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Activity 2: Causes of Traumatic Stress in Students CERT 05/2020 COHORT…

- - - - This includes nightmares, trouble falling asleep, or trouble waking up in the morning
    - - Feeling guilty or blaming themselves for their loved ones death
    - - Withdrawing from important aspects of their environment
    - - Attempting to avoid physical reminders of the traumatic death, such as activities, places, or people related to the death
    - - Being overly preoccupied with how the loved one died
    - - Showing signs of emotional or behavioral distress when reminded of the loss
    - - Increased fears about safety for oneself or others
    - - Trouble concentrating in school or a sudden decrease in grades
    - - Feeling fatigued or complain of pain, such as a headache or stomachache
  - - - A teacher can be helpful by listening calmly and being nonjudgmental to the student's feelings about the death. You shouldn't force or over-encourage them to talk about it if they don't want to.
    - - While you should try your best to answer the child's questions, it's OK to tell them that you don't know the answer to some of the questions they ask regarding the gory details of death.
    - - Maintain normal school routines as much as possible. They may also need extra reassurance or explanation.
    - - Maintain Predictable and Consistent School Structures
      - Use Teaching Strategies That Aid Organization and Concentration
      - Supportively Prompt or Cue Students Who Go Blank
      - Organize Activities That Children Can Actively Participate in Without Being Put on the Spot
      - Monitor Student's Performance Regularly
      - Collaborate With Parents and Professionals to Promote Learning at Home
    - - Build a relationship of trust with the student's family.
    - - Consider referral to a mental health professional.
- - - - Cut off from feelings
      - Feeling hollow inside.
      - Being easily overwhelmed or discouraged
      - Low self-esteem.
      - Perfectionism.
      - Pronounced sensitivity to rejection
      - Reference: How to Recognize and Overcome Childhood Emotional Neglect
      - Not eating right. Always hungry.
      - Not wearing clean clothes (hygiene issue)
      - Always feeling sick at school
      - Sign of absent of parents at home. Can't contact parents all the time, they are not returning phone calls or emails.
      - Symptoms with disruptive Behaviors
        
        Be aggressive, oppositional, or defiant
        
        Cower or demonstrate fear of adults
        
        Act out, displaying aggressive or disruptive behavior
        
        Be destructive to self or others
        
        Come to school too early or not want to leave school—indicating a possible fear of going home
        
        Show fearlessness or extreme risk taking
        
        Be described as “accident prone”
        
        Cheat, steal, or lie (may be related to too high expectations at home)
        
        Be a low achiever (to learn, children must convert aggressive energy into learning; children in conflictmay not be able to do so)
        
        Be unable to form good peer relationships
        
        Wear clothing that covers the body and that may be inappropriate in warmer months (be aware that this may be a cultural issue as well)
        
        Show regressive or less mature behavior
        
        Dislike or shrink from physical contact—may not tolerate physical praise such as a pat on the back).
        
        Reference: The Role of Educators in Preventing and Responding to Child Abuse and Neglect
  - - - Share support resources with other teachers.
      - Make sure to keep talking to students, updating and reflecting with responsiveness.
      - Keep the classroom safe.
      - Watch what teachers say.
      - Encourage the student to share feelings.
      - Academic support
        
        Provide consistency and structures
        
        Give more time to finish tasks and transitions.
        
        Give choices instead of asking for an answer.
        
        Give students an opt-out option.
        
        Develop strengths and interests.
        
        Be patient with the student’s growth
        
        Review and reflect with the student
      - Be there for students.
      - Gather information as much as possible
        
        Report to manager. Let school know about this ASAP.
        
        Seek professional help
        
        Talk to students
        
        Watch out for:
        
        If self-disclosing, praise the child for revealing what has happened to him or her. It is not up to the educator to determine if the child is telling the truth.
        
        When talking with a child concerning a possible inflicted injury or condition of neglect, the educator should refrain from asking leading questions.
        
        Let the child tell his or her story without probing for information that the child is unwilling to give.
        
        The child should be made as comfortable as possible under the circumstances.
        
        The child should be put at ease, and the educator should sit near the child, not behind a desk or table.
        
        The educator who talks with the child should be the designated person to handle such matters (e.g., the school social worker).
        
        Children often feel or are told that they are to blame for their own maltreatment and for bringing “trouble” to the family; therefore, it is important to reassure children that they are not at fault.
        
        If maltreatment is suspected, the educator must always remember that he or she is a mandated reporter, and this should be explained to the child in an age-appropriate way.
        
