Doctor Deibler holds a master’s degree in School Psychology, and a doctorate in Clinical Psychology, and he specializes in clinical diagnostic work and therapeutic services for children with severe mental illness.
Doctor Deibler has been a school psychologist for 29 years and has worked in a variety of settings serving children with mental health needs. These include, public and private schools, self contained special education facilities, residential treatment facilities, and psychiatric inpatient and outpatient hospital programs.
He’s currently employed by the Educational Services Unit of the Burlington County Special Services School District. The Burlington County Special Services School District Educate students with special needs from across Burlington County in order to enable each student to reach their full potential through academic, vocational and therapeutic programs adapted to each student’s unique needs and abilities. And it’s now my great pleasure to hand off the presentation to Dr. Deibler that we can go ahead and get started. Thank you, Christine, Kelly, and …, so, let’s get started.
OK, so, we actually were talking about this presentation last week when I ran through it for the first time talking about how much things have changed since N J CTS originally approached me about giving this talk about what school might look like when everyone got back and what we could expect in terms of reactions from our kids. We originally started talking about this at the end of the last academic year and things have done nothing but change since that time. Including today, I’ve seen a number of school districts have revised their plans there. What people are doing in different places changes every single day and will continue to change both now and even after this presentation, up to the beginning of school, and probably, even after. Why I picked the title in these uncertain times at the beginning of the pandemic in the United States, when, we saw a lot of commercials, we saw a lot of companies starting there.
Whatever their message was with, in these uncertain times, it was over and over and over again, that it became essentially a cliche.
You can even see on YouTube there are compilations of all the commercials that start with, in these uncertain times, but cliche or not, it is really true. Things are nothing if not uncertain right now, and one thing we know about anxiety is anxiety does not like uncertainty.
So, one of the things we’re going to be looking at here is how our kids, especially our kids with anxiety, may be reacting to the uncertainty of what’s going on, school that they may be returning to, or may not be returning to the kind of reactions that we might be able to expect.
There we go.
Alright. Before we begin, I wanted to start off with three. Things are just kind of a general way that I’m approaching this. First of all, like I just said, situation is going to continue to change. Nobody knows exactly what is happening next, and this is going to continue for an unforeseeable amount of time. We’re all going to have to be flexible. We’re all going to have to adapt to the situation as a change.
The other thing is schools are overwhelmed and underprepared. and I do not mean this as a criticism. I think this is just simply the position that they’ve been put in.
Staff members aren’t trained for this. The buildings are built for this. No one has had to go through something like this before, but they have been tasked with finding a way to bring everybody back safely. They are incredibly overwhelmed. They have an enormous amount of things that they have to do. And here in New Jersey, where I’m based, that they’re trying to follow the guidelines from the governor, and the guidelines are changing over time as well. The schools are constantly having to try and meet these demands and provide safest situation possible. And I also wanna let people know, I have a trigger warning in here because we’re going to be talking about PTSD, including some of the features of it, trauma abuse.
And this is sometimes difficult, a difficult subject for some people to hear. So when we get to those sections, I’ll give you a warning again.
So what is going to be like for our kids when they return to school?
I have broken this down into four main points, what we know, what we don’t know, what to look out for, and what we can do. So what we know is we can take a look at some other kinds of situations that have had traumatic effects, previous studies of disasters, social disruption, that leads us directly into what we don’t know. These things don’t necessarily apply exactly to what we have here, a prolonged pandemic, but we may be able to take what we’ve, what we’ve experienced already, and come up with some reasonable assumptions about what we’ll see, what to look out for. We’re going to be looking out for signs of distress and traumatic reactions and kids, what those look like and what you may be able to do about the last, what we can do. I’m going to focus in particular on something called psychological first aid. And I have slides about this later on.
But in brief, what it is, it’s an approach to try and help immediately after some kind of traumatic event to help reduce effects produced negative psychological effects. Later, now, this is going to be more for school persons and for or other health care professionals. But there are useful things in here for parents to, and it’s a good thing to take a look at, very least, to see how these things are structured.
So first, what do we know? We’re gonna talk about some of the lessons that were learned from Hurricane Katrina in 2005, which I’m calling a disaster with social disruption. So we have a traumatic disastrous event and disruption that happened afterwards. So some basic facts.
During Hurricane Katrina in the United States, over 1500 dead, over 372,000 displaced from their homes. Over 100 public schools destroyed, many, many more severely damaged, and the schools were closed for a number of weeks.
So in studies of the effect of this afterwards, and the weeks and months following from child, children, and adolescents showing increased signs of the big three, you’re gonna see repeated over and over again in these things, anxiety, depression, post-traumatic stress disorder.
There’s actually a big five. Because a number of them also will show learning difficulties and behavioral difficulties. But emotionally we’re looking at anxiety, depression, and PTSD as being recurrent themes in these situations.
So in the time after Katrina, children were relocated to new schools. But the negative effect, the signs of anxiety, depression, PTSD, persistent, identified your follow up, They found that one third of the students who had been displaced, or at least one year behind, academically behind their peers who were, not displaced.
Now, this is from Argentina. But it still has some interesting lessons that we might be able to apply.
In Argentina, in the 19 eighties and 19 nineties, there were widespread teacher strikes that closed schools for many, many weeks. So we can look at this as a social disruption kids without a disaster. So there was no traumatic event. Nothing bad happened. The schools were closed.
Now, when they went back and they did a study of 2019 of adults who witnessed many as 90 days of school, due to the strikes, they found that the kids who had missed school were less likely to have earned a degree, were more likely to be unemployed. And they earned, on average, two to 3% less than people who had gone to schools that have been less impacted, not even necessarily not impacted, but less impact. So even in this, this disruption relatively short term still had effects into their adulthood.
What we don’t know, and this is really important for us, what we don’t know, are the specific child, mental health effects of an epidemic or pandemic. Now, we have things. We have information, we have studied about epidemics and pandemics, but they don’t exactly give us the information that we need. The 2014 Ebola epidemic, closed schools for five million children for eight months. But there are almost no studies about the long term effects. So I’m sure that there were assembled. We really can’t say much about it.
