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Crisis Management

Supporting Students One Year After the Boston Marathon Bombing

By Jennifer Greif Green, Shane Jimerson, & Melissa K. Holt

April 2014 marks the 1-year anniversary of the Boston Marathon bombing that resulted in the shutdown of large portions of the Boston area and triggered intense emotions (e.g., fear, anger, sadness) among many children and families. Within a week of the 1-year anniversary, Boston will host the 2014 Marathon. This is expected to be a highly attended and publicized event, with an anticipated 36,000 official entrants in the race (an increase from 27,000 runners in 2013). During the weeks preceding the anniversary period, it is anticipated that there will be a high level of media coverage that will likely include numerous images and videos of the 2013 attacks, as well as stories of the victims and their families. The anniversary of the event presents a teachable moment, in which many lessons may be learned; however, it is also important for schools to prepare for the challenges that some children, teachers, and staff may face during this sensitive period of time.

The Boston Marathon bombing is among several mass crises this past year that impacted youth and schools across the United States. The effects of these traumatic events are known to have a significant impact on the mental health of children in affected communities, including posttraumatic stress disorder (Hoven et al., 2005; McLaughlin et al., 2009; Pfefferbaum et al., 1999). For instance, studies that followed children after the tragic events in New York City on September 11, 2001 and the 1995 Oklahoma City bombing found that even children who did not have direct exposure to the attacks could develop symptoms of posttraumatic stress disorder as a result of their exposure to media related to the attacks (Pfefferbaum et al., 2003; Saylor, Cowart, Lipovsky, Jackson, & Finch, 2003).

When the Boston Marathon bombing occurred (April 15, 2013), many schools were out of session on April break. However, when schools resumed, it was imperative to determine whether and how to address the events that occurred. The team at Boston University has been surveying Boston-area teachers to understand their responses to the attack and its aftermath. Responses document the range of school policies that were implemented and the many ways in which teachers put into place supportive and caring practices to respond to the needs of their students. For instance, teachers described leading class discussions related to the attacks, engaging students in activities to provide materials and supports to victims, connecting with families in acute need, and keeping an eye on students who might be particularly vulnerable. Although many teachers described feeling well prepared and confident in their response to student needs, many also reported that they would have liked more specific information from their schools about how to lead discussions with students and how to identify students in need of additional mental health supports.

As the 1-year anniversary of the Boston Marathon bombing nears, it is important that school psychologists plan and prepare to both educate and support students. Research reveals that the effects of crises on mental health are often persistent and can last over a year, particularly when children continue to be exposed to reminders of the traumatic event (McLaughlin et al., 2009; Nader, Pynoos, Fairbanks, & Frederikc, 1990). The anniversary of events can, in particular, elicit further distress (sometimes called anniversary reactions; Nemeth et al., 2012; Hamblen, Friedman, & Schnurr, 2010). Unlike crises themselves, anniversaries are events we can prepare for and, as such, education professionals should establish support systems and guidelines for staff in advance.

Below are five key suggestions for school psychologists responding to the anniversary of the Boston Marathon bombing, as well as other crisis events that have occurred in the past year. Further information may be found in Brock and Jimerson (2002) and Zibulsky (2012), which informed the following suggestions.

Recognize that students will have a range of responses and needs. Not all students will be affected the same way by the anniversary, and students will show their feelings in many different ways. Thus, it is important to thoughtfully consider the student population at your school when planning support services. Physical and emotional proximity are two important factors that influence individual responses to such tragic events.

Those students with greater physical proximity to the area of the bombing are most likely to experience heightened emotional reactions during the anniversary period (for instance, those in the Boston area, relative to those in Minnesota and California). Some students with particular proximity to the events—for instance, students in the city of Watertown (the community where the second suspect was apprehended after a door-to-door search) or in the city of Cambridge, where the suspects attended school—will be more likely to exhibit heightened reactions relative to students in less intensely affected Boston-area communities.

In addition to differences related to the proximity of communities, school psychologists should expect a great deal of variation in student responses, even among students with seemingly similar experiences last April. Relationships to victims of the bombing, reactions of parents, preexisting support systems, and personal trauma history are some of the many factors that affect how any individual will respond. Age of students is also particularly critical, as it is associated with their ability to understand and process events.

