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For children and adolescents,
exposure to traumatic events and the symptoms
that follow may interfere with the ability to
have a reasonably normal school experience.
In fact, posttraumatic symptoms may make the
school experience and other aspects of life
intolerable for some children. Trauma's disruption
of school life can take many forms. If the child
feels stigmatized, frightened, or easily overwhelmed,
s/he may resist returning to school. Relationships
may be difficult because of symptoms or because
of distrust related to experiences such as repeated
abuse or violence. Postttrauma behaviors and
attitudes, such as irritability, fears, rage,
or increased reactivity, may alienate other
youth and adults. Arousal symptoms may interfere
with attention and concentration and may undermine
academic performance. The youth may become unable
to handle multiple stimuli such as chatter,
multiple images, pages of print, and competing
sounds. Normal school noises may be difficult
to tolerate. The youth may overreact to stress
or perceived threat. S/he may see threat or
degradation when there is none intended. Traumatic
reminders may trigger increased symptoms or
behavioral outbursts that seem strange or disruptive.
Case Examples
- Months after part of her
school came crashing down during an earthquake,
killing several students, 7 year-old Kendra
would jump under her desk every time there
was thunder and when there was a rumbling
noise of any kind. She had trouble concentrating
on her schoolwork and became frustrated and
cried easily.
- After a boy was badly injured
and severely traumatized in a tornado, he
found noise and the hovering of curious peers
intolerable. He would sometimes cover his
ears and begin to scream. He refused to return
to school or to be away from his mother.
- After a school shooting,
a previously well-liked girl's irritability
and low stress tolerance resulted in rejection
by her peers. Children said she had turned
into a bully. She snapped at them frequently,
- After 9/11, a 9 year-old
New York boy talked about the terrorist attacks
repeatedly. His regressed behaviors made him
seem strange to his peers. He drew pictures
of the towers and of airplanes during class.
He remained hypervigilant because he was fearful
of another terrorist attack.
- During hurricane Katrina,
for hours, twelve year-old Tanya was on the
roof of a house with her sisters waiting for
rescue. She saw bloated bodies float by and
every time the water started to slap against
the edges of the roof or spray on her, she
feared that she would end up dead in the water,
eaten by gators or killed by snakes. After
she returned to school, she became particularly
distressed on rainy days, especially if the
streets started to have water buildup. She
screamed and cried when anyone splashed water
on her.
- Brandy was pretty and tough.
Her father had abused her from the time she
was 8 years old. She was angry all of the
time. She expected aggression from others
and saw threat and insult when it wasn't there.
In her family, her abusive father held all
of the power. She was reactively aggressive
(e.g., reacted with aggression to perceived
insult) and proactively aggressive (e.g.,
she bullied and insulted others). She had
learned that the aggressor had all of the
control. She sometimes did things in anticipation
of needing to reduce someone's power or when
she felt her control threatened. When they
were changing for gym class, if anyone mentioned
the scars on her legs, she slugged them. Some
of the scars were from her father and some
from her cutting.
- Sonny was picked on from
the time he started school. He was average
height and thin. Other children called him
names like "nerdy boy" or "geeko".
He was pushed around, and, in later school
years, boys threw things at him. Because he
was identified as a victim, other children
seemed to condone pushing him around. In his
elementary school years, he was depressed
and hated going to school. In middle school,
he started to become angry. In high school,
he began to read about the boys who shot at
Columbine.
- Despite the term "army
brat", Jennifer, age 14, was a happy,
responsible girl before her father's deployment
to Afghanistan. She was very close to her
father. After her father's deployment, one
classmate's father died in Iraq when an improvised
explosive device hit his convoy. One's mother
died in their camp in Baghdad, when they were
barraged with rocket-propelled grenades. In
the hall of their high school is a wall where
the men and women killed in action are honored.
Each one has a set of pictures and other hanging
items that celebrate his or her life. In English
class, the names of hundreds of deployed soldiers
are on the walls. The family car has bumper
stickers reading, "Support our Troops"
and "Half My Heart Is in Afghanistan".
Jennifer watched the news and listened for
the information that might tell whether her
father was among those killed. She sent him
email every day, but he was not able to write
back every day. She had become distracted
and worried. Her grades dropped significantly.
