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The concept of a person suffering from grief because of a death, which may have been sudden, violent or unexpected (*)

The traumatic distress from the death that can interfere with a normal or typical grief response (*)

May involve PTSD and/or chronic, possibly extreme, reactions that go beyond what would be expected for normal bereavement. (@)

Example symptoms for students include

Changes in sleeping and eating patterns

Feelings of sadness, anger, anxiety, guilt, and self-blame

Thoughts about the death

Nightmares

Bedwetting

Regressive behaviors (acting in a younger or needier way)

Avoidance of reminders of the loved one who died or the death experience

Irritability

Decreased concentration

Difficulty in school

Stomachaches

Headaches

Fears about their own safety and the safety of other loved ones (@)

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Moving is a highly variable experience. It can be affected by the age of the student, their economic status, the communities/culture they are moving from and into, the schools they are joining and whether they have extra curricular activities/clubs available, etc... Not only is moving stressful and potentially traumatic, it also creates conditions for other traumas to potentially occur. Bullying and emotional neglect are the first that come to mind. Being a fresh face in a new school can feel isolating and even conducive to being labeled as an “other”. Meanwhile on the home front, the logistics of managing a move or starting a new job can keep parents of a student occupied and unavailable. It is important that educators and school admin work to smooth the transition, mitigate incongruity, and make the student feel welcome.

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-- When new students arrive --
. Prime your class for the arrival of a new student:  Have your class do something to greet the new student warmly.

. Have a counselor contact the student right away:  It's important that the new student knows where to turn to ask questions and report problems that may not be within the expertise of the teacher.

. Retrieve info from the students prior school: Any information about where the student has struggled and excelled will help you provide aid and opportunities, smoothing the transition.

. Provide informal assessments: This on top of the info retrieved from their previous school will help reveal issues that may be arising from the transition.  Keep in mind these should be relaxed assessments, we don't want to stress the student out more with testing.

. Partner new students with a " class buddy":  A class volunteer can help demonstrate class routines and answer small questions about what is expected at the school.

. Notify the new student of any extracurricular activities or informal get-togethers that may be available to them:  It's important for a student to find community in their new school, extracurriculars are a good opportunity for this.

-- When students leave your school--
. Compile a memory book for the departing student:  Children and young adolescence need to feel that their existence matters, not just from their new peers but also their old ones.  Have the class sign a goodbye card or a make a memory book where peers can say their adieus.

. Share info with their new school:  Make sure you are available to transfer any pertinent info about the departing student to their new school.

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"Suicidal ideations (SI), often called suicidal thoughts or ideas, is a broad term used to describe a range of contemplations, wishes, and preoccupations with death and suicide"
https://pubmed.ncbi.nlm.nih.gov/33351435/#:~:text=Suicidal%20ideations%20(SI)%2C%20often,preoccupations%20with%20death%20and%20suicide.

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Suicidal ideations (SI), often called suicidal thoughts or ideas, is a broad term used to describe a range of contemplations, wishes, and preoccupations with death and suicide. There is no universally accepted consistent definition of SI, which leads to ongoing challenges for clinicians, researchers, and educators. For example, in research studies, SI is frequently given different operational definitions. This interferes with the ability to compare findings across studies and is frequently mentioned as a limitation in meta-analyses associated with suicidality. Some SI definitions include suicide planning deliberations, while others consider planning to be a discrete stage.

Beyond the lack of clear nomenclature, there are other concerns. A systematic review of the numerous interprofessional clinical guidelines for suicide yielded no consensus on a clinical gold standard for assessing and managing SI or people at risk of suicide. Although scales to measure depression, SI and risk for suicide exist, none produce a score that is sufficiently reliable or clinically useful in predicting the very small subgroup of suicide ideators whose death by suicide is imminent. (The American Psychiatric Association Practice Guidelines for Psychiatric Evaluation of Adults, 3rd ed. 2016, p. 19).

It is evident that suicidal ideations present in a "waxing and waning manner" , so the magnitude and characteristics of SI fluctuate dramatically. It is critically important for healthcare professionals to recognize that SI is a heterogeneous phenomenon. It varies in intensity, duration, and character. As there is no "typical" suicide victim, there are no "typical" suicidal thoughts and ideations. Unfortunately, healthcare records often document SI in a binary yes/no fashion, although it encompasses everything from fleeting wishes of falling asleep and never awakening to intensely disturbing preoccupations with self-annihilation fueled by delusions. Therefore, thoroughly assessing and monitoring the pattern, intensity, nature, and impact of SI on the individual and documenting this accordingly is important for all healthcare professionals. It is also important to reassess SI frequently due to its fluctuating pattern.

The magnitude of SI fluctuations was studied using an ecological momentary assessment method. Individuals who attempted suicide in the past year plus a sample of suicidal in-patients recorded the intensity of their suicidal thoughts from hour to hour for four weeks. Analysis of these data showed dramatic fluctuations in the intensity of SI by all participants. All participants had SI, which varied in its intensity, either upwards or downwards, by one standard deviation on most days. Many had one standard deviation fluctuations several hours apart within the same day. This knowledge is important for all healthcare professionals to consider and highlights the need to monitor fluctuations and not dismiss the possibility of sudden increases in suicidal urges, even when the current level is mild, and the individual currently has control over them. Additionally, SI is considered a better predictor of lifetime risk for suicide than imminent risk, so assessments should include describing the characteristics and impact of prior SI as well as current.

The Center for Behavioral Health Statistics Quality publishes the results of the American nationwide household survey, the National Survey of Drug Use and Health (NSDUH). Piscopo's 2017 publication summarized the results from the 2009-2014 surveys, which show that 6% of 18-25-year-olds respond affirmatively to the survey question, "At any time in the past 12 months, did you seriously think about trying to kill yourself?" In contrast, the lowest rate of SI was 1.6% in those aged 65 years and above. There is no clear association between endorsing SI and attempting suicide. For every 31 Americans with SI, only one individual will attempt suicide. The rates of suicide deaths also vary by gender, age, race, and other demographic variables. Further evidence of the weak association between reported SI and fatal suicides is apparent when comparing the NSDUH results to CDC mortality records. Despite the low prevalence of SI in white males over age 75 years, they have the highest rate of fatality by suicide (approx. 40 per 100,000). Meanwhile, females over 75 years have much lower rates (4 per 100,000). The suicide ideators in the 18-25-year-old group had significantly fewer suicide deaths (approx. 17.5 per 100,000 for males and 4 per 100,000 for females).

Most people have control over SI and do not attempt suicide, even when reporting SI. Psychiatric Association Practice Guidelines for Psychiatric Evaluation of Adults (2016, p. 19) points out that SI is a symptom of another primary psychiatric diagnosis and suggests that 90% of people who end their lives by suicide meet the diagnostic criteria for one or more psychiatric diagnoses. However, data clearly show that numerous medical illnesses are associated with increased odds of suicide, and that suicidal death extends through all demographic groups and includes virtually all psychiatric and medical diagnoses. The CDC's mortality records for 2017 reveal over 50% of deaths by suicide were by people with no known psychiatric illness. Some criticisms have been made that suicidality should be regarded as a distinct psychiatric diagnosis, with its symptoms and unpinning pathological processes. Although this is beyond the scope of this paper, this contention is becoming more widespread. After reviewing all of the existing clinical guidelines, Bernert et al. concluded there is an urgent need for "easily-accessible best practice guidelines, adaptable to diverse fields of medicine and clinical specialties, that may be the first point of contact for risk detection, intervention, and prevention."

Although this paper aims to focus primarily on suicidal ideation, it is important to provide context. Therefore, while the intention is not to broaden the focus to suicide, it is impossible to address the significance of SI without also discussing suicidal behaviors and outcomes to some extent. It is estimated by the Center for Disease Control and Prevention (CDC) that in 2017 there were approximately 10 million people in the USA who experienced suicidal thoughts. Fortunately, the majority of ideators in the USA and globally will never attempt suicide, and fewer will use lethal means that result in death. Of the 10 million Americans with SI, it is estimated there were 1.4 million suicide attempts in 2017, but healthcare was only sought by approximately one-third of those who attempted. The degree of suicidal intent and the lethality of means used during attempts vary tremendously. One-half of the 47,000 suicides that occurred in America during 2017 were caused by firearms. (CDC).

Globally, the World Health Organization (WHO) collects mortality data, including the prevalence and means of suicides, for all member nations. Beginning in 2013, after declaring that the rising suicide rates constituted a "global public health crisis," they advocated for evidence-based strategies to prevent suicides globally. In developing nations, where the ingestion of pesticides was the leading cause of fatal attempts, suicide prevention efforts promoted using less toxic pesticides. Evidence exists that reductions in suicides can be achieved by reducing access to lethal means, but this requires a comprehensive systemic approach that includes collaboration between policy-makers, healthcare professionals, and interventions to reduce modifiable risk factors.

Primary Care Professionals Concerning SI

A recent meta-analysis of 44 studies of healthcare services used by suicide victims showed a chief reliance on primary care professionals in all countries. Only 31% of suicide decedents received inpatient or outpatient mental health services in the year before their death; 57% of the decedents had contact with mental health services at some point during their lifetime. Primary care professionals are more apt to have an established relationship with patients and have a more complete understanding of their health history. Furthermore, due to having a pre-established relationship, when patients experience worsening SI or stressors that may precipitate suicidal behaviors, they are more likely to seek help from primary care professionals. Studies show that 80-90% of suicide decedents increased their contact with primary care professionals in the year and months before their suicide; 44% of those who died by suicide had contact with primary care in their last month of life. Although the impetus for increased contacts is undoubtedly variable, it does indicate opportunities exist for healthcare professionals to identify any new risk factors for suicide and offer treatment options to address modifiable factors.

During their final visit with primary care professionals, 90% of successful suicides in a UK study disclosed their SI to primary care providers. These same providers were interviewed about their experience losing a patient in their practice to suicide (n=39). In each case, the primary care physician had referred their patient for psychiatric services, so the physician's communication with both their patient and the psychiatric service professionals (physicians and community psychiatric nurses) could be examined in the study. Twenty percent of the physicians who heard their patients endorsing suicidal thoughts stated they were concerned about their patient's safety during their final appointment.

The researchers noted that many of the primary care providers were uncertain about how to interpret the meaning of SI when expressed by their patients. This was particularly evident when the patient had a history of voicing SI. Examples of statements from the primary care physicians include;

1. "Although we put her down as a moderate suicide risk, none of us thought she'd ever do it because she talked about it so much." (p. 263)

2. "He'd done this on numerous occasions. Taken overdoses, not as a suicidal attempt but in an attention-seeking, in a [state of] mental distress, help me, [a] cry for help ... there was never a disorder"

The limited understanding of how to assess and treat people with SI was apparent in some of the interviews in this UK study, although there was substantial variability between physicians. However, similar gaps in knowledge are also evident in other studies involving primary care professionals. An observational study of primary care providers in the Netherlands showed SI was assessed in only 44% of clinically depressed patients and 66% of new-onset depression patients. The frequent lack of suicide risk prevention policies in primary care practices is also apparent, and even when they do exist, there may be uncertainty regarding what they entail. Julie Goldstein Grumet, director of US Health and Behavioral Health Initiatives for the Suicide Prevention Resource Center and the director of the Zero Suicide Institute, published preliminary research data in the Jan. 2019 Journal of Health Care Compliance. Less than one-third of healthcare providers (n=15,000) who completed an optional self-test for the Zero Suicide initiative in the USA reported feeling knowledgeable about suicide risk warning signs. Similarly, only 1 in 3 knew their organization's procedures for patients at increased risk or felt confident in their ability to respond to a suicidal patient. Although standardized tools, instruments, and rubrics do not provide a clear indication of imminent suicidal risk, the American Psychiatric Association Clinical Guidelines for Evaluating Suicidality suggests these tools can be useful as prompts when interviewing to ensure thoroughness in the questions asked during the risk assessment. Grumet et al. reported that only 35.5% of the providers stated they use any of these available tools when screening or assessing. Furthermore, only one-third of the healthcare professionals responsible for delivering treatment (n = 4,101) indicated they "strongly agreed" when self-rating their level of confidence or comfort in treating patients with elevated suicide risk.

Although additional training is recommended by many to improve the competence of healthcare professionals, the outcomes from an interprofessional course which included how to assess SI produced modest results. Students were taught the importance of SI assessments during an online module and then required to practice completing suicide risk assessments on standardized patients. However, later in the semester, only 55% of the students (65.5% of medical; 54.5% of nursing; 46.4% of pharmacy) completed an SI assessment on the depressed standardized patient during their final objective clinical standardized exam (OSCE). This emphasizes the importance of reinforcing learning in academic settings and monitoring competence and compliance in healthcare organizations.

There were additional findings in the study of UK primary care physicians that are pertinent to consider. Multiple barriers with psychiatric services were described by the primary care physicians. The primary care providers commented that they often felt frustrated when they were left to manage suicidal patients alone or when the system created obstacles and referral mazes which made it difficult for them to advocate for what they believed was in their patient's best interests: Examples of statements from the interviews include;

1. "Because the patient did not attend his last psychiatric appointment, the psychiatrist discharged him and sent a letter to us stating this. I disagreed [because the patient needed the psychiatrist's expertise]" p. 264.

2. "Sometimes we feel like we have to manipulate the system [to expedite referrals] just to get a patient assessed ... we, therefore, refer to hospital [emergency department] as patients will get seen and assessed on the day and they do follow-up as their referrals go to the CMHT (Community Mental Health)" p. 265.

Almost all of the physicians (90%) said they knew their deceased patient "well," but this knowledge may have been under-utilized during the subsequent psychiatric treatment planning. One of the physicians was frustrated about being excluded from providing input into the psychiatric treatment plan - a plan he disagreed with and which he suggested may have contributed to the suicide.

The issues and conclusions identified in this UK study are consistent with other studies. A review of literature focusing on improving primary practice professionals ability to detect and treat SI and prevent suicide produced four major recommendations:

i) educating practitioners on risks for suicidal thoughts and behaviors

ii) providing patient screening to identify suicide risk and/or mood disturbances

iii) using evidence-based interventions, including collaborative, multi-disciplinary teams, to manage depression

iv) assessing for the presence of suicide risk factors and managing suicide risk when symptoms arise.

These recommendations are similar to the reaction of the American accreditation agency, the Joint Commission (JC), to address frequent suicides following contact with ED, PCP, and MH services. The Joint Commission's Sentinel Event database received 1,089 reports of suicides from 2010 to 2014 among patients receiving care in an accredited hospital or within 72 hours of hospital discharge or release from an emergency department. Shortcomings in the patient's psychiatric assessment were the most frequently cited root cause. As of July 1, 2019, the JC requires the use of validated screening tools to assess any patient whose primary reason for seeking treatment or evaluation is for a behavioral health problem. However, universal screening was not mandated, although many organizations may elect to do this. The JC, working with other suicide reduction organizations, has numerous resources on its website to assist members to meet this accreditation requirement. Their stated rationale for new requirement included rising suicide rates, increased empirical knowledge and available risk assessment tools, and the non-compliance of over 21% of accredited behavioral health organizations and 5% of hospitals to meet JC's National Patient Safety Goal (NPSG) 15.01.01 "Element of Performance 1 - Conduct a risk assessment that identifies specific patient characteristics and environmental features that may increase or decrease the risk for suicide" (Joint Commission, NPSG 15.01.01)

The JC advised that all accredited organizations should do the following:

1) Review each patient's personal and family medical history for suicide risk factors.

2) Screen all patients for suicide ideation using a brief, standardized, evidence-based screening tool.

3) Review screening questionnaires before the patient leaves the appointment or is discharged.

4) Take action based on the assessment results to inform the level of interventions needed. (The Joint Commission, 2016, p. 3)

Active and Passive Suicidal Ideation

"Active" suicidal ideation denotes experiencing current, specific, suicidal thoughts. Active SI is present when there is a conscious desire to inflict self-harming behaviors, and the individual has any level of desire, above zero, for death to occur as a consequence. The probable lethality of their actions, based on the means used for the suicide attempt, is not the focus. Rather, the individual's expectation that their attempt could produce a fatal outcome is the key consideration.

Example of an Active SI assessment item

Miller et al. (1991) Modified Suicidal Ideation Scale

"Over the past day or two, when you have thought about suicide, did you want to kill yourself? How often? A little? Quite often? A lot? Do you want to kill yourself now?"

"Passive" SI refers to a general wish to die but when there is no plan of inflicting lethal self-harm to kill oneself. Passive SI includes indifference to an accidental demise which would occur if steps are not taken to maintain one's own life. Passive SI receives less attention from clinicians and researchers than active SI. Although most research studies do not distinguish between active and passive SI, few studies focus on passive ideations. One author pointed out the underlying assumption of healthcare professionals is that the desire for death is not typically thought of as a harbinger of more severe suicidal outcomes.

Examples of Passive SI assessment items

Beck et al. (1979) Scale for Suicidal Ideation (SSI) was the first to measure "passive suicidal desire"

1. 0 = Would take measures to save [one's own] life

2. 1 = Would leave life/death to chance

3. 2 = Would avoid steps necessary to save or maintain life

European Depression Scale item,

"In the past month, have you ever wished you were dead?"