When considering whether and how to address the anniversary, schools should take into consideration the extent to which students in their communities were affected by the events. Furthermore, school psychologists in highly impacted communities should be prepared for students (as well as school staff and parents) to exhibit a wide range of reactions. Some might have responses similar to intense responses to the original crisis (e.g., fear, sadness, anger), while other students may be relatively unaffected by the anniversary. Understanding this variation and preparing for such diverse responses is important to support students, teachers, and staff.

Some emotional responses and behaviors may have deleterious effects at school. Schools can expect that affected students might act out more, describe physical symptoms (e.g., stomachaches, headaches), or become withdrawn as they cope with their responses to the anniversary. All of these reactions are normal and school staff should establish plans to support students in the days leading up to and following the anniversary.

Develop a communication system for school staff and parents. Schools should establish a clear plan regarding how they will communicate with school staff and parents in advance of the anniversary. A thoughtful and well-orchestrated series of communications from the school leaders will reassure students and families that the professionals at their school are well prepared to support their needs. Furthermore, all teachers at a particular grade level should agree upon a common plan for responding. For instance, teachers can establish clear guidelines regarding in-class lessons or discussions, and highlight school- and community-based resources available for further support. Such coordination is important so that teachers are well prepared to present information and facilitate purposeful discussions that would be appropriate for the given population of students.

Communication with parents is particularly critical because parents will often want to know what they can expect their child might discuss in school, and parents can provide important information to schools about whether their child might need additional support around the anniversary. Schools can provide parents with recommendations regarding limiting media exposure and providing opportunities for their children to discuss the events without forcing or repeatedly bringing up the events. School psychologists are encouraged also to provide information about local mental health resources and tips for parents in how to lead discussions with their children about terrorism (NASP has some particularly useful resources available online at http://www.nasponline.org/resources/crisis_safety).

Provide specific guidelines to teachers. Whether and how to lead discussions with students about the 1-year anniversary of the event should be informed by the age of the students and their level of exposure. Some messages that teachers can offer to their students are that they are safe, that adults are doing everything possible to keep students safe, and that it is understandable to have a wide range of feelings in response to the anniversary. Teachers should also remind students of the adults that are available in the school to support and listen to them, and ask students who they might go to if they are upset or having a hard time. Teachers should not force discussion or repeatedly bring up the events.

When appropriate, some teachers may want to discuss the events or explicitly address them in class, but may be unsure about what to say or how to lead discussions. Some teachers who participated in the Boston University survey commented that they used Open Circle or another similar social–emotional program in their classroom. Such programs may provide teachers with a structure and language to use to lead discussions about responses to crisis events.

Teachers should consider delaying significant tests or major assignments during the weeks preceding and following the anniversary of the event. Although standards do not need to be reduced, delaying particularly intensive schoolwork can provide students with the opportunity to experience and express a range of responses to the event, without negatively impacting their academic performance.

It is also recommend that schools and teachers limit media exposure to the events. For some students (and some adults) viewing images and video of the attack and victims can be retraumatizing. Some young children might not remember the attack from a year ago or might not have previously seen images or video of the events. Viewing repeated video of the attacks could be confusing for children who might not understand that the media is playing old footage.

Encourage healthy coping responses among adults. Parents, teachers, and other caregivers are affected by the anniversaries of crisis events as well. Before addressing events with students, adults should be aware of their own feelings and responses. Schools in more intensely affected communities should consider meetings with school staff and offering additional staff support resources prior to the anniversary. Children draw their emotional cues from the adults in their lives. In front of students, adults should, as much as possible, remain calm and controlled in order to communicate that they are available and able to help students needing support and that school and routines will continue to function as usual. There may be instances where some adults are intensely impacted, and it would be better not to have them involved in direct discussions or support services for students at school.

Watch for children who might need additional support. Teachers, school staff, and parents should monitor students for signs that they might need additional mental health supports. Although most children can be expected to adjust well following the anniversary of an event, for some children, the anniversary can generate significant distress, even delayed onset of posttraumatic stress disorder.

Key signs to look for include: withdrawal or sadness; fear or nervousness; acting out or behavioral problems; inattention or hyperactivity; and verbal, written, or illustrated threats to self or others. These symptoms are cause for concern when they represent a marked change from the student's typical behavior, when they persist beyond the anniversary event and beyond the responses of most peers, when they are particularly extreme or intense, and when they significantly interfere with a student's ability to function at school or at home.

