Assemble a School-Based Multidisciplinary Trauma Team

Develop a team of interdisciplinary professionals committed to supporting children who have been traumatized. The team should include members of the school crisis, safety, and mental health teams in order to facilitate the seamless delivery of prevention, preparedness, and intervention activities to reduce the likelihood of trauma. This will help prevent traumatized children from falling between the cracks of these different service teams and allow each team to share its unique perspective and skills related to the needs of the children. It also will provide a coordinated support system that can collectively and efficiently combine to address the multifaceted needs of students in a school. Support, consistency, and stability provided by the school community are essential for students to build protective factors and/or to heal from trauma.

Prevent Psychological Trauma

The needs of the youth will vary greatly dependent on their individual experiences. Because trauma is unpredictable, and often unavoidable, all children will benefit from skills that will help them to cope if they encounter such experiences.

Therefore, prevention measures and tier 1 supports should be provided to all students in the school. These services integrate learning, social and emotional functioning, mental and physical health, and focus on developing the overall well-being of students. Tier 1 services improve school climate and conditions for learning by developing a more emotionally healthy student body. The collective emotional health will facilitate a “safe” environment within which students feel supported by their peers and adults. In order to successfully establish and maintain this environment, it is essential to include all school staff members, from the janitors and lunch staff to the school board.

Training school staff regarding salient aspects of youth development, school climate, and the importance of positive adult-child relationships is important in promoting healthy and meaningful relationships. Establishing routines such as teachers, administrators and support staff personally welcoming students as they enter the school each morning can contribute to feelings of belonging and safety. A culture that models and expects respect, empathy and kindness for one another will lay the foundation for youth feeling cared about and seeing school as a safe zone even when other areas of their lives may not feel as safe. Intentional efforts aimed at building this culture should be designed and implemented annually with continued evaluation and development. For example, identifying a weekly school-wide topic (e.g. respect) that can be emphasized and reinforced in a variety of ways dependent on grade level (write or draw about the meaning, act it out in play, or debate the importance of respect) can be used to promote a positive school culture.

Teaching children how to ask for help when they need it is essential. Adults who receive such requests should listen and model effective problem-solving skills with the child that emphasize the control the youth has and choices he or she can make to build an internal locus of control. An important piece of this is teaching children how to identify and appropriately express their feelings from an early age. This also can be planned and incorporated intentionally into multiple educational mediums such as recreation, art, and English. These life skills also can reduce the potential effects of trauma exposure by minimizing the length or intensity of trauma effects.

The examples above help create a healthy school environment (i.e. school climate) that addresses each of the protective factors listed below that help minimize the impact of trauma if/when it occurs:

• The reliable presence of a positive, caring, and parents/caregivers who can help protect their children against adverse experiences
• Children knowing that they are loved, supported, and cared for by multiple adults
• Professional support for the child/family
• Peer support and positive social relationships
• Effective coping and problem-solving skills
• The ability for children to express themselves and seek support when needed
• High self-esteem and self-confidence
• Connections with prosocial institutions
• Internal locus of control

If a crisis or traumatic event occurs that impacts multiple students in a school setting, there are several responses that can minimize the likelihood of a traumatic reaction. First, school staff must reaffirm the physical health of the student(s). This can be done through implementing the established crisis plan for lockdown, lockout, shelter-in-place, or evacuation. School staff must also reaffirm the student(s) perceptions of safety in order to minimize the trauma impact. This is largely influenced by how adults respond to the event. School staff must communicate clear and accurate information, dispel rumors, and advise children and their caregivers about typical responses to a crisis and how to help. It is also important for adults to limit children’s exposure to graphic scenes or images in order to minimize the trauma impact. In order to help make them feel safe and have access to emotional support, it is important to attempt to reunite students with their caregivers as soon as possible. It is advised to return to a safe school environment and reestablish typical routines as soon as possible.

Identify and Intervene with Psychological Trauma

In order to effectively intervene in the aftermath of a trauma, it is critical to provide training on how trauma impacts children to build awareness, sensitivity, and improve the identification of children who may need additional assistance. All staff should be trained and regularly reminded to watch for and recognize warning signs, common behaviors and trauma responses often displayed at different developmental stages.

