# Presentation: 219463

## RECOVERY

**Melissa Brymer**
- National Center for Child Traumatic Stress
**Kelly Ryan-Biskup**
- Windham (ME) School Department
**U.S. Department of Education**
- Office of Safe and Drug-Free Schools
- 400 Maryland Avenue, SW
- Washington, DC 20202

***DRAFT***

## Overview of Session

- Identify Key Messages
- Define the Recovery Phase
- Identify Key Components of Recovery:
- Physical aspects
- Business/fiscal elements
- Academic structure
- Emotional/mental health
- Discuss How to Prepare for Recovery in Advance
- Review Key "Issues/Debates" in Recovery
- Discuss Recovery Scenario
- Questions?

## Key Messages

- The Recovery phase is designed to assist students, staff, and their families in the healing process and to restore educational operations in schools
- Plan for common events; plan for uncommon events
- Recovery is an ongoing process that is directly linked to the other three phases of crisis planning
- Strong community partnerships are key to supporting Recovery efforts for schools

**Notes:**
Recovery efforts depend on the development of Memorandum of Understanding (MOUs) with both community mental health partners and service providers as well as pre-negotiated contract with various vendors and contractors
Key point is that most recovery efforts are going to be directed at common events.  Fiscal, physical recovery aspects are essential to plan for, although most common events create a need for mental health interventions.

## Recovery

**Recovery**

**Prevention/Mitigation**

**Preparedness**

**Response**

## What is the Recovery Phase?

- The Recovery phase is designed to assist students and staff in the healing process and to restore educational operations in schools
- Recovery can be a long-term process
- Planning for Recovery begins in the Prevention/Mitigation phase
- Providing for Recovery efforts requires leadership and buy-in from the top
- There is a direct link between emotional stress and academic achievement
- GOAL: Restore a safe and healthy learning environment

**Notes:**
If Recovery efforts are to be successful, upper-level administrators must be supportive of Recovery work and must reach outside of the school for help if/when it is needed
Those impacted by 9/11 are still in various stages of recovery, for example.
Leadership is needed at the Superintendent and Principal level, too.

## Types of Events in Schools/Districts

- Student deaths
- Staff deaths
- Accidents (students hit by cars, bus accidents, car accidents, swimming, etc.)
- Violence in schools or community (assaults, murders, drive-by shooting in community, etc.)
- Suicides
- Natural disasters (tornado, earthquake, wildfire, hurricane, etc.)
- School shootings

**Probability of Event**

**Notes:**
1. Note that events are loosely ranked and may vary by community.  For example, in some urban settings, there may be more community violence.
2. Suicides: 3rd leading cause of death among 15-24 year olds

## Preparing in Advance for Recovery: Introduction

- Planning and Policies
- Partners and Resources
- Training

## Preparing in Advance for Recovery: Policies and Planning

- Planning in advance of an event
- Outline service delivery systems
- Develop template letters for emergencies
- Pre-determine strategies for accepting contributions/donations following a death/incident
- Outline strategies for dealing with "empty chairs"
- Determine a policy for memorials (be consistent across events)
- Ensure a process is in place for parental consent
- Compile resource kits

**Notes:**
Schools need to develop protocols for determining when and how MH services will be delivered.
Schools need to also remember to always document everything they do regarding service provision for students and staff.

## Preparing in Advance for Recovery: Policies and Planning

- Consider the structures and departments
-  Coordinate with district departments
- Safety and security, facility management, risk management, budget office, transportation, food services, technology services, etc.
- Develop and practice a continuity of operations plan (COOP) at district and school levels
- Create Damage Assessment Response Teams (DART)
- Assemble Crisis Recovery teams:
- District teams
- School-based teams
- Define procedures for crisis recovery
- Coordinate with outside community partners and agencies

**Notes:**
Schools need to develop protocols for determining when and how MH services will be delivered.
Schools need to also remember to always document everything they do regarding service provision for students and staff.
"DART" teams can assist with assessing damage during major disasters and immediate needs for recovery. (physical assessment)
Schools and districts may call "teams" by different names, but the key is to ensure available providers and staff will be accessible when needed

