A Guide for Intermediate and Long-term Mental Health Services
After School-related Violent Events
Recipients of Services
After a school-related violent event, mental health services should be available for all students on campus and in the community. Services should not be limited only to those students who ask for help, or to those who are directly involved in the trauma. This finding was true not only for the immediate aftermath of a school-related violent event but also for intermediate and long-term time frames.
Schools should also provide trauma-specific mental health services after a violent event for teachers and school personnel. These services may be necessary long after the event. One mental health expert said, "I think in trauma there isn't a cap after six months, so that it still requires people with a high level of training to deal with those that are traumatized." A teacher indicated, "[In my experience] there were some teachers who, three years later, were just exhibiting signs now, and this is right when they wanted to cut off services… You can't put a timeline on when people are going to manifest symptoms."
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Roles of School and Community Personnel
Role of Teachers
Teachers should be trained to recognize trauma-related symptoms, and to answer questions that may arise in the classroom after a violent event, but they should not provide mental health services. Teachers play an important role in restoring and maintaining the social and emotional climate of the classroom after traumatic events. The expert panel, which included teachers, recommended that teachers should receive training to recognize trauma-related symptoms in their students, and to address questions that may arise in the classroom, but they should not be expected to provide treatment. Some of the comments were:
"Teachers shouldn't provide therapy… The teachers need to provide the regular routine of school."
"Recognize that teachers are the front line, but don't expect the front line to do it all, just to be able to identify and refer."
"As long as [the teachers'] role is clear, differentiated, comfortable for them, and supported by the district administration, there is certainly a role for them. I would not ever refer to that role as treatment."
Role of School Counselors, School Psychologists and School Social Workers
It was recommended over all phases of recovery that school counselors, school psychologists and school social workers should provide trauma-specific mental health services to students on school grounds. In addition, the school should provide referral services to community mental health service agencies, especially if long-term treatment is necessary.
Role of School Nurses
After an act of school-related violence, the role of school nurses in mental health recovery should be focused on triage and referral. Those with specialized training in child psychiatric services may be able to provide therapy. However, it was noted by most of the panelists that the majority of school nurses have other mandated duties that prevent them from longer-term intervention.
Role of Community Mental Health Agencies and Additional Mental Health Staff
Schools often need a great deal of help after a violent event, and the panelists agreed that community agencies should provide mental health services on school grounds after severely disruptive violent events. However, in the case of some less disruptive incidents, such as threats, too many outside people may cause confusion and perhaps compound trauma. It also may be helpful to hire additional mental health staff after a severely disruptive violent event, if practitioners trained in trauma-specific mental health services are available.
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Location of Intermediate and Long-Term Mental Health Services
From the experience of many mental health and education staff, intermediate and long-term mental health services were more effective when provided in a location on the school site. Referrals to offsite community agencies were found to be less effective. One panelist said, "After we made referrals, we found that many students never made it to the agencies… I see the need for community agencies on school grounds."
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Mental Health Screening
In unpublished reports of mental health services after a school shooting, mental health screening and surveys of violence exposure were found to be helpful in planning and implementing intermediate and long-term services to students and staff. Optimal timing of the surveys and screening measures, however, is an issue that is yet to be determined. While they are helpful for clinical and program assessments, there is a concern that assessment instruments used too soon after traumatic events may compound traumatic effects of the victims/survivors. In these situations, the panelists felt that subtler methods of detection, such as teacher and parent referrals, were more appropriate ways of determining who should receive treatment.
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Training of School-Based and Community Mental Health Staff
The lack of available personnel who are adequately trained in trauma-specific mental health services, both in the school and in the community, was a recurring point in our focus group discussion. The expert panelists have found it difficult to find people who are fully prepared to help them, whether in schools or in community agencies or anywhere else. This shortage of trained personnel, although beyond the scope of our project, seems to be a compelling concern. As one panelist stated, "They are not finding adequately trained people… We have so many people that are in need of help, and there really are just not enough (trained) providers."
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Findings of the Expert Panel
In keeping with the mission of education, the most striking finding of the expert panel was their emphatic agreement that teachers, while having a very important role to play as the first line of defense for students, should never be asked to act as therapists. They felt that the teachers' role was to bring a sense of normalcy back as soon as possible after the crisis, and that while they should be aware of the psychological ramifications of trauma, treatment should never be their responsibility.
Another striking finding was the consensus about the need for mental health services across the immediate, intermediate and long-term time frames. While the number of students and staff requiring treatment might be significantly lower several months after the critical event, the panelists indicated that they thought services may be needed even several years after severely disruptive events, such as school shootings resulting in multiple deaths and injuries.
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