Now, people often compare Kobe 19, pandemic to the 19 18 influenza pandemic and we know that that had widespread disruption had a very large number of fatalities. However, don’t really have historical studies of its effect until the 19 seventies. So when they started looking back in earnest the people who were kids that were in their seventies themselves. So they’re asking them to look back 50 years or so to say what was the slide?
Now it’s interesting There are some historical things that are written about it that it seems like the prevailing attitude in the United States at least was when a pandemic was over when they’re epidemic that the local epidemic was over. People wanted to move on immediately and they didn’t really even want to address. And to find people now that we’re not aware that there was this widespread national catastrophe of illness up until, you know, it, until this happened, they may have never heard of it before. Now, even though they didn’t, they didn’t do too many studies, at the time. There is, a study is from Norway, but, but, it is applicable study in the late 20th Century from Norway, when they were looking at what were called then Asylum hospitalizations, like, the early versions of psychiatric hospitalizations.
And they were looking at over 50 or so year period from 18 72 to 19 29 and that covers the pandemic and one thing they found is during the pandemic and immediately afterwards, there was a huge increase in first time psychiatric hospitalizations for people who are experiencing emotional problems. Immediately after the pandemic it went up dramatically.
And the things that they found when they were interviewing those patients, survivors were reporting sleep, disturbance, depression, mental, distraction, dizziness, difficulties, coping at work. All the things you kind of would expect from a traumatic reaction, They didn’t have the diagnosis of post-traumatic stress disorder, then. But now, we realize we recognize these sorts of things as at very least traumatic effects.
What else, we don’t know. And this is important for us, as well.
The effects of direct trauma that’s like being there when a disaster happens, versus indirect exposure or disruption. Just maybe you didn’t see the disastrous effect, you were not there during the accident or what have you, but your life is altered because of the disruption. Now, this is important. Well, actually, I’ll go through this personal C Y. So, we know the trauma is actually fairly common. Large-scale com, trauma is common on a worldwide basis, as many as 33 million individuals worldwide, are affected by some kind of a disaster, significant social disruption, a storm and earthquake warfare, things like this. This is 33 million in a given year. Often used, in those communities, maybe direct witnesses to two very disturbing things to see.
Massive destruction dead or injured individuals’. They may see ruins, they may have been evacuated from their school. They may have been evacuated to a shelter. They may have lost a loved one. But, what we see overall on these things is, there are an increase in, again, the same things we said before, PTSD, anxiety, disorders, depressive disorders, learning disorders and behavioral difficulties. This is common in all.
However, there are studies that show that youth who are not proximately exposed, that means they weren’t there, but they had experienced some of the disruption, so they didn’t see any of the same things, but their lives are disrupted. They also have elevated rates of psychopathology.
But they don’t know as much about that, it’s not as well studied. So, a lot of it is really targeted, more the kids who like it or through some sort of large-scale destructive event.
And there’s less information available about the kids who work there, but their lives are disrupted in some way. But at least we know from this that they do experience some of the same effect. It’s just unclear to what degree or how it over to the frequency.
Another thing we don’t know, and it’s worth pointing out here, we don’t necessarily know the effects of distance learning and virtual social interaction. You’re gonna see a lot of people who are going to be critical of it from a learning standpoint, saying, Well, I’m not learning as much, and my kids aren’t learning as much as when they were in class. But I’m going to tell you my suspicion, and really, it’s it’s only my suspicion at this point. I have a couple of things that I think I can back it up with, but it’s not the same as a study. I have the feeling that, in terms of social interaction and maintaining connection, it is positive. And I feel like I can go out on a limb and say that it’s certainly more positive than not doing it at all.
And this is something that, in a lot of these other studies, looking at other kinds of interactions, people in the past did not have this as an option. So there was no way to remain in your home, and still have social connections, and still go to school. So and this is going to take a long time for them to figure out, I suspect there’s positive benefit from it. But overall, we don’t know what the effects are.
Now, there are some possible insights that we can gain from, in particular, taking a look at studies that were conducted after the 9 11 terrorist attacks, particularly in New York, Because this is an event that has a very heavy disaster component, and also has a great deal of social disruption. So there’s little, to actually go to something that shows you the degree of how things changed in New York, the degree of destruction.
three months after 911, over 18,000 businesses in New York, where they were either dislocated, disrupted, or outright destroyed, 430,000 people have lost jobs. Over two point eight billion dollars in lost wages, and we’re talking 20 years ago, and only three months. And that there was something that did that may not be appreciated outside of New York City, so much is that there was a significant delay and disruption in transport and kids. To their schools. They had to be rerouted. They had to be maybe take different bus routes take completely different methods of getting to school because of road closures, construction debris clearance is affected 750,000 students. So even that was a major disruption.
Now, there’s a big study about specifically what happened afterwards. This was taken six months after 9 11 and involve 8000, some New York City Public School students in grades 4 through 12.
Now, in this group alone, now they weren’t doing diagnostic stuff, you’ll see why it’s a problem. They seem to be showing signs of this, but they weren’t outright diagnosing them. In this group alone, 11% showed probable post-traumatic stress disorder now.
The numbers are hard to nail down, exactly, but, but at least I can give you an idea of how much you would normally expect to see in kids in a typical six month prevalence, and that’s how they will look at these things. In any given, six month period, 3.7% of boys, and 6.3% of girls may also show probable PTSD. So, it’s, you know, 2 to 3 times, probable depression was 8%, are typically you’d expect around 3.2%. So again, 2 to 3 times higher probable conduct disorder and conduct disorder is, is significant behavioral issue where where kids act out to hurt other people, to deliberately break rules, to violate the rights of others. It’s, it’s a, it’s a serious problem. that hit 12% were normally that 7.4%.
So almost twice as much and probably other anxiety disorder. They lump them all together 25.4% normally would be about 7.1%. So you’re looking at 3 or 4 times as high.
Thing to note from this, I had to put this in as a note at the bottom, the prevalence of all these disorders, especially the mood disorders, has been increasing over time and kids. And the figures I’m giving you now are from the last five years or so, somewhere in that range. So, 15 years earlier than, that, 20 years ago, when the attack happened, the, the results would have been even lower. So, you know, I don’t have, I don’t have prevalence rates from from 2000, 2001. But you can just estimate that they were lower so that the degree to which they were showing these changes was even higher.
