Lisa Jaycox Supporting Students Exposed to Stress and Trauma though Schools

Lisa JaycoxLisa Jaycox

Supporting Students Exposed to Stress and Trauma though Schools

HurricaneKatrina

Sandy Hook

Most children are exposed to violence

Any violence

Directassault

Witnessany violence

Witnessfamily violence

61%

46%

25%

10%

National Survey of Children’s Exposure to Violence, 2008

In many urban areas, nearlyall children are exposed

Jaycox 5 Apr 19, 2023

And Its Not Just about Violence

12%Been in a natural disaster

Been in a serious accident 19%

Attacked by a dog or other animal 27%

Been very sick or injured 29%

Had someone close to them die 49%

71%Had someone close to them very sick or injured


Post-traumatic stress disorderEmotional and behavioral problemsPoorer school performanceProblems with friends, familyBut are children getting quality treatment?

The emotional impact of violence and other trauma can be profound


Outline of Today’s Talk

• How does trauma affect students?

• What have we developed to support them?

• How can we apply this work military children and schools?


What are the consequences of trauma?

…One night several years ago, I saw men shooting

at each other, people running to hide. I was scared

and I thought I was going to die.

After this happened, I started to have nightmares.

I felt scared all the time. I couldn’t concentrate

in class like before. I had thoughts that

something bad could happen to me. I started to get in

a lot of fights at school and with my brothers…

– Martin, 6th grader


What are the consequences of trauma?

…One night several years ago, I saw men shooting

at each other, people running to hide. I was scared

and I thought I was going to die.

After this happened, I started to have nightmares.

I felt scared all the time. I couldn’t concentrate

in class like before. I had thoughts that

something bad could happen to me. I started to get in

a lot of fights at school and with my brothers…

– Martin, 6th grader


Distress from Trauma Has Negative Effects on Students in the Classroom

• Classroom performance declines due to…

– Inability to concentrate

– Flashbacks and preoccupation with the trauma

– Avoidance of school and other places

• Other behavioral and emotional problems develop that can impede learning and interpersonal relations

– Substance abuse

– Aggression

– Depression


These Effects Take a Measurable Toll

Decreased IQ and reading ability

(Delaney-Black et al.,

2003)

Lower grade point average

(Hurt et al., 2001)

More days absent from school

(Hurt et al., 2001)

Decreased rates of high school

graduation

(Grogger, 1997)

More suspensions and expulsions

(LAUSD survey, 2006)


Important to find ways to reach youth outside of the mental health sector

• 80% of children with emotional problems don’t get needed treatment

• Disparities in access are real

• Schools and other programs can be ideal settings for detecting trauma in children and intervening

– Barriers to accessing mental health care are partially removed



• How are youth affected by trauma and violence?




Cognitive Behavioral Intervention for Trauma in Schools (CBITS)

Early Detection

Informed Teachers and Parents

Student Learning

For Children

• 10 group-therapy sessions for trauma symptoms

• 1-3 individual sessions for exposure to trauma memory and treatment planning

For Parents• 4 group sessions to…

− Educate about trauma

− Provide parenting support

• Family outreach and liaison for other social services

For Teachers• In-service to educate about…

– How trauma can affect students

– How to detect signs of trauma

– How to support traumatized students in the classroom


Goal 1: Symptom Reduction

Primary targets: PTSD symptoms General anxiety and arousal Re-experiencing of the trauma Trauma-specific anxiety Trauma-specific avoidance Emotional numbing

Secondary targets: Depressive symptoms Low self-esteem Behavioral problems Aggressive and impulsive

Goals are tailored to each child


Goal 2: Building Resilience

• Building new skills

• Practicing existing skills to improve them

• Applying existing skills to the traumatic event and reminders

• Choosing the appropriate strategy


Goal 3: Building Peer and Parent Support

• Peer support within the group

• Parent support

Better communication

Parent understanding


CBITS Session Outline

Session 1 Introductions

Session 2 Common reactions to trauma, relaxation

1-3 Individual Sessions

Imaginal exposure to traumatic event (between Group Sessions 2 and 6)