She was angry but didn't know who to be angry
with-the president or army for sending him,
her father for leaving, the kids whose fathers
had already come home. Her mother was also
distraught and not always of much support
for Jessica. After a military man started
shooting at people at a base in Texas, her
stress increased to include worry about her
mother and friends. Her poor concentration
worsened. It was difficult to do schoolwork.
A traumatized child may become easily overwhelmed.
S/he may become disruptive or self-destructive.
The youth may deal with distress by externalizing
(e.g., conduct disturbances, defiance) or internalizing
(e.g., anxiety, depression, suicidality, self-mutilation).
Some children express their distress through
both internalizing and externalizing. Additional
traumas in a youth's country or region may increase
distress. For example, the news of children
being hurt in another state may add to a youth's
fear and feel unsafe. For children whose parents
are deployed to war zones, fears and worries
about their parent's safety may increase with
news reports about war zones and deaths. Recent
violence on an army base has brought the danger
close to home as well. No matter what form school
problems take, interventions must be tailored
to the individual child or adolescent and to
the specific situation and school. In order
for interventions to be successful, relevant
school staff must be willing and able to become
a part of them. This article discusses some
of the things to consider when developing an
individualized intervention method and describes
a few of the interventions that have been used.
GOALS
- It is important to discover
what is possible and is needed within the
child's school, class, and situation.
- It is essential for school
interventions to enable and restore the youth's
ability to function successfully at school,
the youth's positive self-image, the youth's
good image among her/his peers, and the youth's
ability to engage peacefully in schoolwork.
Restoring some sense of personal control may
be a part of this.
- It is important to prepare
the child, her/his parents, the teacher, and,
sometimes, the class and school staff for
possible needs and problems, for transitions,
and for possible regressions. In some cases,
the youth's permission will be needed before
information is shared.
- Transitions should be made
as easy for the youth and school staff as
possible and should be well paced. For example,
transitions may include those from home to
school (if the child has been away from school
because of injuries or distress), from a reduced
study load to a normal one, from assisted
work to independence, from stepped up support
to normal support.
- The traumatized youth should
be made aware of her/his available human resources
(e.g., school psychologist, nurse, locations
for calming or walking off stress) and of
how to handle times when symptoms increase
or it is difficult to control behavior.
- Efforts to help the youth
should be well coordinated among therapist,
school psychologist or counselor or other
school staff, and parents.
Assessing
the Situation
Parents, teachers,
school psychologists, other school staff, and
the child's individual therapist may be a part
of both assessment and intervention. Before
information is shared with peers or teachers,
it is important for the therapist and parent
to prepare the youth and to have her/his cooperation,
permission, and input regarding what is shared
with teachers and peers. In contrast, information
shared with the clinician and with the school
psychologist must be comprehensive enough to
enable successful interventions.
What Parents Can Do
When a traumatized child is having a difficult
school experience because of trauma symptoms,
the parent can be instrumental in obtaining
helpful interventions from the appropriate professionals.
In order to be able to assist the child's recovery
for as long as it takes, the parent must also
keep her/himself in shape, physically, emotionally,
and spiritually (at the core of self). A good
support system is important for parent, child,
and those who intervene.
•Find a good therapist
If the child is having posttraumatic symptoms
severe enough to disrupt her/his school experience,
it is likely that the parent has already found
a therapist who is a trauma specialist for the
youth. It is important to research therapists
in order to find a good one. Some therapists
will provide group or individual treatments
for youth. The Sidran Institute (www.sidran.org)
has a list of therapist/clinicians who treat
trauma in your area. It is important to investigate
a therapist's good standing and success with
others by contacting other clinicians who know
their work, licensing agencies, and individuals
who have used trauma therapists.
•Request a school
consultation
-The parent may ask the child's therapist for
a school consultation. This consultation may
include the therapist's meeting with the school
psychologist or principal and/or obtaining permission
to observe in the classroom.
-Depending on the school, the trauma-related
skills of the school psychologist, and the methods
of the child's trauma therapist, the parent
(or parent and therapist) may request that the
school psychologist meet with the parent and
that the classroom situation be assessed.