Although trauma responses are varied and impacted by many factors, there are certain behaviors that are more commonly demonstrated. Children suffering from traumatic stress symptoms very often have difficulty regulating their behaviors and emotions. They may be clingy and fearful of new situations, easily frightened, difficult to console, and/or display aggressive and impulsive behavior. They frequently have sleep difficulties, trouble concentrating, and regress developmentally. Also, they often have trouble controlling and expressing emotions, and may respond with inappropriate or violent behaviors to trigger situations. A child with a complex trauma history may display problems with friendships and with authority figures such as teachers.

Individual needs should be carefully assessed to determine the level and intensity of intervention warranted. It is important to consider the severity of the trauma, the number of prior traumas the child has experienced, the child’s perceptions of the threat of the situation, what supports are available to the student, and the student’s demonstrated response. Once the most appropriate intervention is identified and implemented, the student should be reassessed to determine whether or not he or she needs additional more intensive supports.

Interventions that may be used in a school setting include play, art, or storytelling to help children express their feelings about the trauma. Books can be useful tools as well, because reading and talking with supportive adults can help children understand and cope in a developmentally appropriate way. Reading allows for quality time with a caring adult, which fosters a sense of security and normality. These techniques may be helpful in encouraging children’s exposure to aspects of the event, and their feelings about it, without doing it in a way that is too intense, or inappropriate for the school setting. School mental health professionals who are appropriately trained may also use cognitive-behavioral interventions such as cognitive restructuring and relaxation training to help children manage anxiety. Training parents and caregivers on ways to support their child is also important.

For mental health professionals in schools who feel comfortable and adequately trained, Cognitive–Behavioral Intervention for Trauma in Schools (see http://cbitsprogram.org) also can be utilized. There are several components within this intervention, such as relaxation training, social problem-solving, cognitive restructuring, relapse prevention, and an exposure component. This typically involves talking, drawing, or writing to aid the child in approaching and dealing with the trauma. Even if a school-based mental health professional has the expertise to use such interventions, their workloads, access to supervision and consultation, and the philosophy of other school staff regarding offering this type of service may be obstacles to providing such treatment in schools.

For children who have experienced a significant trauma or multiple traumas, the school may need to refer the child and family to community-based services where they can get more intensive care. It is important for schools to know when to refer to community-based services and to create and regularly update a list of possible resources. To develop a referral list, it is advised to consult with other professionals, contact agencies, search on the internet, find a psychologist via the American Psychological Association, and contact related associations. Then the school should meet with the parent(s) and discuss the possibility for referral. If they decide to pursue a referral it also can be helpful for the school-based mental health professional to write a concise letter to the community-based professional to inform the provider of any concerns and to share a brief history. It is also important to talk to a school administrator about how to make the referral in a way that is consistent with school board policy (often structured in a manner in which the school does not bear financial responsibility). In addition, the school should try to secure parent and/or student’s consent for appropriate school staff to discuss treatment with the community service provider to ensure quality and continuity of care. There are several community-based services to consider for children who have experienced a significant trauma. Individual and group Cognitive Behavior Therapy with a trauma focus should be considered for children and adolescents with PTSD. Depending on the severity of the trauma, Eye Movement Desensitization and Reprocessing (EMDR), an information processing therapy that attends to past experiences, current situations that trigger dysfunctional emotions, beliefs and sensations, and the positive experience needed to enhance adaptive behaviors and mental health also might be appropriate. Any of the above treatments should try to include a parent component to improve treatment outcomes. Psychopharmacological treatment should only be contemplated after exhausting other psychological, behavioral, and family treatments when working with children and adolescents.

Follow-up

It is important to continuously document and evaluate the effectiveness of prevention and intervention programs used. This can be done by tracking the child’s progress through behavioral observations, contact with the mental health professional, or via school records.

Suggested Resources

• The National Child Traumatic Stress Network
• Helpguide.org
• National Center for PTSD
• Kid’s Mental Health Info.com
• Cognitive-Behavioral Intervention for Trauma in the Schools

Recommended Citation: NASP School Safety and Crisis Response Committee. (2015). Preventing Childhood Trauma: Guidelines for Administrators and Crisis Teams. Bethesda, MD: National Association of School Psychologists.

Contributors: Amanda Nickerson, PhD, NCSP; Shane R. Jimerson, PhD, NCSP

© 2015, National Association of School Psychologists, 4340 East West Highway, Suite 402, Bethesda, MD 20814; (301) 657-0270, Fax (301) 657-0275; www.nasponline.org