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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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