# SCCAP/Resources for Dealing with a School Shooting

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This is a page for caregivers, professionals and members of the public as a resource for dealing with a school shooting. It recommends some steps that each target group should take following such an event.

## The first four weeks following the event

According to the DSM-5, in the first few days up to 4 weeks following a traumatic event, those who display symptoms of Post-traumatic Stress Disorder (PTSD) should more appropriately be given a diagnosis of Acute Stress Disorder (ASD). The two share many similar symptoms, but a key difference is the increase of dissociative symptoms for acute stress disorder. However, what may appear to be symptoms of Acute Stress Disorder are also common reactions in the immediate aftermath of a trauma. As a result, the majority of people will not develop Acute Stress Disorder or PTSD, meaning resiliency is the norm. Social support has a powerful role post trauma support in facilitating resilience
What to do in the first four weeks following a school shooting :
| Group | What to do |
| Clinicians | Acute stress disorder, or acute stress reaction, is a condition that may affect individuals in the days, up to 4 weeks, following a traumatic event. Research has shown that acute stress disorder can be a predictor of PTSD in the months following the traumatic event, which makes assessing for acute stress disorder important. A suggested treatment for acute stress disorder to prevent the development of PTSD is "an early provision of cognitive behavior therapy" with an emphasis on prolonged exposure as the latter may be a crucial component in treatment. It is also important to note that the majority of people will not go on to develop acute stress disorder or PTSD. Resiliency is the norm following traumas, and to help build that resiliency social support is crucial. |
| Parents/caregivers | In the days and even weeks after a traumatic event, parents and caregivers should be on the watch for any concerning signs that the child may not be coping well. Above all, caregivers and parents should strive to support the child as best as possible, knowing that resiliency following a traumatic event is the norm. Below under the helpful resources tab list a wide array of helpful resources including what kinds of "red flag" behaviors to be on the look out for, how to talk to the child, how to support the child, and where to begin seeking help. The National Child Traumatic Stress Network also has a wide breadth of resources in English, Spanish, Japanese, and Chinese on their website. |
| Teachers | Teachers also play a crucial role in maintaining the mental and physical wellbeing of a child. Teachers are with the child for 8 hours a day, 5 days a week, which allows them to notice any changes in behavior, especially following a trauma. Like parents or caregivers, teachers should be on the watch for any kinds of concerning behaviors in relation to a traumatic event. Below are a list of resources for teachers on how to provide psychological first aid to their students. Teachers should also try to provide resources such as how to get into contact with local therapists and school counselors. It is also important, however, that teachers assess their own wellbeing at the same time. Here is a handout that provides tips on how to do this. |
| Survivors | Some times survivors of trauma feel overwhelmed by trying to cope with the trauma and simultaneously get help. However, it is important to remember that there are an endless number of resources available to those survivors. Here are a few handouts that may be helpful for survivors of trauma. Here is a handout on how to seek social support following a traumatic event. Here is a handout on what survivors may experience following a traumatic event and some coping strategies. Here are some tips for relaxation. Following a traumatic event, some survivors turn to drugs or alcohol to help cope. Survivors who already drink or use drugs may also increase the amount they drink or use. For survivors who use drugs or alcohol to cope, here is a handout for some tips as to how to curb the desire to drink and use, and why drinking and using drugs as a way to cope is ultimately counter-productive. Should there be any thoughts of suicide, or if there is a crisis situation, those in the US should dial 911 or use one of the hotline numbers found at the bottom of this webpage. |

### Questionnaires to administer

| Instrument | Where to Obtain | Qualtrics version | Age Range | Administration/ Completion Time | Scoring Information |
| Acute stress disorder interview | here (copyright, members only) | N/A | 17 to 65 | varies | Found in manual |
| Acute stress disorder scale (ASDS) | here | Under review | 17 to 65 | 5-10 minutes | Dissociative cluster (Questions 1-5): ≥9 Cumulative score: ≥28 |

