1. Lisa Jaycox Supporting Students Exposed to Stress and Trauma though Schools

2. Hurricane Katrina

3. Sandy Hook

4. Most children are exposed to violence Any violence Direct assault Witness any violence Witness family violence 61% 46% 25% 10% National Survey of Children’s Exposure to Violence, 2008 In many urban areas, nearly all children are exposed

5. Jaycox 5 7-Oct-15 And Its Not Just about Violence 12% Been in a natural disaster Been in a serious accident 19% Attacked by a dog or other animal 27% Been very sick or injured 29% Had someone close to them die 49% 71% Had someone close to them very sick or injured

6. Jaycox 6 7-Oct-15 Post-traumatic stress disorderEmotional and behavioral problemsPoorer school performanceProblems with friends, family But are children getting quality treatment? The emotional impact of violence and other trauma can be profound

7. Jaycox 7 7-Oct-15 Outline of Today’s Talk How does trauma affect students? What have we developed to support them? How can we apply this work military children and schools?

8. Jaycox 8 7-Oct-15 What are the consequences of trauma? …One night several years ago, I saw men shooting at each other, people running to hide. I was scared and I thought I was going to die. After this happened, I started to have nightmares. I felt scared all the time. I couldn’t concentrate in class like before. I had thoughts that something bad could happen to me. I started to get in a lot of fights at school and with my brothers… – Martin, 6 th grader

9. Jaycox 9 7-Oct-15 What are the consequences of trauma? …One night several years ago, I saw men shooting at each other, people running to hide. I was scared and I thought I was going to die. After this happened, I started to have nightmares. I felt scared all the time. I couldn’t concentrate in class like before. I had thoughts that something bad could happen to me. I started to get in a lot of fights at school and with my brothers… – Martin, 6 th grader

10. Jaycox 10 7-Oct-15 Distress from Trauma Has Negative Effects on Students in the Classroom Classroom performance declines due to… –Inability to concentrate –Flashbacks and preoccupation with the trauma –Avoidance of school and other places Other behavioral and emotional problems develop that can impede learning and interpersonal relations –Substance abuse –Aggression –Depression

11. Jaycox 11 7-Oct-15 These Effects Take a Measurable Toll Decreased IQ and reading ability (Delaney-Black et al., 2003) Lower grade point average (Hurt et al., 2001) More days absent from school (Hurt et al., 2001) Decreased rates of high school graduation (Grogger, 1997) More suspensions and expulsions (LAUSD survey, 2006)

12. Jaycox 12 7-Oct-15 Important to find ways to reach youth outside of the mental health sector 80% of children with emotional problems don’t get needed treatment Disparities in access are real Schools and other programs can be ideal settings for detecting trauma in children and intervening –Barriers to accessing mental health care are partially removed

13. Jaycox 13 7-Oct-15 Outline of Today’s Talk How are youth affected by trauma and violence? What have we developed to support them? How can we apply this work military children and schools?

14. Jaycox 14 7-Oct-15 Cognitive Behavioral Intervention for Trauma in Schools (CBITS) Early Detection Informed Teachers and Parents Student Learning For Children 10 group-therapy sessions for trauma symptoms 1-3 individual sessions for exposure to trauma memory and treatment planning For Parents 4 group sessions to… −Educate about trauma −Provide parenting support Family outreach and liaison for other social services For Teachers In-service to educate about… –How trauma can affect students –How to detect signs of trauma –How to support traumatized students in the classroom

15. Jaycox 15 7-Oct-15 Goal 1: Symptom Reduction Primary targets:  PTSD symptoms  General anxiety and arousal  Re-experiencing of the trauma  Trauma-specific anxiety  Trauma-specific avoidance  Emotional numbing Secondary targets:  Depressive symptoms  Low self-esteem  Behavioral problems  Aggressive and impulsive Goals are tailored to each child

16. Jaycox 16 7-Oct-15 Goal 2: Building Resilience Building new skills Practicing existing skills to improve them Applying existing skills to the traumatic event and reminders Choosing the appropriate strategy

17. Jaycox 17 7-Oct-15 Goal 3: Building Peer and Parent Support Peer support within the group Parent support  Better communication  Parent understanding

