By: William Steele, MSW, PsyD
Research documenting the effects of trauma on learning and behavior
has become increasingly available and consistent in its descriptions
of the cognitive and behavioral alterations following exposure
to trauma. From early infancy through adulthood, trauma can alter
the way we view ourselves, the world around us, and alter how we
process information and the way we behave and respond to our environment.
Without intervention these cognitive processes and behavioral responses
can lead to learning deficiencies, performance problems, and problematic
behavior. School systems need to be encouraged to provide trauma-specific
intervention to its traumatized students to help minimize the learning,
and behavioral difficulties that can result when the needs of trauma
victims go unrecognized or ignored. To appreciate the preventative
need for structured trauma-specific intervention following critical
incidents, one must understand the functions of the brain in the
midst of trauma.
Arousal and Cognitive Functions
exposure to a potentially trauma-inducing incident, survivors may
become frozen in an activated state of arousal. Arousal refers
to a heightened state of alert or a persistent fear for ones safety.
Short-term and prolonged arousal can effect cognitive and behavioral
functions. In the arousal state, changes in the brain are triggered
by a variety of stress related functions (van der Kolk, 1996).
Bremmer et al. (1996) found that victims of physical /sexual abuse
traumatization had lower memory volume in the left-brain (Hippocampal)
area than did the non-abused. This left-brain function refers to
understanding or processing information. One of these functional
alterations takes place in the neocortex. Perry & Szalavitr
(2006), Bremmer (2001), and others have found that while in the
arousal state it becomes difficult to process information because
of the altered functioning of the neocortex. Anyone who has had
to see a physician for potentially life-threatening condition may
remember very little of what the physician says. Only after getting
home, (a place of safety) comes the realization of how many questions
needed to be asked, which were forgotten at the time. Health advocates
today, understand how difficult it is for a patient to process
information while in a anxious (arousal) state and recommend that
patients take another family member or friend with them to the
doctors office as well as write down all the questions needing
to be asked.
If a child/student who has been traumatized remains in an aroused
state of fear and finds it difficult to process verbal information
it then becomes difficult to follow directions, to recall what
was heard, to make sense out of what is being said. Focusing, attending,
retaining and recalling verbal information becomes very difficult.
These are primary learning functions that can be altered during
or immediately following traumatic exposure and for some continue
unrecognized for long periods.
Cognitive deficits such as poor problem solving, (unable to think
things out or make sense of what is happening), low self-esteem
(how one thinks of oneself – victim-thinking) and hopelessness
(loss of future orientation) have all been clearly linked to negative
(traumatic) life events (Stein & Kendell, 2004; LeDoux, 2002;
Schore, 2001; Teicher, 2000; Yang & Clum, 2000). The fact is,
trauma has been shown to significantly compromise cognitive development
(Levine, 2007; Perry & Szalavitr, 2006; Trickett, McBride,
and Chang, 1995). Yang and Clum (2000) using a series of structured
equation analysis showed that “early negative life events” have
a strong impact on cognitive deficits, which are now related to
have a strong impact on suicidal behavior as well (p. 183). Furthermore,
stress induces the release of glucocorticoids, such as cortisol,
that can damage the left Hippocampal area of the brain, increasing
memory deficit (Perry & Szalavitr, 2006; Bremmer, 2001).
Cognitive alterations following trauma can take place at any age
including early infancy. The right brain is involved “in
the vital functions that support survival and enable the organism
to cope actively and passively with stress (Schore, 2001, p. 41).” “The
right hemisphere controls perception analysis of visual patterns….
and emotions (Alessi & Ballard, 2001, p. 398). Buck (1994)
supports the belief that the right brain is where the dominant
reactions to stress occur. Main (1996) observes that the ability
to regulate ones response to stress can be negatively altered even
during early infancy when a child is exposed to such negative environmental
influences as violence. Schore (2001) concurs and Hopkins and Butterworth
(1990) support these and similar findings that appropriate responses
to external changes (stress/crisis) can be altered by activation
of the arousal state – the heightened state of fear induced
by traumatic exposure.