Session 3 Thoughts and feelings

Session 4 Combatting negative thoughts (Hot Seat)

Session 5 Avoidance and coping

Session 6,7 Exposure to trauma through imagination / writing / drawing

Session 8 Introduction to social problem-solving

Session 9 Practice with problem-solving and Hot Seat

Session 10 Planning / graduation


Start of pilot test

1

Month

2 3 4 5 6

Middle School 1

Middle School 2

126 studentsparticipated in the pilot

61 students received CBITS immediately

65 students received CBITS after 3 months

A Pilot Test of CBITS in Schools Demonstrated its Effectiveness

Screening3-month assessment

6-month assessment


CBITS reduced trauma symptoms

30

25

20

15

105

0Start 3-month

assessment6-month

assessment

Source: Stein et al., JAMA 2003

PTSD symptoms(average

score)

CBITS

No program

The improvement lasted

No program

Group 2CBITS


Parents reported children doing better

30

25

20

15

105

0Start 3-month

assessment6-month

assessment

Source: Stein et al., JAMA 2003

Psychosocial

impairment(average

score)

CBITS

No program

No program Group 2CBITS

Children receiving CBITS early also performed better in math

and reading


Making training more accessible

www.cbitsprogram.org


Website is expanding reach


Support for Students Exposed to Trauma (SSET) Was Designed to Fill a Gap

• A modified version of CBITS for use by non-clinical school staff

• School personnel can deliver this intervention

• Pilot tests indicate that SSET is promising


Bounce Back: An Intervention for Elementary School Children Exposed to Traumatic Events

• A modified version of CBITS for K-5th grade students

• More involvement of parents in screening and processing trauma

• Preliminary study (in press) shows effectiveness


•Interactive, self-paced stress reduction curriculum•Components:

• Audio with motion graphics

• Interactives to teach content Assessments with feedback Drag and drop / matching Create your own adventure Open response sections

Culminates in a digital (video) game•Ability to save things to pdf for printing or to binder for later use in the course•No back-end – completely confidential

Life Improvement for Teens



• How are youth affected by trauma and violence?




What are the most relevant stressors for children in military families?

• Parental Deployment & Redeployment• Separation, less connection with deployed parent• Changes in roles and responsibilities• Less attention from (single) parent• Need for self-reliance

• Frequent Moves• Stress of moving on parents, finances, housing• Loss of social connections• Academic stress

• Less frequently, parental physical or psychological injury or death


Overarching Goals for School-based Stress Program for Children in Military Families

1. Increase ability to cope with deployment related stressors

2.Reduce distress related to deployment and family changes

3. Improve communication and support from parents (deployed and home)


Topics to be Covered

Session CBITS Military Stress

1 Introductions & Overview of Thoughts – Feelings - Actions

Introductions & Overview of Thoughts – Feelings – Actions (modified)

2 Education about common reactions to trauma, relaxation training

Education about common deployment stresses, relaxation training

3 Distress Thermometer, Link between Thoughts and feelings

Distress Thermometer, Link between Thoughts and feelings (modified)

4 Combatting negative thoughts (Hot Seat)

Combatting negative thoughts (Hot Seat) (modified)

5 Approaching trauma-related triggers

Other Coping Strategies to Manage Anxiety and Worry

Staying Active and Connected: Identifying and scheduling pleasant activities (for self and family)

Other Coping Strategies to Manage Anxiety and Worry


Topics to be Covered

Session CBITS Military Stress

6 Exposure to trauma through imagination / writing / drawing

Assertiveness training / Negotiation

7 Exposure to trauma through imagination / writing / drawing

Getting Organized for Success

8 Introduction to problem-solving Brainstorming solutionsDecision-making: Pros and cons

Introduction to problem-solving Brainstorming solutionsDecision-making: Pros and cons

9 Practice with problem-solving and Hot Seat

Practice with problem-solving and Hot Seat

10 Planning / graduation Planning / graduation

• No individual sessions to process trauma• Parent tip sheet on how to work with school personnel related to

military stressors (deployment, moves)

Documents

Lisa Jaycox Supporting Students Exposed to Stress and Trauma though Schools