RAND Identifies Programs for Long-term Recovery For Children

The RAND Corporation issued the first guide that shows how to provide school-based mental health programs for students exposed to violence, natural disasters, and other traumatic events.

Titled “How Schools Can Help Students Recover from Traumatic Experiences: A Tool Kit  for Supporting Long-Term Recovery,” the guide moves beyond the short-term responses typically taken by schools after disasters strike. The toolkit was developed by RAND Health for the RAND Gulf States Policy Institute (RGSPI) to enable schools to help students
displaced by natural disasters like Hurricanes
Katrina and Rita.

“We found that following Hurricanes Katrina and Rita, schools were in a unique position to help the
displaced students they enrolled, but had limited information about how to help,” said Lisa Jaycox, a RAND senior behavioral scientist who is the lead author of the guide. “This toolkit should be used as a step toward closing the information gap.”

Although schools have developed good capacity as “early responders” to support communities in the aftermath of disasters or crises, they have much
less experience in how to support the longer- term mental health issues of students and staff members.

Originally developed a few months after the
hurricanes, the toolkit has now been expanded to include national and international mental health programs for treating other traumatic experiences
such as sexual abuse and assault, the sudden death of family members, terrorism incidents, and trauma experienced by refugees.

The toolkit compares 24 trauma-focused programs
that have been developed and used by schools
across the United States and in other countries that have experienced ongoing wars and acts of terror.
The guide assesses these programs based on the potential needs of students; and provides school officials with estimates of the time, funding, training, and other resources needed to put the programs into place.

Among the programs that the report describes are:

• A program by RAND, the University of
  California at Los Angeles (UCLA), and the
  Los Angeles Unified School District (LAUSD)
  called Cognitive-Behavior Intervention for
  Trauma in Schools (CBITS) [see article in
  this issue: “Dr. Bradley Stein Given Award for Excellence”], which was developed to treat students exposed to multiple acts of violence. Students showed emotional and behavioral improvements six months following initial therapy. The program has since been implemented in other states including
  Maryland, Wisconsin, and Illinois.
  
  
• The UCLA Trauma/Grief Program for Adolescents, which has been used in New
  York City schools following the World Trade Center attacks of Sept. 11, 2001, and in schools in postwar Bosnia. The program
  targets middle- and high-school students following terrorism incidents, community violence, manmade disasters, and war.
  P rogram participants have displayed
  decrease in depression and improvement in academic performance and classroom
  behavior.
  
  
• The Friends & New Places program, which
  has been used to help 1,100 K-12 students
  who were displaced to the Dallas
  Independent School District following
  Hurricane Katrina. Results have not been formally evaluated, but the program is
  designed to reframe how displaced children think about their traumatic experiences in relation to their new environment and emphasizes making treatment for traumatic events culturally acceptable.

In addition to evaluating programs for schools to choose from, the toolkit also includes funding
options for securing program materials and training staff. However, RAND researchers note that
information on funding resources can change rapidly, and that schools should thoroughly investigate which
resources are available in their district.

Development of the toolkit and selection of the programs were guided by work from the National
Child Traumatic Stress Network (NCTSN). NCTSN is funded by the Substance Abuse Mental Health Services Administration (SAMHSA). RAND Health,
a division of the RAND Corporation, is the nation's
largest independent health policy research program, with a broad research portfolio that focuses on
quality, costs, and delivery, among other topics.

To order copies of "How Schools Can Help Students Recover from Traumatic Experiences: A Tool Kit for Supporting Long-Term Recovery" (ISBN: 0-8330-
4037-5), contact RAND's Distribution Services (order@rand.org or call toll-free in the U.S. 1 (877)
584-8642). If you would like to download the
document from the RAND Gulf States Policy
Institute, Click Here.

Click to View Printable Version

Homelessness is devastating to a child.  Homeless children are sick and hungry twice as often as other children.  Many have witnessed violence or are suddenly separated from their families to be placed with a relative or in foster care.  The trauma of these experiences is etched on their young lives.  They have four times the developmental delays and twice the learning disabilities.  By age eight, one-third has diagnosable mental disorders for which most receive no treatment.

Each year in the United States, more than 1.3 million children are homeless as a result of the combined effects of extreme poverty, lack of affordable housing, decreasing government supports, the challenge of raising children alone, domestic violence, and fractured social supports.  While homelessness itself is profoundly traumatic for a child, the exposure to an array of related incidents compounds the damage to a young body and mind.

Imagine a child fleeing with her mother from a violent domestic partner to the relative safety of a homeless shelter.  Thrust into this strange and busy place, the child is cutoff from everything she has known.  Without familiar things to anchor her—toys, books, clothes, pets, friends—she is surrounded by unknown people who are themselves in crisis.  Even with her mother’s dedicated concern for the child’s safety and welfare, the young girl feels scared, lonely, and uncertain.  She has no idea what will happen next or when this all will end.

Because the shelter is understaffed and overburdened, the mother and child are taken in with little formal assessment.  The mother’s trauma from interpersonal violence and the extreme stresses of homelessness go unmeasured and unacknowledged.  Likewise, the trauma to the child remains unobserved and unspoken.  In the rush to meet immediate needs of shelter, food, and safety, these unseen needs are left to operate insidiously on the mother and the child.

“Homeless children have been left behind by virtually every service system,” notes Ellen Bassuk, MD, president and founder of The National Center on Family Homelessness.  “NCTSN has made an important contribution by inviting us into their Network to help build awareness of the complex interaction between trauma and homelessness.”

The Collaboration on Trauma Surviving Homeless Children, a Category II site in Boston Massachusetts, is a partnership between the Trauma Center at JRI and the National Center on Family Homelessness working in local shelter and schools.  The Collaborative is helping homeless and domestic violence shelters transform their milieu to become trauma informed.  The Collaborative has develop a Tool Kit composed of a trauma informed organizational self-assessment and a companion guide to help programs examine their policies, procedures, and services and make the necessary modifications to account to prevalence of traumatic stress in the population they serve.  We are providing training and consultation to local shelters and schools on trauma-informed services, including:

• Assessment, service planning and case management;
  
  
• Consultation to teachers and other school personnel;
  
  
• Direct intervention with children and families;
  
  
• Training to homeless, education, and mental health providers in the Gulf region;
  
  
• Raising awareness about the characteristics and needs of homeless children and families;
  
  
• Adapting evidence-based practices in homelessness settings; and
  
  
• Conducting psycho-educational groups

Fortunately, the role of trauma in the lives of homeless children is being increasingly acknowledged and understood.  Essential to this progress is the necessity for shelters and other service settings to be “trauma-informed”—that is, the staff must be able to understand, anticipate, and respond to the special needs of trauma survivors, and provide a safe, supportive, non-threatening service environment characterized by:

• Maximizing choice and control for participants;
  
  
• Avoiding provocation and power assertion;
  
  
• Maintaining clear and consistent boundaries;
  
  
• Sharing power in the running of shelter activities; and
  
• Delivering services in a nonjudgmental and respectful manner.

The Collaborative is currently developing curricula to train shelters on a national scale.  The curricula are geared to realities of shelter life, and provide opportunities for one-on-one training as well as feedback and assessment to create sustainable trauma informed organizational changes. For more information, visit www.familyhomelessness.org.