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Support for Students Exposed to Trauma: A Pilot Study

School Mental Health volume 1, pages 49–60 (2009)Cite this article

Abstract

With high rates of trauma exposure among students, the need for intervention programs is clear. Delivery of such programs in the school setting eliminates key barriers to access, but there are few programs that demonstrate efficacy in this setting. Programs to date have been designed for delivery by clinicians, who are a scarce resource in many schools. This study describes preliminary data from a pilot study of a new program, Support for Students Exposed to Trauma (SSET), adapted from the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program. Because of its “pilot” nature, all results from the study should be viewed as preliminary. Results show that the program can be implemented successfully by teachers and school counselors, with good satisfaction among students and parents. Pilot data show small reductions in symptoms among the students in the SSET program, suggesting that this program shows promise that warrants a full evaluation of effectiveness.

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Fig. 1

Notes

  1. Missing values for student assessments ranged from none to nine missing values missing on total scores included in this paper, depending on the time point. Parent and teacher assessments had more substantial missing values, with 20–27 values missing for teacher reports and 16–24 values missing for parent reports on the different time points.

References

  • Allensworth, D., Lawson, E., Nicholson, L., & Wyche, J. (1997). Schools and health: our nation’s investment. Washington, DC: National Academy Press.

    Google Scholar 

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. (DSM-IV). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Cohen, J. (1998). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Laurence Erlbaum & Associates.

    Google Scholar 

  • Cooper, J. (2008). The federal case for school based mental health services and supports. Journal of the American Academy of Child and Adolescent Psychiatry, 47(1), 4–8.

    Article  PubMed  Google Scholar 

  • Delaney-Black, V., Covington, C., Ondersma, S. J., Nordstrom-Klee, B., Templin, T., Ager, J., et al. (2002). Violence exposure, trauma, and IQ and/or reading deficits among urban children. Archives of Pediatrics and Adolescent Medicine, 156(3), 280–285.

    PubMed  Google Scholar 

  • Department of Health and Human Services. (2000). Health people 2010: With understanding and improving health and objectives for improving health (2nd ed., Vol. 2). Washington, DC: U.S. Government Printing Office.

    Google Scholar 

  • Department of Health and Human Services. (2001). Mental health: Culture, race, and ethnicity a supplement to mental health: A report of the surgeon general. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.

  • Farrell, A. D., & Bruce, S. E. (1997). Impact of exposure to community violence on violent behavior and emotional distress among urban adolescents. Journal of Clinical Child Psychology, 26(1), 2–14.

    Article  PubMed  Google Scholar 

  • Finch, A. J., Jr., Saylor, C. F., & Edwards, G. L. (1985). Children’s depression inventory: Sex and grade norms for normal children. Journal of Clinical Child Psychology, 53(3), 424–425.

    Google Scholar 

  • Finkelhor, D. (1995). The victimization of children: A developmental perspective. American Journal of Orthopsychiatry, 65(2), 177–193.

    Article  PubMed  Google Scholar 

  • Finkelhor, D., & Dziuba-Leatherman, J. (1994). Children as victims of violence: A national survey. Pediatrics, 94(4 Pt 1), 413–420.

    PubMed  Google Scholar 

  • Foa, E. B., Treadwell, K., Johnson, K., & Feeny, N. C. (2001). The Child PTSD Symptom Scale: A preliminary examination of its psychometric properties. Journal of Clinical Child Psychology, 30(3), 376–384.

    Article  PubMed  Google Scholar 

  • Garrison, E. G., Roy, I. S., & Azar, V. (1999). Responding to the mental health needs of Latino children and families through school-based services. Clinical Psychology Review, 19, 199–219.

    Article  PubMed  Google Scholar 

  • Goodman, R. (1997). The Strengths and Difficulties Questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38, 581–586.

    Article  PubMed  Google Scholar 

  • Goodman, R. (1999). The extended version of the Strengths and Difficulties Questionnaire as a guide to child psychiatric caseness and consequent burden. Journal of Child Psychology and Psychiatry, 40, 791–801.

    Article  PubMed  Google Scholar 

  • Goodman, R., Meltzer, H., & Bailey, V. (1998). The Strengths and Difficulties Questionnaire: A pilot study on the validity of the self-report version. European Child and Adolescent Psychiatry, 7, 125–130.

    Article  PubMed  Google Scholar 

  • Goodman, R., & Scott, S. (1999). Comparing the Strengths and Difficulties Questionnaire and the Child Behavior Checklist: Is small beautiful? Journal of Abnormal Child Psychology, 27, 17–24.

    Article  PubMed  Google Scholar 

  • Grogger, J. (1997). Local violence and educational attainment. The Journal of Human Resources, 32(4), 659–682.