        The child may be afraid that either he or she will be taken from the home or the parent may be arrested. If such a fear is expressed, the educator should acknowledge not knowing what will occur.
        
        Children may be fearful of others learning about their maltreatment issues. The educator should assure the child that the information would not be shared with classmates or others who have no need to know.
        
        It is vital, however, that the educator also acknowledge that in order to provide help to the child, it may be necessary to discuss these issues with other school personnel, law enforcement, or CPS. It is important that the educator abides by the promise to protect the child’s right to confidentiality.
        
        Reference: The Role of Educators in Preventing and Responding to Child Abuse and Neglect
        
        Record everything
        
        Get together with school counselor and doctor/nurse
        
        Gathering information of the proof of neglects from the student's family
        
        Analyse behavior
        
        Talk to classmates about the student
      - We must learn
        
        Learn how to get their needs met appropriately.
        
        Learn how to express feelings, which enables
        children to separate these feelings from actions.
        
        Learn to take responsibility for their actions.
        
        Learn how to make decisions and solve problems.
- - - - Mentally not present
    - - Loss of loved ones/friends
    - - Lack of focus
    - - Sleeping in class or lethargic
    - - Sporadic attendance
    - - Showing emotional ups and downs
    - - Low academic results/lack of trying
  - - - Keep Learning Alive
        
        Distance Learning
        
        Ensure that distance learning strategies include support for parents’ and teachers’ roles in children’s learning at home through developing and promoting tips, resources and activities.
        
        Provide Sexual and Reproductive Health Programs
        
        Provide sexual and reproductive health and rights programming which includes the safe distribution of menstrual hygiene kits to girls, as well promoting empowerment, addressing stigma and targeting gender-based violence.
        
        Child Protection Reporting
        
        Ensure that child protection reporting and referral systems can be adapted for times of school closure, ensuring that providers of specialist social services and mental health and psychosocial support services have adequate equipment to support children if needed.
        
        Continued Payment to Teachers and Staff
        
        Ensure the continued payment and incentives of teachers and school staff during and after school closures to retain existing teachers. Ensure teachers are adequately supported and trained to support distance learning programming with the right resources and guidance.
        
        Provide effective, flexible and inclusive distance learning programmes, including digital learning, interactive radio instruction and printed learning materials, with a focus on reaching the most marginalised children, including girls, the youngest children, children with disabilities, internally displaced children and refugees. These programmes should support early learning, mental health and psychosocial support, child protection and public health objectives, and address harmful gender norms.
        
        School Meals
        
        Provide food to children who normally rely on school meals – through take-home rations, vouchers or cash schemes.
        
        DELIVER INCLUSIVE DISTANCE LEARNING WHILE SCHOOLS ARE CLOSED
      - On Returning
        
        Ensure Schools are safe Spaces including health and safety infrastructure and protocols, gender-responsive WASH facilities, menstrual hygiene management kits, additional classrooms, and staffing to enable physical distancing requirements. Develop preparedness plans in case schools need to close again due to localised outbreaks.
        
        ENSURE HEALTH AND HYGIENE FACILITIES ARE ACCESSIBLE TO ALL AT SCHOOL
        
        REDUCE SCHOOL DROPOUT BY TARGETING THE MOST MARGINALISED CHILDREN
        
        Waive school fees and other costs
        
        School Feeding Programs
        
        Makeup Lost Learning
        
        Introductory program
        
        formative Learning assessments
        
        Catch-up Classes
        
        Remedial Programs
        
        Accelerated Education Programs
        
        Social and Emotional Learning
        
        Provide every child with a learning assessment on their return to school to inform blanket and targeted interventions – including catch-up classes, remedial programmes, and accelerated education programmes.
        
        Minimise the use of schools as health facilities and quarantine sites where possible.
        
        Provide mental health and psychosocial support services for children and young people, and link children to additional services when necessary and available.
        
        Address gender-related barriers to education, including laws, policies and harmful social norms that prevent girls from continuing their education if they are pregnant, married or child mothers.
      - Support for Teachers
        
        INVOLVE TEACHERS IN DECISION-MAKING AND PLANNING
        
        PROVIDE EFFECTIVE TEACHER PROFESSIONAL DEVELOPMENT
        
        SUPPORT TEACHER WELLBEING
- - - - Bed-wetting
        
        Thumb-sucking
        
        Increased crying & whining
        
        Severe separation anxiety
        
        Signs of terror such as stuttering or hidind
        
        Difficulty falling or staying asleep
    - - Stomachaches
        
        Headaches
        
        Low grades
        
        Cause trouble
        
        Low self-esteem
        
        Feelings of guilt for abuse
    - - Skipping school
        
        Low self-esteem
        
        Depression
        
        Bullying others
        
        Trouble making friends
        
        Risky Behaviour
        
        4 more items...
  - - - Talking to them about their fears: Let them know that it's not their fault.
        