Miller et al. (1991) Modified Suicidal Ideation Scale

"Would you deliberately ignore taking care of your health? Do you feel like trying to die by eating too much (too little), drinking too much (too little), or by not taking needed medications?"

Passive SI, Death Wishes, and the Older Adult Population

Assessing SI is an essential component of suicide risk assessment for individuals extending beyond those with known psychiatric conditions, especially in the older adult populations around the world. Individuals who endorse SI have a higher lifetime risk of future suicide than individuals who have never experienced any SI, although the prediction value is only weak. The value of SI in predicting imminent suicide risk has not been shown but does factor into the overall assessment of protective versus risk factors in short-term, imminent suicide risk.

A common misconception is that passive SI has less clinical importance. Large population-based studies (n>85,000) that compared the odds ratio to predict suicide attempts based on reported passive SI or reported active SI show there is no significant difference. Including questions to assess both active and passive SI was recommended as the best clinical practice to predict risk.

Compared to younger populations, older adults are more apt to endorse passive SI and less inclined to express active SI or seek mental health care. Also, the majority die on their initial attempt. White males over 85 years have the highest rates, largely due to the use of lethal means like firearms. A systematic review revealed that older adults who died by suicide have very different personality profiles than younger suicide victims. Overall, older suicide victims had less evidence of maladaptive personalities, and the majority did not meet the threshold for psychiatric diagnosis. The only significant association was with a relatively small number of older suicide victims who had obsessive-compulsive and avoidant personality disorders. The researchers suggested these personality traits may have made later-life changes and transitions more difficult. They also noted that older suicide victims were more heterogeneous in both their risk factors and experiences compared to early-life suicide victims.

Overall, there is a paucity of research addressing the nature of SI in older populations, although passive SI is understood to be more associated with older adults. However, when searching the literature using analogous terms like "death ideation," "death wish," "self-chosen death," and "wish to hasten death" (WTHD), it becomes more clear that this terminology has been ascribed to older adults' ideations. Healthcare professionals should bear in mind the social constructs and norms that influence the way suicidality is addressed and indirectly minimized by the use of these terms to describe SI in this age group. Without drifting too far into this literature, several examples of recent studies may help illuminate this relatively well-researched area of study.

1. Death wishes: A death wish was expressed in 9.5% of a large sample (n= >35,000) of New Zealanders aged 65 and older who were being evaluated for home care services. Depression, poor self-reported health, and loneliness were each independent, predictive variables of death wish.

2. Self-chosen death: Interviews with Dutch older adults (n=25) who were 70 years or older (mean age of 82), who wanted to die because they considered their lives complete and no longer worth living. All of these ideators had age-related debilitation, but none had a terminal disease. They considered their death wish to be reasonable and wanted to have the same ability as those with terminal illnesses to chose death based on the Dutch euthanasia laws.

3. Wish to hasten death: A systematic review of 16 studies examining WTHD in patients with advanced illnesses showed that feeling like a burden contributed and may have triggered the WTHD.

A study of incarcerated prisoners aged 50 years and older (n=124) found past alcohol dependence and self-rating one's health as poor/fair were equally associated with both passive (10%) and active (11%) SI. Compared to inmates who denied any SI, both groups of ideators had significantly higher incidences of previous suicide attempts and/or major depressive episodes.

A European study of retired middle-aged and older adults (n >35,000) examined the association between health status and passive suicidal ideations. They found increased odds of passive suicidal ideation when the participant had been diagnosed with a heart attack, diabetes/high blood sugar, chronic lung disease, arthritis, ulcer, and hip/femoral fractures. Other studies show elevated odds ratios for suicide with hepatic disease , CVA physical disability [31]). These findings suggest a need for all healthcare professionals to be aware that the lack of adherence to the medication or dietary regime may warrant further exploration concerning possible SI.

Research findings from a community sample of older adults (n=1,226) who participated in the PROSPECT study (Prevention of Suicide in Primary Care Elderly: Collaborative Trial) showed that SI was present in 29% of participants with major depression; 11% with minor depression; and 7% without depression. The findings from this study underscore the need to assess SI in older patients, including those who do not have signs and symptoms of depression. A systematic review of self-harm in older adults concluded that more research needs to be done better to understand this population's unique characteristics and needs. Suicide attempts in this age group are usually fatal in their first attempt due to the lethality of their means, existing fragility, and lack of desire or opportunity for rescue. Because older adults typically have frequent contact with PCPs, opportunities to detect SI and provide appropriate interventions.

Suicide Risk Assessment and Suicide Risk Formulation

The suicide risk assessment (SRA) focuses on identifying the risk factors and protective factors for any given individual. This is followed by the suicide risk formulation (SRF), which assigns a level of imminent suicide risk. The subsequent triage and treatment plans are based on the SRF. One of the concerns discussed in the literature is the emphasis on the patient's communication of suicide ideation. The American Psychiatric Association (2016) Practice Guidelines for the Psychiatric Evaluation of Adults states, "When the clinician is communicating with the patient, it is important to remember that simply asking about suicidal ideas or other elements of the assessment will not ensure that accurate or complete information is received." (p. 21).

Not all ideators are apt to share their SI. Over a dozen research studies have shown that 75% of patients who die by suicide denied SI the final time they were asked by a healthcare professional. Typically, their death by suicide occurred within the month of their last visit . Berman completed chart reviews of 157 patients throughout the USA who died by suicide within 30 days of being evaluated by a healthcare professional. All victims were either receiving in-patient or out-patient mental health care; or were evaluated in an emergency department or by their primary care professional. The Joint Commission requires healthcare professionals in these practice settings to assess SI for anybody at risk of suicide. However, despite being asked, the majority (66%) denied SI. Within two days, 50% of these individuals who had denied SI ended their lives by suicide. Berman noted that the denial of SI provides a basis for patient discharge if the individual was admitted due to SI. While this may be an incentive for a patient to deny SI, particularly if they want to be discharged, caution should be exercised. Berman states that too frequently, clinicians assume that SI must exist for suicide to occur when SI is only a risk factor for suicide. Additionally, SI is a weak predictor of increased lifetime risk, it does not predict imminent risk -- but, then again, nothing does.

Ribet et al. examined the root causes that may have contributed to 141 veteran suicides within a week of their hospital discharge. Flaws in communication were frequently cited. It was also noted that almost half of the suicides occurred following an unplanned discharge. The Joint Commission released multiple sentinel event warnings over the past decade based on reports of patient deaths in hospitals or shortly after discharge from mental health units or release from emergency departments. They stated, "there is no typical suicide victim" and cautioned against assuming only certain individuals are at risk based upon their diagnosis or treatment setting.

Emergency Department Suicidal Ideation Assessments

Beginning July 1, 2019, healthcare professionals are required by the Joint Commission's NPSG 15.01.01 to use a validated tool to assess suicidal risk for all patients whose primary reasons for seeking healthcare is the treatment or evaluation of a behavioral health condition. The ability to accurately triage patients is contingent on the reliability of the instruments and also the clinician's clinical judgments. Much remains to be learned about the risk factors for imminent, short-term, and long-term suicidal behavior and the best way to identify risk. A recent prospective study in Canada compared the risk of suicide attempt within 6 months for individuals presented in ED with SI but whose presentations differed, as evident in their responses to screening questions (n= 5,655). During ED triage screening, some individuals primarily endorsed SI characterized by an "ambivalence about living" while others expressed active SI. Within 6 months, 3% of the initially screened sample presented again in the ED with a suicide attempt. Individuals who initially identified with "ambivalence about living" had more than double the risk of suicide attempts (odds ratio [OR] = 2.57, 95% CI = 1.64-4.02, P < 0.001). Those with active suicidal ideation had more than triple the risk of an attempt within 6 months compared to non-SI individuals (OR = 3.75, 95% CI = 2.61-5.34, P < 0.001) Both active suicidal ideation and ambivalence about living are concerning presentations associated with risk of attempt within 6 months. Clinicians should be mindful that differentiating between active suicidal ideation and ambivalence about living are presentations that warrant follow-up due to the increased 6-month risk of attempts.

Data show that 10% of people who ended their lives by suicide visited an emergency department within two months of inflicting fatal self-harm. People who have psychiatric histories, substance use disorders, or depression were most apt to be assessed for SI, but this negates the significance of many other known socioeconomic factors. Chart reviews of suicide victims who ended their lives within hours to days of being assessed by a healthcare professional showed the pitfalls of relying too much on patients' admissions of SI. Berman's review of the victims' charts showed strikingly similar profiles between the patients who admitted to SI or denied the presence of SI. There were no significant differences in their diagnoses, current presentations, or current circumstances. Almost all suicide decedents' charts had documentation showing current anxiety/agitation and sleep problems, current interpersonal problems or job/financial strain, current comorbid diagnoses, current social isolation/withdrawal, plus a history of SI/prior attempts plus many had a family history of a mental disorder. Healthcare professionals should bear in mind that relying on verbalized or reported SI as a gateway to assessing suicide risk may be inadequate, especially when SI is denied.

A 2013 study indicated that 0.6% of emergency department (ED) visits were due to suicidal thoughts, but when screening for SI was done, incidental, occult suicidal ideation was found in over 11% of patients who arrived due to medical complaints. Although SI was identified in medical patients and communicated, no follow-up regarding their SI occurred while on the medical unit. The Joint Commission does not require universal screening of all patients, but some suicide risk reduction programs, professional organizations, and healthcare systems are advocating and implementing policies for universal screening in ED. A recent study of ED nurses and physicians in ED showed that most felt confident completing SI screenings, but only 7% of physicians (residents and attendings) and 37% of nurses reported they did so all of the time or most of the time. Focus group interviews with ED nurses produced skepticism that the risk for suicide can be more reliably assessed with a brief screening tool question, such as 'Do you have thoughts or plans to harm yourself?' compared to a clinician's judgment. The participants described their efforts to improve suicide screening during ED triage required an ongoing iterative process of assessing for SI, which included probing, eliciting, evaluating, and reacting to identify occult SI.

Children ages 10-12 years who presented at the ED were screened with the Ask Suicide-Screening Questions (ASQ) and Suicidal Ideation Questionnaire. Positive screen results were present in 54% of patients whose chief complaint was psychiatric, but screening also showed positive results for 7% who presented to the ED with chief medical complaints. The overall rate of SI for these pre-teens was 29%, with 17% reporting engaging in prior suicidal behaviors. Although this sample was small, these findings highlight the potential value of screening children as young as 10 years for SI, including those who present with medical concerns. These findings suggest that a substantial number of individuals who present in ED may have occult SI. The interprofessional ED team should bear in mind that some individuals may express suicidal thoughts differently or deny SI when presented in the form of a screening tool and feel more comfortable disclosing it when approached privately in a supportive, direct manner. The literature suggests that all healthcare providers in ED will benefit from additional training to increase their knowledge, skills, and confidence.

A large meta-analysis (71 studies N= 4,669,303 individuals) included inpatient and non-inpatient adult populations to examine whether expressing SI was associated with subsequent suicides. Only limited sensitivity of SI for suicide was found (41% at 95% Confidence Interval (CI) 35-48), which means approximately 60% of suicide victims did not report experiencing SI. These authors examined whether there was a difference between using a structured instrument to assess SI versus relying on the healthcare professional's clinical judgment. Using structured instruments to assess SI was associated with a non-significantly lower pooled odds ratio (2.38, 95% CI 1.14-4.99) than when SI was clinically defined (OR = 3.72, 95% CI 2.96-4.67), but a great deal of heterogeneity in the studies. An important finding was that having a suicide plan, which was reported in only four studies, did significantly increased eight-fold (OR = 8.51, 95% CI 5.51-13.06). Two studies used an expressed wish to die as their operational definition of SI (OR = 3.01, 95% CI 1.49-6.06). 65 studies did not specify the individual's level of intent or planning when describing SI. There was a moderately strong but highly heterogeneous association between suicidal ideation and later suicide (n = 71, OR = 3.41, 95% CI 2.59-4.49, 95% prediction interval 0.42-28.1, I2 = 89.4, Q-value = 661, d.f.(Q) = 70, P ≤0.001).

Suicidal Ideation and Psychosis

Chapman's (2015) meta-analysis examined whether expressing SI was related to subsequent suicides for two different groups of individuals -- adults diagnosed with mood disorders (11 studies reporting on 860 suicides) and adults diagnosed with schizophrenia spectrum psychotic disorders (14 studies reporting on 567 suicides). Results showed that people with schizophrenia spectrum psychosis who expressed SI had over a six-fold increase of suicide [14 studies; Odds ratio (OR) 6.49, 95% confidence interval (CI) 3.82-11.02]. Meanwhile, the association between expressing SI and suicide among patients with mood disorders was not significant (11 studies; OR 1.49, 95% CI 0.92-2.42).

Another meta-analysis used data from 50 longitudinal studies that followed individuals who had experienced psychotic symptoms. These researchers attempted to differentiate between the impact of positive and negative symptoms of psychosis and their association with SI. Findings showed that positive symptoms in psychosis were weakly associated with SI (50 studies; OR = 1.70, 95% CI 1.39-2.08). On the other hand, negative symptoms in psychosis failed to show significance with SI and were found to be protective factors against death by suicide.

A meta-analysis and systematic review of longitudinal studies of individuals in the general population (n > 84.000 representing 12 samples from 23 countries) showed that people who reported having at least one lifetime psychotic experience had double the odds of experiencing SI in the future (5 articles; n = 56,191; OR 2.39, 95% CI,1.62-3.51); triple the odds of a future suicide attempt (8 articles; n = 66,967; OR = 3.15 95% CI, 2.23-4.45), and four times the odds of future suicide death (1 article; n = 15,049; OR= 4.39 95% CI, 1.63-11.78]. The authors concluded these elevated risks exceeded what could be explained by co-occurring psychopathology. suggesting healthcare professionals should be alert to the risk of SI in anybody with a history of psychotic experience. These findings emphasize the need for healthcare professionals to recognize the importance of psychosis as a risk factor for SI and suicidal behaviors.

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national center for biotechnology information

# data[].attributes.attachment_link.description
Suicidal ideations (SI), often called suicidal thoughts or ideas, is a broad term used to describe a range of contemplations, wishes, and preoccupations with death and suicide. There is no universally accepted consistent definition of SI, which leads to ongoing challenges for clinicians, researchers ...

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Link Between Trauma and Suicidal Tendencies

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Link Between Trauma and Suicidal Tendencies

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167439/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5240465/

We need to understand there is a clear connection between trauma and suicidality. As educators we need to be aware and recognise that trauma survivors are a high risk group.

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Abstract

This study aimed to investigate the associations between various types of childhood trauma and suicidal behavior in the general population in South Korea. This mental health survey included a total of 1,490 general citizens living in a metropolitan South Korean city who completed a questionnaire that assessed respondents' histories of childhood trauma before the age of 12 years, including bullying victimization, emotional abuse, sexual abuse, and physical abuse, as well as suicidal behavior, including current suicidal ideation and histories of suicide planning and attempts. The following psychiatric scales were administered: Hospital Anxiety and Depression Scale (HADS), Rosenberg Self-Esteem Scale (R-SES), Connor-Davidson Resilience Scale (CD-RISC), Perceived Stress Scale (PSS), and visual analogue scale of EuroQol 5D (EQ-5D). Participants who experienced any childhood trauma had significantly higher HADS and PSS scores, and significantly lower EQ-5D scores. Additionally, participants with any type of childhood trauma were significantly more likely to have current suicidal ideation and histories of planned and attempted suicide. Multivariate analyses adjusted for confounding variables indicated that bullying victimization and sexual abuse were associated significantly with all types of suicidal behavior. Physical abuse was associated significantly with histories of suicide planning and attempts. The present findings showed that any type of childhood trauma was associated with higher levels of suicidality, anxiety, depression, and perceived stress, as well as lower health-related quality of life, in the general population. In particular, associations between childhood trauma and suicidality were identified after adjustment for confounding variables.

Keywords: Sexual Child Abuse, Bullying, Depression, Attempted Suicide

INTRODUCTION

Exposure to trauma, such as physical and emotional violence and sexual abuse, disrupts the normal stages of childhood development and continuously impacts mental health in adulthood. For example, the likelihood of experiencing childhood-onset psychiatric disorders such as post-traumatic stress disorder, adjustment disorder, separation anxiety disorder, eating disorder, dissociative disorder, substance abuse, anxiety disorder, or depression may increase after exposure to traumatic stress during childhood. 1 Furthermore, childhood adversity often leads to chronic developmental disturbances, such as increased vulnerability to future life stress and physical health problems. 2, 3

The likelihood of experiencing adulthood pathologies may be increased following childhood adversity because severe early stress and maltreatment can induce a cascade of events that potentially influence normal brain development. For example, childhood abuse affects neurogenesis, synaptic overproduction and pruning, and myelination during specific sensitive periods, 4 and may also induce hyperactivity in the hypothalamic-pituitary-adrenal (HPA) axis and result in smaller hippocampal volumes. 5 Furthermore, childhood adversity is associated with increased exposure to negative life events in adulthood and heightened emotional reactivity to stress. 6

Childhood trauma is a strong and independent risk factor for suicidal behavior. However, most of the studies that have investigated this association were conducted in Western countries and in specific populations. In a previous study in Korea, parental death before age 12 years and suspension of school due to financial strain during adolescence were associated with adulthood suicidal behavior in the general population. 7 However, that study did not investigate traumatic events that occurred outside the family, including physical and sexual abuse. In another study in Korea, significant associations between childhood adversity and suicidality were observed in a clinical population with depressive disorder. 8 However, the ability to generalize this association to the general Korean population is limited.

