How to respond to a child in distress u Stay calm and listen u Keep child and other students safe u “I’m right here and will keep things safe for you” u Label feeling (use gentle voice) u Offer suggestions for relaxation u Model use of relaxation strategy u Sometimes silence is best u Problem solve once child is calm u Goal is to help child restore equilibrium u Remember: “This is a child who can’t. Not a child who won’t.”
How else can you help… u Create a classroom where talking about the trauma is okay u All you need to do is listen u Be aware of trauma triggers u Be mindful of professional limits and boundaries u Communicate your concerns with parents u Self-care u Refer as needed u School counselor
Remember… Children look to significant adults in their lives for guidance on how to manage their reactions after the immediate threat is over. Schools can play an important role in this process by providing a stable, familiar environment. Through the support of caring adults school personnel can help children return to normal activities and routines (to the extent possible), and provide an opportunity to transform a frightening event into a learning experience. Lazarus, Jimerson and Brock (2003)
Resources Social Emotional Foundations for Early Learning u u http://csefel.vanderbilt.edu/resources/strategies.html#teachingskills Tips and Resources for teaching Hurricane Harvey u u https://www.literacyworldwide.org/blog/literacy-daily/2017/09/05/back-to- school-after-a-natural-disaster-teaching-hurricane-harvey National Child Traumatic Stress Network u u www.nctsn.org Disaster Related Sources: u u https://www.naeyc.org/newsroom/ u https://www.acf.hhs.gov/ohsepr/children-and- familiesResources_on_coping_with_disasters Tips for Helping Students After a Trauma u u https://www2.ed.gov/parents/academic/help/recovering/recovering.pdf
Replace #Houston with #yournameStrong and draw a picture of how YOU are strong YOUR NAME
What’s in your heart?
School aged youth: 5-11 year-olds Stephanie Hernandez, DO
How and why would you use these exercises for school aged children?
Objectives Identify coping skills appropriate for school aged youth u Discuss normal emotional and cognitive development in school aged youth u Identify characteristics of students at risk for longer term problems u Discuss typical reactions after a natural disaster in school aged youth u Identify ways to help students bounce back u Discuss ideas to rebuild the classroom u
Coping skills…what do they help with? u Improves self confidence and self-esteem u Increases student independence u Helps with self-assertion and agency u Decreases time it takes to deal with students’ crises, issues, meltdowns u Good life long skills u Improves problem solving skills
Deep breathing: for school aged youth u How can we teach deep breathing for school aged children?
Normal development: cognitive u By 5 years old… u Ego-centrism weakens, “decentration” u Language, memory, imagination u Understand and express the past and future u Transductive reasoning
Concrete operational stage (7-11 year olds) u Increased awareness of external events u Reason about tangible objects u Think logically with practical aids u Conservation, inductive reasoning
Psychosocial stage of development: Industry vs Inferiority u Development of competencies u Learn, create and accomplish new skills, knowledge u Very social stage of development u Self comparisons u Caution for unresolved feelings of inadequacy and inferiority amongst peers: self esteem, social, academic u More significant relationship with school and neighborhood: competitive, cooperative, empathic u Parents are still important, but not the absolute authority
Emotion identification: school age youth are learning to… u Name feelings u Describe feelings u Regulate their feelings
A study of long-term effects Hurricane Andrew: 3-5 grade student PTSD rates (moderate) 60% 45% 30% 15% 0% Month 3 Month 7 Month 10 PTSD symptoms Helping children cope with disasters: a manual for professionals working with elementary school children: LaGreca et al 1994.
Melody: pre-hurricane u Melody is a 7-year-old Hispanic female whose home is a 3-bedroom apartment that she shares with her 11-year-old brother and biologic parents. She has shared in class that she will be a “big sister” soon. u In class, she tends to be more reserved than her peers, appears to be learning at grade level and has friends that she sits with at lunch and plays with at recess.
Melody: post-hurricane u Melody’s attendance has been variable, and when she does come to school she frequently is late and does not have her homework. u She remains appropriately dressed with good grooming and basic hygiene. u She is more giggly and almost hyperactive in the classroom needing some redirection. u Her father, instead of mother who typically comes to parent teacher conferences, meets you in the fall to discuss Melody’s progress in school.
Discussion: What are your concerns for… u School u Home u Thoughts about how to approach Melody
Melody: pre-hurricane u Melody is a 7-year-old Hispanic female whose home is a 3-bedroom apartment that she shares with her 11-year-old brother and biologic parents. She has shared in class that she will be a “big sister” soon. u In class, she tends to be more reserved than her peers, appears to be learning at grade level and has friends that she sits with at lunch and plays with at recess.