•Help to determine
the child's immediate and long-term needs
Is the child currently able to learn in the
classroom setting? Can s/he be there without
disrupting others' abilities to learn? Will
the child's symptoms in the classroom damage
the child's self-image, image among her/his
peers, and ability to have success in (and out
of) school into the future? If the answer is
no to either of the first two questions or yes
to the third question, a period of schooling
at home should be considered.
•Investigate/assess
recommended treatments
If you feel concern about any of the recommendations
for your child, investigate them before they
are implemented. For example, if medication
is recommended, it will be important to weigh
the benefits against the potential risks. Find
out about potential long-term side effects and
consequences of treatments. Ask if the effects
have been studied. For example, ask if the use
of a medication in early life may affect brain
chemistry and development, other aspects of
the nervous system, intelligence, long-term
health, personality, skills, and skill development.
Compare the results to the current and long-term
consequences of not using the treatment or medication.
If, for example, your child's problems are severe
enough that she or he is a danger to himself
and/or others, you will need to investigate
hospitals to find a suitable one. There are
good hospitals that protect and assist children.
However, because some youths have learned bad
habits or been exposed to other things as inpatients,
one of the questions to ask is what other youth
will be there and how the hospital or institution
will prevent your child's learning bad habits
from them (e.g., drug use; other illegal activities)
or being additionally traumatized by them.
•Be available to assist
school interventions
The parent may assist interventions by, for
example, being present at the school for the
child's support when needed, providing information
that will help the mental health professionals
to assist the youth, and helping the child to
practice coping skills or to learn to identify
posttraumatic triggers or reminders that set
off difficult episodes. The therapist or school
psychologist may be able to help with how to
practice coping and how to identify triggers.
•Recognize your child's
functioning age
In general, if the child has regressed or is
functioning like a younger child (e.g., tantrums,
low frustration tolerance for her/his age level
and the normal demands of her/his environment),
it might be important to use methods appropriate
for a younger child in dealing with his or her
behavior. The youth's therapist should be able
to help you with this process.
•Be cognizant of the
needs of the rest of the family
The wellbeing of other family members (including
yours) may have been undermined by the intensity
of reactions and needs of the traumatized child.
Ask the therapist to help you assess your own
and other family members' needs and how to assist
them through the changes brought about by the
trauma. A number of books are available to assist
children with grief or other problem circumstances.
On online search can elicit books and reviews
of the books. (a list of some books will be
added later to the appendix)
•Engage in good self-care
In order to assist the youth, it is important
to take care of self. Self-care should include
healthful, restorative behaviors (e.g., appropriate
exercise, rest, nourishment, support from others)
and times away from the traumatized child to
restore energy and equilibrium. Pay attention
to the needs of your spiritual or core self-the
part of you that has qualities such as hope,
faith, trust, and uplifting experiences.
What Clinicians and School Psychologists
Can Do
Posttrauma school interventions require cooperative
efforts in order to be successful. It is important
for all helping professionals to engage in ongoing
effective communication about the child and
her/his progress. Preparation for effective
interventions includes assessment of the child
and the situation (see appendix).
•Determine if a period
of schooling at home is needed
-As noted earlier, a number of questions should
be addressed: Is the child currently able to
learn in the classroom setting? Can s/he be
there without disrupting others' abilities to
learn? Will the child's symptoms and behaviors
in the classroom damage the child's self-image,
image among and ability to have relationships
with peers, and/or ability to have success in
(and outside of) school into the future? Will
the responses of other children to the youth's
symptoms increase the youth's distress, reactivity,
and potential for aggression or self-destructive
behaviors? If the answer is no to either of
the first two questions or yes to the third
or fourth questions, a period of schooling at
home should be considered.
-If it is important to postpone the child's
presence in the classroom, mental health professionals
can set up a tentative guideline for the child's
return to the school. Outline the indicators
that the child is ready to be eased back into
the school.
•Assist Reentry and/or
school functioning
Prepare a method of easing the child back into
the classroom.
-Does the child need a trusted adult's presence
for a period of time? If so, how will the child
be weaned from this supportive presence?