Following the September 11, 2001 attack on America, millions in
this country experienced the absence of a sense of safety and,
as a result, thought processes were immediately altered. Unlike
the tragedy and massacre at Columbine High School, parents across
the country rushed to school to be with their children, or to take
them home. Their thoughts and behavior reflected fear, terror,
a sense of powerlessness, confusion; the inability to think clearly,
to process all the information. For a brief moment, Americans experienced
to some degree immediate arousal. No matter what was said (cognitive)
people no longer felt safe. Cognitive processes were significantly
At some point, trauma victims must begin or have help to think
differently about what they experienced, how they view themselves
and the world. For many trauma victims, increased arousal keeps
them frozen, thinking as a “victim”– powerless,
hopeless, under constant threat. The reduction of arousal is essential
to the restoration of these functions. Such intervention can be
applied in school settings the days and weeks following trauma-inducing
critical incidents, which impact school students and staff.
Interventions must help trauma victims become trauma survivors
by helping them to change their thought processes. However, cognitive
intervention can only be successful when first the sensory experience
to trauma is altered. Following September 11th, for example, Americans
were repeatedly reassured (cognitively) they were safe, but this
could not be accepted until they first felt safe – a sensory
experience. Parents who saw uniformed police officers in the parking
lot when they arrived at their child’s school, felt safer
than those who saw no visible sign of safety. What was seen communicated
a greater sense of safety than what was being heard. Understanding
trauma as a sensory experience is also critical to understanding
the levels of intervention necessary to restore cognitive functioning
as well as behavioral appropriateness.
Sensory Functions – Behavioral Responses
have learned that while in the arousal state or, not feeling safe
at the sensory level, cognitive functioning and processing is altered.
Short-term memory suffers (Staknum, Gebarskie, Berent, and Schfeingart,
1992); verbal memory also decreases (Bremmer, 1995). Behavior is
in response to what is sensed. Aggression, agitation, exaggerated
withdral, loss of small motor activities; like being unable to
unlock a door, make a phone call, unable to talk (stuttering),
unable to sleep, are not uncommon behaviors in response to trauma
(Le Doux, Romanski, and Xagoraris, 1991). Children can be easily
startled and become behaviorally reactive to perceived threats.
A study on children’s recall following
a horrific earthquake found that 90% remembered the earthquake,
but their memory was very selective and related to events that
had personal meaning for them (Azarian, Lipsett, Miller, and
Skriptchenko-Gregorean, 1999). If that meaning involves a sensory
(felt) threat, real or perceived, behavior changes accordingly.
Even though the danger may be over the “sense” that
it is not can lead children, for example, into being fearful
of leaving home. Behavioral changes in addition to the alterations
of cognitive processes discussed earlier are often misread for
resistance, stubbornness, over reactiveness, impulsiveness, confrontation
or a having a learning disability or Attention Deficit Hyperactive
Disorder (ADHD) (Levine, 2007; Weinstein, 2000).
As a sensory experience trauma is encoded in the implicit memory
(right-brain area). Implicit memory also referred to as “procedural
memory” refers to how an event is remembered by the body
and central nervous system (van der Kolk, et. al 1996; Squire,
1994; Rothchild, 2000). The trauma experience is stored implicitly
via images, sensations, affective and behavioral states. Although
in the early days following the attack on America, Americans were
repeatedly reassured of their safety by the President, The Wall
Street Journal (date unknown) reported that for several weeks the
consumption of mashed potatoes had significantly increased. In
other words, it was comfort food (a sensory experience) that brought
some relief. In the midst of trauma, and for some, following their
traumatic experience cognitive reassurances, attempts to appeal
to our “explicit” or “declarative” memory
simply is not enough. At the sensory level what we see, what we “sense” becomes
far more important to survival than verbal information. Telling
parents their children were safe at school was not enough on September
11, 2001; parents needed to be with their children and to “see
for themselves” that they were safe.
This “sensory state” of
trauma is defined by a sense of terror, powerlessness, and the
absence of a sense of safety. In this sensory state, behavior is
altered in response to the danger we sense. Well-trained and knowledgeable
educators on September 11th left television sets on all-day in
elementary classrooms across the country. In their panic and terrifying
alarm, they lost sight of the undue exposure they inadvertently
provided their students. Weeks later, when some sense of safety
was returned, the very same educators reported they now realized
that, in their own panic, they left the children unprotected and
over exposed; they weren’t
thinking clearly at the time. They were functioning at a sensory
level, not a cognitive level.
van der Kolk, (1994); Levine, (1997); Saigh, (1999) have supported
that trauma is experienced as a sensory experience and only later
ordered as a cognitive experience. Another way to state this is
that students who do not feel safe, find it difficult to learn;
they even find it difficult to remember (Perry & Szalavitr,
2006; Matthews & Saywitz, 1992) and, while in an aroused state,
begin to behave in ways that are problematic. Not until a “sense
of safety” is returned are cognitive processes restored,
behaviors returned to pre-trauma level. The questions this presents,
therefore, are what type of intervention can best restore this
sense of safety (decrease arousal); how soon can we intervene and
can these interventions be provided in the school setting?