Now, one of the things that this study has that helps us understand is that 40% of those 8000, some kids, had some kind of disruption, some kind of major disruption in their life, a very low number, less than 1% had their family relocated.
Another. You know, a little over 1% had to have their school relocated. A little less than 2% had their school clubs.
But here’s a big one, and we’ll talk about this in another slide.
Next, restricted travel by parent choice, hit over 17%. And what I mean by parent choice is, these are people who, these are kids who had their travel there, their ability to leave home, restricted by their parent. Not by, like a government order, like, we’re experiencing now, or they’re telling you not to go to restaurants or something like that. These were parents telling their kids that it wasn’t safe. And they didn’t want to go outside.
So they were written, and that, that will play later when we talk for for risk factors, but it was parents making the choice. They felt it was too safe for them to not safe enough for their kids to leap and the last one, which is a big one, you might expect almost one third of them had a family member who lost a job.
But the one that really becomes important is this restricted travel, you might think that family job loss was more important.
But for parent restricted travel, the probable PTSD rate goes up to over 26%, which is almost three times greater than the than the overall group, which is already almost three times greater, than typical kids.
Probable other anxiety disorder hits over 33%, which is again, almost two times greater than this group that had all been through this. And probable depression hits almost 13%, which is almost two times greater. So there’s something different about this when kids were not allowed to interact, when they weren’t allowed to go anywhere, when they had to stay home. Their outcomes were worse. And before anybody gets worried about, oh, everybody’s been home from school house. That’s going to be. It may be for different factors that we’ll get to in a little bit here.
Common themes in all of these studies. Even though we can’t necessarily tell, well, what, We don’t have anything that will say exactly what this is like. But through all these different kinds of disasters, direct, indirect, social disruption, all these things have certain things in common. one is that children in traumatic symptom situations predictably have increased incidences of PTSD, other anxiety disorders, depression, behavioral disability, difficulties, and learning issues, the big five, and the big three emotional PTSD, anxiety disorders, depression.
Children, who an approximately exposed to disasters, but have a lot of disruption, they also had increases of the same things, but don’t know to what degree, other than this one study that we’ve looked at. So, even though they’re not directly exposed to it, they have similar, they have similar effects, but, to an unknown degree, and this is important to remember all the way through. And I’ll just read a tradeoff here. Children are neither expose, equally exposed, nor equally affected.
So children that have fewer resources are economically disadvantaged or discriminated against groups. They they have less access to health care. Kids with a greater amount of stressors and fewer resources they fare worse. So, sure we’re looking at is the kids in the worst situations have the worst outcomes for kids, get the brunt of it. There is one study actually from the UK about this distance learning experiment that everybody’s doing.
They did a little differently there and they were able to show that kids who came from wealthy backgrounds and were in private schools, they are with their parents were home, working from home, they were typically experiencing virtual school all day long, started getting normal time and ending into normal time. They’re in class all day, kids and a lot less.
Privileged economic status were in school for an hour a day or less, and frequently didn’t attend. So even in those two groups, the kids who had the most resources, they got the most benefit. And the kids who didn’t, didn’t even get access to school so much. So this is gonna come up over and over again and in particular, when we talk about how this is going to affect everybody. Now, here’s your trigger warning. We’re gonna start talking about PTSD, because PTSD is clearly emerging as the most significant emotional factor from this. I mean, anxiety storage in general are difficult. Depression is difficult. PTSD is fairly significant and one of the things we’re going to look out for at the highest level.
So instead of going through just a regular clinical description of the diagnostic, things about PTSD, I thought I’d pull this, this comes from the Stanford Children’s Health System in California to number of hospitals, health centers and things. And they have a nice description about what PTSD feels like for kids in a more accessible way. So, this is pulled directly. From, from their kids, who are experiencing PTSD.
They have problems sleeping.
They may be depressed, Grouchy, irritable, They feel nervous, Jerry, Alert, and Watchful which clinicians would call hyper vigilant. They’re looking out for threats. They may lose interest in things they used to enjoy. They may be emotionally detached and they have trouble feeling affectionate. They can be more aggressive than before or violent. They might stay away from certain places or situations that brings back memories that are painful or difficult. It may have flashbacks and I think a lot of people when you say A flashback to think about how they’ve been portrayed in war movies, where soldiers are reliving scenes of battle. Which is something that can happen but but it can be a lot different from that as well in evolving something Maybe a little less intensive, little, less obvious and kids. They may have intrusive images. They may remember, or even experienced sounds, smells, feelings. They might believe that these things are happening again, but I think the thing you’re gonna find the most is that kids have intrusive images. And intrusive thoughts about the situation or the trauma that they’ve experienced.
Kids might lose touch with reality. so they may they may actually not be entirely sure what’s happening, especially like at a very high anxiety moment. They may re-enact the event, especially younger kids. They may act out some of the things that they’ve seen or that they’ve had to do.
They may have problems in school, in a general sense, have trouble focusing worrying about dying at a young age or worrying about the future in general. They may regress and do earlier behaviors, such as thumb sucking bedwetting, wanted to sleep with the parents, other kinds of basic regressive behaviors, and I may have physical symptoms, We call somatic symptoms, headaches, stomach aches, and these are really more symptoms of their anxiety, that they experience physically. You may notice that, a bunch of things in here when we talk about having trouble focusing. And things like that may look kind of like ADHD. But the important part is that these things are changes from how their function was before. So, you know, you don’t suddenly develop ADHD. You have that over time, typically, from the time you know your first in school, and usually. We expect to see it, by first grade, but like a fifth grader doesn’t suddenly become ADHD, but kids who are experiencing traumatic stress or just high levels of anxiety, in general. They may look sort of the same way they may be fidgety, but it’s it’s agitation not impulsivity.
They might be fidgety. They might have trouble remembering things. They might have trouble concentrating, and it’s a change from what you’ve seen before.