-How will classmates and teacher be prepared
for the child's return to class and her/his
needs in class until recovery? What information
has the child given permission to share?
-What support systems are in place to assist
the youth?
-What measures are in place to reduce distress?
-What time out locations will be available to
the child while s/he is still recovering?
- Does the child need a reduced study load and
a gradual increase in load as mental health
is restored? If the child has moved from another
school because of the traumatic experience,
what is needed to get the child in sync. with
the new classroom? How will a desirable peer
support system be developed?
-How can the teacher be helped to deal with
the child's special needs? Will the teacher
recognize the youth's functioning age?
-What methods will be used to continue to assess
progress and needs?
•Assess the child's
classroom behaviors
-Meet with the youth's teachers and other relevant
staff in private to make a list of the problem
behaviors teachers/staff are observing.
-Observe the child in the classroom. In order
to do so effectively, the observer must stay
long enough and quietly enough to become an
essentially invisible presence.
-Determine what problem behaviors occur. Make
note of what triggers the problem behaviors
(e.g., overwhelm because of the inability to
concentrate, reduced frustration tolerance,
and/or intolerance of multiple stimuli; traumatic
reminders; noise; grieving; helplessness; sadness).
-Identify the child's currently functioning
skills (e.g., coping abilities) and functioning
age.
-Make intermittent re-assessments of the youth's
symptoms, behaviors, and progress.
•Assess resources
-Assess the youth's personal resources for learning
to cope and participate in planning intervention
strategies. What were the youth's pre-trauma
strengths and talents? What were her/his methods
of coping with stress? Do pre-trauma methods
still help or work for her/him?
-Determine whether or not there are sympathetic
peers who can be of assistance or who will at
least avoid exacerbating the problem.
-Determine whether teachers/staff will be willing
and able to reduce stressors and triggers to
the problem behaviors, develop a reduced load
to be gradually increased with the child's increasing
ability to function, provide feedback in a timely
manner, and avoid exacerbating the problems
through attitude or behavior.
-Assess other support systems (e.g., supportive
parents, siblings, friends, relatives).
•Set up support systems
and time out locations
-Pinpoint locations (and people) in the school
where the child can go if s/he needs a time
out (e.g., to use calming methods, exercise
away agitation, rest, talk, engage in calming
activities).
-Develop guidelines for when and how many times
a day (then week) the child may use a time out.
-Has the child moved from another location because
of the trauma? Will s/he need extra assistance
to develop a support system and to develop helping
friends among youth who do not know the youth's
pre-trauma self?
•Coordinate interventions
for problem behaviors
-Coordinate therapist and school psychologist's
roles in the youth and teacher's learning the
triggers that lead to problem episodes and how
to cope with the youth's reactions.
-Coordinate the method and location of teaching
the youth coping skills.
-Coordinate the enlisting of peer support.
-Assign methods of communicating regarding the
youth and her/his progress.
•Prepare for Transitions
Prepare the youth, the teacher, and the parent
(and, when needed, the class) for changes or
transitions. Give the youth ample time to adjust
to any upcoming changes without giving so much
time that anticipation significantly increases
stress.
•Be aware of the impact
of the youth's symptoms and reactions on other
family members
Having a traumatized child in the family can
be trying for everyone. The traumatized or externalizing
child may become the full focus of attention.
Assess the needs of other family members. When
needed, provide interventions or help to establish
support and relief systems that help regain
equilibrium.
•Engage in Good Self-care
Clinicians and school staff also need good self-care,
in general and especially when working with
traumatized youth. In addition to the information
for parents on good self-care, a number of resources
are available that discuss self-care (Boaz &
Panos, 1998; Boaz, Panos, Panos, & Steele,
2006; Figley, ; Rothschild, 2006).