earlier, trauma can trigger (arouse) the activation of the autonomic
nervous system to ready itself to resist or solve the real or perceived
threat presented by exposure to a critical incident (van der Kolk,
et. al 1996). If the response (arousal) is not discharged or deactivated,
the sustained arousal state can lead to sustained cognitive and
behavioral dysfunction (Levine, 2007; Grill, 2001). Trauma being
a sensory experience (Lang, 1979; Steele, & Raider, 2001; Rothchild,
2000), arousal is experienced as an absence of the “sense
of safety” and
as a “sense of powerlessness.” Aggressiveness, over
reactive responses and exaggerated withdrawal (Le Doux, Romanski, & Xagoraris,
1991) are survival behaviors – attempts to feel safe, in
control. As long as a child is not feeling safe and in control,
this aroused state makes it difficult to process verbal information,
attend, focus, retain and recall (Perry & Szalavitr, 2006,
Bremmer, 2001; Starknum, Gergarski, Berent, & Schteingart,
1992; Saigh, 1999). Intervention designed to deactivate the arousal
state and return the child to a sense of safety and a sense of
power or control, helps to restore previous cognitive and behavioral
patterns (Thompson, Charlton, Kerry et al. 1995). The most immediate,
short-term and long-term intervention, therefore, must be designed
to restore that sense of safety and power.
Four Levels of Intervention
It is important to understand
that not all students/staff exposed to a critical incident will
need all four levels of intervention. Not all students/staff will
experience a critical incident with the same level of vulnerability.
Some victims will feel safer and more in control than others. Some
will perform better at a cognitive level than others. To pull all
students, or all staff for example into debriefing (second level
of intervention) may needlessly overexpose some of the participants
and worsen their original reactions (Mc Farlane, 1994).
We must, therefore, be careful to apply the least intense and
least intrusive interventions first (Rando, 1993). The National
Institute for Trauma and Loss in Children (TLC) approaches trauma
intervention at four different levels. Level one – crisis
intervention, level two – debriefing, level three – social
responsiveness, and level four – structured sensory intervention.
These interventions are detailed in TLC’s Trauma Response
Protocol Manual, Debriefing Handbook for Schools and Agencies,
Structured Sensory Interventions for Children, Adolescents and
Parents (SITCAP), and Schools Response to Terrorism: A Handbook
of Protocols. This format only allows us to identify the key elements
of these four levels of intervention which help to deactivate the
state of arousal or restore a sense of safety and power (control)
as quickly as possible.
Level One - Crisis Intervention
value of crisis intervention was established as early as 1944 by
Eric Lindemann (1944), who detailed the grief reactions of those
involved in the Coconut Grove fire in Boston. Hundreds of books
and research projects have since detailed its benefits for children
and families (Caplan, 1964; Rapoport, 1970; Johnson, 1993; Webb,
1994). Schools became familiar with the importance and need for
crisis intervention in the early 80’s when
suicide among children became an epidemic. Most schools today
have, in place, a set of protocols to initiate when a critical
incident takes place. Some, of course, are more comprehensive,
more practical, and more user-friendly than others. TLC’s
Trauma Response Protocol Manual (Steele, et. al 2000) was developed
with the help of some 1,500 school professionals across the country
who had first-hand experiences with critical incidents. It is
written in a format that details specific tasks needed following
What is most important concerning the types of crisis intervention
initiated is that it directs itself to restoring a sense of safety
and control, for all students and staff. Crisis intervention is
the first level of intervention. It is initiated immediately following
a critical incident and continues for two-to-three days. It consists
of organized responses (protocols), dissemination of information,
in part through classroom presentations and, attending to the emotional
needs of those involved.
How important is it to have an organized protocol? We have learned
that in the midst of trauma normal cognitive functions can be overwhelmed
and disappear because of the sensory nature of trauma. Hundreds
of examples exist which show that otherwise calm, organized staff
lose their ability to think clearly in the midst of trauma. In
a sense, protocols exist so people don’t have to think in
the midst of chaos, yet still act appropriately. Protocols, in
other words, are the result of an orderly “thinking things
through” before they happen, so that appropriate actions
are immediate. “A time of crisis is not conducive to improvisation.