## Preparing in Advance for Recovery: Partners and Resources

- Before an event occurs, schools should
- Consider expertise available for mental health service provision at the:
- School level
- District level
- Community level
- Outline partnership agreements with relevant local partners detailing support available
- Identify a school/district employee to coordinate partnerships with community - a liaison officer
- Identify and train crisis Recovery team members
- Develop a process for screening and registering volunteers
- Develop a process for inventorying district and donated supplies

**Notes:**
Many of community MH partners already have systems in place for inventorying donations - take advantage of these systems.
Generate supporting invoices for all purchases made to support Recovery
Liaison officer may be a member of your MH Recovery team
Good qualities to look for in crisis team members include:
Understanding of school culture or mission
Ability to establish rapport quickly
Ability to maintain confidentiality
Ability to listen to difficult feelings/experiences of others
Awareness of limitations

## Preparing in Advance for Recovery: Training

- To ensure that appropriate training is conducted for Recovery, schools should proactively:
- Identify and train appropriate staff in developmentally and culturally appropriate service provision
- Train mental health staff on specific interventions
- Provide basic training on available resources and common reactions to trauma for all staff (including administrators)
- Provide specific information to all staff regarding the school's referral system (e.g., inform teachers on who students can go to for support - referral systems available)
- Train teachers/staff on early warning signs
- Train teachers/staff on how to work with parents/guardians

**Notes:**
We are not recommending that schools train teachers to be psychologists - rather, that we equip them with a basic understanding of signs they can look for regarding emotional distress and systems available to them for referring students who may be in need of assistance.
Parents/guardians will often turn to teachers following an emergency to ask them how they should engage their children - teachers need to be trained on what they can say to support parents during this time.

## What Are the Key Components of Recovery?

- Physical/Structural Recovery
- Business/Fiscal Recovery
- Academic Recovery
- Psychological/Emotional Recovery

## Considerations for Physical Recovery

**Considerations for Physical Recovery**

- Purpose: To restore facilities necessary
- to enable educational operations
- Key components:
- Assess building/structural
- 	component (e.g., damage assessment team)
- Ensure human safety at educational sites and staff availability to teach
- Resume transportation and food services
- Determine availability of equipment and supplies (books)

**Notes:**
1. Physical recovery has direct impacts on the finances of school districts.

## Considerations for Business/Fiscal Recovery

- Purpose: To restore critical business functions within the school/district as soon as possible
- Business Continuity Plan (BCP) and/
- 	or Continuity of Operations Plan (COOP):
- Restore district administrative functions
- Ensure staff are supported
- Set-up payroll system
- Institute a system for registering out of district students, and for registering students into other schools

**Notes:**
Depending on the scope of the emergency or crisis, there will be different business/fiscal implications for schools to address.
Some districts will call it BCP and some will call it COOP. Basically, it is the idea of ensuring there is a system in place to enable work to get down - to ensure people are paid, for example.
Following a crisis, staff will be concerned about their own homes/families. Have a system for ensuring they are able to tend to personal concerns, while still assisting in the school-wide Recovery as necessary.
To register out of district students, your district will need a system for transferring records, such as IEPs to the new school
A key consideration here is: How can school districts make student records electronic and transferable?
Some districts have arranged situations where payroll can be managed from off-site of the district business offices.

## Considerations for Business Recovery

- Functional Responsibilities
- Identify, in advance, who has responsibility for closing schools, or sending students/staff to alternate locations
- Identify who is responsible for restoring which business functions for schools/districts
- Identify succession plans
- Ensure systems are in place for rapid contract execution in the event of an emergency

**Notes:**
Under "Logistics" in NIMS, schools should identify who is responsible for restoring various components of the educational system: food services, transportation services, administrative support, etc.
Pre-negotiated contracts can be very critical to ensuring business/facility/academic Recovery following an emergency.
Some school districts have experienced delays in their ability to award critical counseling or other services contracts because of cumbersome contracting procedures.