Melody: post-hurricane u Melody’s attendance has been more variable, and when she does come to school she frequently is late and does not have her homework. u She remains appropriately dressed with good grooming and basic hygiene. u She is more giggly and almost hyperactive in the classroom needing some redirection. u Her father, instead of mother who typically comes to parent teacher conferences, meets you in the fall to discuss Melody’s progress in school.
Characteristics of at-risk students u Gender u Disrupted daily life u Threatened physical safety, loss of possessions, relocation u School, friends, family u Other major stressful events post-Harvey u Change in support Helping children cope with disasters: a manual for professionals working with elementary school children: LaGreca et al 1994.
Characteristics of at-risk students u Significant psychologic distress u PTSD-related symptoms u Limited skills coping skills u “I wish bad things never happen” u “I try to forget all the time” Behavioral changes u u Aggressive outbursts u Decline in academics u Withdrawal or avoiding being alone u School refusal Physical u u Reports of nausea, stomachache and headaches Helping children cope with disasters: a manual for professionals working with elementary school children: LaGreca et al 1994 .
Typical reactions Concentration difficulties u Academic achievement declines u Refusal to attend school u Aggressive, excessively silly, hyperactive u Difficulty sharing & separation u Stomachaches, headaches u
Reactions to watch for: Depressive symptoms u Sadness, crying, irritability u Loss of interest u Appetite changes u Isolating/withdrawal u Sleep (insomnia, not wanting to sleep alone, nightmares)
Reactions to watch for: PTSD-related symptoms u Re-experiencing: play, dreams, flashbacks u Avoidance: reminders of the disaster, general numbness to emotional topics u Arousal: sleep, irritability, concentration
Possible internal thoughts and fears u Feeling more alone, nervous or separated from family u That something will happen them and/or their family u Of the dark, upcoming storms, being alone u That they caused a part of the disaster
Start a discussion
How would you approach a child you’re concerned about?
Rebuilding the classroom
Aiding in student recovery Re-establish routines u Strengthen friendships and peer support u Support what is developing and encourage strengths u u Be curious and inquire, educate and help advocate u Remind families: monitor children’s exposure to media & adult conversations
Encouraging strengths: develop positive self-images Julie Ballew (5th grade teacher) Scholastic.com
Explore feelings…
Develop coping skills and help identify support
Educate “Helping your students deal with Hurricane Harvey,” by teacher Hannah Hill on “Teachers Pay Teachers”
Help advocate "Rise Up" by Andra Day u Brainstorm ways to help the community u Writing letters, poems about feelings and to other students, teachers, families u Donations Teacher Julie Ballew at Scholastic.com u Make a classroom “fight song”
u Take care of yourself u Use your community for ideas and support!
Sources and supplemental teaching products National Association of School Psychologists (NASP) u Federal Emergency Management Agency (FEMA) u The National Child Traumatic Stress Network (NCTSN) u American Psychological Association (APA) u La Greca, A. M., Silverman, W. K., Vernberg, E. M., & Roberts, M.C. (Eds.) (2001, in press). Helping children u cope with disasters: Integrating research and practice. Washington, DC: American Psychological Association Press. La Greca et al. 1994. Helping Children Cope with Disasters: a manual for professionals working with u elementary school children. Miami, FL: 1994. https://www.teacherspayteachers.com/Product/Help-Your-Students-Deal-with-Hurricane-Harvey-3385989 u Hanna Hill, teacher in Katy, TX https://www.scholastic.com/teachers/blog-posts/julie-ballew/17-18/rebuilding-our-classroom-community- u after-hurricane-harvey/ Julie Ballew, teacher https://www.teacherspayteachers.com/Product/Help-Your-Students-Deal-with-Hurricane-Harvey-3385989 u published by Hannah Hill, elementary school teacher in Katy, TX at “teacherspayteachers.com” http://www.7-dippity.com/docs/After_The_Storm_(2008_Internet_Edition).pdf from the Smithsonian u
Adolescents: 12-18 year-olds Asna Matin, MD and Sophia Banu, MD
Objectives Discuss normal cognitive and emotional development in adolescents u Identify typical reactions after a natural disaster in adolescents u Identify characteristics of students at risk u Identify coping skills appropriate for adolescents u Discuss ideas for rebuilding the classroom u Discuss resiliency and self care u
What’s “Normal?” u Movement towards independence - ‘Who am I?’ u Struggle with sense of identity, feeling awkward u Alternating between high expectations and poor self esteem u Peer influence u Parents are not perfect. Less overt affection, with occasional rudeness u Tendency to return to childish behavior, particularly when stressed u Cognitive changes, future interests u Interest in the present, limited thoughts of the future u Intellectual interests expand and gain in importance u Greater ability to do work (physical, mental, emotional) AACAP Facts for Families
What’s “Normal?” u Sexuality u S hyness, blushing, increased interest in sex u Concerns regarding physical/sexual attractiveness to others u Worries about being normal u Morals, values, self-direction u Rule and limit testing u A bstract thinking - hypotheticals u D evelop ideals and select role models u E xperimentation with sex and drugs u Physiological u Hormonal changes; puberty - growth spurt, acne, secondary sex characteristics AACAP Facts for Families