Now, let’s talk about the prevalence of PTSD in general and kids. And it’s, it’s harder to say that most of the stuff you have in our diagnostic manuals and things like that are really written for adults, For kids, It’s a little bit harder to say. So we’ll talk about the prevalence, and then some of the risk factors for what makes somebody vulnerable are more vulnerable to develop PTSD, especially in kids.
So what we know in general, somewhere around 15 to 43% of children go through at least one traumatic event of some kind during childhood. So, quite a few kids go through, quite a bit more.
Of the kids who’ve experienced trauma, somewhere between three and 15% of girls, and one to 6% of boys will go on to develop PTSD at some point in their lives. Not necessarily then, maybe much later.
In general, though, what you’re going to find is that there’s a higher risk of PTSD with certain kinds of trauma.
Interpersonal, violence, like sexual assault, physical abuse. And you’re looking at PTSD numbers.
30 to 70%, much higher. Wor an armed conflict.
47% being displaced, physically displaced and living as refugees. It’s unclear the numbers of this but we know that. It’s one of the things that can contribute to PTSD and kids who have been forced to be child soldiers. Where they are physically forced into combat anywhere from 35 to 97%. And a common theme here is that events that have a higher degree of red, where you feel like you could potentially lose your life, the higher the degree of threat, the more likely they are to trigger PTSD.
Now, let’s look at some of the risk factors. And we’ll start out with risk factors in children themselves.
Girls are 2 to 3 times more likely to develop PTSD. And that’s even after you account for the particular kinds of trauma, the girls are more likely to experience than boys. And they don’t really know why that is. There’s a number of theories, but they don’t actually know. But it does seem more common in girls, even if the experiences are similar.
Children who have a history of and other mental disorder in particular anxiety disorders and mood disorders, they are more likely to be affected with PTSD to develop PTSD symptoms. In fact, there’s a longitudinal study, and I’m quoting here, over one thousand adults who met the criteria for PTSD 90, 3.5% of them met criteria for another disorder as children.
Now, family characteristics that can be risk factors, one is probably pretty easy to understand poor family functioning. So if there’s a lot of problems in the way the family interact, a lot of problems in the family itself, that increases the risk for PTSD, but this is important as well.
Parent reactions to trauma, especially when the parents than ship sails show PTSD that makes PTSD more likely in the kids. And unfortunately, for one reason or another, it’s more significant when it’s the mother that has PTSD symptoms than it is with, the father has PTSD symptoms, but this is a good point.
Children with greater social support are less likely to develop PTSD, and it doesn’t really matter what kind of support that is, whether it’s family or friends, school, other kinds of social interaction. Those kinds of social supports are protective factors.
And that’s one of the reasons why I think that having virtual school, even if it may not be as academically effective, it can very much help with this. It helps maintain social support, certainly, that’s my belief.
Child PTSD factors, Responses to trauma, and what I mean, is like how the child responds to the trauma. These are some risk factors to watch out for. Higher levels of anger about the event, kids at camp with anger, go over what had happened. Higher levels of rumination, catastrophizing, rumination about an event. Rumination means just going over it in your head over and over again and think about it all the time. Catastrophizing is imagining. How bad things could be in the future. This happened, and I’m not going to be able to catch up, and I’m not going to go to college, and I’ve never going to have a job like that that’s catastrophizing, more negative appraisals of the event. Like, they can only see the bad parts. They have trouble seeing the things that are more positive. Elevated levels of avoidance and repression of trauma related thoughts, basically, they don’t want to think about it. They don’t want to talk about it that they don’t want to deal with. it.
Dissociation which is feeling that that you are removed from your body like watching yourself. That things aren’t real and all that kind of stuff or dissociative things, like that’s during the event, and that’s more of a traumatic situation.
And, maladaptive coping strategies.
It is not sound negative, like when you say it this way, but I like distraction and blaming others.
But distraction, in this sense, really means I’m not going to think about it and I’m going out and go to a party and I’m not going to talk about it. I’m going to keep myself busy. I’m going out on a date, be like all these kinds of things where they are trying to keep themselves distracted so that they’re not alone with their own thoughts. Blaming others is, is pretty self explanatory. It’s more like, this happened because of you, I failed because you didn’t get me the right kind of tutor. Isn’t your fault like that kinda stuff? All of these things are are indicative of greater chance of PTSD.
Now, what to look out for overall, when we know all this stuff and I just call this my take because this is this is how I am conceptualizing it myself.
Kobi 19 looks less like a traumatic event and more like a slow speed, widespread prolong social disruption with uneven incidence of trauma intersperse.
What I mean by this is there’s a large scale, slow moving, long, lasting set of social disruptions where everything is thrown off. Go places, they can’t see people the way they used to. They can’t go to school. They can’t go to stores, and everything else that’s happening.
But there are traumatic incidents that are in here, and these are not evenly spread out. There are kids, in my placement already, there are kids who have lost their parents, lost a parent to cope with 19. There are people who’ve lost their jobs and have to move. And this, like, that is not the same experience for that kid as it is for the kid, where the parents can stay home and work, and they can keep everybody isolated. So, there are just going to be, And even amount of trauma, it will be very traumatic.
For some kids, kids who’ve lost a teacher, kids who have lost everything, There are going to be kids who have lost very little, except for social interaction.
So, they’re not all coming in with the same experience.
What we’re gonna be looking for in all these kids really is increases in emotional distress.
Emphasizing depression, anxiety, PTSD, in particular.
So, what are you going to look for when you have kids? What do you look for as a traumatic or anxious reaction? And I like this, I pulled this set of things. This is PTSD reactions, and this is for from the Star, Commonwealth. And the Star family started one of the first schools for boys, at this point, the boys with emotional problems with behavioral problems in the United States. And they really, the idea was that none of these kids were problem kids. They just had problems that could be worked on and the Star Commonwealth system, 100 years later, it’s still working in there. And there’s still producing these kind of materials. So, here’s how they describe it is largely their words, like what we see you might see kids who have problems with memory and learning. And they get very specific examples here when a student becomes A C student, but you’re gonna see really, in general, that they’re not able to do as much as they were before. They’re not doing as well.
