1. Bringing trauma-focused intervention services to schools Lisa Jaycox, Terri Tanielian, Bradley Stein RAND Corporation January 16, 2007

2. Questions What interventions are available? What are their characteristics? What are issues in dissemination of these programs? –Examples from Hurricane Katrina Study

3. What interventions exist? Thorough review of the literature reveals at least 30 programs designed for schools –For long-term recovery from trauma –Majority use cognitive-behavioral skills Only 5 have been evaluated in any kind of controlled trial – All use cognitive-behavioral skills –Some also use experiential activities –CBITS, Multi-Modality Trauma Treatment, UCLA Trauma/Grief Program, Overcoming the Threat of Terrorism, and Classroom Based Intervention

4. What are their characteristics? Brief, time-limited group activities for students Average 8-20 group sessions Some have components for parents or teachers Focus on symptom reduction and skill-building –Anxiety management –Resolution of trauma (narrative) –Peer support –Cognitive skills Run by mental health professional in most cases –1 program run by teacher –Adaptation of CBITS for teachers is underway

5. Are schools using these programs? Some urban schools are beginning to take up programs like CBITS We are supporting these efforts through the National Child Traumatic Stress Network However, we know most schools are not using them Hurricane Katrina gave us the opportunity to look at this issue in a widespread disaster

6. Hurricane Katrina Study Goals The Hurricanes created the most widespread displacement of students in US History, with ethnic minorities disproportionately affected As CBITS developers we got only a few calls to inquire about the program Study questions: –What can we provide to schools to give information about such trauma interventions and why they should use them? –What is the perceived level of student need? –What services are schools providing? –What are the main barriers to providing needed services?

7. Educator Perceptions of Student Need Varied Needs of existing students vary from high to low (mental health, behavioral, prior trauma) Many principals saw mental health issues subsiding –“Kids are coming to school, doing their work.” –“Students now seem ready to put the hurricane behind them, are tired of hearing and talking about it” But screening of displaced students in one large district showed that many have highest level of need

8. Creation of Tool-Kit for Schools Drafted a tool-kit in the Fall of 2005 for a one-stop resource on what schools can do for traumatized students –Define trauma and its consequences –Describe existing programs and how to find out more Disseminated the toolkit to the Gulf States concurrent with research project Refined toolkit based on feedback and learnings from the research project, now available on the internet and as a Web decision-tool (www.rand.org/pubs/technical_reports/TR413)www.rand.org/pubs/technical_reports/TR413

9. Interviews of School Personnel Targeted schools and school districts that took in many displaced students or closed completely and later reopened Four states: Louisiana, Mississippi, Alabama, Texas Both public and private schools Lots of variation in size, prior mental health infrastructure, degree of damage, number of affected students

10. Activities Tapered Off After Acute Phase Primary emphasis on getting students registered and into classroom There were early efforts at coordinated response –Mississippi sent team of counselors into schools –Louisiana offered training sessions for staff –The Substance Abuse and Mental Health Services Administration (SAMHSA) offered time-limited services Some schools used existing programs but shifted focus to displaced students Implementation of trauma programs was rare due to scarce resources

11. Schools Face Barriers to Intervention Lack of capacity –Limited funding –Lack of trained staff to implement programs –Under-resourced before –High level of Pre-Katrina student needs Competing priorities –Academics –Broader community issues--housing and rebuilding Other barriers –Poor communication and resource sharing between districts –Staff members saying “enough already” –Difficulty of communicating with parents

12. Capacity to intervene Existing resources Priorities, information, training, funds Intervention Perceived displaced student needs Existing needs School Capacity for Intervention Depends on Balance of Resources and Needs

13. Conclusions The window of opportunity for addressing student mental health was small in many districts Schools leveraged their crisis intervention training and staff to enroll and accommodate displaced students and staff, and then quickly turned back to academics Schools and districts with existing resources for mental health were able to leverage them, and continue to do so Information about programs needs to be “on the shelf”— pre-positioned prior to disaster—to be useful Staff need to be trained in advance of disaster

14. Recommendations Better evaluations of programs are needed, as are programs that can be effectively delivered by regular school staff (non-clinical staff) But programs aren’t enough – staff need to be in place and be trained prior to disaster or school crisis Crisis intervention training and requirements may provide a good model for getting schools ready Trauma intervention training has dual-use for trauma and other cognitive-behavioral, evidence-based interventions, so the investment may build capacity to address mental health problems

15. Acknowledgments and Contact Information Lisa Jaycox (jaycox@rand.org);jaycox@rand.org Terri Tanielian; Lindsey Morse; Gretchen Clum; Bradley Stein; Priya Sharma