## Four weeks and longer following the event

After four weeks following the traumatic event, the DSM-5 reports that symptoms related to an acute stress disorder diagnosis should be treated as PTSD. However, it is important to note that someone may have PTSD even if they did not have an acute stress disorder diagnosis. The following are resources for clinicians, parents or caregivers, teachers, and survivors for how to cope with the symptoms of PTSD. However, these resources are only meant to be a source of support and should by no means take the place of professional treatment.
| Group | What to do |
| Clinicians | The assessment of PTSD can be done using the following assessment tools. The Child PTSD Symptom Scale (CPSS) is the gold standard assessment of PTSD in children, while the PTSD Checklist for the DSM-5 (PCL) is promoted by the National Center for PTSD in assessing PTSD in adults. Clinicians should also be more aware of any suicidal ideation that may turn into action for patients with PTSD. |
| Parents/Caregivers | Kids can experience negative feelings and emotions even a month after a traumatic experience. Whether these negative feelings have persisted since the trauma or have seem to suddenly appear weeks after the trauma, they should not be ignored. The same kind of "red flag" behaviors should be monitored. Here is a booklet provided by the National Center for PTSD that describes what PTSD is and the treatment for PTSD. Here is a link to the National Institute of Mental Health's (NIMH) page about PTSD, which include tips on what kinds of behaviors to look out for depending on the age of the child, as well as how the best support the child. |
| Teachers | Teachers should continue to be vigilant about any dramatic changes in behavior, or persistent alarming behavior following a traumatic event. Teachers should familiarize themselves with "red flag" behaviors listed in the NIMH page above in the parents or caregivers section. Moreover, teachers should remember to also practice self-care while looking out for their students. Here is a link to a handout that provides tips to teachers on how to provide psychological first aid while practicing self-care at the same time. |
| Survivors | Survivors may feel a wide array of emotions even months after the traumatic event. Sometimes those emotions begin right after the trauma and continue for months after. Sometimes those emotions seem to appear suddenly months after the trauma. It is important to remember that whether those emotions began right after the trauma or months after, those emotions are valid. Here is a link to the National Center for PTSD's website on how to find a therapist in your region, and there is another link at the bottom of this page to help with that as well. Further, here is a webpage with links to other webpages, smartphone applications, and ways to community support groups to help cope with symptoms after a trauma. Should there be any thoughts of suicide, or if there is a crisis situation, those in the US should dial 911 or use one of the hotline numbers found at the bottom of this webpage. |

### Questionnaires to administer

| Instrument | Where to Obtain | Qualtrics version | Age Range | Administration/ Completion Time | Scoring Information |
| Child PTSD Symptom Scale | here | Under review | 8-18 | 5-10 minutes | here |
| PTSD Checklist for the DSM-5 | here(towards bottom) | Under review | 18 and older | 10-15 minutes | here |

## Help resources

| Group | Resource |
| Clinicians | Post Traumatic Stress Disorder Information Resource from The University of Queensland School of Medicine APA practice parameters for assessment and treatment for PTSD (Updated 2017) Resources for professionals from VA National PTSD Center |
| Parents/Caregivers | By National Child Traumatic Stress Network: Tips for parents on shooting media coverage Parent guidelines to helping youths after a shooting Caregiver tips for helping teens with traumatic grief Caregiver tips for helping school-age children with traumatic grief |
| Educators | By National Child Traumatic Stress Network: Teacher tips for providing psychological first aid Educator tips for helping youths after a community trauma |
| Survivors | By National Child Traumatic Stress Network: Psychological impacts of recent shootings Tips to talking to youths about a shooting Tips to talking to children about a shooting Helping young children heal after a crisis Psychological first aid for schools Resources and manuals on psychological first aid VA National PTSD Center: Resources for the public from VA National PTSD Center |

## Local resources
### Hotlines

* SAMHSA Disaster Distress Helpline: 1-800-985-5990. 24/7 number that can be called for assistance. The DDH is a sub-network of the National Suicide Prevention Lifeline.
* Suicide Prevention and Crisis hotline: 775-784-8090
* National Suicide Prevention Hotline: 1-800-273-8255

### Find-A-Therapist Resource

* How to find a therapist

## Resources for Stigma Reduction: Misplacing Blame on Mental Illness for School Shootings

Media representations of shootings can lead to the misconception that mental illness often causes people to act violently. Understanding the facts helps counteract this stigma:
* Mass Shootings and Mental Illness--American Psychiatric Association
* Autism Society Statement on Florida Shooting
* Autism & Aggression--Autism Speaks
* "The Link Between Autism and Violence Isn’t Autism"
* /Psychological First Aid