They’re having problems and inability to concentrate tremendous fear and anxiety, which, of course, you’d expect increased aggression, fighting, and assaultive behavior. And they say that these are some of the first reactions, as a change, since the trauma. And I, I’m not sure how accurate that is, It may be, but That’s one of the things, I guess to consider. I don’t know whether you will see at first, or not. But we do look for kids who are having more aggression with other kids. And especially the idea of revenge, if there’s been some sort of violence.
Survivor guilt where they think that if they had done something differently, things would have been better. Or, if they’ve lost a loved one, if they had been the one, if they’re the one that actually transmitted disease to someone else in their family, is a great deal of guilt.
Intrusive images, flashbacks. Traumatic dreams. They may talk about how they dreamt about these things happening over and over again.
We’ve already covered that exaggerated startle reaction. That’s another sign of hypervigilance, where they seem to be very easily set off very easily startled. It seems overly or more dramatic than it was before.
And the idea of emotional attachment, and numbing.
So, in the end, what are we going to do about this? What can we do? And I want to present, especially for our school folks here, elements of psychological first aid.
And if you haven’t heard of this before, there’s still time before the school year starts to get training in this, It’s not complicated. But it, but it is a very specific set of things. And I’m gonna give you a brief overview here. School folks may find it useful. Parents may be able to use this as well. But I’m actually gonna do this in a different order. Psychological first aid was a concept that was originally proposed in an article in 19 54, where they were saying that they thought it would be possible through a series of targeted interventions, immediately after some kind of trauma, to, to be able to reduce the effects that they would have later. If there are certain things you couldn’t do immediately afterwards, you might be able to head off some of the negative effect, and this has turned out to be true.
And they’ve developed this ever since NIH has worked on it. Kennedy Krieger, Johns Hopkins, has worked on it. A lot of people have worked on it. And the stuff that I’m going to be talking about here is something where a psychologist, doctor Marlene Long, actually tried to adapt this for this pandemic. So they’re saying it’s kind of a long title here: Psychological First Aid, PFA for schools, teachers, and students during the worldwide pandemic. And in particular, in section in this article, saying, You know, psychological first aid for schools, listen, protect, connect, model, and teach. And those are the five factor approach that they have taken to psychological first aid as apply to schools. They call it really by the first three letters LPC.
So, let’s take a look at this.
There are five components here. Listen, protect, connect, being the first three model, and teach being extra on the side. I’m gonna give you, the way they phrase it, and I’m going to try and go through them quickly here.
First, listening, and this is the idea of listening, in a way that conveys your interest and your empathy, so, you’re, You’re reflecting to them that you hear what they say. That you’re concerned about what they say. That it is safe and OK to talk to you about those experiences.
Protect, this is a big one.
You’re going to try and avoid any possibility of re traumatizing them. So, the idea is, you’re not making the whole situation more traumatic by doing this. You’re going to try to establish feelings of physical and emotional safety for schools. A lot of this is going to be establishing a routine that they can follow. You’re going to be commonly offered them information about what’s going on, and what people are doing to try to keep everybody safe When kids are nervous about, Well, why can’t I sit next to this person?
You talk about it in a positive way. It’s like, Well, this is one of the ways that we try to make sure that people don’t get sick, you know, We’d like to be able to answer those questions and showing that you are concerned about their safety.
This is really a thing where you’re helping them establish and maintain re-establish actually, their social relationships. Try to stay connected to other people.
one of the things that happens, like it says here, one of the most common reactions to trauma or fear is emotional and social isolation, and a sense of loss of social supports. And we know this is this. These are some of the biggest complaints that kids had from the very beginning. I can’t see my friends. I can’t do my sport. I can’t go out. This is something that they experienced as a loss right away. So, one of the things we have to do is to try to restore, to rebuild these connections, using online methods if you have to, but anything like that, to try and keep those connections going. It does promote stability, and it helps a lot.
Model, meaning, model, is, you showing what they’re supposed to do, your modeling, the response for them, you’re modeling the emotional response, which can be very difficult for adults who are also experiencing this trauma of something. But the idea is, I underlined it here. You’re going to try to demonstrate a positive and optimistic approach to a new normal.
You’re going to tell them about how these things are temporary, but these are the things that we’re doing and how we can get through it. And, when they’re saying things like, You know, I don’t know how I’m going to wear a mask all the time. He said, Well, I’m not really sure how I’m going to do it either. But, I’m going to try. And, one of the things I do is, I think about how I’m going to be helping my students. If I wear my mask, I’m doing my part to help everybody else be safe.
So, you’re modeling the response. You’re modeling optimism rather than anxiety, but you’re not tell them you know the answers to everything. You’re really just showing, Well, I don’t know either.
I’m not sure, But I’m going to I’m going to do this, and I know who to ask all that kind of stuff to show you can cope teach.
This is maybe, you know, the, one of the more practical and important things that you can do. This is one where parents can do this as well. Where is you’re going to try and show that these feelings are normal. You’re going to teach them about these feelings. When, you know, you can imagine perhaps what it would be like to be a child who’s experiencing intrusive thoughts of disaster. Never experienced this before, it’s terrifying, and they have no idea what it means, what you do, and you can help them experienced this. You can help explain what’s going on and saying a lot of people, when they go through these things, when they have difficult situations and stressful, events like this. They also have these feelings, and these are some of the things we can do to help. you normalize their experience and say that a lot of people are feeling it as well. So they understand what the range of normal reactions is, you are helping them put that in context.
Now, here are some sample questions that they get about ways of interacting with kids, when this is especially good when you don’t know what to say. This is kind of stuff they say.
like, Now, to demonstrate this, this kind of listening, tell me how you’ve been affected by stay at home orders during the coronavirus. What’s your schedule like from Monday through Friday? How do you spend your weekends?
Ready to listen, when you are ready to share.
Things like this, where you’re asking them really to attend to the structure around it and then hearing what the results are.
Protect. Are you worried about your safety? Worried about the safety of others?
What are you most worried about right now?
Connect, if you ever had to confront a situation like this, where you couldn’t go outside, when you wanted to. And they probably haven’t, you know, but by this point, it’s very familiar for what can your family members do to help?
