On February 14, a 19-year-old former student expelled for undisclosed disciplinary reasons killed at least 17 people in a mass shooting at a Florida high school. It was the deadliest US school shooting since December 2012, when a gunman killed 20 first graders and six adults at Sandy Hook Elementary School in Newtown, Connecticut.
There have been at least 239 school shootings in America since Sandy Hook, leaving 138 people dead — and many more students traumatised. Nor are school shootings the only causes of childhood trauma on a massive scale; natural disasters like Hurricane Katrina, which claimed more than 1,800 lives, inflict an untold psychological toll on communities.
According to one study, half of all fourth to 12th graders in affected Louisiana parishes exhibited symptoms of depression or post-traumatic stress disorder (PTSD). Trauma, though less visible than a physical injury, can be no less debilitating for schoolchildren: its symptoms interfere with concentration, memory and cognition, leading to decreased IQ and reading ability, a lower grade-point average, decreased rates of high school graduation and increased expulsions and suspensions.
Teaching kids to cope
In the wake of the Sandy Hook shooting, the Connecticut legislature created a budget specifically to focus on children’s mental health and trauma. It funds a program of Cognitive Behavioral Intervention for Trauma in Schools (CBITS), which it began in spring 2015 in Bridgetown and has since expanded to more than 50 schools and over a dozen communities.
The program, which is run by mental health experts, teaches groups of pupils cognitive behavioural skills and includes individual sessions with the child and parent. The program includes relaxation training, combating negative thoughts, reducing avoidance, developing a trauma narrative, and building social problem-solving skills. Between sessions, children complete assignments and participate in activities that reinforce the skills they’ve learned. Each student works individually with the counsellor, telling stories and deciding what to share with the group.
There have been at least 239 school shootings in America since Sandy Hook
Several studies have underscored the success of CBITS, which was first developed more than a decade earlier. A randomised controlled trial in 2003 demonstrated a 47% reduction in depressive symptoms and a 64% reduction in PTSD for participants, compared to a 27% and 34% decrease in a control group that was kept on the waiting list.
A 2010 study of children’s mental health care after Katrina showed that at a 10-month follow-up, PTSD scores improved for participating students, as they did for those on other programs. Depressive symptoms improved for both groups, but the improvement was only statistically significant for the CBITS group.
Tip of the iceberg
While trauma is most often discussed in the aftermath of tragedy, screening students to select participants can unearth issues that previously lay hidden.
“Probably about half the kids were working on trauma relating to Katrina and the aftermath,” CBITS co-creator Dr Lisa Jaycox, a senior behavioural scientist and clinical psychologist at the RAND Corporation, recalled of an intervention in New Orleans. “The other half was working on more common issues like family violence or a traumatic loss.”
Kim Jewers-Dailley, the director of Trauma Informed Schools/New Haven Trauma Coalition, echoed this sense of surprise. “What we know about trauma is that it cuts across all lines — gender, race, rural, urban,” she said. When carrying out screenings in New Haven, she discovered that about 90% of students aged 12 to 18 reported at least one trauma. The average is about seven traumas each — typically witnessing community violence (fights, robberies, gang activity, gun violence), having an incarcerated loved one or experiencing the death of a friend or family member. Even then, trauma is still likely to be underreported because of shame, guilt or desire to protect one’s family or community.
Despite the universal impact of trauma, “certain types of trauma are experienced at a higher rate in certain communities,” noted Jewers-Dailley. Poverty and immigration status can put children particularly at risk.
“Poverty can create trauma or worsen trauma”
In New Haven, the majority of students in the CBITS program come from low-income families. About 15 million children in the US, or a fifth of all children, live in families with incomes below the federal poverty line. Research shows poverty fuels conflict at home and low-income families are more likely to contend with domestic violence. “Poverty can create trauma or worsen trauma, or simply make parents less prepared to deal with trauma, because they are dealing with so many other stresses,” said Jewers-Dailley. “We don’t believe you can treat a child at school without treating the home.”
Jaycox also points out that the level of exposure to violence and trauma can be higher in immigrant communities — sometimes because they live in low-income neighbourhoods where community violence is higher; sometimes because of violent experiences in their home countries; or because the moving process itself can be traumatic. CBITS itself was originally developed in collaboration with Los Angeles Unified School District (LAUSD) Mental Health Division to help diverse populations and is designed to be flexible across languages and cultures.
For many children of undocumented immigrants, uncertainty over their futures is an increasingly common source of mental health problems. Federal plans to scrap DACA, the program that gives temporary protection to undocumented migrants who arrived in the US as children, have heightened these anxieties; schools in California are using CBITS and other trauma therapy programs to help ease distress among students.
“They tend to think everybody is against them”
Schools are particularly effective settings in which to treat young people and attendance is a key factor in CBITS’ success: according to Jason Lang, a trauma expert at the Child Health and Development Institute of Connecticut who is coordinating the expansion of CBITS across the state, 90% of kids who start a group complete the entire program — significantly more than non-school-based interventions in which anywhere from 20 to 80% of families drop out prematurely.
Age, too, is key. According to Jewers-Dailley, with older children or adults, “the cognitive distortions are a little more rigid. They tend to be more hardened, to think everybody is against them. There’s more of a lack of hope.” Intervention is most effective at an early stage — helping children learn how to manage trauma before they drop out of school and end up on a very different path.
Footing the bill
More than five years on from Sandy Hook, the Connecticut CBITS program has maintained the political goodwill and funding to ensure its stability. Yet districts often lack the resources to launch or sustain such programs. For example, the Healthy Environments and Response to Trauma in Schools program, implemented in 2008 in the San Francisco School District, achieved a 93% drop in referrals to the principal and an 89% decrease in suspensions during its five years. But due to budget constraints, it has been cut back.
Many of those involved in CBITS say a major problem is that preventative programs tend to be underfunded because it’s less clear what schools are getting for their money. An external benefit-cost analysis of providing cognitive behavioural therapy for children suffering from trauma, including CBITS, indicated that there is a net lifetime cost saving of $21,837 for children who receive these types of treatment — largely related to improved work opportunities and reduced health care costs.
“Some of these parents have been through their own trauma”
CBITS can sometimes also have trouble convincing parents to participate. “We know some of these parents have been through their own trauma and didn’t receive support, or people have called child services on them,” said Jewers-Dailley.
But anecdotal evidence suggests that starting with children offers unexpected benefits to traumatised communities.
“Students will tell me how they showed their mom to do deep breathing or another technique. These skills are then reaching into families and communities, to people who didn’t get these opportunities,” Jewers-Dailley noted. “This is all happening very recently in schools, but I’m interested to see how we can create change across generations.”
(Picture credit: Flickr/joejinky)