http://www.specialneedsdigest.com/2015/11/the-adolescent-brain-subject-of-long.html
It's in your…
Changes to observe • oppositional defiant behaviors with u irritability authority figures u increased somatic complaints • withdrawal/isolation u avoidance behaviors • angry outbursts • restlessness (hyperactive) u over/under reacting to sounds, sudden movements • emotional numbing • aggressive reckless or self- u decreased attention destructive behavior. u declining grades • increased drug use u absences NCTSN
Reactions of Adolescents to Disasters u Detachment, shame, guilt u Self-consciousness u Acting out behaviors u Fear of recurrence u Abrupt shifts in interpersonal relationships u Premature entrance into adulthood u Concern for other survivors and families NCTSN
What can teachers do? u Understanding potential behavior related to trauma/stress leads to: u I ntervene appropriately rather than escalate the situation u R ealize that its not necessarily intentional! u P artner with caregivers/counselors to provide preventative education, effective interventions for recovery u C onsider IEP, 504 accommodations NCTSN
Why? u With support and intervention u For some, recovery can occur within weeks to months u Some may need more time to heal - refer to counseling, mental health providers u Some may have intermittent recurrent symptoms (e.g. anniversaries, media coverage) NCTSN
Role of Counseling Adolescents have stronger language capacity u So, they may be able to better express their emotions u BUT, they are still learning to identify, label and communicate their emotions
Role of Counseling u Help adolescents and caregivers re-establish a sense of safety u Have a nonjudgmental space to make sense of their traumatic experience u Learn about impact of trauma u Learn techniques for dealing with overwhelming emotional reactions
Joe: pre-hurricane u You are Joe’s counselor, though you only see him about 4 times a year and do not know much about his home life. u He is a 14 year old male, repeating the 9 th grade at Lee High School under current assessment for possible IEP plan, as he failed his STARR exam and some classes last year. u He was on the basketball team, but since he needs to repeat the grade, is not eligible to participate this year. u You see him in the hallways laughing with peers and appears to be well-liked by others.
Joe: post-hurricane u Joe has not been coming to class and is in danger of exceeding the total amount of days missed allowed. u When you do see him, he appears tired, somewhat heavier in weight, though he is smiling and seen with peers. u His grades remain in the C/D range, though they are dropping.
Discussion u What are your concerns? u How would you approach Joe?
Joe: pre-hurricane u You are Joe’s counselor, though you only see him about 4 times a year and do not know much about his home life. u He is a 14 year old male, repeating the 9 th grade at Lee High School under current assessment for possible IEP plan, as he failed his STARR exam and some classes last year. u He was on the basketball team, but since he needs to repeat the grade, is not eligible to participate this year. u He see him in the hallways laughing with peers and appears to be well-liked by others.
Joe: post-hurricane u Joe has not been coming to class and is in danger of exceeding the total amount of days missed allowed. u When you do see him, he appears tired, somewhat heavier in weight, though he is smiling and seen with peers. u His grades remain in the C/D range, though they are dropping.
Consider…. u If a child is daydreaming? intrusive thoughts? and you touch him from back he may react out of proportion u It's not all PTSD u inattention… u anxiety? u depression? u ADHD? u It's not necessarily a choice!!
Rebuilding in the classroom u Creating a safe space and school culture u Maintain usual routine u Physical activities u Hobbies, projects u Encourage volunteering u Encourage creative expression - art, journaling, story telling, music u Deep breathing exercises, counting, etc.
Deep breathing u Diaphragm breathing u Where is my diaphragm? a big band of muscle across the bottom of your lungs u and above your stomach. u u Put your little fingers near your belly button and the rest of your fingers on your stomach. Sniff! Your diaphragm can be felt moving when you sniff
How it works
Why it works u What does breathing do… u To your heart rate? u To your body temperature? u To your breathing? u To your thoughts?
Resilience u It's not all gloom and doom u Children are resilient u Resiliency increases when community is supportive u Studies have shown that children and caregivers who use the community resources are more resilient than ones who do not use them.
Self-care u What is secondary or vicarious trauma? Compassion fatigue? u Recognize the signs – u Increased irritability, impatience u Difficulty planning classroom activities u Decreased concentration u Feeling numb or detached u Intense feelings
Self-care u Do: u Engage in fun activities, u Take a break during the work day, u Self-reflect, meditation, u Eat well, exercise, u Allow yourself to cry.
Self-care u Get support u Talk to colleagues while respecting confidentiality of students u Support from administrators u Create a support group amongst your peers u Seek professional help if signs persist for over 2-3 weeks
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