    Google Scholar 

  • Hoagwood, K., & Erwin, H. D. (1997). Effectiveness of school-based mental health services for children: A 10-year research review. Journal of Child & Family Studies, 6(4), 435–451.

    Article  Google Scholar 

  • Hurt, H., Malmud, E., Brodsky, N. L., & Giannetta, J. (2001). Exposure to violence: Psychological and academic correlates in child witnesses. Archives of Pediatrics & Adolescent Medicine, 155, 1351–1356.

    Google Scholar 

  • Jaycox, L. (2003). Cognitive-behavioral intervention for trauma in schools. Longmont, CO: Sopris West Educational Services.

    Google Scholar 

  • Jaycox, L. H., Kataoka, S. H., Stein, B. D., Wong. M., & Langley, A. (2005). Responding to the needs of the community: A stepped care approach to implementing trauma-focused interventions in schools. Report on Emotional and Behavioral Disorders in Youth, 5(4): 85–88, 100–103.

  • Jaycox, L. H. & Langley, A. K. (2005). Support for students exposed to trauma: The SSET Program. Lesson Plans, Worksheets, and Materials. Unpublished manual.

  • Jaycox, L. H., Morse, L. K., Tanielian, T., & Stein, B. D. (2006). How schools can help students recover from traumatic experiences: A tool-kit for supporting long-term recovery. Technical Report: TR-413. Santa Monica, CA: RAND Corporation. Retrieved from http://www.rand.org/pubs/technical_reports/TR413/.

  • Jaycox, L. H., Stein, B. D., & Amaya-Jackson, L. M. (2009). School-based treatment for children and adolescents. In: E. Foa, T. M. Keane, M. J. Friedman, & J. A. Cohen (Eds.), Effective treatments for PTSD: Practical guidelines from the International Society for Traumatic Stress Studies (2nd ed.). New York: Guilford Publications.

  • Jaycox, L. H., Stein, B. D., Amaya-Jackson, L. M., & Morse, L. K. (2007). School-based interventions for child traumatic stress. In S. W. Evans, M. Weist, & Z. Serpell (Eds.), Advances in school-based mental health interventions (Vol. 2, pp. 16-1–16-19). Kingston, NJ: Civic Research Institute.

    Google Scholar 

  • Jaycox, L. H., Stein, B. D., Kataoka, S., Wong, M., Fink, A., Escudera, P., et al. (2002). Violence exposure, PTSD, and depressive symptoms among recent immigrant school children. Journal of the American Academy of Child and Adolescent Psychiatry, 41(9), 1104–1110.

    Article  PubMed  Google Scholar 

  • Jaycox, L. H., Tanielian, T., Sharma, P., Morse, L., Clum, G., & Stein, B. D. (2007). Schools’ mental health responses following Hurricanes Katrina and Rita. Psychiatric Services, 58(10), 1339–1343.

    Article  PubMed  Google Scholar 

  • Kataoka, S., Stein, B. D., Jaycox, L. H., Wong, M., Escudero, P., Tu, W., et al. (2003). A school-based mental health program for traumatized Latino immigrant children. Journal of the American Academy of Child and Adolescent Psychiatry, 42(3), 311–318.

    Article  PubMed  Google Scholar 

  • Kendall, P. C., Cantwell, D. P., & Kazdin, A. E. (1989). Depression in children and adolescents: Assessment issues and recommendations. Cognitive Therapy and Research, 13(2), 109–146.

    Article  Google Scholar 

  • Klaus, P., & Rennison, C. M. (2002). Age patterns in violent victimization, 1976–2002 (NCJ 190104). Washington, D.C.: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics.

    Google Scholar 

  • Kliewer, W., Lepore, S. J., Oskin, D., & Johnson, P. D. (1998). The role of social and cognitive processes in children’s adjustment to community violence. Journal of Consulting & Clinical Psychology, 66(1), 199–209.

    Article  Google Scholar 

  • Kovacs, M. (1981). Rating scales to assess depression in school-aged children. Acta Paedopsychiatrica, 46(5–6), 305–315.

    PubMed  Google Scholar 

  • Langley, A. K., Jaycox, L. H., & Dean, K. L. (2005). SSET: Group leader training manual. Unpublished manual.

  • Martinez, P., & Richters, J. E. (1993). The NIMH Community Violence Project: II. Children’s distress symptoms associated with violence exposure. Psychiatry Interpersonal and Biological Processes, 56(1), 22–35.

    Google Scholar 

  • Osofsky, J. D. (2003). Prevalence of children’s exposure to domestic violence and child maltreatment: Implications for prevention and intervention. Clinical Child and Family Psychology Review, 6(3), 161–170.