Interventions
There are a number of possible
school based interventions for youth that may
supplement the child's individual treatment
for her/his posttraumatic reactions. Methods
used successfully with traumatized children
may be incorporated into school interventions
or be a part of a youth's ongoing, separate
individual treatment. For example, a Duke University
protocol describes a group method that involves
"bossing back trauma" (March, Amaya-Jackson,
Foa, & Treadwell, 1999). There are a number
of cognitive behavioral methods (Cohen, Berliner,
& Mannarino, 2000) and play therapy methods
(Lehmann & Coady, 2001; Webb, 2002) available
for use with traumatized children. Methods that
have helped youth to deal with bullies in a
nonviolent manner or to develop coping skills
have been identified (Kalman, 2005; Nader, in
press). If the child's posttrauma school experience
is greatly hindering her/his self-esteem, ruining
her/his relationships and potential for relationships,
and not enhancing her/his learning, then interventions
are essential. The child's symptoms can also
disrupt the learning of her/his peers. A consultation
between the therapist and school psychologist
as well as the therapist's subsequent meetings
with other relevant school personnel or by the
school psychologist in cooperation with the
therapist can be helpful. Planning and interventions
must take into account their future impact,
what the school district allows, the child's
ability to engage in them and the resources
available to the child (e.g., peer support,
teacher skills and sympathy levels, parent's
energy and availability).
When School Life is
Too Difficult
For some children or adolescents, an immediate
return to school is ill advised. Factors that
should be considered, when deciding whether
schooling at home is advisable, are how it will
affect the youth to return to school and how
it will affect the classroom for the child to
be in it. Are the child's symptoms severe enough
to make school life very difficult to tolerate
without a period of intervention? Will the child's
symptoms permanently damage her/his self-image
and/or her/his image among her/his peers? Will
her/his behaviors disrupt the classroom significantly?
Will the school experience be so bad that it
interferes with the child's future life at school,
among peers, and later?
Some children will need a reduced
set of learning demands and to be eased back
into a normal load. The amount that is manageable
and reasonable and the time it takes to return
to a usual course will vary depending on the
child and her/his symptoms. A youth can be eased
back into her/his classroom as well as into
her/his studies. For example, the child may
begin with two hours of classroom time daily
or a half-day with the parent in the classroom,
and time may be gradually increased, as s/he
is able.
Reentry. It
is important to make transitions as easy as
possible for the youth. When a traumatized child
has been schooled at home for a time before
reentry, the classroom can be prepared for her/his
return and needs. What will be discussed with
the class can be discussed with the youth beforehand.
Trauma can make an individual feel like s/he
has no control over her/his life. If it would
not add unneeded stress, making the child a
part of the decision making for the reentry
can be therapeutic for her/him. The youth can
help to decide what is okay for the other children
to know and what needs to remain private. The
clinician or school psychologist who assists
reentry can then decide how to present the information
in an age-appropriate manner and in a way that
enlists the aid of the youth's peers. For example,
the clinician might say no more than that the
youth was hurt or saw someone hurt in a very
scary situation or the clinician or school psychologist
may describe the situation, depending on what
best assists the child currently and over time.
New to the school.
The trauma may have resulted in relocation for
the youth. If the youth is new to the school,
assessment of previous learning in comparison
to her/his current class will be needed at some
point. It may not be possible to successfully
assess the youth's academic skills or level
until her/his functioning age has been restored
to normal or nearly normal. Extra efforts will
be needed to construct a support system among
peers, if the child is new to the school. If
there was relocation, the child may be experiencing
grief related to several different losses (e.g.,
home, friends, relatives, an expected life,
status among peers, activities, opportunities).
Losses may intensify traumatic reactions. With
the child's permission, the therapist and school
psychologist will need to consider whether or
not it would be helpful to the child to share
things about the way the youth used to be and
what s/he went through with a small number of
potentially supportive peers or the teacher.
Case Example
When an earthquake partially collapsed an elementary
school gymnasium, injuring twenty-three children
and two teachers and killing five children,
Tony (age 8) sustained a leg broken in three
places and a fractured hip (Nader, 2008). He
was hospitalized for 3 weeks and required a
period of physical recuperation after he returned
home. Before the earthquake, Tony was a good
student. He was well behaved and well liked
by both peers and adults. Following the earthquake,
he was nervous and jumpy. He became anxiously
attached to his mother and refused to go back
to school. To her distress, he would not let
his mother leave his immediate area. He had
periods of nervous quiet or of expressing fears
of disaster recurrence. He was easily distracted
by sounds or movement and became frightened
when the windows rattled or a passing truck
made the building shake. When his peers visited,
he began to scream and cover his ears if they
hovered or more than one of them talked at the
same time. He couldn't stand for anyone, except
his mother, to touch him. Tony had difficulty
concentrating and frequently engaged in angry
outbursts. He startled easily, cried out in
his sleep nightly, and complained of stomachaches.