Suicide rates in Korea are remarkably high. According to statistics reported in 2019, the suicide rate in Korea was not only the highest among Organisation for Economic Co-operation and Development countries but was more than twice the average of these countries. 9 Thus, the development of suicide prevention strategies and the performance of additional research to identify suicide risks in the general Korean population are necessary. The present study aimed to investigate the associations between different types of childhood adversity and suicidal behavior in the general Korean population.

MATERIALS AND METHODS

1. Participants

The present study was conducted as one component of a mental health survey of the general population in South Korea. A total of 1,490 citizens living in the metropolitan city of Gwangju completed survey questionnaires in 2016 and 2018. The institutional review boards of Chonnam National University Hospital approved this study (no. TMP 2017294).

2. Suicidal behavior and childhood trauma

The primary study variables, assessed using survey responses, were suicidal behaviors, including current suicidal ideation over the past year and the lifetime histories of suicide planning and attempts. Childhood trauma was evaluated using six questionnaires that assessed childhood adversity before the age of 12 years. 8 The types of childhood trauma included bullying victimization, violence by parents, emotional abuse, sexual violence, sexual harassment, and severe physical assault. Sexual violence and sexual harassment were classified together as sexual abuse, and violence by parents and severe physical assault were classified together as physical abuse. Thus, experiences of childhood trauma were represented by four variables in the present study.

3. Sociodemographic and clinical characteristics

The present study involved the assessment of a variety of sociodemographic characteristics, including age, sex, length of education (<12 and ≥12 years), health care insurance status (Medicare and Medicaid), and religiosity.

4. Psychiatric scales

Anxiety and depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS), on which higher scores indicate more severe anxiety and depressive symptoms. Although this scale was originally developed to screen for anxiety and depression in physically ill patients, its reliability and validity for the assessment of symptoms of these conditions in the general population have been verified. 10 Subjective stress severity was assessed using the Perceived Stress Scale (PSS), on which higher scores indicate more severe levels of perceived stress. 11 Resilience was assessed with the Korean version of the Connor-Davidson Resilience Scale (CD-RISC), which measures strength, endurance, optimism, sense of control, and spirituality. Higher CD-RISC scores indicate better resilience. 12 Rosenberg's Self-Esteem Scale (R-SES) was administered to evaluate self-esteem; higher scores indicate greater self-esteem. 13 Health-related quality of life (HRQoL) was assessed using the visual analogue scale of the EuroQol 5D (EQ-5D), on which higher scores indicate a better quality of life. 14

5. Statistical analysis

Respondents' sociodemographic characteristics, clinical scale scores, and suicidal behaviors were compared independently according to the presence of the four types of childhood adversity using chi-squared and t tests. To identify independent associations between childhood adversity and suicidal behaviors, logistic regression analyses were performed with covariates that were significant in the univariate analyses. All statistical analyses were performed using the Statistical Package for the Social Sciences (version 25.0; IBM Corporation, Armonk, NY, USA), and two-tailed p values <0.05 were considered to indicate statistical significance.

RESULTS

Table 1 displays the sociodemographic characteristics of the participants according to histories of childhood adversity. The mean age of the 1,490 participants was 42.9±14.2 years. A total of 332 (22.3%) reported more than one type of childhood adversity. Physical abuse was the most common type of adversity (10.8%), followed by bullying (9.3%), sexual abuse (7.2%), and emotional abuse (6.4%). Participants who experienced bullying or sexual abuse during childhood were significantly younger than those who did not report such experiences. Women were more likely to report experiences of bullying, sexual abuse, and emotional abuse, whereas men were more likely to report experiences of physical abuse. Additionally, participants who experienced bullying, physical abuse, or emotional abuse were more likely to have Medicaid insurance, which represents poor economic status.

TABLE 1

Table 2 shows the comparisons of psychiatric measure scores and suicidal behaviors according to histories of childhood adversity. Participants who experienced any type of childhood adversity had significantly higher HADS and PSS scores and lower EQ-5D scores, whereas participants with histories of bullying, physical abuse, or emotional abuse, but not sexual abuse, had significantly lower CD-RISC and R-SES scores. Participants who experienced any type of childhood adversity were more likely to have current suicidal ideation over the past year and lifetime histories of suicide planning and attempts.

TABLE 2

Table 3 shows the results of multiple logistic regression analyses of the associations between each type of childhood adversity and types of suicidal behavior after adjustment for age, sex, education, Medicaid insurance, other childhood traumas, and scores on the HADS, R-SES, CD-RISC, PSS, and EQ-5D. These multivariate analyses revealed that bullying victimization and sexual abuse were associated significantly with all types of suicidal behavior. Physical abuse was associated significantly with histories of suicide planning and attempts. Emotional abuse was not significantly associated with any suicidal behavior after adjusting confounding variables.

TABLE 3

DISCUSSION

The main result of the present study was that the experience of childhood adversity was associated independently with suicidal behavior in the general Korean population. Additionally, the present study showed that all types of childhood trauma were associated significantly with suicidal ideation over the past year and histories of planned and attempted suicides. After adjustment for demographic and clinical characteristics, most of these associations remained significant. In particular, individuals who experienced bullying victimization or sexual abuse were approximately two to three times (odds ratio, 2.5-5.3) more likely to have recent suicidal ideation. Furthermore, bullying victimization, physical abuse or sexual abuse were associated significantly with a lifetime history of suicide planning and attempts (odds ratio, 2.2-5.2). Taken together, the present findings demonstrate that the experience of childhood adversity is associated significantly with the risk of suicide in the general Korean population.

Recently, bullying in schools has become an important issue in Korea. The present study showed that participants who experienced bullying were from younger generations. According to a 2018 study that was the first investigation of school violence to include bullying, 70% of all bullying victims are elementary-school students. 15 Furthermore, cross-sectional studies have found that high-school students who are victimized by bullying are more likely to have suicidal ideation. 16 Similarly, a prospective study of middle-school students revealed associations between suicidality and bullying among victims and offenders. 17 To our knowledge, however, the present study is the first to document an association between bullying experienced before the age of 12 years and lifelong suicidal behavior. These findings suggest that school mental-health programs should include interventions to prevent current and future suicidality associated with bullying.

Several previous studies have revealed associations between childhood physical abuse and suicidal behavior. Historically, Korean culture features a patriarchal family system in which childhood physical abuse by parents as corporal punishment is permitted more than in Western countries. Recent meta-analyses have shown that individuals who experience spanking and physical abuse during childhood tend to express antisocial behaviors and aggressiveness, 18 and lifetime aggression has been shown to be an important mediator of the relationship between childhood physical abuse and lifetime suicide attempts. 19 Taken together, these findings of strong associations between childhood physical trauma and suicidal behaviors suggest the need for education about the negative impacts of physical abuse, including corporal punishment, during childhood in the context of the high suicidality rate in the general Korean adult population.

Many previous studies have documented associations between childhood sexual abuse and suicidal behaviors. In Korean patients with depressive disorder, childhood sexual abuse was found to be associated with current suicidal ideation and a history of past suicide attempts, but the significance of this association disappeared in adjusted multivariate analyses. 8 The present finding of a significant association between histories of childhood sexual abuse and high suicidality in the general Korean population suggests the need for careful long-term clinical support for children victimized by sexual abuse.

A meta-analysis showed that emotional abuse has strong effect on suicidal behavior. 20 Similarly, emotional abuse in childhood is more associated with suicidal ideation and suicide attempts than is sexual or physical trauma. 21 However, the significance of the relationships between emotional abuse and suicidal behavior disappeared after adjustment for other types of trauma and various correlates in that analysis. The limitations of the questionnaires used to identify emotional abuse must also be considered.

Childhood adversity can disrupt the early development of the central nervous system, and negatively affect the functioning of the prefrontal cortex and hippocampus later in life. 22 These biological changes induced by toxic stress can have severe adverse influences on judgement and emotional regulation. Thus, individuals who experienced traumatic events during childhood are more likely to exhibit problems with emotional and behavioral self-regulation later in life, and to attempt suicide. 23 In addition, adults who experienced childhood trauma have higher levels of stress perception, anxiety, and depression. 2, 3 It can be inferred that childhood trauma victims have high stress perception due to abnormalities in the HPA axis caused by trauma-induced dysregulation of the early neurobiological stress response. 24 In biological terms, dysregulation of the HPA axis plays a major role in the pathology of depression. For example, stress-induced hypercortisolemia results in the downregulation of glucocorticoid receptors, which, in turn, alters the cortisol negative feedback loop and results in heightened corticotropin-releasing hormone and adrenocorticotropic hormone levels. This vicious cycle increases cortisol levels and ultimately results in hippocampal atrophy and a reduced nerve regeneration rate. The HPA axis and glucocorticoid hormones are also involved in the development of anxiety and fear after exposure to stress. 25

In terms of cognition, early maladaptive schemas formulated by traumatic experiences could aggravate ambivalence regarding emotional expressiveness and induce the use of negative coping styles, which could exacerbate depressive symptoms in adults. 26 Similarly, a recent study conducted in Korea showed that rumination mediates the influence of childhood trauma on the development of depression and anxiety in non-clinical adults. 27

Except for sexual abuse, childhood adversities are associated with lesser resilience, self-esteem, and HRQoL. Resilience is a defense mechanism that individuals can develop against adversities. For example, a study targeting a community population with no major depressive disorder in the past 12 months showed that many childhood trauma victims have longitudinal psychological damage, and that resilience may be a protective factor against this process. 28 In other words, individuals with high levels of resilience are more likely to be mentally healthy despite their childhood traumas, whereas those with less resilience are more likely to develop major depressive disorder after childhood trauma. However, whether resilience is a temperamental ability that is applicable against trauma or the result of an adaptive process according to specific types of adversity remains unclear.

In general, previous studies have revealed strong positive correlations between childhood maltreatment and low self-esteem. A systematic review revealed similar patterns of this correlation in the East Asia and Pacific regions. 29 For example, Asian populations including those in Korea, tend to consider traditional values to be very important because they embody family hierarchy, shame, and Confucian principles. The present results suggest that Korean individuals who are maltreated search for the causes in themselves and, due to internalization, have lower levels of self-esteem and resilience. Similarly, HRQoL is a multidimensional concept that incorporates physical, mental, emotional, and social functioning domains. A systematic review identified robust and consistent evidence of an inverse relationship between childhood maltreatment and current HRQoL in adults, 30 which is comparable to the present results.

The present study has several limitations that should be considered when interpreting the results. First, childhood adversities and suicidality were assessed using a checklist; thus, recall bias may have been present due to the participants' current mental states. Second, the severities of the suicidal behaviors and childhood traumas were not assessed; quantitative measures could have been employed. Finally, the causality of relationships between childhood adversity and mental health issues in adulthood could not be examined due to the cross-sectional design of the study, which involved measurement of the variables at a single timepoint. Nonetheless, considering the limited amount of previous studies investigating associations between various childhood adversities and adulthood suicidal behavior in the general Korean population, this study has important clinical implications. The present study provides clinical evidence that the identification of childhood adversity is very important for the appropriate management of suicide risk and mental health difficulties in the general population.

In conclusion, the present study demonstrated that various types of childhood adversity, including bullying, sexual abuse, and physical abuse were associated with suicidal behavior in a general population of Korean adults. Additionally, these findings showed that mental health and HRQoL were related to the experience of childhood trauma, suggesting the need to prevent childhood adversity in Korean society to reduce suicidality and mental health issues in the general adult population.

ACKNOWLEDGEMENTS

This research work was conducted as part of the Gwangju Mental Health Project supported by Ministry of Health & Welfare and Gwangju Metropolitan City, Republic of Korea.

Footnotes

CONFLICT OF INTEREST STATEMENT: None declared.

References

10. Oh SM, Min KJ, Park DB. A study on the standardization of the hospital anxiety and depression scale for Koreans: a comparison of normal, depressed and anxious groups. J Korean Neuropsychiatr Assoc. 1999;38:289-296. [ Google Scholar]

11. Lee J, Shin C, Ko YH, Lim J, Joe SH, Kim S, et al. The reliability and validity studies of the Korean version of the perceived stress scale. Korean J Psychosom Med. 2012;20:127-134. [ Google Scholar]

13. Rosenberg M. Society and the adolescent self-image. Princeton: Princeton University Press; 1965. [ Google Scholar]

26. Kim EJ, Kim JS. The relation between childhood trauma and early adulthood depression: the mediating effects of early maladaptive schemas, ambivalence over emotional expressiveness and avoidance coping style. Korean J Couns Psychother. 2010;22:605-630. [ Google Scholar]

Articles from Chonnam Medical Journal are provided here courtesy of Chonnam National University Medical School and Chonnman National University Research Institute of Medical Sciences

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Association between Childhood Trauma and Suicidal Behavior in the General Population

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This study aimed to investigate the associations between various types of childhood trauma and suicidal behavior in the general population in South Korea. This mental health survey included a total of 1,490 general citizens living in a metropolitan South ...

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Being in a natural disaster can be very frightening, and the days, weeks, and months following the event can be very stressful. Most families recover over time, especially with the support of relatives, friends, and their community. But different families may have different experiences during and after, and how long it takes them to recover will depend on many things.

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Being in a natural disaster can be very frightening, and the days, weeks, and months following the event can be very stressful. Most families recover over time, especially with the support of relatives, friends, and their community. But different families may have different experiences during and after, and how long it takes them to recover will depend on many things.

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The National Child Traumatic Stress Network

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The following resources on child trauma were developed by the NCTSN.

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Emotional abuse is any type of abuse that involves the continual emotional mistreatment of a child. It's sometimes called psychological abuse. Emotional abuse can involve deliberately trying to scare, humiliate, isolate or ignore a child.

Emotional abuse includes:

humiliating or constantly criticizing a child

threatening, shouting at a child, or calling them names

making the child the subject of jokes, or using sarcasm to hurt a child

blaming and scapegoating

making a child perform degrading acts

not recognizing a child's own individuality or trying to control their lives

not allowing them to have friends

persistently ignoring them

manipulating a child

never saying anything kind, expressing positive feelings, or congratulating a child on successes

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Child sexual abuse is defined as engaging in sexual activities with a child who has not reached the legal age for sexual activities, where use is made of coercion, force or threats; or abuse is made of a recognised position of trust, authority or influence over the child, including within the family; or abuse is made of a particularly vulnerable situation of the child, notably because of a mental or physical disability or a situation of dependence.

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Lack of confidence and self-esteem

Difficulties controlling emotions

Extreme behaviour, like becoming overly demanding, aggressive, having outbursts, or becoming passive

Difficulties making and maintaining relationships

Behaviour that is inappropriately infantile or adult-like

Persistent running away from home or being missing from school

Anxiety, unhappiness or withdrawal

Having few or no friends

Seeming to be isolated from parents/family

Lack social skills

Self-harm or attempts at suicide

Babies or toddlers might not have a close relationship or bond with their parent(s)

Babies or toddles might be overly affectionate with strangers

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1. Establish social and emotional safety in your classroom

Classroom contracts

Explicit anti-bullying or community-building curricula

Timely interventions in conflicts and hurtful exchanges

Teaching and modeling of empathy and active listening skills

2. Create a behavior-management plan that focuses on positive reinforcement.

Implement student-generated agreements and contracts

Explore stress-management strategies to diffuse tense situations and help students process feelings in the moment

Give students opportunities to demonstrate their strengths

3. Increase your self-awareness and trauma competency.

Seek professional support

Share support resources with other educators

Connect with community organizations

Engage in ongoing self-assessment and reflection on your trauma responsiveness

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https://www.nspcc.org.uk/what-is-child-abuse/types-of-abuse/emotional-abuse/

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Explore our guide on identifying emotional abuse, its impact, and steps for reporting. Get the support you need to protect children from harm.

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Working with Younger Students (Ages 5-8)

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Working with Younger Students (Ages 5-8)

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Children at this developmental stage need to feel secure in their families. When they experience this safety and reassurance, they feel encouraged to explore the world around them and make new friends. But when this security is threatened by divorce, children may feel angry or sad. They might feel guilty and blame themselves for what happened, secretly thinking that their bad behavior caused the divorce. Children in early elementary school may feel worried that parents are going to stop loving them, so they may misbehave to test whether this is a justified fear.

Signs of Struggle with Divorce

Difficulty concentrating on schoolwork

Frequent crying or emotional distress

Lack of interest in fun activities

Headaches or stomach problems

Increased separation anxiety

For young children, any regression to earlier behaviors, such as wetting the bed, throwing tantrums, or wanting a pacifier, might indicate they need extra support during this time of transition.

How Elementary School Counselors Can Help

Above all, school counselors are called to be active listeners for their students. Create a safe space for them to express their sadness and feelings of loss, anger, shame, or embarrassment. Don’t dismiss their worries about their parents, and listen to their fears, no matter how irrational they may seem. If they feel too scared to express these fears to either parent, consider having a meeting with the parents where the child can safely express these worries. Help the parents communicate to the children that the divorce wasn’t their fault, and that they will never stop loving them.