    Article  PubMed  Google Scholar 

  • Osofsky, J. D., Wewers, S., Hann, D. M., & Fick, A. C. (1993). Chronic community violence: What is happening to our children? Psychiatry, 56(1), 36–45.

    PubMed  Google Scholar 

  • Overstreet, S. (2000). Exposure to community violence: Defining the problem and understanding the consequences. Journal of Child & Family Studies, 9(1), 7–25.

    Google Scholar 

  • Putnam, F. W. (1997). Dissociation in children and adolescents: A developmental perspective. New York: Guilford.

    Google Scholar 

  • Pynoos, R. S., Steinberg, A. M., & Goenjian, A. (1996). Traumatic stress in childhood and adolescence: Recent developments and current controversies. In B. A. van der Kolk, A. C. McFarlane, & L. Weisaeth (Eds.), Traumatic stress: The effects of overwhelming experience on mind, body, and society (pp. 331–358). New York: Guilford Press.

    Google Scholar 

  • Ruchkin, V., Henrich, C. C., Jones, S. M., Vermeiren, R., & Schwab-Stone, M. (2007). Violence exposure and psychopathology in urban youth: The mediating role of posttraumatic stress. Journal of Abnormal Child Psychology, 35(4), 578–593.

    Article  PubMed  Google Scholar 

  • Schwab-Stone, M. E., Ayers, T. S., Kasprow, W., Voyce, C., Barone, C., Shriver, T., et al. (1995). No safe haven: A study of violence exposure in an urban community. Journal of the American Academy of Child & Adolescent Psychiatry, 34(10), 1343–1352.

    Article  Google Scholar 

  • Singer, M. I., Anglin, T. M., Song, L. Y., & Lunghofer, L. (1995). Adolescents’ exposure to violence and associated symptoms of psychological trauma. Journal of the American Medical Association, 273(6), 477–482.

    Article  PubMed  Google Scholar 

  • Singer, M. I., Miller, D. B., Guo, S., Slovak, K., & Frierson, T. (1998). The mental health consequences of children exposed to violence: Final report. Cleveland, OH: Case Western Reserve University.

    Google Scholar 

  • Stein, B. D., Jaycox, L. H., Kataoka, S., Rhodes, H. J., & Vestal, K. D. (2003). Prevalence of child and adolescent exposure to community violence. Clinical Child and Family Psychology Review, 6(4), 247–264.

    Article  PubMed  Google Scholar 

  • Stein, B. D., Jaycox, L. H., Kataoka, S., Wong, M., Tu, W., Wlliott, M., et al. (2003). A mental health intervention for school children exposed to violence. Journal of the American Medical Association, 290, 603–611.

    Article  PubMed  Google Scholar 

  • Stein, B. D., Zima, B. T., Elliott, M. N., Burnam, M. A., Shahinfar, A., Fox, N. A., et al. (2001). Violence exposure among school-age children in foster care: Relationship to distress symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 40(5), 588–594.

    Article  PubMed  Google Scholar 

  • U.S. Public Health Service. (2000). Report of the surgeon general’s conference on children’s mental health: A national action agenda. Washington, D.C.: Department of Health and Human Services.

    Google Scholar 

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Acknowledgments

The authors wish to acknowledge the contributions of a large team: Steven Evans, Phyllis Ellickson, Sheryl Kataoka (consultation), Dan McCaffrey (design and randomization), Fernando Cadavid (student screening and student and teacher surveys), Barbara Colwell, Roberta Bernstein, Pia Escudero (LAUSD school logistics), Diana Polo Huizar (parent interviews), Stefanie Stern (focus groups and adherence ratings), Anita Chandra (qualitative interviews), Taria Francois (data entry and manuscript preparation), Suzanne Blake, Daryl Narimatsu (school principals), and Patricia Fuentes-Gamboa, Yvette Landeros, Lajuana Worship, Maria Sanchez (SSET implementers). This project was supported by a grant from the National Institutes of Mental Health (R01MH072591).

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Authors and Affiliations

  1. RAND Corporation, 1200 South Hayes Street, Arlington, VA, 22202, USA

    Lisa H. Jaycox, Priya Sharma & Molly Scott

  2. UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA

    Audra K. Langley

  3. RAND Corporation, Pittsburgh, PA, USA

    Bradley D. Stein & Matthias Schonlau

  4. Los Angeles Unified School District, Los Angeles, CA, USA

    Marleen Wong

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  1. Lisa H. Jaycox
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Correspondence to Lisa H. Jaycox.

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Jaycox, L.H., Langley, A.K., Stein, B.D. et al. Support for Students Exposed to Trauma: A Pilot Study. School Mental Health 1, 49–60 (2009). https://doi.org/10.1007/s12310-009-9007-8

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Keywords

  • School
  • Trauma
  • Violence
  • Intervention