Prior preparation and orientation of staff members regarding management
of a crisis will greatly assist those expected to assume leadership
roles and, initiate actions appropriate to the time of need” (Webb,
This following scenario illustrates the need to have protocol
that are designed to keep everyone safe, regardless of their ability
at the time to think clearly. Imagine a school building under attack.
Panic sets in: some freeze, some flee, and some stand ready to
fight. Those who freeze or run in terror will find it very difficult
to take verbal directions. They need to first see someone they
recognize and then either be physically led or guided to a predesignated
area of safety. This tells us that we must have personnel in that
school who are clearly identifiable (staff identification badges)
and who position themselves as visible reference points for those
in panic to run to and then be directed to a predesignated safe
area. There will also be a need to physically assist those who
freeze and are unable to move into that safe area. Those certified
by TLC understand that the use of personnel in this fashion address
sensory reactions in the midst of trauma versus basic cognitive
functions which may not be accessible to many at the time of the
trauma. Many elementary teachers across the country left television
sets turned on the day of the 9/11 terrorist attacks. We cited
the example earlier that adults had a need to know what was going
on in order to try and manage their anxiety. However, they unduly
over-exposed the children. Weeks later, when feeling safe, most
were able to cognitively understand that they had not afforded
their children protection from over-exposure. They also now understood,
that in the midst of trauma, we do not always, cannot always, rely
on cognitive processes to assist us. These same teachers will act
differently the next time because of what they have learned.
Organized protocols, therefore, help support the deficiencies
in cognitive functioning that can occur in the midst of trauma.
Authority – Information
Imagine being in a surgical waiting room. The doctor tells you
he/she will be out at 3:00PM to let you know how your loved one
is doing. It is now 3:05PM. You begin to think the worst has happened.
What you need more than anything else is a person in authority
(the doctor in this case) presenting information to calm and reassure
you. In school settings it is critical that students, staff, and
parents hear from someone in authority – the principal/superintendent.
It is important that factual information be presented and reassurance
given that the school is prepared, and its staff trained to manage
these situations. Classroom presentations in the first two days
accomplishes this element of crisis information.
Keep in mind that not everyone can process all the information
presented during those initial days. However, for many, information
is what lowers their arousal (anxiety, fear) and restores their
sense of safety. The important issue related to classroom presentations
is that all students are given the same presentation and information.
If each group hears something different it only creates confusion
as students begin to talk to one another about what they were told.
For this reason TLC has a classroom presentation model that it
encourages all presenters follow. This maintains the orderly response
so critical in the first few days. This process also allows students
and staff the opportunity to develop a uniform, cognitive understanding
of what has happened as well as be prepared for what will be happening
the remainder of that day and the days that follow.
For many, no additional
intervention will be needed. However, some will need additional
crisis intervention to attend to their emotional reactions. Listening,
attending, acknowledging, summarizing, reflecting, normalizing,
nurturing, correcting false information, planning for the remainder
of the day, the evening, empathetic responses are the primary crisis
responses at this time. This type of special attention, for those
having a difficult time emotionally, often is all that is needed.
Level Two – Debriefing
research evaluating the outcome differences between those exposed
to debriefing and those not involved in debriefing, those groups
who participated in debriefing reported having shorter duration
of reactions and less intense reactions. Debriefing can accelerate
symptom reduction (Hokanson & Wirth, 2000; Everly & Mitchell,
2000; Eid., Johnson, & Weisaeth, 2001). Dr. Jeffrey Mitchell,
a former fireman, is credited with establishing the Critical
Incident Stress Debriefing Model and process designed to assist
rescue workers and survivors of catastrophic situations. Other
models have been developed: Armstrong, et. al (1991), Raphael
(1986), Hobfoll (1994), but Mitchell’s model receives the
The purpose of debriefing is to give participants the opportunity
to tell their story by using very focused questions that identify
the cognitive, affective and behavioral experiences of the participants.
The formal debriefing model is, however, very cognitive and its
processes do not address the unique needs of schools and students.
The National Institute for Trauma and Loss in Children, with the
help of some 1,500 professionals across the country developed several
models to meet the needs of the various ages of students; the needs
of the most exposed and least exposed, the needs of staff and of
administrative response. Trauma Debriefing for Schools and Agencies
(Steele, 1999) is now used in schools across the country. Defusing
for younger children, debriefing for adolescents and adults, operational
debriefing for all staff and debriefing crisis teams are the major
models used by TLC. Debriefing is only for the most exposed and
takes place in most situations about the third or forth day following
the incident. In New York following 9/11 over 8,000 students were
evacuated from the target area and relocated to other schools and
sites (Lehmuller & Switzer, 2002). Because of all that was
actually happening, debriefing was not a possibility for several
days. In situations where major everyday functions or resources
cease like electricity, or water supply, inaccessible roads, etc.
the initiation of debriefing may not occur until these services
and resources are returned.