18. Jaycox 18 7-Oct-15 CBITS Session Outline Session 1Introductions Session 2Common reactions to trauma, relaxation 1-3 Individual Sessions Imaginal exposure to traumatic event (between Group Sessions 2 and 6) Session 3Thoughts and feelings Session 4Combatting negative thoughts (Hot Seat) Session 5Avoidance and coping Session 6,7Exposure to trauma through imagination / writing / drawing Session 8Introduction to social problem-solving Session 9Practice with problem-solving and Hot Seat Session 10Planning / graduation

19. Jaycox 19 7-Oct-15 Start of pilot test 1 Month 23456 Middle School 1 Middle School 2 126 students participated in the pilot 61 students received CBITS immediately 65 students received CBITS after 3 months A Pilot Test of CBITS in Schools Demonstrated its Effectiveness Screening 3-month assessment 6-month assessment   

20. Jaycox 20 7-Oct-15 CBITS reduced trauma symptoms 30 25 20 15 10 5 0 Start3-month assessment 6-month assessment Source: Stein et al., JAMA 2003 PTSD symptoms (average score) CBITS No program The improvement lasted No program Group 2 CBITS

21. Jaycox 21 7-Oct-15 Parents reported children doing better 30 25 20 15 10 5 0 Start3-month assessment 6-month assessment Source: Stein et al., JAMA 2003 Psychosocial impairment (average score) CBITS No program Group 2 CBITS Children receiving CBITS early also performed better in math and reading

22. Jaycox 22 7-Oct-15 Making training more accessible www.cbitsprogram.org

23. Jaycox 23 7-Oct-15 Website is expanding reach

24. Jaycox 24 7-Oct-15 Support for Students Exposed to Trauma (SSET) Was Designed to Fill a Gap A modified version of CBITS for use by non-clinical school staff School personnel can deliver this intervention Pilot tests indicate that SSET is promising

25. Jaycox 25 7-Oct-15 Bounce Back: An Intervention for Elementary School Children Exposed to Traumatic Events A modified version of CBITS for K-5 th grade students More involvement of parents in screening and processing trauma Preliminary study (in press) shows effectiveness

26. Jaycox 26 7-Oct-15 Interactive, self-paced stress reduction curriculum Components: Audio with motion graphics Interactives to teach content  Assessments with feedback  Drag and drop / matching  Create your own adventure  Open response sections  Culminates in a digital (video) game Ability to save things to pdf for printing or to binder for later use in the course No back-end – completely confidential Life Improvement for Teens

27. Jaycox 27 7-Oct-15 Outline of Today’s Talk How are youth affected by trauma and violence? What have we developed to support them? How can we apply this work military children and schools?

28. Jaycox 28 7-Oct-15 What are the most relevant stressors for children in military families? Parental Deployment & Redeployment Separation, less connection with deployed parent Changes in roles and responsibilities Less attention from (single) parent Need for self-reliance Frequent Moves Stress of moving on parents, finances, housing Loss of social connections Academic stress Less frequently, parental physical or psychological injury or death

29. Jaycox 29 7-Oct-15 Overarching Goals for School-based Stress Program for Children in Military Families 1. 1.Increase ability to cope with deployment related stressors 2. 2.Reduce distress related to deployment and family changes 3. 3.Improve communication and support from parents (deployed and home)

30. Jaycox 30 7-Oct-15 Topics to be Covered SessionCBITSMilitary Stress 1 Introductions & Overview of Thoughts – Feelings - Actions Introductions & Overview of Thoughts – Feelings – Actions (modified) 2 Education about common reactions to trauma, relaxation training Education about common deployment stresses, relaxation training 3 Distress Thermometer, Link between Thoughts and feelings Distress Thermometer, Link between Thoughts and feelings (modified) 4 Combatting negative thoughts (Hot Seat) Combatting negative thoughts (Hot Seat) (modified) 5 Approaching trauma-related triggers Other Coping Strategies to Manage Anxiety and Worry Staying Active and Connected: Identifying and scheduling pleasant activities (for self and family) Other Coping Strategies to Manage Anxiety and Worry

31. Jaycox 31 7-Oct-15 Topics to be Covered SessionCBITSMilitary Stress 6 Exposure to trauma through imagination / writing / drawing Assertiveness training / Negotiation 7 Exposure to trauma through imagination / writing / drawing Getting Organized for Success 8 Introduction to problem-solving Brainstorming solutions Decision-making: Pros and cons Introduction to problem-solving Brainstorming solutions Decision-making: Pros and cons 9 Practice with problem-solving and Hot Seat 10 Planning / graduation No individual sessions to process trauma Parent tip sheet on how to work with school personnel related to military stressors (deployment, moves)