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Teenagers are tasked with the preparation to someday leave home and live independently. During a divorce, they might take on additional adult responsibilities, and it can be easy to forget that they are still developing emotionally and ethically. Teens might struggle to see far into the future and imagine a successful adulthood, or they may consider themselves to be invincible as they experiment with new and risky behaviors
External link:open_in_new.

Signs of Struggle with Divorce

Extreme negativity or criticism

Risky sexual behaviors

Increased aggression

Poor academic performance

Substance use

How High School Counselors Can Help

A school counselor takes a teenager’s perspective and listens to how they make sense of what has happened in their family. An adolescent might take responsibility
External link:open_in_new for what has happened between their parents or feel that they have to care for their younger siblings. They might anticipate having to sacrifice their own plans for the future or feel guilty for wanting to leave home sooner than planned. A counselor may choose to involve the parents to assuage some of these fears. A counselor can also encourage the continued development of a strong sense of self-esteem for the teen and help them see beyond the present toward a hopeful future.

Finally, school counselors can be aware that long after a divorce is over, children may have new questions and concerns as they enter new developmental stages. By having the patience and the foresight to field these emerging issues, counselors can help foster a level of resilience that will serve a child long into their adult life.

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Children in late elementary school to early middle school are testing out new levels of independence. During a divorce, they may feel stuck in the middle of fighting or embarrassed when parents have public conflict. Children in this age group commonly express anger about the changes in their routine or living situation. And if they see one parent in particular who is struggling with the change, they might take on increased responsibility for the emotional health of the parent.

Signs of Struggle with Divorce

Feigned antipathy for activities once enjoyed

Premature interest in sex

Headaches or stomach problems

Increased conflict with peers

Overfunctioning in responsibilities

How Middle School Counselors Can Help

Because older children may feel the pressure to take on more adult responsibilities in the family during a divorce, school counselors can help redirect their focus to taking care of themselves and expressing their emotions. Counselors also can help them try out activities they enjoy and encourage them to simply “be a kid.” By involving parents in the work, school counselors can also make them aware of the pressure their child feels to keep them happy during this difficult time.

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8 Strategies to help students when their parents' divorce

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8 Strategies to help students when their parents' divorce

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info for educators

When parents divorce, children may turn to teachers and others in their schools because you are already important people in their lives. They may see you as a stable and concerned presence during the stress of big changes in their lives. Here are some specific things you can do to help them.

1. Provide consistency and structure. Children thrive on routine and clear expectations for their behavior.With so many things changing in their lives, they may look to their school as a place that provides stability and support. Listen to and accept their feelings, but set limits on behaviors that are unacceptable.

2. Affirm and reinforce their strengths. Let them know that they are valued through your smiles and positive feedback for their efforts as well as their progress. Many children say they do not want to be pitied, but they do want to hear about what they do well. Give them opportunities for leadership to build on their strengths.

3. Watch for behavioral signals of underlying problems. When children are unruly or withdrawn, or if they exhibit dramatic changes in behavior patterns, these may be signals that something is going wrong in their lives. Children whose parents are in conflict or are undertaking a separation or divorce often have very powerful feelings, but they are also very likely to try to hide those feelings, especially from their parents. As a result, the stress they feel can produce difficult or disturbing behaviors that spill over into the classroom. If they are willing to talk with you about what's going on in their lives, you may be able to help them deal with their feelings or help them to find resources to address their needs.

4. Encourage the adoption of an evidence-based prevention program in your school. Children whose parents divorce often feel alone in their experiences and feelings and isolated from their peers. Supportive group programs such as the Children of Divorce Intervention Program, developed by Dr. Pedro-Carroll, have been proven to provide significant and lasting benefits for children.

5. Encourage the adoption of evidence-based parenting programs for divorcing or divorced parents. All children need quality parenting, with abundant love and consistent limits on their behavior. Children who are experiencing major life changes-such as those brought about by divorce-especially need the security of effective parenting. You may help the children in your school by helping their parents find a program in your school district or local community.

6. Help children develop an accurate understanding of their parents' divorce. Children need to understand that they did not cause, and cannot solve, the problems between their parents. But many children and teens develop serious emotional difficulties because they somehow believe they are to blame. You may be in a position to help uncover those feelings and lead children to a more accurate understanding of the changes in their family.

7. Encourage parents to focus on their children's best interests. Convey that children benefit from the loving support of both parents in their lives. Educators often hear the overflow of parents' emotions and thoughts about each other, since school is the connecting point for their children. In meetings with parents, or even in informal encounters, you can help children by discouraging their parents from criticizing, blaming, or denigrating the other parent in front of their children. Children understand that both parents are somehow a part of them, and when a parent is made to look bad, children often feel that they are somehow defective, too.

8. Communicate with parents regularly about their children's strengths as well as problems or concerns. When there are concerns, take a problem-solving approach with a plan for improvement. Divorce means that parents and children are going through one of the most stressful times of their lives-and it can continue for many months. Your support, understanding and encouraging words about their child can make an enormous difference.

NAPPA Gold Award, 2010, National Parenting Publications Awards

2010 Mom's Choice Awards® Gold Recipient

Putting Children First:
Proven Parenting Strategies for Helping Children Thrive Through Divorce

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Eight ways teachers can help children when their parents' divorce

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Teachers, aides, and other school personnel can provide critical stability and help to children when parents divorce. Here are eight proven ways to help.

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How teachers can help support children during their parents’ divorce

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How teachers can help support children during their parents’ divorce

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Useful and effective actions teachers in our study took included:

developing an understanding of children’s reactions to their parents and divorce by reflecting on their observations and conversations with children

developing an understanding of the type and effect of parents’ stress

having private conversations with children, asking if they are OK, being a good listener, letting children talk, and providing reassurance

arranging one-on-one time with a teacher aide to provide emotional support or to help them settle into the day

being available for children and parents to speak to

creating a safe, friendly environment where children feel free to talk

developing friendships with children and families so they can feel safe and secure to talk to them

communicating with parents about how their child is going emotionally, socially and academically at school

referring children to the student welfare coordinator when necessary for additional support

talking about catastrophic scales to help children put their problems into perspective on a scale from zero to ten where zero is no problem and ten is the worst problem ever

being consistent with school routines, rules and expectations

making sure the child is included in supportive friendship groups, both in the classroom and playground

making activities and communication inclusive – for example, not always saying “tell mum” but instead saying “tell the person who packs your lunch” or “does your homework with you”

having flexible expectations with the child’s school work

arranging tutoring for the child with the teacher, other parents, peers, and teacher aides

getting financial support through the school welfare budget or community organisations for resources, food and to help pay for school excursions and camps

providing encouragement for children to make good decisions and to manage their own behaviour.

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Almost one in two marriages in Australia end in divorce. It's estimated that in Australia, one in five children under the age of 18 have a parent living elsewhere. This represents around one million Australian children.

For many children, their parents' separation and divorce is a stressful time. Children have different experiences and reactions and bring these into their classrooms. Children's social and emotional well-being, and learning can be affected for many years. At this time, it may be difficult for parents to provide the support their children need as they deal with their own stress.

Read more: How will my divorce affect my kids?

Teachers and schools can help children make positive adjustments. Teachers see these children the most each day apart from their parents. They're in an ideal position to provide support when needed. But they may not know how to help in these situations. Our study provides some helpful strategies that have proven to be successful for teachers.

Negative impacts of divorce

Much is known about the short-term and long-term effects of separation and divorce on children's social and emotional well-being and learning. But there is little known about these children's experiences at school. There is even less known about how their teachers work with them.

Related studies have shown having a support network that includes children's teachers can promote resilience.

Another study found children talked to their teacher so their teachers were aware of their situation. Teachers could then offer support if needed.

Other studies showed children felt secure when the daycare and school environment was friendly, structured and predictable. While these studies provide some awareness, little is known about teachers and their interactions with these children to promote well-being and learning. This provided the motivation for our study.

Our study

Grounded theory research design was applied in this study. Grounded theory is a useful methodology to use when little is known about the topic. It explores the perspective of participants - this could be through interview, focus groups, journalling or observation, although many researchers rely on interviews.

Read more: How to tell your child you're getting divorced

In our study, teachers from multiple government schools in regional Victoria were interviewed. During the interviews, teachers talked about their experiences with children in their class whose parents were separated or divorced.

Useful strategies for teachers

Our study showed teachers were firstly concerned with children's social and emotional well-being. They believed when children felt safe and secure they could learn. Importantly, the support teachers in our study provided varied depending on the different needs of children and their families, as it should.

Useful and effective actions teachers in our study took included:

developing an understanding of children's reactions to their parents and divorce by reflecting on their observations and conversations with children

developing an understanding of the type and effect of parents' stress

having private conversations with children, asking if they are OK, being a good listener, letting children talk, and providing reassurance

arranging one-on-one time with a teacher aide to provide emotional support or to help them settle into the day

being available for children and parents to speak to

creating a safe, friendly environment where children feel free to talk

developing friendships with children and families so they can feel safe and secure to talk to them

communicating with parents about how their child is going emotionally, socially and academically at school

referring children to the student welfare coordinator when necessary for additional support

talking about catastrophic scales to help children put their problems into perspective on a scale from zero to ten where zero is no problem and ten is the worst problem ever

being consistent with school routines, rules and expectations

making sure the child is included in supportive friendship groups, both in the classroom and playground

making activities and communication inclusive - for example, not always saying "tell mum" but instead saying "tell the person who packs your lunch" or "does your homework with you"

having flexible expectations with the child's school work

arranging tutoring for the child with the teacher, other parents, peers, and teacher aides

getting financial support through the school welfare budget or community organisations for resources, food and to help pay for school excursions and camps

providing encouragement for children to make good decisions and to manage their own behaviour.

Read more: How to co-parent after divorce

Teachers can buffer the stress of divorce or separation and help children adjust to their changed family arrangement. The strategies for teachers identified in this study can help teachers support children and families through these unsettled times.

The actions teachers take are important in increasing the bonding between children, families and teachers. Teachers must consider the uniqueness of children and their family situation as they promote resilience and coping skills, encourage a realistic and positive outlook, and decide which of these strategies to use.

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How teachers can help support children during their parents' divorce

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Almost one in two marriages in Australia end in divorce. It's estimated that in Australia, one in five children under the age of 18 have a parent living elsewhere. This represents around one million Australian children. For many children, their parents' separation and divorce is a stressful time.

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The impact of divorce on children: Tamara D. Afifi at TEDxUCSB

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> Feelings of anxiety, fear, and worry about safety of self and others (including pets):

> Children may have increased fears and worries about separation from family members.
> Changes in behavior:

Increased activity level
Decreased concentration and attention

Increased irritability

Withdrawal

Angry outbursts

Aggression

> Increased physical complaints (e.g., headaches, stomachaches, aches and pains)
> Changes in school performance.
> Lack of interest in usual activities, including interest in playing with friends
> Regressive behaviors in young children (e.g., baby talk, bedwetting, tantrums)
> Increased chance of high-risk behaviors in adolescents (e.g., drinking, substance abuse, self- injurious behaviors.

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Understanding the spectrum of Suicidal Ideation: Differentiating between passive and active suicidal ideation 

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Understanding the spectrum of Suicidal Ideation: Differentiating between passive and active suicidal ideation 

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https://www.biltmorecounseling.com/anxiety/the-difference-b-n-passive-and-active-suicide-ideation/

https://theswaddle.com/suicidal-ideation-exists-on-a-spectrum-and-might-involve-no-plans-to-die/

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The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Affiliations

¹ Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

² Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

Free PMC article

Abstract

Purpose: This study compared predictors of passive suicidal ideation (SI), active SI, and suicide attempt (SA) among elderly Thai patients in tertiary care settings.

Patients and methods: Psychiatric diagnoses and suicidality of 803 older people were assessed using the Mini-International Neuropsychiatric Interview and the Structured Clinical Interview for DSM-IV-TR. All participants completed the Montreal Cognitive Assessment, multidimensional scale of perceived social support (MSPSS), 15-item Thai geriatric depression scale (TGDS-15), 10-item perceived social scale and the Core Symptoms Index. The chi-square test, t-test and ANOVA were used for bivariate analysis of predictors of specific suicidality types. Multiple logistic regression was used to determine the predictors for each type of suicidality.

Results: The patients' mean age was 69.24 ± 6.90 years, and the majority were female (69.74%). Passive SI, active SI and SA were found among 20.42%, 3.74% and 2.37%, respectively, of the patients. Major depressive disorder (MDD) was a predictor of both passive and active SI (OR = 2.06 and 3.74, respectively). Other predictors of passive SI included hypomania (OR = 8.27) and positive score on the TGDS-15 (OR = 1.29). Predictors of active SI included agoraphobia (OR = 6.84) and hypomania (OR = 7.10). Predictors of SA included a family history of alcohol dependence (OR = 14.16), a history of depression (OR = 4.78) and agoraphobia (OR = 19.89). Surprisingly, hypertension and self-reported anxiety symptoms were protective factors for passive SI (OR = 0.51 and 0.85, respectively). Likewise, MSPSS was a protective factor for SA (OR = 0.90).

Conclusion: Predictors of each type of suicidality differed. MDD was the main predictor for SI; however, agoraphobia and poor perceived social support were more pronounced among individuals with SA. Further investigation, especially in longitudinal fashion, should be warranted.

Keywords: elderly; predictor; risk; suicide.

Conflict of interest statement

The authors report no conflicts of interest in this work.

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References

Organization WH. Distribution of suicides rates (per 100000) by gender and age. Available from: https://www.who.int/mental_health/prevention/suicide/suicide_rates_chart.... Accessed August15, 2019.

Organization WH. Preventing suicide: a global imperative. Available from: https://www.who.int/mental_health/suicide-prevention/world_report_2014/en/. Accessed 15August 2019.

Sheehan DV, Lecrubier Y, Sheehan KH, et al. The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(Suppl 20):22-33;quiz34-57. - PubMed

Kittirattanapaiboon P, Khamwongpin M. The validity of the mini international neuropsychiatric interview (MINI)-Thai version. J Mental Health Thailand. 2005;13(3):125-135.

Stolz E, Fux B, Mayerl H, É R, Freidl W. Passive suicide ideation among older adults in Europe: a multilevel regression analysis of individual and societal determinants in 12 countries (SHARE). J Gerontol B Psychol Sci Soc Sci. 2016;71(5):947-958. doi:10.1093/geronb/gbw041 - DOI - PMC - PubMed

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national center for biotechnology information

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Predictors of Passive and Active Suicidal Ideation and Suicide Attempt Among Older People: A Study in Tertiary Care Settings in Thailand - PubMed

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The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site. The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

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Modify lesson plans. They may have to be adapted over the recovery period to reduce the class’s workload, move at a slower pace, and be more enjoyable.

Communicate with students. Be open to talking with students about their feelings and concerns about the hurricane. It is important to provide accurate factual information to help clarify misunderstandings and reduce fear. End the discussion with focus on current safety procedures and helpful plans for coping.

Know your students’ experiences. It is important to invite students and parents to let you know when a student is affected by some change in his or her personal life so that you can better understand any change in classroom behavior or school performance.

Share information with others. It is important for teachers to speak with one another and other school staff to share information and monitor how students are doing.

Provide structure. Maintain a predictable, structured class schedule with specific rules and consequences to provide support and consistency for your students.

Refer distressed students for help. Teachers should encourage distressed students to meet with the school counselor, social worker, or nurse.

Encourage your students. Teachers should encourage students to get appropriate rest and exercise and to eat a healthy diet.

Be patient. Recovery comes in stages over weeks and months. Don’t become discouraged because some students take more time than others or have temporary setbacks.

Promote prosocial activities. It is very important to engage preadolescents and adolescents in prosocial activities to help rebuild their school community and social life. Prosocial activities are important to building a sense of community and citizenship. These activities can include a project to help improve their school or neighborhood or a project to help others in their community.

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https://youtube.com/playlist?list=PLOMRb_Q39wPzkEwJlb2RP3Q5KCGVgDGMM

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Share your videos with friends, family, and the world

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Teacher Guidelines for Helping Students after a Hurricane

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Teacher Guidelines for Helping Students after a Hurricane

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https://www.nctsn.org/sites/default/files/resources//teachers_guidelines_talking_students_after_hurricanes.pdf

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Teacher Guidelines for Helping Students after an Earthquake

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Teacher Guidelines for Helping Students after an Earthquake

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https://www.nctsn.org/sites/default/files/resources//teachers_guidelines_talking_students_after_earthquake.pdf

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Teacher Guidelines for Helping Students after a Tornado

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Teacher Guidelines for Helping Students after a Tornado

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https://www.nctsn.org/sites/default/files/resources//teachers_guidelines_talking_students_after_tornadoes.pdf

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While any child can become a victim of sexual abuse, younger children, girls, and children with disabilities are especially susceptible.
Parental neglect, lack of family support, poverty, homelessness, and living in a community with high levels of violence are also risk factors.

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Children who have been sexually abused are at increased risk for depression, suicide, drug and alcohol abuse, sexually transmitted infections, early pregnancy, and sexualized acting out.

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Unexplained changes in behavior, such as aggression, social withdrawal, nightmares, disturbed sleep, or bedwetting.
Age-inappropriate sexual behavior, such as sexualized talk, inappropriate touching, or masturbation.
Unexplained decrease in focus and attention.

