

123
Lesson Nine Practice with Social Problems and
the Hot Seat
124
Goals and Objectives
  • Increase students competence in challenging
    negative thoughts.
  • Increase students ability to handle real-life
    problems.

125
Materials and Leader preparation
  • Evaluation forms
  • Return to class slips
  • Check in with students to assess continuing
    problems and symptoms.
  • Consult with supervisor about referrals that will
    be made to outside services.

126
Overview
  • Introduce agenda
  • Review homework
  • Continued practice with problem solving and hot
    seat.
  • Review key concepts that students have learned in
    group.
  • Hand out evaluations
  • Review session

127
Lesson 10Planning for the Future and Graduation
128
Goals and Objectives
  • Help students review and celebrate their progress
    and consolidate skills they have learned.
  • Students will identify positive change/progress
    made during the group
  • Students will anticipate possible future
    challenges and consider ways of applying skills
    to future situations
  • Students will celebrate graduation from SSET

129
Materials
  • Copies of Note to Self
  • Copies of Certificate of Achievement
  • Special snacks, gifts, treats and/or party
    supplies

130
Leader Preparation
  • Review Ending the Group
  • Review Individual students progress and have at
    least one genuine positive statement in mind
    regarding his/her involvement in the group
  • Have students verbalize positive feedback to each
    other or have them right these down on slips of
    paper to be read to the group
  • Make phone call to parents (optional)

131
Overview
  • Introduce agenda
  • New Group Member Game
  • Planning for the Future
  • Graduation Ceremony and Individual Appreciation
  • Wrap-up and Goodbyes

132
SummaryRecognizing and
Responding toChild Traumatic Stress in
School-age Children
133
Small group/Individual Consultation
134
Recognizing and Responding toChild
Traumatic Stress in School-age Children
  • Douglas W. Walker, PhD
  • Clinical Director - Mercy Family Center
  • Project Director - Project Fleur-de-Lis
  • dwallacewalker_at_yahoo.com
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