        Talking to them about boundaries: Let them know that on one has the right to touch them or make them feel uncomfortable, including family members, teachers, coaches, or other authority figures. Also, explain that they don't have the right to touch others either.
        
        Helping them find a reliable support system: in addition to a parent, this can be a school counselor, a therapist, or another trusted adult who can provide ongoing support.
        
        Getting them professional help: Cognitive behavioral therapy may work best for children who have experienced violence or abuse. The therapist can also help the child learn healthy ways to cope with stress.
    - - Positive physical space: Putting up positive visuals and quotes can inspire creative thinking and teamwork in students. Increased natural light can enhance an open, warm, and relaxing environment.
        
        Ease transitions: Give time warnings ahead of activity transitions.
        
        Provide structure and consistency: Write the agenda on the board. Use entry and exit routines.
        
        Provide choice: Provide safe ways for students to exercise choice and control within an activity and within the environment.
- - - - intentional violence (child physical abuse/sexual abuse)
      - domestic violence
      - natural disaster, accidents, war
      - painful medical procedures
      - sudden lose of a parent/caregiver
  - - - poor verbal skills
      - memory problems
      - scream or cry excessively
      - poor appetite, low weight, or digestive problems
    - - have difficulties focusing or learning in school
      - develop laerning disabilities
      - show poor skill development
      - act out in social situations
      - immitate the abusive/traumatic event
      - be verbally abusive
      - be unable to trust others or make friends
      - believe they are to blame for the traumatic event
      - lack self-confidence
      - experience stomach aches or headaches
  - - - A Cognitive Behavioral Therapy
      - Attachment, Self-Regulation, and Competence: A Comprehensive Framework
      - Child-Parent Psychotherapy
      - Parent-Child Care
      - Parent-Child Interaction Therapy
- - - - Establish clear, honest and caring communication with the student.
        
        Engage the discussion and listen actively
      - Set up group workshops
        
        Choose positive wording: “worldwide fabulous team”
      - Multicultural activities
        
        Give specific moments for the students to share about his own culture - and valorizing multiculturality in front of the class or in small groups
        
        Educate all the students of the classroom about the global context and migration : "What is inclusivity?"
        
        Educate the students about his "new country" : "How integrate yourself without giving up your identity"?
        
        Be sensitive when bringing up information in class that could be a trauma reminder for a child, e.g., discussing a child’s country of origin in a geography class or discussing war in a history class
      - Educate staff and students about being sensitive to cultural differences
        
        invite a refugee parent or community
        member to inform staff about the culture and experiences of the refugee groups entering the school system.
      - Writing/Speaking
        
        Provide interpreters and/or cultural brokers in the school setting
        
        Translate documents whenever possible
      - External Help
        
        Connect with refugee resettlement agencies to share information and resources
        
        Consult with the school mental health professional regarding concerning behavior; describe any patterns that
        you have noticed in the youth
      - School placement
        
        A classroom based on age that may not correspond with their skill or
        experience level
      - Expectations
        
        Ensure that academic expectations match academic ability
        
        Understand that students might struggle with some tasks. Provide support to the students, and let them know that these struggles are expected and normal.
        
        Let the child know what to expect—predictability is especially good for trauma-affected youth
- - - - Combined Parent Child Cognitive-Behavioral Approach for Children and Families At-Risk for Child Physical Abuse
        CPC-CBT is a short-term, strengths-based therapy program for children ages 3-17 and their parents (or caregivers) in families where parents engage in a continuum of coercive parenting strategies. These families can include those who have been substantiated for physical abuse, those who have had multiple unsubstantiated referrals, and those who fear they may lose control with their child. Children may present with PTSD symptoms, depression, externalizing behaviors and a host of difficulties that are targeted within CPC-CBT. Goals of CPC-CBT are to help the child heal from the trauma of the physical abuse, empower and motivate parents to modulate their emotions and use effective noncoercive parenting strategies, and strengthen parent-child relationships while helping families stop the cycle of violence. There are four phases of the intervention.
        
        Fact sheet link:
        https://www.nctsn.org/sites/default/files/interventions/cpccbt_fact_sheet.pdf
      - PARENT-CHILD INTERACTION THERAPY
        evidenced-based treatment model with highly specified, step-by-step, live coached sessions with both the parent/caregiver and the child. Parents learn skills through PCIT didactic sessions. Using a transmitter and receiver system, the parent/caregiver is coached in specific skills as he or she interacts in play with the child. Generally, the therapist provides the coaching from behind a one-way mirror. The emphasis is on changing negative parent/caregiver child patterns.
        
