Traumatic Events in the School
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Transcript Traumatic Events in the School
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)
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 Exposure
on 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 in
Elementary 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
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
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
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 PostTrauma 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 Aid
During 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
–
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–
–
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:
–
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–
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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 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
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.