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Report suspected abuse to the lawful authorities.
Referral to therapeutic and case management services.
Allow the student to leave class and go to a safe place when needed.
Teaching mindfulness, relaxation, and self-soothing techniques to manage emotions.

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This report from UNICEF summarizes the evidence on the effectiveness of various responses.

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(*) Seven ways to support children with traumatic grief at school

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(*) Seven ways to support children with traumatic grief at school

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WHAT CAN WE DO IN THE SCHOOL ENVIRONMENT? – SEVEN WAYS TO SUPPORT A CHILD OR YOUNG PERSON

1. Recognise

Recognise that the child or young person will be dealing with both the impact of trauma as well as traumatic grief. Alter classroom expectations to allow a child to deal with their grief.

1. Respect

Grieving is an individual process and respect needs to be given to the unique experiences and the different ways a child and young person may express their grief. The school may have more than one child from each family, and so there may need consideration given to this.

1. Relationships

Caring and connected relationships are important in supporting the child or young person to grieve. It’s critical to recognise the age and stage of the child while remembering that traumatised children/young people may be operating at a younger developmental age which may impact on their understanding of death and reactions to grief.  Ensure that relationships within the school that are safe, supportive and important to the child are maintained and prioritised… making them as available as possible…

1. Reassure

Children and young people may have difficulty understanding and articulating their feelings and understanding the feelings of others. Hence, they attempt to understand their experience of loss from their own frame of reference. It is important to actively listen to the child, reassure them that they are loved, care for them and keep them safe. Make time in the school day to reassure, listen and care for these students.

1. Routines

As much as possible children and young people should be able to continue with their regular routines.   At school, focus on providing consistency, predictability and safety.

1. Remembering

Allow the child or young person to choose special ways to remember the person who has died. Perhaps they would like to write a poem or draw a picture or make a memory box.

1. Refer

Seek to refer the child or young person and their family if additional support is needed. Traumatic grief treatment integrates trauma and grief-focused interventions to help manage trauma symptoms and typical grief processes.

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This blog post is written by Carolyn Grace, Senior Training Consultant, School Services Program.
"Hi my name is James, I'm thirteen and at this camp, I am remembering my foster mum who took her life..."
Those words pierced my heart as I listened to James introduce himself at a grief and loss camp for children and young people. At this particular camp, there were many children who had a foster or grandparent carer die.

Many of the deaths experienced were traumatic; due in part to because of the circumstances in which they died. Tragically, some of these had been either homicides and suicides.

As a Camp Leader and Mentor, as well as in my previous work as a School Counsellor and now as a Senior Training Consultant, I have seen or heard about the impact of traumatic grief in the lives of many children and young people.

For these young people who are already dealing with trauma in their lives from either abuse, family violence or neglect, dealing with an additional traumatic event such as a death of a carer is devastating and adds another layer of grief and loss to their traumatic lives.

Traumatic grief can be defined as

The concept of a person suffering from grief because of a death, which may have been sudden, violent or unexpected

The traumatic distress from the death that can interfere with a normal or typical grief response

WHAT WE MAY SEE IN CHILDREN AND YOUNG PEOPLE - UNDERSTANDING THE IMPACT
Coupled with dealing with trauma reminders of their original trauma experiences such as intense fear, helplessness and hypervigilance, experiencing the traumatic death of a parent or caregiver evokes a further sense of fear and disenfranchisement. This is because of the shame, alienation and labelling that is associated with the loss. It has been said "you may have grief without much trauma, but you can never have much trauma without grief. Ignoring the trauma component of grief, or the grief component of trauma, is surely negligent" (Simpson, 1997 p. 6)

Other characteristics of traumatic grief include:

Self-blame, anger, deep sadness, which can be internalised or externalised - "was it my fault that they died?"

A shattered view of themselves and the world - a lost sense of security, trust or control - "I am unlovable, everyone leaves"

A sense of powerlessness, which is overwhelming and overpowering

A sense of loss and betrayal

Stigmatisation

Dissociation, detachment or absence of an emotional response.

Wanting to either reenact the trauma or avoid all reminders of what has happened

Preoccupation with the person who has died (yearning, longing or searching)

Difficulties in their social, emotional and relational functioning

(Jacobs, 1999; Kail & Cavanaugh, 2007; Lewis-Herman, 2001; Sweeney, 1997)

In addition to this, children and young people are triggered by loss reminders and change reminders. Loss reminders cue the child to remember the person who died. Listening to people talk about the person who has died, seeing pictures or navigating celebrations such as Christmas, Mother's or Father's Day or Grandparents Day, may have a significant impact.

Change reminders are cues that prompt thoughts about how their way of life or identity has changed. The child may think, "Do I have to move house again?", "Who's going to care for me now?" "What if I lose that person too?"
WHAT CAN WE DO IN THE SCHOOL ENVIRONMENT? - SEVEN WAYS TO SUPPORT A CHILD OR YOUNG PERSON
Recognise that the child or young person will be dealing with both the impact of trauma as well as traumatic grief. Alter classroom expectations to allow a child to deal with their grief.

Grieving is an individual process and respect needs to be given to the unique experiences and the different ways a child and young person may express their grief. The school may have more than one child from each family, and so there may need consideration given to this.

Caring and connected relationships are important in supporting the child or young person to grieve. It's critical to recognise the age and stage of the child while remembering that traumatised children/young people may be operating at a younger developmental age which may impact on their understanding of death and reactions to grief. Ensure that relationships within the school that are safe, supportive and important to the child are maintained and prioritised... making them as available as possible...

Children and young people may have difficulty understanding and articulating their feelings and understanding the feelings of others. Hence, they attempt to understand their experience of loss from their own frame of reference. It is important to actively listen to the child, reassure them that they are loved, care for them and keep them safe. Make time in the school day to reassure, listen and care for these students.

As much as possible children and young people should be able to continue with their regular routines. At school, focus on providing consistency, predictability and safety.

Allow the child or young person to choose special ways to remember the person who has died. Perhaps they would like to write a poem or draw a picture or make a memory box.

Seek to refer the child or young person and their family if additional support is needed. Traumatic grief treatment integrates trauma and grief-focused interventions to help manage trauma symptoms and typical grief processes.

Are you interested in learning with us? If you would like to find out more about the great courses and workshops we have on offer, click here!
Resources
If you would like further information on how you can support a child or young person, please check out these websites.
Australian Centre for Grief and Bereavement https://www.grief.org.au The National Centre for Childhood Grief https://childhoodgrief.org.au/ Winston's Wish, UK https://www.winstonswish.org/ References
Cohen, J.A., Mannarino, A.P., & Deblinger, E., (2017). Treating Trauma and Traumatic Grief in Children and Adolescents, Second Edition. The Guildford Press: New York

Dillon, I. (1994). Exploring grief with your child. Pal Alto: Enchante Publishing.

Dyregrov, A., & Dyregrov, K. (2012). Complicated grief in children. In Stroebe, M., Schut, H., van den Bout, J., & Boelen, P. (Eds.). Complicated grief: Scientific foundations for health care professionals. (pp. 68-81). London, UK: Routledge.

Hall, C. Understanding of loss and grief in children. Community Paediatric Review, 11 (3) December 2002 (pp 1 - 4).

Horowitz, M.J., Siegel, B., Holen, A., Bonnano, G.A., Milbrath, C., & Stinson, C.H., (1997). Diagnostic disorder for complicated grief disorder. American Journal of Psychiatry, 154.

Jacobs, S. (1999). Traumatic Grief: Diagnosis, Treatment and Prevention. Bruner/Mazel: New York

Kail, R., & Cavanaugh, J. (2007). Human Development - A life-span view. Belmont: Thomson Higher Education.

Lewis - Herman, J. (2001). Trauma and recovery. London: Pandora

Mannarino, A. P., & Cohen, J. A. (2011). Traumatic loss in children and adolescents. Journal of Child & Adolescent Trauma, 4, (pp 22-33).

Simpson, M.A. (1997). Traumatic bereavements and death-related PTSD. In Figley, C.R., Bride, B.E., & Mazza, N. (eds) Death and trauma: the traumatology of grieving, (pp 3 - 16). Washington, DC: Taylor & Francis

Stroebe, M.S., Hansson, R.O., Stroebe, W., & Schut, H. (Ed.) (2001). Handbook of Bereavement Research. American Psychological Association. Washington DC.

Sweeney, D. (1997). Counselling children through the world of play. Eugene: Wipf and Stock Publishers.

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Seven ways to support children with traumatic grief at school - Australian Childhood Foundation Professionals

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This blog post is written by Carolyn Grace, Senior Training Consultant, School Services Program. "Hi my name is James, I'm thirteen and at this camp, I am remembering my foster mum who took her life..." Those words pierced my heart as I listened to James introduce himself at a grief and loss camp for ...

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Suggestions for helping different age groups

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Suggestions for helping different age groups

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Tips for Specific Age Groups
Preschool

Avoid euphemisms as preschoolers have trouble understanding death and may believe the death is reversible.

Provide opportunities to express thoughts and feelings about death through play activities and drawing.

Answer questions using concrete descriptions and be prepared to repeatedly answer questions.

Possible reactions include:

Crying or screaming

Clinging to caregivers or other trusted adults

Fear of separation

Regressive behaviors such as wetting pants and thumb sucking

Decreased verbalization

Elementary School

These students may ask questions and seek to try to understand what happened. Be patient and refer them to adults that can answer their questions.

Students below the age of eight may engage in magical thinking and believe they could have prevented the death. Recognize these feelings and fears but do not validate them.

Students ages nine through twelve may feel less comfortable showing feelings and seeing expressions of grief in others. Make sure to provide these students with a variety of ways to express grief.

Possible reactions include:

Behavioral difficulties

Decreased concentration

Poor school performance

Depression

Irritability

Withdrawal

Somatic complaints (headaches & stomachaches)

Middle and High School

Do not force students to share their feelings with others, including their peers if they do not feel comfortable. Provide them with opportunities to share their feelings privately.

Students often seek support via social media. Be aware of what is being posted and shared. Encourage students to seek support for a friend in need.

Students in their mid-to-late teens tend to feel more comfortable expressing their feelings and grief similar to adults.

High school students may use physical contact to show their support and empathy (e.g., hugging or touching the arm)

Possible reactions include:

Poor school performance

Anxiety

Depression

High risk behaviors or substance use

Emotional numbing

Suicidal thoughts

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National Association of School Psychologists (NASP)

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School-based support and increased understanding are essential when a student experiences the death of a friend or loved one. While each student will be affected differently depending on his or her developmental level, cultural beliefs, personal characteristics, family situation, and previous experiences. There are some strategies that can be helpful in supporting bereaved students.

General Tips to Support Students of All Ages

Be understanding and tolerant of common grief reactions which include: decreased appetite, difficulty sleeping, a decreased ability to concentrate, increased sadness, and social withdrawal. Students sometimes also feel anger toward the deceased for leaving them.

Be simple and straightforward. Discuss death in developmentally appropriate terms for students.

Use words such as "death," "die," or "dying" in your conversations and avoid euphemisms such as "they went away," "they are sleeping," "departed," and "passed away." Such euphemisms are abstract and may be confusing, especially for younger children.

Let students know that death is not contagious. Although all human beings will die at some point, death is not something that can be "caught" and it is unusual for children to die.

Be brief and patient. Remember that you may have to answer the same question multiple times and repeat key information to ensure understanding.

Listen, acknowledge feelings, and be nonjudgmental.

Express your own feelings in an open, calm, and appropriate way that encourages students to share their feelings and grief.

Avoid making assumptions and imposing your own beliefs on students.

A variety of feelings are normal. Be sensitive to each student's experience, as there is no one right way to respond to a loss. Feelings and behaviors will vary across students and will change throughout the bereavement process.

Normalize expressed feelings by telling students such are common after a death. However, if their expressions include risk to self (e.g. suicidal thoughts) or others, refer immediately to the appropriate professionals.

Be sensitive to cultural differences of students and their families in expressing grief and honoring the dead.

Consider a student's intellectual abilities, behavior, and conceptual understanding of death. For children with developmental disabilities. Their limited communication skills do not mean they are unaffected by the death. Behaviors such as increased frustration and compulsivity, somatic complaints, relationship difficulties, and increased self-stimulatory behaviors may be expressions of grief.

Maintain a normal routine in your classroom and engage students in activities they previously enjoyed.

Provide the opportunity to talk and ask questions and use these questions to guide further discussion. Encourage students to share feelings, but in ways that are not disruptive to the class or hurtful to other students.

Keep in mind that some children may have a difficult time expressing their feelings or may not feel comfortable talking at school. Do not pressure these students to talk. Some may prefer writing, drawing, listening to music, or playing a game instead of talking about their feelings. Provide students with a variety of options for expressing grief.

Talk to the bereaved student's classmates about grief and emphasize the importance of being understanding and sensitive.

Help bereaved students find a peer support group. There will likely be other who have also experienced the death of a loved one.

Tips When the Whole School is Affected by a Teacher or Student Death

A letter and/or direct communication via email should be sent home to all parents on school letterhead informing them of the death. Information to include in the communication:

Facts about the death to dispel rumors

Discussion of the range of feelings and reactions that may occur throughout the grief process

Guidance about talking to their children about the death

Indicators of the need for mental health counseling

Direction on how to contact the school if they have questions or believe their child may benefit from counseling

Direction on how to obtain community resources

Share factual information with staff (through meetings and bulletins), students (through class announcements and meetings), and parents (through letters/email). Regularly provide them with relevant updates.

Provide teachers with guidelines on how to share information about the death with their students and establish referral procedures for students requiring additional support.

Pay close attention to students who have experienced recent deaths or key life changes, witnessed the death, or have emotional problems.

Tips for Specific Age Groups

Preschool

Avoid euphemisms as preschoolers have trouble understanding death and may believe the death is reversible.

Provide opportunities to express thoughts and feelings about death through play activities and drawing.

Answer questions using concrete descriptions and be prepared to repeatedly answer questions.

Possible reactions include:

Crying or screaming

Clinging to caregivers or other trusted adults

Fear of separation

Regressive behaviors such as wetting pants and thumb sucking

Decreased verbalization

Elementary School

These students may ask questions and seek to try to understand what happened. Be patient and refer them to adults that can answer their questions.

Students below the age of eight may engage in magical thinking and believe they could have prevented the death. Recognize these feelings and fears but do not validate them.

Students ages nine through twelve may feel less comfortable showing feelings and seeing expressions of grief in others. Make sure to provide these students with a variety of ways to express grief.

Possible reactions include:

Behavioral difficulties

Decreased concentration

Poor school performance

Depression

Irritability

Withdrawal

Somatic complaints (headaches & stomachaches)

Middle and High School

Do not force students to share their feelings with others, including their peers if they do not feel comfortable. Provide them with opportunities to share their feelings privately.

Students often seek support via social media. Be aware of what is being posted and shared. Encourage students to seek support for a friend in need.

Students in their mid-to-late teens tend to feel more comfortable expressing their feelings and grief similar to adults.

High school students may use physical contact to show their support and empathy (e.g., hugging or touching the arm)

Possible reactions include:

Poor school performance

Anxiety

Depression

High risk behaviors or substance use

Emotional numbing

Suicidal thoughts

References:

Black, S. (2005). Research: How teachers and counselors can reach out to bereaved students. When children grieve. American School Board Journal, 192, 28-30. Retrieved from http://www.asbj.com/

Brown, J. A., Jimerson, S. R., & Comerchero, V. A. (2014). Cognitive development considerations to support bereaved students: Practical applications for school psychologists. Contemporary School Psychology. Advance online publication. doi:10.1007/s40688-014-0018-6

Dogan-Ates, A. (2010). Developmental differences in children's and adolescents' post-disaster reactions. Issues in Mental Health Nursing, 31, 470-476. doi:10.3109/01612840903582528

© 2015, National Association of School Psychologists, 4340 East West Highway, Suite 402, Bethesda, MD 20814, 301-657-0270, www.nasponline.org

Please cite this document as:

NASP School Safety and Crisis Response Committee. (2015). Addressing grief: Tips for teachers and Administrators. Bethesda, MD: National Association of School Psychologists. Bethesda, MD: National Association of School Psychologists.

Contributors: Benjamin S. Fernandez MSEd, Victoria A. Comerchero NCSP, Jacqueline A. Brown NCSP, Catherine Woahn, NCSP

Note. Schools and community agencies may adapt this handout to local needs for educational and student support purposes as long as proper credit is given to NASP.

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Addressing Grief: Tips for Teachers and Administrators

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School-based support and increased understanding are essential when a student experiences the death of a friend or loved one.

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(@) Traumatic Grief: How to Cope &  When to Get Help

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(@) Traumatic Grief: How to Cope &  When to Get Help

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While this goes beyond students and deals with people of all ages, at the bottom of the page there is also a link to another page about ADHD and Trauma that matches well with my experience. Younger students, in particular, are unlikely to be able to recognize when they need help, so it becomes incumbent upon others to recognize the symptoms.

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Clues that a Student is Contemplating Suicide and How to make them talk More 

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Clues that a Student is Contemplating Suicide and How to make them talk More 

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https://childmind.org/article/signs-a-child-might-be-suicidal/

https://www.nimh.nih.gov/health/publications/warning-signs-of-suicide

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Signs a Child Might Be Suicidal

What to watch out for and how to help

Rachel Ehmke

Some young people who are thinking about suicide let people close to them know that they are in pain and are open about needing help. Others hide their feelings from family and friends. If you are wondering if your child is suicidal, experts say that asking him is the best way to find out.