## Considerations for Academic Recovery

- Purpose: To facilitate students' return to learning; restore structure and routine
- Short-term considerations
- Quick decision making regarding school/academic routines
- Brief administrators and staff
- Communicate with parents/guardians on events and the plan
- In general, maintaining the school routine is helpful
- Can the school remain open?
- Can the school routine be maintained?  Modified?
- Are academic materials needed?

**Notes:**
1. Key questions to consider here are: How do we develop services to support student's academics during the recovery phase? And Is the school safe? Can it be inhabited? Are there teachers available to teach?

## Considerations for Academic Recovery

- Academic success and Recovery are linked
- Youth exposed to violence and trauma have been shown to have:
- Lower grade point averages (Hurt et al., 2001)
- Decreased reading ability (Delaney-Black et al., 2003)
- More negative remarks in their cumulative records
- More reported absences from school (Hurt et al., 2001)

**Notes:**
Rand corp: Exposure to violence (trauma) lower gpa, more absences
Trauma disrupts schools.
Impacts academics, 

## Considerations for Academic Recovery

- Youth exposed to violence and trauma have been shown to have:
- Decreased rates of high school graduation (Grogger, 1997)
- Increased expulsions and suspensions (LAUSD Survey)
- Traumatized students may:
- Engage in uncharacteristically aggressive behavior
- Have difficulty concentrating and learning

**Notes:**
Rand corp: Exposure to violence (trauma) lower gpa, more absences
Trauma disrupts schools.
Impacts academics, 

## Considerations for Emotional Recovery

- Purpose: To promote coping and resiliency for students,  staff, and their families following an emergency or crisis
- Key components
- Recovery/mental health services that are available and acceptable in your district
- Internal and external resources
- Short-term considerations
- Overview of mental health interventions
- Psychoeducation
- Psychological first aid
- Intervention strategies & models
- Long-term considerations

**Notes:**
1. There will be a small, sub-population of those impacted who will experience additional, long-term difficulties resulting from trauma.

## Considerations for Emotional Recovery:

- Crisis recovery/mental health services available and acceptable in the district
- Support from leadership is critical
- All planning involves the school Principal or their designee
- Some schools may be hesitant to bring in "outside" mental health support - think this through in advance
- Long-term services need support from the school board
- Familiarity with funding sources after disasters

**Notes:**
Schools should research in advance what community resources exist to provide assistance in case of a school-based crisis. 
Whenever possible develop MOUs with local MH partners or even nearby school districts to help develop your structure for MH support.
Some schools will be leery of bringing in "outside" MH support
One option is to bring in external counselors to provide additional training for school/district MH staff.

## Considerations for Emotional Recovery: Internal and External Resources

- Consider local mental health resources
- Develop a structure for support
- "Outside" vs. "Inside" help

**Notes:**
Schools should research in advance what community resources exist to provide assistance in case of a school-based crisis. 
Whenever possible develop MOUs with local MH partners or even nearby school districts to help develop your structure for MH support.
Some schools will be leery of bringing in "outside" MH support
One option is to bring in external counselors to provide additional training for school/district MH staff.

## Considerations for Emotional Recovery: Short-Term

- Short-term Recovery
- Identify circles of impact and provide triage
- Triage is the process of identifying the immediate needs of students and staff, and ensuring referral to appropriate services
- Provide psychoeducation for families, students, and staff
- Consider psychological first aid
- Consider utilization of services for staff through district Employee Assistance Programs (EAPs)
- Leverage union resources available for teacher support
- Be aware of impacts of possible trauma history

**Notes:**
Providing support for staff, as well as students, is critical
Schools may want to work with teachers' unions or teachers' advocacy groups to offer additional MH services support for teachers.
NOTE: EAPs may not have suitably qualified counselors - districts should research this issue in advance.