After his physician approved his return to school,
Tony refused to go. During home schooling, the
teacher observed that Tony was anxious, exhibited
poor concentration, and frequently displayed
angry outbursts. He would not let his mother
leave the room. Tony was treated for PTSD. With
his and his mother's permission, his therapist
met with his classroom to help them to understand
his symptoms and needs. Among other things,
they learned to avoid noisily hovering around
him, to warn him of their approach, that he
might become distressed if more than one person
talked at a time or there were loud noises,
that trying to concentrate might be hard some
of the time, and he might periodically need
their help. On his first day back at school,
the therapist conducted a meeting with Tony
and his class, so that he could help them understand
how they could help him. His therapist and he
talked about what would be discussed before
the classroom meeting. Tony began with two hours
a day in class. His mother's presence in his
classroom helped him. She began by sitting in
the desk next to him and then moved to the back
of the class until a week after he was staying
in class for the full school day. She then moved
just outside the door, within his view. She
moved to the school library until he could tolerate
being at school without her. She began to regain
some of her privacy and free time, which in
turn improved her ability to assist her son.
Meanwhile, he continued to make progress in
therapy. For a period of time, he experienced
a regression because of a televised disaster
that renewed his fears and stress level. The
school and his mother responded to this regression
by again permitting his mother's presence at
the back of the classroom and then her gradual
withdrawal. Her progression out of the classroom
took less time after the regression. Tony's
peers were helped to understand his regression.
In his individual therapy, he worked on the
impact of seeing another disaster on television
and the trauma issues it resurrected.
Small Peer Support Groups
When children are traumatized and/or suffering
from traumatic grief, 30 to 45 minute small
groups comprised of the youth and two or three
peers (depending on the nature of the group)
have proven to be effective supplemental treatments
for some children. The classmates can help by
serving as a support system for the child and
a feedback system for the child and therapist.
It can be of benefit for at least one of the
peers to have previously resolved a trauma or
loss. The peer's trauma or loss should be well
resolved and a reasonably distant time in the
past-enough so that the group does not threaten
gains already made. Groups should be tailored
to the needs of the individual child and engaged
only if they will benefit the child's recovery
and ability to function in school. They should
not be engaged if they would make the child's
image or self-image suffer significantly. The
therapist may plan the topic of sessions in
advance or have a basic structure and take the
input of group members before sessions begin.
The support peers should be well respected by
their peers, be emotionally mature for their
age group, be kind, and feel sympathy for the
traumatized youth. Lists of students with these
qualities can be obtained from teachers and
from a peer nomination exercise (see appendix).
Several different kinds of groups may be used.
Among them are those that assist coping, recovery
from grieving, learning to handle bullies, and
improving self-skills (e.g., self-control, empathy,
self-protection). A brief description of one
kind of coping group and a grief group are described
here.
Peer nomination is optional.
If it is used, it should be presented as a separate
study rather than as something having to do
with the traumatized youth. The information
can be useful to a number of discoveries that
may benefit the school's youth, such as issues
related to bullies and victims. Answers should
be confidential and truth-telling should be
enhanced. Results should not be announced.
Coping Groups.
Coping groups have centered on learning coping
skills. Although the main goal of the group
may be to assist the traumatized youth, one
focus can be on developing methods for the participants
to help each other in times of stress at school.
With signed agreements for confidentiality,
the 3 youth may share stories about what is
hard to cope with and/or how they handled a
difficult situation. It is possible that the
traumatized youth will remember successes in
handling past stresses. The group members may
be able to help the traumatized youth (or all
members of the group) to identify what triggers
increased stress or meltdowns. A form in the
appendix can help the youth to recognize triggers
by writing down what preceded the noticeable
distress. Group members can complete one of
the forms, if the forms are used, to say what
seemed to trigger the experience, from their
perspective.