Not everyone will need
debriefing. Debriefing is generally reserved for the most exposed.
There are four possible ways to be exposed, 1) as a surviving victim – victim
of physical/sexual abuse, other assaults, community violence, critical
injuries, catastrophic situations, etc., 2) as a witness to any
potential trauma-inducing incident; violent or non-violent – murder,
suicide, assault, car fatality, bus tragedy, house fire, drowning,
etc., 3) being related to the victim – as a family member
friend, or peer. (“Being related” can also include
similarity to or personal identification with victims.) Milgram
and associates (1988) found in their study of 268 seventh graders
following a tragic school bus accident that “personal involvement” with
the victims, rather than the incident itself, increased the level
of prevalence. A study of 64 children (Schwarz & Kowalski,
1991) following a school shooting showed that irrespective of
physical nearness to the event, emotional stress resulting from
personal identification also led to Posttraumatic Stress Disorder
(PTSD); 4) Verbal exposure – Saigh (1991) found that listening
to the details of traumatic experiences, traumatic stress reactions
can be induced. This is especially true for professionals responsible
for intervention with traumatized children. Vicarious traumatization
is always a potential development. Children who are exposed to
repeated media coverage of details and survivors, understandably
still may be vulnerable to trauma reactions.
Being “related to” and a “witness to” is
far more frequent in today’s technological society. Approximately
six months after the Oklahoma City bombing this author was speaking
to a group of Head Start teachers. During the presentation, on
of the teachers told the story of how her children spontaneously
devised a game where one half of them took all their sleeping (floor)
mats and covered themselves. The other half, in pairs of two, one
at a time would go over to the other children, lift up the mat,
picked up the child under the mat and then escort that child over
to the other side of the room by their indoor soccer nets. They
did this until all of the children under the mats were rescued
and taken to the “safety” nets. Afterward, they switched
sides. Rescuers became victims trapped under the mats; victims
were now rescuers.
By being witnesses to the tragedies of the bombing and seeing
the rescue workers carry out children their own ages from the rubble
of their day care center, these children identified with the victims
and consequently needed to find a way to conquer the fear induced
by being witnesses and recovery themselves to be “related
to” the victims.
Debriefing is unlike any counseling process. Training is necessary
to learn how to conduct debriefing. In school settings, debriefing
should only be conducted by trained social workers, counselors
with experience in working with the age level of those being debriefed
and who also have a working knowledge of the developmental issues
at the various age levels. Debriefing six-year-old children is
far different than debriefing sixteen-year-old adolescents.
Level Three –
Social Responsiveness and Empowerment
three is not a formal intervention for persistent reactions,
but is actually happening concurrently with debriefing. It applies
itself to the general population who needs to do something to feel
These intervention activities are sometimes spontaneous and can
be initiated by staff or students. In most cases, they begin three
or four days following the critical incident, but can begin earlier.
They are sensory in nature, in that participants are actively involved
in doing something in response to the trauma experienced. Following
9/11, for example, blood drives were initiated, monies were collected,
letters written, pictures drawn that were then sent to victim’s
families and students in the attack area, vigils were held, community
forums addressing cultural and religious issues triggered by the
attack were convened, the meaning of such an attack were discussed
in social science and history classes.
It is this kind of social response at a sensory level that helps
to return a sense of control and power to those who were left feeling
vulnerable following exposure. They can help to empower not just
individual students or staff, but an entire community. They also
provide the opportunity to teach children about the value of life,
respect for diversity, generosity of spirit, care for others, and
how to collaboratively work together to support one another in
a time of crisis. They generate a social conscience as well as
help teach children difficult lessons. They also help restore a
sense of hope.
Numerous activities were encouraged and supported by the US Department
of Education, Parent Teacher Associations, American Psychological
Association, National Association of School Social Workers, Educators
for Social Responsibility, American Academy of Child and Adolescent
Psychiatry, National Institute of Mental Health, National Institute
for Trauma and Loss in Children, and many other state and local
organizations. Schools Response to Terrorism: A Handbook of Protocols,
published by TLC (Fall, 2002) provides a wide-range of social responsive
and empowerment activities and resources.
