1. Third Annual Ohio Department of Mental Health and Addiction Services Trauma Informed Care Summit Jim Adams, CEO, CBHE Geauga County Board of Mental Health And Recovery Services June 22-23, 2016

2. Prevalence of “mass” school shootings vs. single casualty shootings Violence predictors – and risk factors Behavioral Health responses to violence and trauma Impact of Community-wide Trauma “Political” and Sociological Responses to traumatic events within a community The state of our research into mass shootings and community cohesive factors

3.  February 27, 2012, at approximately 7:30 a.m.  Shooting occurred in the cafeteria of Chardon High School, Chardon, Ohio  One Shooter, no accomplices, 22 caliber handgun – taken from a family member’s house  Six victims shot within 38 seconds, three were declared dead within days, one treated at the scene, two admitted to separate hospitals.  Of the two hospitalized victims that survived, one was discharged after several days, one is permanently paralyzed.

4. Cell phones fail. Parents can not reach kids being held inside at the middle school. Mental Health professionals help to unite families and begin providing trauma and grief support. The mother of the female victim does not learn of her daughter’s injuries until she is told while waiting in line.

5.  Mass school shootings are still VERY rare.  Shootings occur often on the first day of the school week, often at the beginning of the semester  Weapons used in school shootings are most often taken from a family member or friend’s house  At Columbine High School the two perpetrators had successfully completed an early intervention program for at-risk youth  At Chardon High School, the lone shooter had posted images of himself with weapons on the internet.  Community mass shootings are NO LONGER rare.

6. Definition of “Mass Shooting” was changed in 2013 to 3 or more deaths. People killed in mass shootings make up less than half of 1 percent of the people shot to death in the United States. More than half of gun deaths every year are suicides. 2015: 46 killed, 43 wounded: 2016: 58 killed, 69 wounded Going Up??? Hard to say…. 2012: 67 killed, 68 wounded

7. Including Violence to Self… History of violence Inadequate leisure activity Problems at work or school Changes in Eating Patterns, Sleeping Patterns Comments about causing harm to self or others Giving away prized possessions Recent loss or traumatic experience

8.  Risk Factor: Low parental involvement Lack of appropriate free time activities Poor Commitment to School Neighborhood Crime and Low Support from local Community  Protective Factor: Up to 3 relationships with trusted adults. Availability of community resources, e.g. parks, sports, Perception of reward and expectation of school success. Community Celebrates Success (From: Search Institute – Developmental Assets)

9. Predicting Violence: *Is an individual with a mental illness more likely to commit violence? 1. More likely to be a victim 2. Increase chance if untreated, with a co-occurring substance abuse diagnosis 3. Federal definition of violent crimes: murder, robbery, rape, assault 4. Individuals with untreated mental illness and substance abuse = 4% -5%, same as general population Predicting “Low Probably Base Rate Events” Virtually Impossible! Due to the extremely low numbers Clinicians tend to over predict Risk Factors can be mitigated with Assets …”when the incidence of any form of violence is very low and a very large number of people have identifiable risk factors, there is no reliable way to pick out from that large group the very few who will actually commit the violent act.” FBI

10. Survey to Study relationship between childhood trauma, and physical and mental health issues in adults. Over 17,000 responses. Findings showed the relationship between trauma or stress in childhood experiences and social, emotional, or cognitive impairment. Examples: Increased risk of unhealthy behaviors, risk of violence or re- victimization, disease, disability and “early death.”

11. 1. Recurrent physical abuse 2. Recurrent emotional abuse 3. Contact sexual abuse 4. An alcohol and/or drug abuser in the household 5. An incarcerated household member 6. Family member who is chronically depressed, mentally ill, institutionalized, or suicidal 7. Mother is treated violently 8. One or no parents 9. Physical neglect 10. Emotional neglect http://www.acestudy.org/files/ACE_Score_Calculator.pdf

12. Issues of Faith

13. Traumatic Effects on Victims of Violence

16. Trauma is often a community event:  Some of the first calls into the 24 hour Mental Health Crisis line were from war veterans.  Every school district had a threat of some type.  Family and extended family are scattered throughout the community  Children play ball, go to camp, go to church, with the victims, even if they aren’t in the same school. Different people, different responses:  Individuals with severe and persistent mental illness were having devastating symptoms.  Young children were also afraid to go back to school.  First responders had a vast array of personal reaction.  Teachers who had the shooter and victims in the past experienced guilt and grief.  The whole community mourns. SOCIAL MEDIA MATTERS!!!

18. Utilization of Services Increased – CBITS identifies 23% of students in the High School at time of shooting at risk of significant mental health problems. Columbine identified 15% at risk. Increase in Psychiatric Residential Treatment Facility use for Chardon students doubled in just 2 years. Chardon students represent 50% of all residential placements, but comprise only 24% of total student population. Some students just “disappeared”. Some first responders did not return to work. About 33% of school staff did not return after the first year.

19. *Studies are already completed or continued. 2015 study: Pre-shooting = “felt safe at school: 98% most, or all of the time” Post shooting = 54% *Compare community cohesive factors for different communities. *Study the effects of Social Media on resiliency and recovery. *Review effectiveness of Trauma Informed Care on long term outcomes.  Can communities that suffer horrific trauma recover better/faster.  Schools are establishing “see something, say something” procedures.  What is school policy on cell phone use during school hours?  Is your school monitoring social media sites?  What About ALICE?

20. Contact Us At: Jim Adams, CEO Geauga County Board of Mental Health & Recovery Services 13244 Ravenna Road Chardon, Ohio 44024 jadams@geauga.org (440) 285-2282 Geauga County Courthouse, Chardon, Ohio In Memory of Chardon High School Shooting Victims February 27, 2012