        Fact sheet link:
        https://www.nctsn.org/sites/default/files/interventions/pcit_general_031419.pdf
      - ALTERNATIVES FOR FAMILIES - A COGNITIVE BEHAVIORAL THERAPY
        evidence-based treatment designed to improve the relationships between children and caregivers in families involved in arguments, frequent conflict, physical force/discipline, child physical abuse, or child behavior problems. It is appropriate for use with physically coercive/abuse parents and their school-aged children. It is used primarily in outpatient and in-home settings.
        
        Fact sheet link:
        https://www.nctsn.org/sites/default/files/interventions/afcbt_fact_sheet.pdf
  - - - let them know they've done the right thing by telling you
        
        tell them it's not their fault
        
        say you'll take them seriously
        
        don't confront the alleged abuser
        
        explain what you'll do next
        
        report what the child has told you as soon as possible.
- - - - Kids who know what bullying is can better identify it. They can talk about bullying if it happens to them or others. Kids need to know ways to safely stand up to bullying and how to get help.
        
        Encourage kids to speak to a trusted adult if they are bullied or see others being bullied. The adult can give comfort, support, and advice, even if they can’t solve the problem directly. Encourage the child to report bullying if it happens.
        
        Talk about how to stand up to kids who bully. Give tips, like using humor and saying “stop” directly and confidently. Talk about what to do if those actions don’t work, like walking away
        
        Talk about strategies for staying safe, such as staying near adults or groups of other kids.
        
        Urge them to help kids who are bullied by showing kindness or getting help.
    - - Help kids take part in activities, interests, and hobbies they like. Kids can volunteer, play sports, sing in a chorus, or join a youth group or school club. These activities give kids a chance to have fun and meet others with the same interests. They can build confidence and friendships that help protect kids from bullying.
    - - Learning how to interact with others, especially in stressful situations, is important. Bullies will pick on the child who is weakest, not physically or mentally, but socially. Teens must learn to be emphatic and respectful, but also to be confident in themselves and their ability to resolve conflicts, even when failing to do so.
    - - Talk therapy can help your teen understand that their negative feelings are unwanted and detrimental and can help them build the strength and emotional resilience to reject negative thoughts, embrace healthy coping mechanisms, and take up behavior that can help them build a sense of self and greater self-esteem.
    - - Help kids understand bullying. Talk about what bullying is and how to stand up to it safely. Tell kids bullying is unacceptable. Make sure kids know how to get help.
      - Model how to treat others with kindness and respect.
      - Keep the lines of communication open. Check in with kids often. Listen to them. Know their friends, ask about school, and understand their concerns.
      - Encourage kids to do what they love. Special activities, interests, and hobbies can boost confidence, help kids make friends, and protect them from bullying behavior.
  - - - While it can be difficult to empathize with the bully, it’s essential that parents and school officials recognize that bullies engage in bullying behavior for a reason. Without help, the behavior will continue, and potentially worsen, over time.
        
        Increased truancy risk
        
        Increased risk of substance abuse
        
        Difficulty maintaining social relationships
        
        Poor school performance (missed school due to suspensions increases this risk)
    - - With immediate and proper mental health treatment and support systems in place, victims can stave off some of the potential long-term consequences of bullying. Without intervention, however, kids are at risk for the following:
        
        Anxiety disorders
        
        Self-destructive behavior, including self-harm
        
        Chronic depression
        
        Substance abuse*
        
        Post-traumatic stress disorder*
        
        Difficulty establishing trusting, reciprocal friendships and relationships
        
        Poor general health
        
        Increased risk of suicidal thoughts, suicide plans, and suicide attempts
    - - All kids are different and are likely to exhibit varying behaviors during or after bullying by a peer. With relational aggression on the rise and cyberbullying easier than ever, it should be noted that bullying can be ongoing for long periods of time before students seek help.
        
        Symptoms of depression
        
        Poor school performance
        
        Symptoms of anxiety
        
        School avoidance
        
        Higher risk of illness
        
        Low self-esteem*
        
        Changes in eating habits
        
        Bedwetting
        
        Sleep disturbance
        
        Feelings of shame
        
        Social isolation
        
        Psychosomatic symptoms (stomachaches, headaches, muscle aches, other physical complaints with no known medical cause)
    - - Childhood bullying has serious effects on both short and long-term health of children. Immediate intervention and long-term follow-up can help mediate some of these effects. It is imperative that schools, families, and communities work together to understand bullying and its consequences and find ways to decrease, and hopefully eradicate, bullying both in schools and communities.Without proper treatment, bullying behavior is likely to continue into adulthood.
        