Grief Groups.
Grief groups may be comprised of two grieving
youth and two support peers or may be comprised
of individuals with resolved and those with
unresolved grief. It can be helpful when at
least one of the support peers has resolved
grieving a loss in the past. For a traumatically
grieving youth, memories of the deceased may
trigger traumatic distress and interfere with
the grieving and coping process. The person
who leads such a group should understand trauma,
grief, and traumatic grief. It may be necessary
for the youth to successfully complete some
trauma treatment before being able to work successfully
in a grief group.
Case Example
John, age 14, was late arriving at the restaurant
where his family was meeting for his sister's
birthday dinner. As he walked toward the restaurant
door, he heard popping noises and looked up
to see a car with a gun aimed out of the window.
In a matter of seconds, his eyes followed a
bullet as it flew toward the restaurant door;
he saw blood pour out of a man leaving the restaurant
who was hit by one of the bullets; and John
dove for the ground behind the wheel of a car.
He covered his head instinctively. The gunfire
continued and flattened the tire he was hiding
behind, whizzing past his elbow. He stayed flat
on his face for what seemed like forever before
someone told him it was safe and that he could
get up now. There was blood on his shirt from
the man who was shot. At school, John jumped
every time there was a popping sound. The day
that someone set off firecrackers in the hall,
he dove for the ground. Everyone laughed, and
he was really embarrassed as well as very shaken.
Even though he knew that being on time might
not protect him, he worried every time he was
running late for something and yelled at anyone
who was making him late. He refused to go to
restaurants or the neighborhood where the shooting
occurred. He was hypervigilant, had trouble
sleeping, kept seeing the man with blood spurting
out of his chest, and had trouble concentrating
in school. He was used to being a good student
with good self-control. Memories of his experience
made him tense and short-tempered. His inability
to focus on his schoolwork seemed to progressively
worsen. John needed several weeks in therapy
before he was able to be a part of a school
group. The boys met for 30 minutes during free
period. John's best friend, Brad, remembered
what John was like before the shooting. He was
glad they asked him to be a part of John's peer
support group. The other boy in the group had
been through a drive by shooting two years earlier
and had recovered successfully. The three boys
shared the things that "threw them off
their game" and agreed to help each other
cope with things that distressed them enough
to interfere with their functioning. John's
reactions were a priority for them all, since
he was suffering the most. They became really
good at seeing what triggered John's distress
in his studies as well as under other circumstances.
Brad was allowed to move next to John in the
classes they shared. The boys developed signals
for each other-they had signals for different
situations. One of the signals they used when
they saw one of the three was distressed-a fist
to the chest-meant "I'm here if you need
me". They learned a number of coping skills
in the group including some stress reduction
techniques that changed as John was better able
to do some of the newer ones. Some of the signals
they developed to help each other meant "Use
your coping skills." like the one for "Take
a deep breath and look around" (breathe
and assess the situation for real danger) and
the one for "Find your center" (use
stress reduction techniques). Their interactions
increased the friendships among the 3 boys and
helped all of them under conditions of stress.
They especially helped John. Two times per class
in the beginning (reduced to one a class, then
every other class, then one a week), John was
allowed to go out into the hall and walk fast
back and forth down the hall for 3 minutes when
he was too overwhelmed to do his schoolwork.
When something stressful happened in Brad's
home, the boys took the time to focus in on
him in group. It was helpful to John to be able
to help him.
Conclusions
There are a number of possible
ways to assist a youth who is traumatized, including
school interventions. The school interventions
that are possible vary depending, for example,
on the school, school district, traumatized
child, teacher, and the mental health professionals
enlisted to aid the child. Methods used successfully
with traumatized children may be incorporated
into school interventions or be a part of a
youth's ongoing, separate individual treatment.
This paper has presented a few methods that
have been used at schools after mass traumatic
events or a youth's single trauma. Effective
school interventions require the cooperative
efforts of the school staff, the youth's therapist,
and the youth's parent or parents. They necessitate
the flexibility to gauge and adapt with the
youth's progress and regressions.
Note: Case examples have been
disguised to protect the youth described and
are often composite cases.
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