What can your friends do to help? What do you think you can do to make things better? What’s been helpful to you in the past when you’ve experienced a crisis? So these kinds of things. Again, focusing them outward, who is available to help? What can they do? You’re not telling them what’s going to help, or telling them what they should do, Your directing them. You’re showing you how you can connect them to the things around them.
that can be helpful and listening to their answers model. And this is always a great one.
Thank you for the courage you’ve shown and for sharing your concerns with.
This is where you’re making the process, kind of, you’re taking it and making it.
Over to where you’re making it sound like, I’m just commenting on the process. Thank you for the courage, in telling me what you’ve told.
Thank you for sharing this with me. You know, acknowledge it and say, What’s happening.
Let’s talk about some of the things you can do to reconnect with family and friends outside your home.
Let’s brainstorm some of the ways that other students and adults are coping.
Again, focusing outward.
Now, for teach, let’s see.
I’m actually gonna, I’m gonna skip this, because I know we’re a little short on time here, because I’m sitting on a slide that’s more specific about this. But the idea is, you’re going to be talking about that, you know, it’s difficult to have a new schedule, You know, It’s difficult to find regular time for sleeping like these kinds of things. But I’m gonna focus instead here on helping them create a routine. And for parents out there, I’m sure you’ve had, you know, many of you have had some difficulty with this. Keeping the routine when everything has changed. You may have experienced this yourself. If you’re working from home or the way your workplace has changed. Keeping a routine when maybe you’re in your house all the time.
So let’s take a look at this.
How to set up a routine on school days.
Go to sleep. Get up at the same time every day.
Get dressed, eat breakfast, and brush your teeth just like you would if you were going to school.
For these kids that are on hybrid schedules, half days, alternate days, asynchronous, synchronous education, all these things, this is going to be even more important, because the routine may change from day to day.
Attend online classes if you have them on time.
Pick a time where you’re doing your work, maybe 9 to 12, you want. And things like this build in a meal and their summer of nutrition break, go through it As if you were in the building, stay off your phone, don’t, do social media during the hours. When you’re supposed to be doing school, you can put the phone away like, the child can give the phone to the parents. Just like they were in school.
Or like other particle and a good thing to do spend dinnertime at least television time or other kind of entertainment like that with your family as a group if at all possible at least one And eat healthy and exercise. So the thing you need to try to do is Establish a routine that is similar to how things were when when they were back in the building or when they were going to school full-time. This is part of teach, and this is part of this stuff that parents can do.
So I have a few extra suggestions that I’m going to throw in here, as well, overall, like with this model in mind, But just in general. I want everybody to remember that. Even as dire as a lot of this might sound. Most kids are going to be fine. And most of the kids that are struggling they will improve. And even the kids that are struggling a lot are going to improve. Our goal here is to make sure that there are fewer kids that are struggling. And the kids that are improving the need to improve are going to improve more quickly. So we’re trying to head off as many problems as we can.
Parents review your school’s re-opening plan, and let your kids know that it may change.
It probably already has changed. Let them know what it’s going to be like, walk them through it, rehearse the new procedures, talk about the elastically and non threatening, saying, like, no, kids are going to kids who are going to school on a bus, They may experience a very different bus ride, they might be spread out, tell them what this is going to be like, and not as if, like, can you believe they’re doing it, like that. Like, oh oh, they’re spreading everybody, look how they’re, they’re trying to do this maintaining social distancing on the bus. Wow, what do you think that’ll be? Like, trying to get them to imagine. So, that it’s not a shock, when they see it.
Walk them through it as much as you can. If they have issues, wearing masks, practice wearing the mask, practice wearing the mask now, before they have to go in, practice wearing the mask, and increasing time, where the map with them. So, they put on a mask.
You put on a mask, Try it for an hour than two hours, and, you know, if that’s what’s going to be going on at your school, make a consistent place to do schoolwork, which, honestly, people should do anyway. But it’s more important now. So if you are fortunate enough for your children to have access to a desk, that’s great.
If you don’t have a desk, even a counter, a table, part of the table, where they go, and they work their way in front of the TV doing their work. They’re sitting in a place to do work, and that places where they do it So that at least it feels different, here’s my living space. Here is my workspace and parents who are working at home, this is probably a good idea for YouTube, in case you’re interested. They’re in Los Angeles.
They had, I think, this summer, 15,000 new applications for permits for they have some term. I can’t recall what it is right now. But they’re temporary or auxiliary to living spaces where they are basically like a little shed, but for a particular purpose and people are putting in sheds that our offices, their offices or they’re even living courts. Like if they have people that have been exposed to Kobe, they live there perhaps during a quarantine period.
Or just people that need to work all day, and they can’t work in their house, or it’s messing up their, their home life to do this. If they have the means, some people are doing this, but you don’t have to have that much money. To do this, you can separate things and it’s more important now than ever deland bed and do your work. Pick a place to work and do it, and kids should do the same thing. You can model that and you can show them. Maintain a consistent, daily routine.
Get it back. Get a shower. Get dressed the kids. Parents, see.
But, but, you know, get ready as if you were going to school. And this is my own personal one. Help to foster. Social communication is virtually for the kids that do not have They can’t do it physically.
Think of the things that you can do online, And I don’t mean just video games. Although, I think video games are fun, especially now, but but there’s a lot of things that you can do instead. You know, other things like We’ve seen kids who’ve had dinner with friends or what they do is they eat dinner at the same time? And they put a phone FaceTime, or zoom, or something like that. That kids eating dinner their house, your your kids eating dinner at your house. And they talk little things like that. There are also things, like, virtual tours, or family did, one of Those ourselves, a free tour of a foreign city, where everybody can watch and see this, but, things like this.
lot of times, they get passed off as being, you know, a consolation prize for things you can’t do, but their social connections, and their social connections that hopefully, most people have access to. You can be creative with it.
The last thing I want to leave you with.
I do want to really re-iterate again that kids are gonna be fine. Most kids are gonna be fine, even if we don’t do anything. But that’s not an excuse to not do anything. Because there are gonna be kids that are gonna have, They’re going to have trouble. And those kids are the ones that we want to head off and see as quickly as possible. And see if we can, we can do something to make sure that the effects are minimal and that they have the best and quickest chance to improve like everybody else.
So, thank you very much. I really appreciate your time And hopefully we still have some time for some questions.