        Substance abuse
        
        Risk of spousal or child abuse
        
        Less likely to be educated or employed*
        
        Risk of antisocial behavior
- - - - Keeping secrets. Not talking as much as usual
      - Not wanting to be left alone with certain people or being afraid to be away from primary caregivers, especially if this is a new behavior
      - Regressive behaviors or resuming behaviors they had grown out of, such as thumbsucking or bedwetting
      - Overly compliant behavior
      - Sexual behavior that is inappropriate for the child’s age
      - Spending an unusual amount of time alone
    - - Change in mood or personality, such as increased aggression
      - Loss or decrease in interest in school, activities, and friends
      - Decrease in confidence or self-image
      - Self-harming behaviors
      - Increase in unexplained health problems such as stomach aches and headaches
    - - Sexual Transmitted Infections
      - Signs of trauma to the genital area
  - - - Use yourself as a role model of a reliable and regulated adult
      - Regular check-ins with the student
      - Allow children to tell the story of the trauma they experienced, as they see it, so they can begin to release their emotions and make sense of what happened
      - Respond calmly and compassionately, but without displaying shock or judgment
    - - Positive visuals and quotes to help motivate
      - Lots of natural light to make the space warm and inviting
      - Create a mindfulness corner where students can go when they need help regulating their stress
    - - Brain breaks to give students a chance to reflect on what type of energy they need
      - Greet students at the door with a positive greeting and interactions
      - Share positive accomplishments with the class
      - Help children manage their feelings by teaching and modeling effective coping strategies or identifying effective soothing techniques (e.g., taking deep breaths or carrying a personal item that brings comfort)
    - - Read stories about people who use their positive strengths
      - Allow other students the ability to recognize students for showing their character strengths
      - Do a strengths survey so students can identify their strengths themselves
    - - Use role plays to act out skills and help set boundaries
      - Read about people who have overcome adversity and how they can apply the lessons to their lives
      - Coach how to stop negative thinking and increase positive thinking in times of frustrations by giving them phrases to use
    - - Follow your schools protocol of who to notify of the abuse
      - Send the child to the nurse or hospital to address any physical symptoms
- - - - For countries not at war Oklahoma City Bombing 2001 September 11th
      - As well as areas of continual political unrest Guatemala, Northern Ireland, Israel
    - - Oslo July 22nd 2011
        Greater the proximity to the attack = higher the level of distress
        
        Nordanger DØ, Hysing M, Posserud M-B, Lundervold AJ, Jakobsen R, Olff M, et al. Posttraumatic responses to the July 22, 2011 Oslo Terror among Norwegian high school students. J Trauma Stress (2013) 26(6):679–85. doi: 10.1002/jts.21856
      - Comer JS, Kendall PC. Terrorism: The psychological impact on youth. Clin Psychol Sci Pract (2007) 14(3):179–212. doi: 10.1111/j.1468-2850.2007.00078.x
  - - - Hoven CW, Duarte CS, Lucas CP, Wu P, Mandell DJ, Goodwin RD, et al. Psychopathology among New York city public school children 6 months after September 11. Arch Gen Psychiatry (2005) 62(5):545–52. doi: 10.1001/archpsyc.62.5.545
    - - Wu P, Duarte CS, Mandell DJ, Fan B, Liu X, Fuller CJ, et al. Exposure to the world trade center attack and the use of cigarettes and alcohol among New York city public high-school students. Am J Public Health (2006) 96(5):804–7. doi: 10.2105/AJPH.2004.058925
        Chemtob CM, Nomura Y, Josephson L, Adams RE, Sederer L. Substance use and functional impairment among adolescents directly exposed to the 2001 World Trade Center attacks. Disasters (2009) 33(3):337–52. doi: 10.1111/j.1467-7717.2008.01077.x
        Schiff M, Zweig HH, Benbenishty R, Hasin DS. Exposure to terrorism and Israeli youths’ cigarette, alcohol, and cannabis use. Am J Public Health (2007) 97(10):1852–8. doi: 10.2105/AJPH.2006.090514
  - - - Helping Children Cope With Terrorism - Tips for Families and Educators
        
        https://www.nasponline.org/resources-and-publications/resources-and-podcasts/school-climate-safety-and-crisis/mental-health-resources/war-and-terrorism/helping-children-cope-with-terrorism