## Considerations for Emotional Recovery: Short-Term

- Traumatic Stress
- Traumatic stress is an acute distress response that is experienced after exposure to a catastrophic event
- Traumatic stress occurs because the event poses a serious threat to:
- The individual's life or physical integrity
- The life of a family member or close friend
- One's surrounding environment
- Individuals who have witnessed injury or death are also at risk to develop a trauma stress response

**Notes:**
Trauma is determined by: physical proximity, emotional proximity, similar previous experience, fragile personalities, and/or history of emotional disturbances
Trauma can effect students by causing:
Behavioral changes problems
Poor school performance
Post Traumatic Stress Disorder (PTSD)
Depression
Suicide
Remember: Violence and Trauma effect school performance
Lower GPA
More negative comments in record
Higher absenteeism

## Key Components for Emotional Recovery: Mental Health Interventions

- Purpose of mental health interventions
- Promote coping and resiliency for students and staff and to assist with the healing process
- Increase students' (ability to stay in school) academic performance
- Provide a range of immediate and long-term interventions
- Triage and assess immediate recovery needs of students and staff
- Make individual and group crisis counseling available during the first week after a crisis event
- Be aware of secondary adversities and make services available as needed

## Considerations for Emotional Recovery: Psychoeducation

- Psychoeducation
- Provide for everyone in the school community
- Ensure that materials are developmentally and culturally sensitive
- Identify pathways for disseminating information to students, staff, and parents
- Support coping

**Notes:**
1. Every adult on campus plays an important role 
2. Your attitude and actions can have a huge impact on recovery
3. Key question: what is developmental level of the students needing services?
4. Make sure services are adapted for those with special needs

## Considerations for Emotional Recovery: Psychological First Aid

- Psychological First Aid (PFA) is an evidence-informed modular approach for assisting children, adolescents, adults, and families in the immediate aftermath of disaster and terrorism
*Designed to*
- reduce the initial distress
- foster short- and long-term adaptive functioning
- PFA meets four basic standards
- Consistent with research evidence on risk and resilience following trauma
- Applicable & practical in field/school settings
- Developmentally appropriate across the lifespan
- Culturally informed and adaptable

- Source: National Child Traumatic Stress Network and National Center for PTSD, *Psychological First Aid: Field Operations Guide, *September, 2005

## Considerations for Emotional Recovery: Psychological First Aid 

- PFA Core Actions
- Initiate contact and engagement
- Ensure safety and comfort
- Stabilize
- Gather information on current needs and concerns
- Provide practical assistance
- Connect with social supports
- Provide information on coping
- Link with collaborative services

- Source: National Child Traumatic Stress Network and National Center for PTSD, *Psychological First Aid: Field Operations Guide, *September, 2005

**Notes:**
1. Pre-School Strategies
Allow expression, reassure adult control
Clarification that the danger is past (TV/radio)
Use social stories, don't minimize but also don't encourage "magical thinking"
2. School age Strategies
Productively channel feelings of responsibility, fear of reoccurrence, and retelling
Clarify somatic complaints
Monitor tendencies to minimize - when intended to protect adults and friends. 
3. High School age Strategies
Be aware of tendency toward excessive self blame
Identifying / misattributing Acting out behavior - particularly when oriented to regaining control
Be aware of tendencies toward emotional detachment

4. Post-PFA
School base mental health response team focus on classifying students by:
Emotional and physical proximity
Vulnerabilities
PTSD awareness training / information sharing with teachers, coaches etc,.
Detailing mid and long term follow up plans / responsibilities

## Considerations for Emotional Recovery: Long-Term

- Long-term Recovery strategies for mental health
- Conduct ongoing assessment/monitoring of mental health of students and staff
- Monitor attendance, grades, and counselor's visits
- Provide care for caregivers (compassion fatigue)
- Incorporate lessons learned from each event into future planning efforts
- Remember to reinforce ongoing prevention programs
- Be aware of 'key dates,' such as trials, anniversaries, and holidays

**Notes:**
Traumatic stress affects both victims and caregivers
Depending on the event/crisis, key dates may include: anniversaries, upcoming Hurricane seasons, upcoming trial dates, etc.
3. It is critical that there is a system in place to support self-care.