Research related to the value of such activities is limited, yet
administrators across the country saw how such activities had value
in not only giving their students a voice, but in helping them
collectively feel better. They become a way to help the “negativity” and “impotence” survivors
can be left with immediately following exposure (Rowlands, 1998).
They help children “gain control of the intense emotions
and sense of helplessness that follow community disaster” (Austin,
1992). For immediate survivors, the outpouring of support helps
to “validate” the value of the sacrifices made by their
loved ones (van der Kolk, 1996).
This article does not permit a full discussion on memorial services
within school settings, which is a level three intervention. The
National Institute for Trauma and Loss in Children recommends that
memorial services not be conducted in school settings, especially
following a suicide because of the risk of contagion (Phillips & Carstensen,
1986; Gould & Schaffer, 1986). If one understands the nature
of trauma, one understands that prolonged exposure via physical
proximity to memories of the deceased can leave survivors “frozen” in
their grief and trauma. This was the primary reason, that administrators
decided to build an entirely new library for Columbine High School
(Semas, 2001). (Additional protocol following student deaths can
be found in the Trauma Response Protocol Manual and activities
for students following terrorism or when multiple deaths occur
can be found in Schools Response to Terrorism: A Handbook of
Protocols (Steele, Brohl & Brohl, 2002).
The social aspect of this level of intervention may not help individuals
with more intense or severe levels of trauma reactions. For some,
it may even delay reactions. Think in terms of rescue workers,
who work hard at doing what they are trained to do. When all of
the activity ceases, the reality of what they have been exposed
begins to take hold and reactions emerge. For some of these rescue
workers, additional intervention will be needed.
Level Four –
Structured Sensory Intervention
This final level
of intervention responds to those victims who are experiencing
PTSD weeks following exposure, even months or years later. It
also responds to those who may not fulfill the criteria for PTSD
but are, in fact, experiencing one or more trauma-specific reaction
and/or delayed grief reactions (traumatic grief). This level
of intervention can actually be used with students who have been
exposed to a singular incident or chronic multiple traumatizations.
Structured Sensory Intervention for Traumatized Children,
Adolescents, and Parents (SITCAP) (Steele & Raider, 2001) is the result
of eleven years of development, field-testing in school and agency
settings, and research by The National Institute for Trauma and
Loss in Children (TLC). SITCAP includes trauma-specific intervention
programs for pre-school children three-to-six years - What
Color Is Your Hurt?; children six-through-twelve years I
Feel Better Now!; children six-through-twelve years and thirteen-through-eighteen
years Trauma Intervention for Children and Adolescents, formerly
known as – Trauma Response Kit; adults – Adults
and Parents in Trauma: Learning to Survive and Trauma Debriefing for
Schools and Agencies.
TLC has over 3,000 certified Trauma and Loss School Specialists,
Consultants, and Consultant Supervisors using these intervention
programs across the country in school and agency settings with
children and families exposed to such incidents as murder, suicide,
sexual/physical assault, domestic violence and other forms of violent
acts; car fatalities, house fires, drownings, critical injuries,
terminal illnesses, divorce, separation from parents and other
non-violent critical incidents. These interventions are based upon
well-researched cognitive-exposure based intervention strategies
(Saigh & Bremmer, 1999; Malchiodi, 1998; Deblinger et. al,
1996; Roje, 1995; van der Kolk et. al, 1996; Pynoos, 1998).
The restoration of a sense of safety and power is a primary concern
in each program. The activities are primarily sensory activities,
as trauma is experienced at a sensory level, not a cognitive level.
The structure of the intervention, however, directs those sensory
experiences into a cognitive framework, which can then be reordered
in a way that is manageable and empowering for children (Steele & Raider,
2001; Saigh, 1999). This intervention “is structured because
with structure come a sense of control and safety” (Steele & Raider,
2001, p. 63). Trauma-specific questions are used to help the victim
give their experience a language, to tell their story. Sensory
activities are used to help the victims make us a “witness” to
what the experience was like. Once those tasks are completed, the
child can now think differently about what happened.
It was New Year’s
Eve. A high school senior was ushering at a movie complex where
several movies ran concurrently. He was slated to graduate in the
spring and had been accepted into the police academy. Also a football
player, he was physically quite strong and stood over six feet
tall. Several kids in the movie he was assigned to were causing
trouble. He attempted to get control but was unable to do so. He
sought out the manager for help, but the manager had a full house
and told him he would just have to handle it on his own. The situation
did not change. In this complex, movies were scheduled so several
let out at the same time. There was a “common” area
that the theatres opened into, so everyone was moving into this
area simultaneously. The youngster took his post across the common
area outside the doors of the movie he was responsible to monitor.