Parents sometimes worry that asking about suicide may make it more likely, but that actually isn't the case, and asking is very important. For children who have a hard time admitting they need help, it sends the message that a parent cares very much about them, and that struggling and asking for help is okay. That conversation can be lifesaving.

While asking is the best way to find out, there are also some warning signs to watch out for if you are worried about suicide, including the following:

Isolation from friends and family

Problems eating or sleeping

Mood swings

Reckless behavior

Dropping grades

Increased use of alcohol or drugs

Giving away belongings

Talking about feeling hopeless or trapped

Talking about being a burden to others or not belonging

Talking about suicide or wanting to die

Writing or drawing about suicide, or acting it out in play

There are also some risk factors that may make some people more vulnerable to suicide, like a family history of suicide, bullying and access to things like firearms and pills. Struggling with a mental health disorder or alcohol and substance abuse can also be factors. Learn more about risk factors and protective factors here.

If your child has any of the warning signs above, ask her if she is thinking about suicide. If you are worried that she may attempt suicide, call 911. Experts agree that suicidal thoughts should always be taken seriously.
Learn about a form of OCD in which people obsess over the idea of suicide, but are not actually suicidal.

Get tips, articles, and insights about children's mental health and learning disorders.

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Signs a Child Might Be Suicidal - Child Mind Institute

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Lo sentimos, la página que usted busca no se ha podido encontrar. Puede intentar su búsqueda de nuevo o visitar la lista de temas populares. What to watch out for and how to help Rachel Ehmke Some young people who are thinking about suicide let people close to them know that they are in pain and are open about needing help.

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It is defined as the "deliberate and unsolicited" victimization of one's peers, that includes the physical, cyber or social (online), and verbal (NCTSN, n.d.).  The act of bullying can affect a student across the board--such as their academics. And signs to look out are anxiety, isolation, and/or school avoidance, for instance.

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Pediatric medical traumatic stress refers to a set of psychological and physiological responses of children and their families to pain, injury, serious illness, medical procedures, and invasive or frightening treatment experiences. Medical trauma may occur as a response to a single or multiple medical events.

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The National Child Traumatic Stress Network

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Children's responses to medical trauma are often more related to their subjective experience of the medical event rather than its objective severity.

The following resources on Medical Trauma were developed by the NCTSN.

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Pediatric medical traumatic stress refers to a set of psychological and physiological responses of children and their families to single or multiple medical events.

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traumatic stress reactions can:

Impair day-to-day functioning

Affect adherence to medical treatment

Impede optimal recovery

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The National Child Traumatic Stress Network

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Children's responses to medical trauma are often more related to their subjective experience of the medical event rather than its objective severity. Reactions vary in intensity and can be adaptive or may become disruptive to functioning. The majority of pediatric patients and their families are resilient and do well.

Many ill or injured children and their families (up to 80%) experience some traumatic stress reactions following a life-threatening illness, injury, or painful medical procedure. Between 20 - 30 % of parents and 15 - 25% of children and siblings experience persistent traumatic stress reactions that impair daily functioning and affect treatment adherence and recovery. When they persist, traumatic stress reactions can:

Impair day-to-day functioning

Affect adherence to medical treatment

Impede optimal recovery

There are three main types of traumatic stress reactions:

Re-experiencing. Re-experiencing means that the child keeps thinking a lot about the trauma, even when he does not want to. Some re-experiencing is normal and natural. Thinking a lot about what happened, especially at first, is part of how we help ourselves recover from a scary experience.Too much re-experiencing can be very distressing. A child might have nightmares or "flashbacks" that make her feel like she is going through the trauma all over again. She may feel really upset or even have physical symptoms when something - a sight, a sound, a smell - reminds her of what happened.

Avoidance. Avoidance symptoms can start by trying not to think or talk about the trauma, or anything connected with it. Sometimes kids want to stay away from people, places or activities because these reminders upset them. And children sometimes develop new fears or worries. Of course, it can be good common sense to be more cautious after an injury. Children may become more aware of safety - remembering to wear a seat belt, not running into the street after a ball, or staying away from dogs they do not know. But extreme avoidance or fears can become a real problem. Avoidance can interfere with daily life and stop a child from getting back to enjoying things that she usually likes to do.

Hyper-arousal. Hyper-arousal also starts with a natural and normal response to danger, the "fight or flight response." After an injury or accident, this "fight or flight" response might not turn off, even when the child is safe. After a scary situation like being injured, a child might have the feeling that something bad could happen again at any time, or he might jump at any loud noise. The physical feelings that go along with hyper-arousal (e.g., heart racing) can feel scary themselves.

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Children's responses to medical trauma are often more related to their subjective experience of the medical event rather than its objective severity. Reactions vary in intensity and can be adaptive or may become disruptive to functioning.

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*Initial symptoms
*Delayed symptoms
*General Symptoms
Initial symptoms

Some people experience symptoms of trauma immediately after the triggering event. Initial symptoms may include:

Emotional responses, such as anger and sadness

Anxiety and hyperactive behaviors, including impulsiveness, aggressiveness, and an inability to concentrate

Confusion

Extreme tiredness

Dissociation (becoming disconnected from one’s environment, memory, and identity)

And less commonly,

Prolonged dissociation

An inability to rest or settle for an extended period

Constant intrusive thoughts and memories

Delayed symptoms

Some people may not experience noticeable symptoms right away and have a delayed response to medical trauma. Delayed symptoms often include:

Consistently sleeping at inappropriate times

Repetitive dreams

Diagnosed sleep disorders

Avoidance symptoms

Depression

Re-experiencing symptoms

General symptoms

You may experience other signs of medical trauma at any time after a traumatic event or experience. General symptoms of medical trauma include:

Emotional responses, such as anxiety, depression, self-harm, and feelings of guilt. Issues with substance abuse and gambling are related to these emotional responses

Physical symptoms, can be highly variable and include stomach and gut problems, sleep issues, breathing problems, skin issues, and more

Behavioral symptoms include repeatedly reliving and reenacting the trauma, avoiding medical settings and triggering places, and self-harm

Cognitive/mental symptoms, such as dissociation, flashbacks, and poor memory

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Frequently asked questions about medical trauma 

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Frequently asked questions about medical trauma 

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Can medical trauma cause PTSD?

Trauma is an individual experience. The magnitude of a traumatic experience’s effect on a person’s life (or whether it has any effect at all) varies. Most people who experience medical trauma, or any other type of trauma, won’t go on to develop PTSD. Unfortunately, some do. In cases of PTSD, symptoms are prolonged and interfere with daily functioning. If you’re experiencing any signs of medical trauma, schedule an appointment to see your healthcare provider. If you’re in crisis, call 911 immediately.

Who experiences medical trauma?

Anyone can experience medical trauma. It can develop in people of any age, gender, socioeconomic class, ethnicity, and so on. That said, some people, including children, people with lower incomes, and minority groups, may be more likely to have unfavorable medical experiences that may trigger medical trauma or PTSD.

How can I cope with medical trauma?

Fortunately, many treatment options exist for people experiencing PTSD and medical trauma. Some people may need medication, but healthcare providers recommend therapy as the first line of defense.

Different therapies can help regulate emotional responses, learn coping skills, and desensitize a person to minimize their body’s response to triggers.

One form of therapy that can help people with medical trauma is trauma-focused cognitive behavior therapy (TF-CBT). TF-CBT helps people process their traumas and triggering factors to respond more appropriately and develop better-coping skills.

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Top 10 Interventions for Working with Traumatized Students

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Top 10 Interventions for Working with Traumatized Students

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Top 10 interventions with traumatized students

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When teachers are proactive and responsive to the needs of students suffering from traumatic stress and make small changes in the classroom that foster a feeling of safety, it makes a huge difference in their ability to learn.

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Vol. 77

No. 2

Abstract

1. Expect Unexpected Responses

2. Employ Thoughtful Interactions

3. Be Specific About Relationship Building

4. Promote Predictability and Consistency

5. Teach Strategies to "Change the Channel"

6. Give Supportive Feedback to Reduce Negative Thinking

7. Create Islands of Competence

8. Limit Exclusionary Practices

Fostering a Feeling of Safety

Small changes in classroom interactions can make a big difference for traumatized students.

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Credit: Shannon Fagan

Abstract

1. Expect Unexpected Responses

2. Employ Thoughtful Interactions

3. Be Specific About Relationship Building

4. Promote Predictability and Consistency

5. Teach Strategies to "Change the Channel"

6. Give Supportive Feedback to Reduce Negative Thinking

7. Create Islands of Competence

8. Limit Exclusionary Practices

Fostering a Feeling of Safety

Up to two-thirds of U.S. children have experienced at least one type of serious childhood trauma, such as abuse, neglect, natural disaster, or experiencing or witnessing violence. Trauma is possibly the largest public health issue facing our children today (CDC, 2019). Traumatized students are especially prone to difficulty in self-regulation, negative thinking, being on high alert, difficulty trusting adults, and inappropriate social interactions (Lacoe, 2013; Terrasi & de Galarce, 2017). They often haven't learned to express emotions healthily and instead show their distress through aggression, avoidance, shutting down, or other off-putting behaviors. These actions can feel antagonistic to teachers who don't understand the root cause of the student's behavior, which can lead to misunderstandings, ineffective interventions, and missed learning time.

Neurobiologically, students can't learn if they don't feel safe, known, and cared for within their schools (Aupperle et al., 2012). When teachers are proactive and responsive to the needs of students suffering from traumatic stress and make small changes in the classroom that foster a feeling of safety, it makes a huge difference in their ability to learn. Here are some examples.

1. Expect Unexpected Responses

First, teachers must learn to put students' reactions into context-and not to take them personally. Students with trauma histories can react and behave in seemingly unexpected ways, such as having a sudden outburst during a favorite activity or crying out of the blue one second after laughing. Teachers may be taken by surprise. They say things like, "But he was fine this morning, I didn't see that coming!" or "She normally loves playing the drums in music class. I have no idea where her reaction came from." This uncertainty leaves the teacher in a constant state of hyper-alertness when interacting with the student. This in turn can result in fatigue, as the teacher is guarded and unable to predict what will happen from one moment to another.

One way to understand these reactions is to think of the student as a soda can, and events that may trigger their trauma stress as shaking that can. We can't tell by looking if the can was recently shaken, but if it was, opening the can results in an unexpected explosive, messy reaction. If a student is triggered and experiencing heightened emotion, even a benign direction such as, "Please move over to make room for Jenny" could result in an "explosion" that the teacher never saw coming. By using trauma-sensitive strategies in the classroom, we can help reduce the times our students are "shaken."

2. Employ Thoughtful Interactions

Traumatized students often behave in ways that may interfere with teaching and learning, which can be frustrating. Teachers are in a position of power, and these students may be overly defensive, anticipating adult criticism, or defiant, as a way to assert control (Jennings, 2018). Yet for traumatized students, the ability to learn and behave appropriately can be person-dependent. When they are with a safe and supportive adult, their behavior reflects that.

Consider this scenario drawn from schools I've worked with: Trevor, a 6th grader whose father overdosed on heroin two years ago and who has witnessed ongoing domestic abuse throughout his childhood, was in Ms. Carlton's class for part of the day and Ms. Finch's class for the other part. Ms. Carlton had a reputation of working well with hard-to-reach kids, and sure enough, Trevor behaved in a stellar way in her class. When he was with Ms. Finch, however, he was sent to the office nearly three times a week for explosive behavior.

The teacher is 50 percent of every interaction with a student: By changing the way we give a direction or respond, we can reduce problematic behavior. Ms. Carlton had taken the time to build a trusting relationship with Trevor and learned to give directions in a way that he would respond well to. Interaction strategies are a type of accommodation that typically go unnamed and unwritten, but they were the reason that Trevor could feel safe and access the curriculum (Minahan & Rappaport, 2012).

If Ms. Carlton had written down the successful strategies she used with Trevor, the list might have started with avoiding authoritative directives such as, "Pick that up." To give Trevor a sense of control, Ms. Carlton always embedded choice in her directions, asking, "Do you want to be in the front of the line or the back of the line?" instead of simply telling him to "line up." This helped prevent a poor reaction (Minahan, 2019).

Ms. Carlton also conveyed respect and transparency by providing the reason behind each direction. Instead of saying, "No backpacks on the floor. I don't want to trip and fall!" Ms. Carlton would say, "Oh dear, I hope I don't fall. I have a bad knee! Could you please move your backpack?" Stating the reason first assured that Trevor knew the context (and necessity) of the demand.

Conversely, Ms. Finch would often go up close to Trevor, tower over him, and say in front of his peers, "Stop tapping your pencil!" This typically ended in a power struggle and Trevor's escalating behavior. Trevor, like many traumatized students, had experienced a loss of control in his life, and power struggles with an authoritative figure were particularly triggering. Ms. Carlton instinctively knew that a more private nonverbal direction could be less confrontational for a student in "fight or flight" mode. She would write, "Please stop tapping" on a piece of paper, put it gently on Trevor's desk without his peers noticing, and then give him space by walking away quickly. When possible, she also gave Trevor extended time to comply with directions to avoid power struggles, asking, for example, "Can you please pick that up before lunch?" rather than, "Pick that up now" (Minahan, 2019). This allowed Trevor time to decompress and respond rationally.

3. Be Specific About Relationship Building

At one point in the year, Ms. Carlton told Ms. Finch that building a relationship with Trevor was key to her success with him, and she suggested that Ms. Finch do the same. Unfortunately, saying, "Build a relationship" is too vague and leaves too much up to the teacher's instincts. Instead, Ms. Carlton could have told Ms. Finch that she greeted Trevor every day at the classroom door and asked him about the Avengers or basketball. She could have told Ms. Finch how she used the "two by ten" rule; she talked to him for two minutes a day for 10 days in a row about topics unrelated to academics or behavior. Whenever Ms. Carlton could see she wouldn't have time for this in the 10-day period, she asked the counselor or special education teacher to cover her class for two minutes so she could go for a walk with Trevor. She repeated this trust-building strategy several times throughout the year, especially after he exhibited anger or frustration and after school vacations and long weekends.

Ms. Carlton skillfully used relationship-building and interaction strategies to work with Trevor. Yet the impact could have been greater had she written and shared those strategies with Ms. Finch and the rest of Trevor's team via a shared document, behavior plan, or student success plan (Minahan, 2019). Likewise, if counselors, school nurses, and psychologists write and share such techniques with each classroom teacher, kids like Trevor, when triggered, wouldn't always have to leave class to find a safe adult.

Not knowing what is coming next can put anyone on high alert, especially traumatized students. Providing predictability through visual schedules of the class agenda or school day can help. Ms. Carlton was adamant about previewing any changes to the normal routine ahead of time (saying, "We are going to have indoor recess today because of the snow," or "The DVD player isn't working so we can't watch a science video at the end of class today"). This prepared Trevor and thus elicited a calmer response.

A teacher's behavior can also feel unpredictable to traumatized students. When students are working independently and quietly-doing what they are supposed to be doing-they don't know when they will get the teacher's attention. But when students are doing the wrong thing-like drumming on the desk with a pencil in each hand or swearing-teachers are more predictable and react quickly! Because predictability is comforting to students with anxiety and trauma histories, they may resort to getting the teacher's attention through inappropriate means. Trevor could get Ms. Finch to react immediately by flipping his water bottle noisily, but could go 20 minutes without so much as eye contact from her when he was quietly reading.

To counter this imbalance and create an overall feeling of safety, teachers can use predictable positive attention (Minahan, 2014). During independent work time, if a teacher says to a student "Great work! I'll be back to check on you," the student has no way of predicting how long they need to wait-and from past experience they know that the teacher may forget to return altogether. Using predictable positive attention, however, the teacher can say, "I am going to check on you in 10 minutes," put a timer on the student's desk, and add, "Come tap me on the shoulder when the timer goes off." If the teacher has many students in the class that could benefit from this, she could transfer the strategy to small groups: "I will check on this desk group at X time."

Another strategy for providing predictable attention, especially for middle and high school students, is to hand an anxious or traumatized student a sticky note with a time on it as they walk into class each day. The first time, the note will need to be explained: "If you don't understand something in class, please don't worry-I am going to check on you during independent work time at 11:45, and I will answer any questions you have then." Ms. Carlton found this strategy comforting to Trevor. This predictable check-in pairs the negative thoughts the student may have ("I don't know how to do this") with a reassuring thought ("But my teacher will be here in seven minutes!"). The student can better tolerate uncomfortable feelings when they know help and a positive interaction are coming. Telling the student what will happen and when and always following through establishes the teacher as a consistent, reliable adult.

5. Teach Strategies to "Change the Channel"

Traumatized students often engage in inaccurate thinking, tending to focus on the negative. Common classroom management strategies often only exasperate this tendency. How many of us have seen frequent movement breaks on a student's IEP or student success plan? It is one of the most common accommodations that we offer to students who seem dysregulated. Unfortunately, during these breaks, students can ruminate on negative memories, current stressors, angry thoughts, or worries. If we ask a high school student who is getting angry and becoming agitated to take a walk, he may ruminate the whole time and return just as angry. Sending a 1st grader to a "calming chair" can leave her to perseverate on worrying thoughts. Instead, we need to help them "change the channel." Both Ms. Carlton and Ms. Finch used breaks with Trevor, but in vastly different ways.