Teachers frequently identify students with emotional needs for mental health services, and school-based professionals (including school psychologists) are among the most frequent providers of mental health services and referrals (Kataoka, Zhang, & Wells, 2002; Merikangas et al., 2011). When crises occur, the importance of school psychologists and other school-based mental health professionals is amplified. School psychologists are frequently the first responders when crises occur during school hours and, even when events occur when school is not in session, schools can play a key role in reaching out to students and their families and identifying students in need of mental health supports.

Schools Have a Critical Role

During the anniversary of a crisis, as communities attend to the needs of children, schools can be particularly critical in three primary ways. First, they can provide a consistently structured and nurturing community where children generally feel safe and supported by caring adults. Second, they can reduce children's anxiety and fear by communicating to children that a wide range of responses are normal and that there are adults available to listen. Third, they can identify students in need of more intensive mental health supports. By preparing and planning for anniversary events, school psychologists can provide the support most needed by students and staff in their communities.

References

Brock, S. E., & Jimerson, S. R. (2002). One year later: Remembering September 11, 2001. Communiqué, 31, 1, 5–6.

Hamblen, J., Friedman, M., & Schnurr, P. (2010). Anniversary reactions: Research findings. Retrieved from http://www.ptsd.va.gov/professional/pages/anniversary_reactions_pro.asp

Hoven, C. W., Durante, C. S., Lucas, C. P., Wu, P., Mandell, D. J., Goodwin, R. D., … Susser, E. (2005). Psychopathology among New York City public school children 6 months after September 11. Archives of General Psychiatry, 62, 545–551.

Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among U.S. children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159(9), 1548–1555.

McLaughlin, K. A., Fairbank, J. A., Gruber, M. J., Jones, R. T., Lakoma, M. D., Pfefferbaum, B., … Kessler, R. C. (2009). Serious emotional disturbance among youths exposed to Hurricane Katrina 2 years postdisaster. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 1069–1078.

Merikangas, K. R., He, J., Burstein, M., Swendsen, J., Avenevoli, S., Case, B., & Olfson, M. (2011). Service utilization for lifetime mental disorders in U.S. adolescents: Results of the national comorbidity survey—adolescent supplement (NCSA). Journal of the American Academy of Child and Adolescent Psychiatry, 50(1), 32–45.

Nader, K., Pynoos, R., Fairbanks, L., & Frederick, C. (1990). Children's PTSD reactions one year after a sniper attack at their school. American Journal of Psychiatry, 147, 1526–1530.

Nemeth, D. G., Kuriansky, J., Reeder, K. P., Lewis, A., Marceaus, K., Whittington, T., … Safier, J. A. (2012). Addressing anniversary reactions of trauma through group process: The Hurricane Katrina anniversary wellness workshops. International Journal of Group Psychotherapy, 62, 129–142.

Pfefferbaum, B., Nixon, S. J., Tucker, P. M., Tivis, R. D., Moore, V. L., Gurwitch, R. H., … Geis, H. K. (1999). Posttraumatic stress responses in bereaved children after the Oklahoma City Bombing. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1372–1379.

Pfefferbaum, B., Seale, T. W., Brandt, E. N., Pfefferbaum, R. L., Doughty, D. E., & Rainwater, S. M. (2003). Media exposure in children one hundred miles from a terrorist bombing. Annals of Clinical Psychiatry, 15, 1–8.

Saylor, C. F., Cowart, B. L., Lipovsky, J. A., Jackson, C., & Finch, A. J. (2003). Media exposure to September 11: Elementary school students' experiences and posttraumatic symptoms. American Behavioral Scientist, 46, 1622–1642.

Zibulsky, J. (2012). Preparing for the anniversaries of crisis events. In S. Brock & S. Jimerson (Eds.), Best practices in school crisis prevention and intervention (second edition), 423–434. Bethesda, MD: National Association of School Psychologists.


Jennifer Greif Green, PhD, is an assistant professor of special education at Boston University's School of Education. Shane Jimerson, PhD, is a professor and chair in the department of counseling, clinical, and school psychology at the University of California, Santa Barbara. Melissa K. Holt, PhD, is an assistant professor of counseling psychology at Boston University's School of Education.