Great. Thank you so much. That was such a great presentation. I know, so much good information. We’ve got some interesting questions. So, let’s see. So the first question I thought we’d, we’d start with was on, that came in wondering about challenges that school counselors might have, an identifying students that are struggling, if they’re only seeing them virtually, you went over some things, some different signs of PTSD and such, but yeah, they’re looking for some, some other tips on how to identify students when we’re only seeing them in the virtual world.
That is an excellent question.
What I, personally, well, I’ll give you something that psychologists do. You have a set of screening questions. Or, if you don’t have those, you can, you can put them together now. And you can say things like, have you had any trouble with how you’ve been feeling? Have you been feeling anxious if you’ve been having any trouble sleeping Has anything changed? If anybody has had experience with a psychiatrist. These are often the kind of questions that they will ask. So it’s not a bad idea to just ask if any of these things are happening. Looking for some of those highlights.
So they may not tell you. Otherwise, they might seem totally fine during an irregular session. So, my advice, is that, put in some screening questions that you do every session?
Great. Thank you.
So, we also had someone wondering about, for those students that start off with in person learning, but potentially may end up having to revert back to virtual learning, would you anticipate even more increases in anxiety and other mental health concerns? Would it be a re traumatizing or disruptive event?
Anything you can say on that? I wish that I knew. For that, I’m not sure, I think it’s gonna depend a lot on the individual situation of each kid. And I’ll give you an example where, I’ve heard some people speak with, their kids present about schools closing again, and I’m no warning before, I entered, this will sound inappropriate, but I’ve heard people say, no, there there sacrificing these kids.
They’re going to put them out there and the minute one of these teachers dies, they’re all going to help. Those kids are going to have problems if they hear stuff like that. And, that’s really a concern where it’s like this. For some people, the way they’re hearing about this, is that it’s going to be a disaster, and the sign, they’ll know that it’s a disaster is when everybody goes home.
So, if that’s what they’ve heard, I would assume that they’re more likely to have problems. So, maybe one way you can probably you can try to have this off is, you can tell kids that, you know, if you’re a teacher, if you’re a parent, you can tell kids that there’s a possibility that school, my close. again.
If they do it, it’s because they’re concerned that they want to make sure that everybody’s sake. So, I view it as a positive thing. If a school is going to close, it means that they’re trying to stop a problem. So, I would go ahead and phrase it positively. It’s still going to happen either way, but I think that would be the main concern There is the circumstances under which they believe a school with close.
Great. Those are some good suggestions. And, yeah, definitely, I think freezing it in a positive manner and being proactive seems like a good bet. And we all are just going to experience those together.
And yes, do our best to say, again. It’s OK not to know the answers. And the people want answers.
The kids may want the answer is, it is OK to say that you don’t know, But that you’re going to cope. That’s like that whole modeling thing. Say, Well, I don’t know what’s going to happen when we do this, but we know how to keep safe. And we’re going to, we’re going to do that. We’re going to follow the best instructions. We have, I’m sorry. Go ahead.
No, No, thank you for jumping in. So, someone was referring back to the, when you’re talking about the post 911 studies, where the increase in anxiety was so large compared to the increase in PTSD or depression or conduct disorders, anything, You can say, why anxiety in particular jumped so much compared to these other concerns?
Well, they don’t say in the study, but I think it’s a reasonable assumption would be that anxiety disorders, in general, are much more common than PTSD. If you’re looking at the overall prevalence data, anxiety disorders are the most common mental health issue in kids. So, it’s already widespread, and they’re kind of all of them together. So, all the different sorts of things, generalized anxiety, disorder, read, all the other things there. So, they, they’re just looking at their overall increase, so, there’s more of them to start with, and they are more easily track that way.
Great, Thank you.
See, I have another question here about what some schools, what’s your knowledge of some schools done to prepare to for the emotional and mental health concerns in the students and the staff, as we return to the classroom?
Well, in New Jersey, there is, in there, they called the road to return the, the, the actual chart. Further, if somebody turns these days, but, like, the, the, the guidelines that have been set up by the state. There is a component in there. So, you know, I have been looking at plans from various districts, and I have found everything from detailed plans about how they’re going to handle emotional issues to one plan that had a single sentence.
And out of all the pages, and I think, you know, my assumption for this is a lot of schools Don’t know what they’re going to do with this right now.
So, they may be putting it low down in their priorities, which is why we all need to know about. So, some schools are relatively well prepared, and we know that some schools are doing things like hiring outside services. They’re bringing in extra counselors, they’re already doing this, because they are saying, we can’t develop something in this amount of time, but we can bring somebody in, And, unfortunately, there are schools that seem to have done very little preparation for this at all. So, the one thing I’d encourage, is to see, like, what your school is doing is read your plan. If you’re not sure, you can contact their child study team, or the applicable group, or for the state that you’re in.
Child Study Team are the people that that do, things like evaluations for special education, and more, where you’re gonna find the clinicians, and ask them what they’re doing, if they don’t know.
I would suggest to them that they study psychological first aid. Tell them that you saw a presentation, and they that they talked about the availability of psychological first aid, They can get trained for free. They can do some self training, it’s better than nothing. But if they don’t have anything, make sure that they at least have that.
So, someone was curious if there was any information. If adults show the same trend in, you know, increased anxiety and depression, etcetera, when they’re exposed to disasters and disruptions, do we see the same thing in the adult population? Yes, actually, we do. So I didn’t even go over those studies, Because we’re just looking at the effects on kids. The effects on, on adults are considerably more developed in terms of their studies. There’s a lot of studies on them, which is where they get, you know, the idea of like, what kinds of trauma are more likely to produce PTSD. So there is a lot of literature on that. And yes, like people that are exposed to this.
And people who have disruption, although there’s less information for that adults as well, are likely to experience a lot of the same things.
Maybe not learning difficulties, but no job performance difficulties, certainly. So that’s another thing. You know, I didn’t cover it in this, but it’s something to think about that there are going to be a lot of parents, and a lot of teachers, and a lot of other school staff members, who are also having emotional issues that are having traumatic reactions. And it makes things like psychological first aid. All the more important they need to recognize when it’s happening to a staff member. And hopefully that, that the staff member can get some kind of stabilization outside of the district to help with it. Because it’s totally reasonable that they will have fears as well, that they will have similar issues.