When adults can't sleep, we often read a book or watch TV, which distracts us from uncomfortable thoughts so we can fall back asleep. Teachers can use the same principle for kids with trauma and anxiety: Teach students that their brain is like a remote control that they can use to "switch the channel" to help them calm down (Minahan & Rappaport, 2012). These switching activities are called cognitive distractions or thought breaks and are incompatible with negative thinking. A listening center or "find the picture" activity can be helpful to young children. For older students, you might try Mad Libs, trivia, or more abstract strategies such as counting all the green items in the room, saying the alphabet backwards, or thinking of the first 10 lines of a favorite movie. Ms. Carlton taught Trevor to do Star Wars trivia when he was upset, which helped him calm down quickly. Conversely when Ms. Finch had Trevor go for a walk, his negative thinking would escalate, and he would often not return to class.

6. Give Supportive Feedback to Reduce Negative Thinking

Many traumatized students interpret information through a negativity amplifier. When a teacher says, "Please correct the first problem," the student might hear, "You are stupid." Or a student might report that the teacher screamed at her when the teacher was really using a calm tone, as even neutral facial expressions can be misinterpreted. It is helpful to smile and explicitly say when you are happy with the student, a strategy Ms. Carlton utilized. When giving negative feedback, teachers can use the positive sandwich approach-starting and ending with a positive comment: (1) "I love how you remembered the formula," (2) "You made a small calculation error there," (3) "Great job getting problem #3 correct."

7. Create Islands of Competence

Recognizing areas of strength in students is a powerful way to combat the poor self-concept and negative thinking associated with trauma (Jennings, 2018). To support a more accurate self-concept, teachers can provide what Robert Brooks calls "islands of competence" for students swimming in a sea of inadequacy (2003). When a student thinks negatively, the negative moments during the day tend to weigh more heavily than the positive moments. We need to counter this effect with positive experiences. Educator teams need to ask themselves, "Does the student feel competent during the day?" If the answer is no, contriving an island of competence for the student is in order. Ms. Carlton often asked Trevor to help a younger student or a peer who was struggling in an academic area Trevor was strong in, or had him fix the stapler when it was malfunctioning. She would also point out in a written note to Trevor that he was the first student to finish a math activity. In high school, educators may want to foster students' talents by never letting them drop electives (which might require creativity in scheduling academic support in core classes).

It is important that students experience competence to develop a more accurate self-narrative and to begin to create a positive future picture of themselves. We want them to say, "I really helped that student with her artwork. When I grow up, I could work with kids." Or "I am good at fixing things. I could be a mechanic someday."

8. Limit Exclusionary Practices

Behavior is communication, and we've looked at how traumatized students often communicate feelings through their behavior. Teachers' behavior is also communication-and it may not be communicating the message we are striving to send. Common teacher practices such as ignoring inappropriate behavior, sending students to the office, or sending younger kids to sit alone at a back table or in the hallway can unintentionally trigger students who have experienced abandonment or neglect. We need to remember that when some of our students were young and cried, no one came. Ignoring them can trigger a trauma response and make them feel the teacher doesn't like them or is even happy that they are upset.

Ms. Finch would ignore Trevor when he was expressing anger, such as by crumpling up a paper, growling, or slinging a book from his desk onto the floor. On the other hand, Ms. Carlton responded to such moments at the beginning of the year by validating Trevor's feelings ("I am sorry you are upset" or "I see that you are angry"). This is a much more empathetic approach, will preserve the relationship, and will avoid triggering a trauma response in the student.

Another practice to be cautious about is using time with a preferred adult as an incentive. For example, a principal might say, "If you get all your homework done this week, you and I will have lunch together!" The problem with this is that if the student doesn't get all their homework done, then the principal withholds their attention and time. This implies the relationship is conditional and can trigger an abandonment trauma response for some students. It is better to use one-to-one time with students in a noncontingent way. This way adults are communicating, "I like you for who you are," not "I like you when you behave the right way."

Fostering a Feeling of Safety

Students can't learn unless they feel safe. When it comes to student trauma, there is much that is beyond educators' power, but there is also a great deal they can do to build a supportive and sensitive environment where students feel safe, comfortable, take risks, learn, and even heal.

Reflect & Discuss

➛ As Minahan writes, "Students can't learn if they don't feel safe." What small changes are you willing to try in your classroom to foster a sense of safety among traumatized students?

➛ Think about one of your students who struggles with behavior. How could you help him "switch the channel" when he is upset?

➛ Do you routinely share-and exchange ideas about-what's working with a traumatized student? How could you better improve lines of communication across the whole support team?

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Let us help you put your vision into action.

We empower educators to reimagine and redesign learning through impactful pedagogy and meaningful technology use. We achieve this by offering transformative professional learning, fostering vibrant communities, and ensuring that digital tools and experiences are accessible and effective.

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Small changes in classroom interactions can make a big difference for traumatized students.

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PEDIATRIC MEDICAL TRAUMATIC STRESS: HOW TO ASSESS AND HELP - EMOTIONAL SUPPORT

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PEDIATRIC MEDICAL TRAUMATIC STRESS: HOW TO ASSESS AND HELP - EMOTIONAL SUPPORT

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HELPING A FAMILY WITH TRAUMATIC STRESS WHEN A CHILD HAS CANCER

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HELPING A FAMILY WITH TRAUMATIC STRESS WHEN A CHILD HAS CANCER

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The National Child Traumatic Stress Network

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Discusses an integrated approach to recognizing and responding to child and family traumatic stress when a child has cancer. This webinar explores the impact of the diagnoses and treatment on the child and family, discusses cultural considerations that may intersect with a family's response, and describes approaches for assessing, managing and treating traumatic stress.

Learning Center Instructions

To view on the Learning Center:

Click on the link above.

Select "Login to this site" if you already have a Learning Center account.

OR Select "create a new account" if you need to register.

Once you have registered and logged in, you will be able to view the course.

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Helping a Family with Traumatic Stress when a Child has Cancer

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Discusses an integrated approach to recognizing and responding to child and family traumatic stress when a child has cancer.

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AFTER THE HOSPITAL: GETTING BACK TO A SCHEDULE

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AFTER THE HOSPITAL: GETTING BACK TO A SCHEDULE

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 Talking to Children When Scary Things Happen

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 Talking to Children When Scary Things Happen

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When scary or violent things happen in the world, whether thousands of miles away, in your state, your town, or your home, youth look to the adults that surround them to help them feel safe and understand what is happening. Safe and supportive adults are the best predictor of resilience in youth. This resource offers guidance to help you talk with children and youth after something scary or violent happens

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At  or after the Hospital: Helping  Child or teen Cope 

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At  or after the Hospital: Helping  Child or teen Cope 

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At the Hospital: Helping My Child Cope
Eight Ways You Can Help Your Child Cope While At The Hospital
After the Hospital: Helping My Child Cope
Eight Ways You Can Help Your Child Cope After Being in The Hospital
At the Hospital: Helping My Teen Cope
Eight Ways You Can Help Your Teen Cope While At The Hospital
After the Hospital: Getting Back to a Schedule

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The National Child Abuse and Neglect Data System defines neglect as "a type of maltreatment that refers to the failure by the caregiver to provide needed, age-appropriate care although financially able to do so or offered financial or other means to do so." (USDHHS, 2007)² Neglect is a unique type of trauma because only children (and, in some cases, dependent adults) are susceptible. In order to experience neglect, a person must be reliant on others for their physical and emotional wellbeing. This vulnerability means that victims of child neglect are predisposed to experiencing related trauma (including PTSD) later in life.

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The Children's Bureau supports programs, research, and monitoring systems that prevent child abuse and neglect while ensuring that children who are victims receive treatment and care.

We provide funding to states and tribes to help them strengthen families and prevent child abuse and neglect. Our funding also provides for child abuse and neglect assessment, investigation, prosecution, and treatment activities.

The following are our child abuse and neglect programs:

Child Abuse & Neglect Reporting Systems

The Children's Bureau collects case-level data on reports of child abuse and neglect and analyzes the data. We make our reports available to the public and provide an annual report to Congress.

Reporting systems include the following:

Child Abuse & Neglect Training and Technical Assistance

Through our Training and Technical Assistance Network, we help states and tribes with the following:

Child protection

Prevention of child maltreatment

In-home services for families

Assistance for infants at risk of abandonment

For more information about training and technical assistance, you can visit the following resource centers:

Federal Inter-Agency Work Group on Child Abuse & Neglect

The amendments to the Child Abuse Prevention and Treatment Act (CAPTA) of 1988 created a Federal Inter-Agency Task Force on Child Abuse and Neglect. Recent reauthorizations of CAPTA highlight coordination and collaboration across agencies related to child abuse and neglect, but do not specify the mechanism to do so. The work group has continued to meet quarterly.

Commission to Eliminate Child Abuse and Neglect Fatalities

The Commission to Eliminate Child Abuse and Neglect Fatalities was created by the Protect Our Kids Act of 2012, and Commissioners were appointed by Congress and the White House to study and make recommendations for ending child maltreatment fatalities. The Commission's final report presents both a comprehensive national strategy for fundamental reform and recommendations for actions by the executive branch, Congress, and states and counties.

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The Children's Bureau supports programs, research, and monitoring systems that prevent child abuse and neglect while ensuring that children who are victims receive treatment and care. We provide funding to states and tribes to help them strengthen families and prevent child abuse and neglect.

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-difficulty forming attachment to caregiver
-difficulty regulating emotions
-difficulty forming attachments to others, especially later in life
-trouble expressing emotions
-violent or inappropriate reactions
-anxiety and/or depression
-dissociation
-trouble with long term planning
-depressed language acquisition skills
-lack of curiosity or perseverance
-learning disabilities

Physical toll
When a child grows under constant stress or is constantly afraid, their immune system is vulnerable to underdevelopment. In fact, if this continues and they are subjected to mild stress later in life, their immune system will respond as if under extreme stress.
There may be secondary long term health affects including obesity, diabetes, as well as the "intangible loss" resulting in pain, sorrow, and reduced quality of life

source: Complex trauma; https://www.nctsn.org/what-is-child-trauma/trauma-types/complex-trauma/effects

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The National Child Traumatic Stress Network

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Children whose families and homes do not provide consistent safety, comfort, and protection may develop ways of coping that allow them to survive and function day to day. For instance, they may be overly sensitive to the moods of others, always watching to figure out what the adults around them are feeling and how they will behave. They may withhold their own emotions from others, never letting them see when they are afraid, sad, or angry. These kinds of learned adaptations make sense when physical and/or emotional threats are ever-present. As a child grows up and encounters situations and relationships that are safe, these adaptations are no longer helpful, and may in fact be counterproductive and interfere with the capacity to live, love, and be loved.

Complex trauma can affect children in a multitude of ways. Here are some common effects.

Attachment and Relationships

The importance of a child's close relationship with a caregiver cannot be overestimated. Through relationships with important attachment figures, children learn to trust others, regulate their emotions, and interact with the world; they develop a sense of the world as safe or unsafe, and come to understand their own value as individuals. When those relationships are unstable or unpredictable, children learn that they cannot rely on others to help them. When primary caregivers exploit and abuse a child, the child learns that he or she is bad and the world is a terrible place.

The majority of abused or neglected children have difficulty developing a strong healthy attachment to a caregiver. Children who do not have healthy attachments have been shown to be more vulnerable to stress. They have trouble controlling and expressing emotions, and may react violently or inappropriately to situations. Our ability to develop healthy, supportive relationships with friends and significant others depends on our having first developed those kinds of relationships in our families. A child with a complex trauma history may have problems in romantic relationships, in friendships, and with authority figures, such as teachers or police officers.

Physical Health: Body and Brain

From infancy through adolescence, the body's biology develops. Normal biological function is partly determined by environment. When a child grows up afraid or under constant or extreme stress, the immune system and body's stress response systems may not develop normally. Later on, when the child or adult is exposed to even ordinary levels of stress, these systems may automatically respond as if the individual is under extreme stress. For example, an individual may experience significant physiological reactivity such as rapid breathing or heart pounding, or may "shut down" entirely when presented with stressful situations. These responses, while adaptive when faced with a significant threat, are out of proportion in the context of normal stress and are often perceived by others as "overreacting" or as unresponsive or detached.

Stress in an environment can impair the development of the brain and nervous system. An absence of mental stimulation in neglectful environments may limit the brain from developing to its full potential. Children with complex trauma histories may develop chronic or recurrent physical complaints, such as headaches or stomachaches. Adults with histories of trauma in childhood have been shown to have more chronic physical conditions and problems. They may engage in risky behaviors that compound these conditions (e.g., smoking, substance use, and diet and exercise habits that lead to obesity).

Complexly traumatized youth frequently suffer from body dysregulation, meaning they over-respond or under-respond to sensory stimuli. For example, they may be hypersensitive to sounds, smells, touch or light, or they may suffer from anesthesia and analgesia, in which they are unaware of pain, touch, or internal physical sensations. As a result, they may injure themselves without feeling pain, suffer from physical problems without being aware of them, or, the converse - they may complain of chronic pain in various body areas for which no physical cause can be found.

Emotional Responses

Children who have experienced complex trauma often have difficulty identifying, expressing, and managing emotions, and may have limited language for feeling states. They often internalize and/or externalize stress reactions and as a result may experience significant depression, anxiety, or anger. Their emotional responses may be unpredictable or explosive. A child may react to a reminder of a traumatic event with trembling, anger, sadness, or avoidance. For a child with a complex trauma history, reminders of various traumatic events may be everywhere in the environment. Such a child may react often, react powerfully, and have difficulty calming down when upset. Since the traumas are often of an interpersonal nature, even mildly stressful interactions with others may serve as trauma reminders and trigger intense emotional responses. Having learned that the world is a dangerous place where even loved ones can't be trusted to protect you, children are often vigilant and guarded in their interactions with others and are more likely to perceive situations as stressful or dangerous. While this defensive posture is protective when an individual is under attack, it becomes problematic in situations that do not warrant such intense reactions. Alternately, many children also learn to "tune out" (emotional numbing) to threats in their environment, making them vulnerable to revictimization.

Difficulty managing emotions is pervasive and occurs in the absence of relationships as well. Having never learned how to calm themselves down once they are upset, many of these children become easily overwhelmed. For example, in school they may become so frustrated that they give up on even small tasks that present a challenge. Children who have experienced early and intense traumatic events also have an increased likelihood of being fearful all the time and in many situations. They are more likely to experience depression as well.

Dissociation

Dissociation is often seen in children with histories of complex trauma. When children encounter an overwhelming and terrifying experience, they may dissociate, or mentally separate themselves from the experience. They may perceive themselves as detached from their bodies, on the ceiling, or somewhere else in the room watching what is happening to their bodies. They may feel as if they are in a dream or some altered state that is not quite real or as if the experience is happening to someone else. Or they may lose all memories or sense of the experiences having happened to them, resulting in gaps in time or even gaps in their personal history. At its extreme, a child may cut off or lose touch with various aspects of the self.

Although children may not be able to purposely dissociate, once they have learned to dissociate as a defense mechanism they may automatically dissociate during other stressful situations or when faced with trauma reminders. Dissociation can affect a child's ability to be fully present in activities of daily life and can significantly fracture a child's sense of time and continuity. As a result, it can have adverse effects on learning, classroom behavior, and social interactions. It is not always evident to others that a child is dissociating and at times it may appear as if the child is simply "spacing out," daydreaming, or not paying attention.

Behavior

A child with a complex trauma history may be easily triggered or "set off" and is more likely to react very intensely. The child may struggle with self-regulation (i.e., knowing how to calm down) and may lack impulse control or the ability to think through consequences before acting. As a result, complexly traumatized children may behave in ways that appear unpredictable, oppositional, volatile, and extreme. A child who feels powerless or who grew up fearing an abusive authority figure may react defensively and aggressively in response to perceived blame or attack, or alternately, may at times be overcontrolled, rigid, and unusually compliant with adults. If a child dissociates often, this will also affect behavior. Such a child may seem "spacey", detached, distant, or out of touch with reality. Complexly traumatized children are more likely to engage in high-risk behaviors, such as self-harm, unsafe sexual practices, and excessive risk-taking such as operating a vehicle at high speeds. They may also engage in illegal activities, such as alcohol and substance use, assaulting others, stealing, running away, and/or prostitution, thereby making it more likely that they will enter the juvenile justice system.

Cognition: Thinking and Learning

Children with complex trauma histories may have problems thinking clearly, reasoning, or problem solving. They may be unable to plan ahead, anticipate the future, and act accordingly. When children grow up under conditions of constant threat, all their internal resources go toward survival. When their bodies and minds have learned to be in chronic stress response mode, they may have trouble thinking a problem through calmly and considering multiple alternatives. They may find it hard to acquire new skills or take in new information. They may struggle with sustaining attention or curiosity or be distracted by reactions to trauma reminders. They may show deficits in language development and abstract reasoning skills. Many children who have experienced complex trauma have learning difficulties that may require support in the academic environment.