When the youths he had trouble with came out of the movie and into
the common area they spotted him, rushed him, knocked him down
and began beating on him. They broke his nose and several ribs.
About a month later his parish priest, who was trying to help this
youngster, called for assistance. The boy was skipping school and
not attending the youth activities at church, which was not at
all like him.
“What was the worst part for you?” was one of the
trauma specific questions that helped to encourage this youngster’s
telling of the story and focusing on specific details. When this
case was presented in trainings and participants were asked to
anticipate what the “worst part” must have been, their
numerous responses rarely identified what the worst part was for
this teenager. Responses ranged from the anger he felt at the manager
for leaving him on his own, the embarrassment and shame that he
couldn’t help himself and the pain he felt during the beating.
The point is, what we often as observers consider to be the worst
part is not necessarily experienced by the victim. Only by giving
the victim the opportunity to make us a witness can we truly know
his experience as he knows it.
The teen’s response was as follows:
“I can see it as if it is happening all
over again. I’m on the ground and they’re kicking me.
As they are kicking me I can see between their legs. (This kind
of detail is unique to trauma in which events seem to happen almost
in slow motion so that such details emerge.) As I’m looking
between their legs, I see all these people standing around and
no one is helping me.”
At that moment in time, he experienced complete abandonment, betrayed
by the adults in his world. Without appropriate intervention this
could have easily triggered very self-defeating, even destructive
responses. He had already begun to isolate himself, was missing
school and was putting his future in jeopardy. If he had gone much
longer without help, it would not have been unusual for him to
start carrying a weapon, join a gang, or even actively seek out
the kids who beat him with the intent of getting revenge. Being
unable to trust the adult world was the worst part of his experience
and one that often leads to destructive behavior and identification
with the aggressor.
By asking this one trauma-specific question, the specialist was
able to help this teen work through the abandonment and cognitive
distortion he experienced; a focus that likely would have otherwise
reframing is scripted to insure that the victim is provided a “survivors” way
of making sense of the trauma experience. The goal is to help move
the victim from “victim thinking” to “survivor
thinking” which leads to empowerment, choice, active involvement
in their own healing process and a renewed sense of safety and
Activities also assist in supporting the reframing of the experience.
The high school senior, in our earlier example, who was beaten
on New Year’s Eve and had lost trust in the adult world,
withdrew. By having him draw what his fears looked like and later
giving them a name, he realized he was responding as a victim to
his own fear that, if the police academy found out, they would
never allow him to start his training. This was irrational, but
not from a “victim’s” viewpoint. A sense of shame
also emerged, as his view of self was not being able to take care
of himself. When asked why standard operating procedure of police
was to always work with a partner, he was able to refocus on the
reality that alone, even in the midst of bystanders, protection
and help was not always given. Working in pairs, he realized, dealt
with the reality that even police could find themselves suddenly
overwhelmed. At a cognitive level, he was then able to reframe
that what happened to him was not his fault and that as a police
officer he would be doing for others what others could not do for
him - help. In this sense, cognitive reframing allowed him to reorder
his experience in a way that gave his future new meaning.
Cognitive approaches are largely used with exposure techniques.
Frank (1988), Meichenbaum (1974), Saigh (1999), have all found
the use of cognitive restructuring /reframing to be a valuable
component for helping individuals move from “victim thinking” to “survivor
thinking”. Cognitive reframing occurs everyday of a student’s
life as a result of daily experiences with teachers and the education
process. It is an essential component of trauma intervention and
needs to be a part of the schools response.
A good deal
of research has concluded that parents are also critical to their
child’s ability to recover from trauma. Pynoos & Nader
(1988) and Vogel & Verberg (1993) cited parents as the single
most important support for school age children following a disaster.
Byers (1996) reported that studies following World War II showed
that the level of upset displayed by the adult in the child’s
life, not the war itself, was the single most important factor
in predicting the emotional well being and recovery of the child.
We see the same relationship today.
An unstable parent creates an unstable child. A traumatized adult
will find it difficult to help her traumatized child. Schwarz (1991)
and many others have found that adults (parents), more frequently
then children, experienced the greatest distress when presented
with a trauma. van der Kolk, et. al (1996) wrote “most children
are amazingly resilient as long as they have caregivers that are
emotionally available.” When a child has been traumatized,
parents also experience extreme distress and often are unable to
adequately respond to their traumatized children without appropriate
Learning about trauma helps parents, especially when their experience
is brought back to life (triggered) by their child's traumatic
experience. Education is an essential, necessary component to help
the parent become aware of how her own unresolved fears may block
her ability to allow her child to openly tell his story. The child
needs a parent who is not terrified and emotionally overwhelmed.