## Key Components for Emotional Recovery: Mental Health Interventions

- Intervention strategies and models
- Trauma and grief focused school-based mental health programs
- Cognitive Behavioral Intervention for Trauma in Schools (CBITS)
- Short-term individual, group, and family interventions
- Depression and suicide prevention

**Notes:**
Critical Incident Stress Debriefing (CISD) is one model that is often mentioned. It can be controversial and the research on this issue varies.
CBITS is a model for mid/long term mental health Recovery. CBITS was published in the Journal of the American Medical Association in 2003. 

## Key Issues for the Recovery Phase

- Issue #1: Opening or closing schools after an event occurs
- Policy should be in place in advance
- Considerations
- How long should the school be closed?
- How can parents/guardians weigh in on decisions about school closures?
- Who has the ultimate decision-making power regarding school closure?
- How will the community be notified?
- Ultimate question -- Will the children be better off in school, or out of school?

**Notes:**
Remember: returning to school is a critical step in the beginning the healing process. Schools should think carefully about recommending prolonged school closures because students need a sense of routine to begin to recover.
One strategy that has worked well for schools is to host a "community meeting" following an event. This allows parents/guardians to express their concerns and gives administrators an opportunity to sense the pulse of the school community - this can help in the decision-making process regarding reopening schools.
Another thing to consider is to keep data within your district about when/how long schools are closed so you can begin to track this issue.
Remember closing school as financial implications on your community - parents have to stay home with kids, etc.

## Key Issues for the Recovery Phase, 

- Issue #2: Memorials after a student or
- 	staff death
- Considerations
- Memorials can be controversial
- Questions may arise about how/if policies should vary depending on the type of death
- Memorials in schools can be considered a suicide contagion
- A date for removing memorial items
- How memorials might reinforce ongoing prevention programming (i.e., scholarship funds, etc.)
- Have a policy in advance

**Notes:**
1. Each school/district will have to decide for itself how to handle the issues of memorials

## Key Issues for the Recovery Phase, 

- Issue #3: How to handle key dates
- Considerations
- Be cognizant of anniversary dates but do not dramatize them
- Watch for reactions around holidays and/or anniversaries
- Prepare a constructive message for anniversaries
- Make sure educators watch for risk behaviors

**Notes:**
1. Key dates may include anniversaries of deaths, upcoming hurricane seasons, trial dates, etc.

## Discussion of Recovery Scenario

## Discussion of Recovery Scenario

- You're a member of the crisis recovery team at YOUR school.
- Scenario
- It's early morning.
- School has just begun for the day.
- One school bus is late arriving due to ice on the roads.

## Discussion of Recovery Scenario

- Details of the Incident
- The bus has 26 students from the  middle and high schools on board (ages 10 - 17)
- As the bus arrives, the driver is unable to stop the bus. The bus skids and then crashes through the wall of the music room.  There are 25 students in the music room
- Additional Information
- Two students are killed and 19 students are injured - four of them severely
- The bus driver was found to be intoxicated

## Discussion Questions

- 1) What are the first five steps you would take to activate your crisis recovery plan?

## Discussion Questions

- 2) Which students and staff are most at risk?

## Discussion Questions

- 3) What types of services would facilitate the recovery process? How would they be unfolded?

## Summary

- Recovery planning is a continual process
- Schools need to plan for emotional/mental health needs of students and staff, as well as for the physical, business, and academic Recovery of their campuses following an emergency or crisis event
- Planning for Recovery involves establishing key community partnerships, developing policies, providing training, and developing memoranda of understanding (MOU)

## QUESTIONS??

## THANK YOU!!!

- For More Information Contact:
- Melissa Brymer: (310) 235-2633 ext. 227
- Kelly Ryan-Biskup: (208) 284-1173
-  or: _[Info@ercm.org](mailto:Info@ercm.org)_