Excellent. Thank you. So, someone actually reached out, and they said that they really great presentation, and they’d love to reach out to you Directly. Are you able to share your e-mail address, or some way to contact you, for anyone that does want to have any questions for you directly. Yes, I can do that, I’m gonna kick. The thing, I should say, is like, I can’t act as a therapist outside of the school system and outside of my job, so I can’t give like therapeutic advice. But I can give, if you have any kind of questions about this, I would be happy to, to, to talk to you about it, and maybe tell you some directions to go, if you need something else. Do you want me to just spell out the e-mail address?
Maybe, if you could, if you want to type it into the chat.
Cheryl, I find it here.
While you’re doing that, I’ll go ahead and grab, I think we’re probably have time for maybe one more question after you go ahead and type that into the chat for anyone who might want to grab your information. And thank you for being willing to share that. No problem.
This is actually at a this is a private practice.
I don’t work at the private sector, This is my wife’s private practice, but I have an e-mail address there. So long, e-mail address.
Great, thanks. So this will be our last question for tonight.
But as someone was wondering about some of the symptoms and signs of PTSD that you went over, how can you distinguish between, you know, maybe a kid that’s exhibiting some of those signs, but and whether it’s actually PTSD or if it’s just something else going on that’s maybe not quite so severe?
That is a great question. With this, one thing to think about in case anybody is, is not familiar with this. You have the idea of, like, well, what psychologists?
And we’re gonna, we’re gonna talk about diagnoses, Psychologists and psychiatrists use the same diagnostic manual clinical psychologists and psychiatrists use the same manual, but there are things that will refer to as subclinical, and it really means that you’re experiencing some significant problems, but you don’t meet all the criteria for a disorder. So, in the end, it doesn’t necessarily matter. So, you can say, like, Well, you know, in the way they work is, you have to have X number of symptoms, six out of nine of this group for X, amount of time for out, of eight of this group, like that kind of stuff. But, just, because you may not meet all those criteria, doesn’t mean you’re not having a problem. If you are experiencing a great deal of distress. If you are finding that it’s impacting your life, it doesn’t really matter whether it’s a disorder or not. So for, like kids, they’re showing distress, the distress is really, the only important feature. The idea of a diagnosis. Is it showing that you are you’re classifying these things, and you may have some idea of what to expect? That’s the whole idea, but diagnostic criteria change over time. So it just makes it easier, shorthand to talk with somebody about what’s going on.
But if you see a significant problem, it’s a significant problem.
And it doesn’t really matter if it’s all the way as, as far as PTSD, it could be subclinical, but you treat the things that you see. So, if you see distress, you treat distress, you treat the symptoms. There’s nothing wrong with that. If they all hang together into a diagnosis, that might make it easier, but overall, it may not matter. You work with what they’re having problems with.
I hope that answers the question.
Great, thank you so much. We appreciate you, taking the time to answer all these questions, and of course, if there’s anything we didn’t get to, it’ll be on our blog.
Have a great night.
BBeauchamp says:August 27, 2020 at 2:59 pm
I am a special education teacher in a private school and my own. anxiety is so high, I am trying to figure what strategies and techniques to bring to the classroom in two weeks, to help ease my student’s anxieties re entering the building .
Eric Deibler says:August 31, 2020 at 6:54 pm
I’m so sorry that you are experiencing pronounced anxiety yourself; however, there are many thousands of educational professionals that feel exactly the same way as you, because this is a legitimately anxiety-provoking experience. If you can, see if you can talk with some of your co-workers and try and support each other positively. I feel that we really have to rely on each other in ways that we probably haven’t needed to in the past.
Beyond that, you may want to look into things like mindfulness or simple meditation. They are easy to do and can help you gain a handle on your own emotional experience. The more control you have over your own anxiety, the easier time you will have all around, and the better you can handle your students’ potential anxiety.
As for the anxieties of your students on re-entering the building, I think that it helps to normalize their experiences by talking about them in an open, objective way. By this, I mean that you can talk about how everyone is adjusting to new procedures and how it might feel strange to do things like spread out the desks, wear masks, and the rest. It’s ok to talk about your own experiences with these things, too, as long as you are focusing on their benefit. By this, I mean make sure that you are focusing on their experiences and feelings. Overall, I think it’s best to keep everyone focused on how all of these procedures are designed to make them as safe as we can, and that we all have to work together.
Lastly, feel free to contact your counselors and CST people for advice and help. They should be able to support you in these efforts fairly easily. If they can’t, then please realize that they SHOULD be able to, and if they’re not, it’s worth bringing up with administration that your district may need to focus on building some basic clinical competencies. This last point is my opinion, but I really feel strongly about it!
GGoodall says:August 27, 2020 at 3:00 pm
How can school counselors identify students who are struggling, even if we only see them via zoom?
Eric Deibler says:August 31, 2020 at 7:29 pm
Personally, I would consider starting each session with some quick screening questions related to PTSD symptoms, such as asking how their sleep has been, their mood, intrusive thoughts, and so on. This isn’t too difficult with a basic knowledge of PTSD – after all, we’re not looking to diagnose, we’re just looking to catch some of the big signs! Here’s a nice link about PTSD screening from the National Child Traumatic Stress Network: https://www.nctsn.org/treatments-and-practices/screening-and-assessments/trauma-screening
If you find anything concerning from your screening questions, it’s probably a good idea to have a more formal screening tool such as the Child PTSD Symptom Scale (CPSS) available, or to have someone on the team who does have it and can screen them right after you see them (if you don’t have procedures like this set up in your district, you should probably get on this ASAP). The CPSS takes about 10 minutes and requires minimal training. I’ll post a link to it below, and you can probably read up on how to use it with a quick Google search and a little spare time. That being said, there are certainly other tools out there, and many would do the trick. If you’re looking for a different one, I think it’s wise to keep it short and focused on symptoms rather than details about traumatic experiences, as we are really only looking to gauge any upsetting symptoms. Hope this helps!