Parents with their own history often discover that their child's
experience threatens to bring all the terror of their own experience
back to life. Unknowingly, they reject their child's cry for help,
or minimize the child’s terror in hopes of calming the child.
Given the reality that parent involvement in intervention can
be minimal, two sessions with parents can still support significant
reduction of trauma reactions in their children. This is especially
the case if those sessions are structured and focused on helping
the parent become “a witness” to their child’s
experience as well.
Research (Steele & Raider,
2001) documented that TLC’s
intervention programs reduce severe levels of trauma reactions
following violent as well as non-violent incidents. It demonstrated
that the most severe victims saw the greatest reductions in reactions;
contrary to the myth that little can be done to help those exposed
to multiple traumas. It demonstrated that trained school counselors,
social workers and psychologists can assist traumatized children
in the reduction of symptoms across all diagnostic subcategories
of PTSD, and for most, continue that reduction months after the
Structured sensory interventions developed by TLC are unique for
several reasons. They have been field-tested and researched in
school settings and can be applied to students exposed to either
violent or non-violent trauma inducing situations. Because grief
is part of any trauma reaction, they are beneficial for managing
grief as well as trauma. They are short-term, no more than eight
sessions with each session following in a sequential manner addressing
the major themes of trauma: fear, terror, hurt, worry, anger, revenge,
guilt, accountability absence of safety, powerlessness, and victim
thinking versus survivor thinking. Not all children will need all
eight sessions, yet the design is such that each session is self-contained
and outcome driven. Resource materials are provided for parents
as well as students to assist in the education of victims and their
families as to the nature of trauma and the normalization of its
Today, crisis intervention is a standard response in schools settings
following critical incidents. Unfortunately, responses are not
always orderly, nor appropriately used because of the lack of awareness
and understanding of the nature of trauma, the way it can impact
victims, the different levels of needs of victims, and the training
needed to appropriately initiate the different levels of intervention
from the least intrusive to the more intense strategies. Age appropriate
resource materials (tools) are also needed to help facilitate successful
intervention at the sensory level.
Understanding that trauma is not a cognitive experience, but a
sensory one, dictates strategies that immediately restore, to victims,
a sense of safety and renewed sense of empowerment/control in the
face of fear and uncertainty generated by the incident. Reduction
of the arousal level is critical to the restoration of pre-trauma
cognitive processes, learning functions, behavior and performance.
However, this must be approached systematically, as students or
staff exposed to traumatic situations will have many varied reactions,
some resolved with level one interventions, others needing up to
level four intervention.
Children are most accessible in the school environment. We also
learned as early as 1986 (Terr, 1990), following the Challenger
space shuttle disaster, that children are vulnerable to trauma
reactions even fourteen months later. Most educators understand
that availability to the media today has left children overexposed
to life events far too early in life and, as a result, children
live in greater fear and anxiety than in past years. The school
setting becomes an opportunity to help minimize that fear and restore
a sense of safety. Valuable lessons can be learned if taught.
Students fully expect to hear from the adults in their environment
following critical incidents. When educators fail to discuss the
kind of critical incidents children are exposed to personally,
via their school neighborhood or via the media coverage of major
disasters, they are left to believe that “adults are afraid
to talk”; “nobody knows what to do”; and/or “I
better not bring this up – there is something wrong about
it” (Terr, 1992 p.87). Critical incidents/disasters present
and opportunity to teach children to alter or expand their cognitive
reactions, to stimulate their emotional growth, to be better prepared
to negotiate the realities of today’s world.
Administrators generally appreciate the value of structured, orderly
process when faced with difficult situations. It is far easier
to exercise flexibility to unique elements of situations when structured
boundaries exist. Crisis intervention in school settings need to
also be structured and orderly, not only to minimize liability
issues, but to maximize the opportunity to provide an immediate,
efficient, outcome oriented resolution of that crisis. In essence,
all members of school crisis teams need to be “on-the-same-page,” know
exactly what their roles are, how and when they are to carry out
these roles, and what is to be communicated to students, staff,
families and communities. This is accomplished through a systematic
initiation of protocols and levels of interventions of the kind
discussed. The National Institute for Trauma and Loss in Children
has been working with school districts across the country since
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