Are the kids ok? Are school-based trauma interventions the answer?

Much of our knowledge about post traumatic stress disorder (PTSD) is based on adult studies. It is however clear from new scientific disciplines that our findings based on adult research studies are not always relevant to children and adolescents. It is therefore not uncommon that mental health professionals have different perspectives on child and adolescent trauma, especially with regards to the effects of trauma and the type of interventions that are most effective in reducing negative outcomes.

The impact of trauma, especially repeated exposure, is often widespread and persistent. It impacts on a child’s physical health as well as his cognitive and psychosocial functioning. Although the exact number of children affected by trauma is difficult to determine, research studies confirmed that a significant number of children are exposed to highly challenging and dramatic life events. A ten year longitudinal study of 1,420 children and adolescents in the United States found that by age 16, more than two thirds of youth had been exposed to at least one traumatic event (Copeland, Keeler, Angold and Costello, 2007). 

Exposure to a single traumatic event is described as “Simple Trauma” whereas repeated exposure to traumatic events refers to “Complex Trauma”. Although simple trauma can cause impaired functioning, it presents less risk to the adolescent than complex trauma. Complex trauma in adolescents often occurs in cases of abuse and neglect but can also occur in the witnessing of domestic violence, war or natural disasters (US Regional Research Institute for Human Services, 2007). Traumatic events also include sexual abuse, physical abuse, community and school violence, medical trauma, motor vehicle accidents, suicide and other traumatic losses.

How adolescents cope with these traumatic events depend on their level of development, age and environmental support.  A key issue in providing this support and preventing psychosocial problems related to trauma, is early identification of traumatised teens and the implementation of an effective treatment approach.  Most children and adolescents develop short-term distress after a traumatic event while most return to their prior level of functioning over time. It is however youth who have been exposed to complex trauma, with a past history of anxiety problems or whom have experienced family adversity that is at a higher risk of showing symptoms of PTSD. Their recovery can also be impeded by individual and family factors which make social, community and governmental support networks critical for recovery.  It is within this support network that the importance of school intervention programmes stand out.

In South-Africa the high poverty and unemployment rates coupled by cumbersome crime and domestic violence statistics, exclaims the need for professional intervention. Unfortunately in the US alone, less than 16% of adolescents with general mental health problems have sought mental health services because of their problems (Helland & Mathiesen, 2009; Rones & Hoagwood, 2000). On a positive note, schools may be one of the most resourceful arenas in providing supportive interventions for adolescents dealing with trauma. Not only are schools easily accessible to all children but it is also a familiar setting that can sufficiently provide a safe and supportive environment for the treatment of trauma symptoms.

 A recently published review on school-based  intervention programmes have identified cognitive behavioural therapy as the most common treatment approach to reduce serious trauma reactions, such as PTSD , anxiety and behavioural problems in treating children and adolescents ( Rolfsnes and Idsoe, 2011). They also found empirical verification for Cognitive behavioural interventions for Trauma in Schools (CBTIS) and Trauma Focused Cognitive Behavioural Therapy (TF CBT) as effective interventions for reducing PTSD symptoms of learners.

Traumatic stress is one of our country’s most important public health challenges due to its high prevalence and widespread impact.  Evidently school professionals play an important role in facilitating the recovery of children and adolescents when traumatic events occur. Beside cognitive behavioural interventions there are also multiple opportunities within the school environment for counsellors or trained professionals to implement prevention-based practises to address these needs. The early identification of learners who are at risk for traumatic stress or of those who have already experienced a single traumatic event needs to be the primary level of intervention. When schools commit to the universal screening of all their students it can provide a crucial way to prevent psychopathology and deficits in school functioning as a result of trauma exposure.

Can we assume the kids are ok? In a high risk country like South-Africa where the exposure to traumatic stress is almost a given it will take professional intervention to ensure that at risk youth do not develop full blown PTSD. Schools offer professionals that opportunity. Its familiarity and easy access provide adolescents with the safe and secure environment where they can begin to review their trauma. When school professionals, teachers and families work in tandem they often provide the best help for children and adolescents who shows symptoms of, or are at risk for, traumatic stress.