Self-Concept and Future Orientation

Children learn their self-worth from the reactions of others, particularly those closest to them. Caregivers have the greatest influence on a child's sense of self-worth and value. Abuse and neglect make a child feel worthless and despondent. A child who is abused will often blame him- or herself. It may feel safer to blame oneself than to recognize the parent as unreliable and dangerous. Shame, guilt, low self-esteem, and a poor self-image are common among children with complex trauma histories.

To plan for the future with a sense of hope and purpose, a child needs to value him- or herself. To plan for the future requires a sense of hope, control, and the ability to see one's own actions as having meaning and value. Children surrounded by violence in their homes and communities learn from an early age that they cannot trust, the world is not safe, and that they are powerless to change their circumstances. Beliefs about themselves, others, and the world diminish their sense of competency. Their negative expectations interfere with positive problem-solving, and foreclose on opportunities to make a difference in their own lives. A complexly traumatized child may view himself as powerless, "damaged," and may perceive the world as a meaningless place in which planning and positive action is futile. They have trouble feeling hopeful. Having learned to operate in "survival mode," the child lives from moment-to-moment without pausing to think about, plan for, or even dream about a future.

Long-Term Health Consequences

Traumatic experiences in childhood have been linked to increased medical conditions throughout the individuals' lives. The Adverse Childhood Experiences (ACE) Study is a longitudinal study that explores the long-lasting impact of childhood trauma into adulthood. The ACE Study includes over 17,000 participants ranging in age from 19 to 90. Researchers gathered medical histories over time while also collecting data on the subjects' childhood exposure to abuse, violence, and impaired caregivers. Results indicated that nearly 64% of participants experienced at least one exposure, and of those, 69% reported two or more incidents of childhood trauma. Results demonstrated the connection between childhood trauma exposure, high-risk behaviors (e.g., smoking, unprotected sex), chronic illness such as heart disease and cancer, and early death.

Economic Impact

The cumulative economic and social burden of complex trauma in childhood is extremely high. Based upon data from a variety of sources, a conservative annual cost of child abuse and neglect is an estimated $103.8 billion, or $284.3 million per day (in 2007 values). This number includes both direct costs-about $70.7 billion-which include the immediate needs of maltreated children (hospitalization, mental health care, child welfare systems, and law enforcement) and also indirect costs-about $33.1 billion-which are the secondary or long-term effects of child abuse and neglect (special education, juvenile delinquency, mental health and health care, adult criminal justice system, and lost productivity to society).

A recent study examining confirmed cases of child maltreatment in the United States found the estimated total lifetime costs associated with child maltreatment over a 12-month period to be $124 billion. In the 1,740 fatal cases of child maltreatment, the estimated cost per case was $1.3 million, including medical expenses and productivity loss. For the 579,000 non-fatal cases, the estimated average lifetime cost per victim of child maltreatment was $210,012, which includes costs relating to health care throughout the lifespan, productivity losses, child welfare, criminal justice, and special education. Costs for these nonfatal cases of child maltreatment are comparable to other high-cost health conditions (i.e., $159,846 for stroke victims and $181,000 to $253,000 for those with Type 2 diabetes).

In addition to these costs are the "intangible losses" of pain, sorrow, and reduced quality of life to victims and their families. Such immeasurable losses may be the most significant cost of child maltreatment.

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Children whose families and homes do not provide consistent safety, comfort, and protection may develop ways of coping that allow them to survive and function day to day.

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Unexplained injuries, such as bruises

Extreme behaviors, such as excessive crying, truancy or running away

Poor hygiene and unsuitable clothing

Excessive fear of parent(s), caregiver(s) or going home

Depression or excessive crying

Poor peer relationships or inability to relate to children of the same age

Sudden change in behavior

Constant hunger, tiredness or lack of energy

Attention-seeking behaviors

source: Recognizing Signs of Child Abuse and Neglect; https://www.nationwidechildrens.org/family-resources-education/700childrens/2017/04/recognizing-signs-of-child-abuse-and-neglect

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Child abuse and neglect are common. At least 1 in 7 children experienced abuse or neglect in the last year, according to the CDC. Every year, Child Abuse Prevention Month is observed in April to raise awareness and honor the important role that everyone can play in strengthening families and supporting children. Protecting children from abuse and neglect is a community responsibility. Most adults want to help but may be unsure about how to get involved. Remember to follow the three Rs - Recognize, Respond and Refer.

Recognize the Warning Signs

Signs of child abuse or neglect include:

Unexplained injuries, such as bruises

Extreme behaviors, such as excessive crying, truancy or running away

Poor hygiene and unsuitable clothing

Excessive fear of parent(s), caregiver(s) or going home

Depression or excessive crying

Poor peer relationships or inability to relate to children of the same age

Sudden change in behavior

Constant hunger, tiredness or lack of energy

Attention-seeking behaviors

For a more in-depth reference tool, please click here.

Respond Appropriately

It is important to respond appropriately to a disclosure or suspicion of abuse. Try to keep your words and body language as calm and neutral as possible. Children may feel confused, scared, sad or angry. Be supportive and non-judgmental. You can let them know that you may need to talk to someone whose job it is to keep them safe.

Don't wait to make a call. In case of an emergency, or if a child indicates that they are afraid to return home, you should call local law enforcement immediately, or 911.

Refer to Community Resources

Contact your local child protective services agency to make a report. This is determined by the county in which the child resides or in which the abuse or neglect is occurring or has occurred. If an incident has happened within the last 96 hours (4 days), an immediate medical assessment may be necessary. For a directory of child protective services agencies, click here.

You should try to include the following information, although it is not required:

The name and address of the child you suspect is being abused or neglected

The age of the child

The name and address of the parent(s) or guardian

The name of the person you suspect is abusing or neglecting the child and the address, if available

The reason you suspect the child is being abused or neglected

Any other information that may be helpful to the investigation

The Center for Family Safety and Healing fully addresses all aspects of family violence, including child abuse and neglect, teen dating abuse, domestic violence and elder abuse. If you'd like to learn more about services or make an appointment, please call 614-722-8200.

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Recognizing Signs of Child Abuse and Neglect

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Child abuse and neglect are common. At least 1 in 7 children experienced abuse or neglect in the last year, according to the CDC. Every year, Child Abuse Prevention Month is observed in April to raise awareness and honor the important role that everyone can play in strengthening families and supporting children.

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-keep body language and voice calm
-reassure child they are right to tell
-reassure child they are safe
-be supportive and non-judgemental
-report to proper authorities or hotline
-remember, don't confront the abuser, your role is to support the child

source: https://www.nationwidechildrens.org/family-resources-education/700childrens/2017/04/recognizing-signs-of-child-abuse-and-neglect

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Child abuse and neglect are common. At least 1 in 7 children experienced abuse or neglect in the last year, according to the CDC. Every year, Child Abuse Prevention Month is observed in April to raise awareness and honor the important role that everyone can play in strengthening families and supporting children. Protecting children from abuse and neglect is a community responsibility. Most adults want to help but may be unsure about how to get involved. Remember to follow the three Rs - Recognize, Respond and Refer.

Recognize the Warning Signs

Signs of child abuse or neglect include:

Unexplained injuries, such as bruises

Extreme behaviors, such as excessive crying, truancy or running away

Poor hygiene and unsuitable clothing

Excessive fear of parent(s), caregiver(s) or going home

Depression or excessive crying

Poor peer relationships or inability to relate to children of the same age

Sudden change in behavior

Constant hunger, tiredness or lack of energy

Attention-seeking behaviors

For a more in-depth reference tool, please click here.

Respond Appropriately

It is important to respond appropriately to a disclosure or suspicion of abuse. Try to keep your words and body language as calm and neutral as possible. Children may feel confused, scared, sad or angry. Be supportive and non-judgmental. You can let them know that you may need to talk to someone whose job it is to keep them safe.

Don't wait to make a call. In case of an emergency, or if a child indicates that they are afraid to return home, you should call local law enforcement immediately, or 911.

Refer to Community Resources

Contact your local child protective services agency to make a report. This is determined by the county in which the child resides or in which the abuse or neglect is occurring or has occurred. If an incident has happened within the last 96 hours (4 days), an immediate medical assessment may be necessary. For a directory of child protective services agencies, click here.

You should try to include the following information, although it is not required:

The name and address of the child you suspect is being abused or neglected

The age of the child

The name and address of the parent(s) or guardian

The name of the person you suspect is abusing or neglecting the child and the address, if available

The reason you suspect the child is being abused or neglected

Any other information that may be helpful to the investigation

The Center for Family Safety and Healing fully addresses all aspects of family violence, including child abuse and neglect, teen dating abuse, domestic violence and elder abuse. If you'd like to learn more about services or make an appointment, please call 614-722-8200.

# data[].attributes.attachment_link.title
Recognizing Signs of Child Abuse and Neglect

# data[].attributes.attachment_link.description
Child abuse and neglect are common. At least 1 in 7 children experienced abuse or neglect in the last year, according to the CDC. Every year, Child Abuse Prevention Month is observed in April to raise awareness and honor the important role that everyone can play in strengthening families and supporting children.

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Amy Ellen Schwartz, Leanna Stiefel, Sarah A. Cordes; Moving Matters: The Causal Effect of Moving Schools on Student Performance. Education Finance and Policy 2017; 12 (4): 419-446. doi: https://doi.org/10.1162/edfp_a_00198

Download citation file:

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Moving Matters: The Causal Effect of Moving Schools on Student Performance

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Abstract. Policy makers and analysts often view the reduction of student mobility across schools as a way to improve academic performance. Prior work indicates that children do worse in the year of a school move, but has been largely unsuccessful in isolating the causal effects of mobility.

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Ways in which we can help stop bullying:
-Teach and Practice 'empathy', 'kindness': this will include addressing how students speak to one another, and introduce activities that promote empathy (SEL is great with this).
-Implement an anti-bullying campaign--as well as a program at school. This paves the way for exemplifying model behavior (the do's and don'ts).
-Create a safe space for students to be able to talk to you and other teachers.
-A good strategy to follow: "see something, say something!", this is great for students to model after. If they see something wrong, they can stand up and be what's called an 'upstander', which is someone who stand up against bullying.

https://lesley.edu/article/6-ways-educators-can-prevent-bullying-in-schools

https://www.stopbullying.gov/

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According to the National Center of Education, as of 2016 more than 20 percent of students reported being bullied.

It's a staggering statistic; especially considering the many ways bullying can affect students' wellbeing. Targeted children often suffer from poor performance in school, sleep issues, anxiety, and depression. And let's not forget the students doing the bullying-they're at a much higher risk for a whole host of issues that could extend into adulthood, ranging from violent behavior to substance abuse.

As an educator, what can do you to make an impact? How can you create a classroom climate that prevents bullying, but also put interventions in place that stop the behavior in its beginning stages? We talked to experts in education and mental health counseling to come up with these six strategies.

1. Teach kindness and empathy.

When students are able to approach ideas and problems from multiple perspectives, they're less likely to bully others.

From the earliest ages, students should participate in activities that boost social-emotional learning. As a teacher, find ways to help children understand and appreciate their identity as well as others'. To do this requires empathy and kindness, two skills that educators like Susan Patterson, who leads a cyberbullying course at Lesley University, believe can be taught.

"Empathy is the ability to put yourself in someone else's shoes, and teachers need to embed this skill into their curriculum," says Patterson. "We need to do identity work with children early on so that kids know who they are and who everybody else is and what their place is in the world."

One way to do this is to have kids get together and talk about their differences. Allow them to practice conflict resolution, work through problems, and build their understanding of those around them.

2. Create opportunities for connection.

Fostering a sense of community in your classroom can lower bullying incidents and facilitate healing for targeted students.

Research shows that when targeted students feel connected to peers, they're better able to cope with being bullied. Studies also indicate that teaching students to speak up when they witness bullying behavior, and to take a stand against it, can reduce future bullying situations by more than 50 percent.

"It's all about connection," says Nancy Beardall, who created and implemented a bullying prevention curriculum in Newton Public Schools. "When students feel connected to their peers, their school, and their community, they do better."

In the classroom, start by creating a safe place for students to express themselves and feel heard. Cultivate students' abilities to advocate on behalf of themselves as well as others. Outside of the classroom, facilitate opportunities for positive reinforcement by helping students get involved in afterschool activities that align with their hobbies and interests.

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6 Ways Educators Can Prevent Bullying in Schools

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Think about your classroom. Now picture your students. Chances are that one out of every five has been bullied. As an educator, what can you do about it? We talked to experts in education and mental health counseling to come up with these six bullying prevention strategies.

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Eli & Alicia are best friends. They experience a scary event together, and both need to go to the hospital. This video explains the impact that medical trauma can have on children and families, and how they can recover.
Medical Trauma is an event that is possibly life threatening to  one's self or someone very close.
It feels like helpless, panic, terror, and horror.

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UCSF Dept. of Psychiatry and Behavioral Sciences

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How Educators can Respond to Suicidal Tendencies in Students

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How Educators can Respond to Suicidal Tendencies in Students

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https://www.education.vic.gov.au/Documents/school/principals/health/suicideguidelines.pdf

Educators- teachers and school administrators need to recognise the growing rates of suicides among young children and need to be vigilant for various red flags. Prompt intervention and appropriate support for these students can help educators save lives.

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What is the Refugee Traumatic Stress on Young Learners？

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What is the Refugee Traumatic Stress on Young Learners？

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The National Child Traumatic Stress Network

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Definitions

Refugee. A refugee is someone who owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of particular social group or political opinion, is outside the country of his nationality, and is unable to or, owing to such fear, is unwilling to avail himself of the protection of that country. (Article 1 of the 1951 Convention Relating to the Status of Refugees)

Asylum-Seeker. An individual who does not meet the legal definition of refugee, but who applies for asylum (or refugee) status after he/she is already present in the US or at a port of entry. Asylum applicants can have any (or no) immigration status when they apply. Asylum status can be granted by either a USCIS asylum officer or by an Immigration Judge within the US Department of Justice's Executive Office of Immigration Review. (Section 208 of the Immigration and Nationality Act)

What Have Refugee Families Experienced?

Many refugees, especially children, have experienced trauma related to war or persecution that may affect their mental and physical health long after the events have occurred. These traumatic events may occur while the refugees are in their country of origin, during displacement from their country of origin, or in the resettlement process here in the US.

While in their country of origin, refugee children may have experienced traumatic events or hardships including:

Violence (as witnesses, victims, and/or perpetrators)

War

Lack of food, water, and shelter

Physical injuries, infections, and diseases

Torture

Forced labor

Sexual assault

Lack of medical care

Loss of loved ones

Disruption in or lack of access to schooling

During displacement, refugee children often face many of the same types of traumatic events or hardships that they faced in their country of origin, as well as new experiences such as:

Living in refugee camps

Separation from family

Loss of community

Uncertainty about the future

Harassment by local authorities

Traveling long distances by foot

Detention

Refugee Core Stressors

Refugee children may feel relieved when they are resettled in the US. However, the difficulties they face do not end upon their arrival. Once resettled in the US, refugees may face stressors in four major categories: Traumatic Stress, Acculturation Stress, Resettlement Stress, and Isolation.

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Refugee children may feel relieved when they are resettled in the US. However, the difficulties they face do not end upon their arrival.

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Effects Of Domestic Violence on Children 

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Effects Of Domestic Violence on Children 

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https://www.verywellmind.com/the-impact-of-domestic-violence-on-children-5207940#:~:text=One%20of%20the%20most%20devastating%20effects

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How Witnessing Domestic Violence Affects Children

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Witnessing domestic violence can have serious negative mental and physical effects on children Learn the lasting impact of seeing domestic violence from parents.

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Signs of a Child Experiencing Domestic Violence

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Signs of a Child Experiencing Domestic Violence

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Signs of domestic abuse in children and young people (saferderbyshire.gov.uk)

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Signs of domestic abuse in children and young people

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Children living in households where domestic abuse is happening are identified as “at risk” of harm, suffered by seeing or hearing the ill treatment of others. This would include witnessing domestic abuse.

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How Toe Help Children Experiencing Domestic Violence

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How Toe Help Children Experiencing Domestic Violence

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Responding to Children Exposed to Domestic Violence - Child Welfare Information Gateway

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The following research studies and policies address a variety of collaborative programs that respond to children exposed to domestic violence. Resources include State and local examples.

Child Protection in Families Experiencing Domestic Violence (2nd ed.)

Office on Child Abuse and Neglect, Children's Bureau

Selleck, Kristen.;Newman, Jeannie.;Gilmore, Debra.

Research shows that children exposed to domestic violence are at increased risk of being abused or neglected. This manual discusses the intersection of child maltreatment and domestic violence with a focus on child protection practice.

Child Witnesses to Domestic Violence

Discusses laws that extend legal protection to children who may be harmed by witnessing acts of domestic violence in their homes. The issues examined include the circumstances that constitute "witnessing" domestic violence and the legal consequence to persons who commit the domestic violence, such as enhanced penalties and fines. This publication presents a general overview of this aspect of child welfare law.

The Childhood Violent Trauma Center
Provides trauma-informed treatment and services to children and families, works to build professional knowledge through research, and aims to advance the field of child trauma treatment through collaboration, training, and information dissemination.

Promoting Protective Factors for Children Exposed to Domestic Violence: A Guide for Practitioners

Development Services Group, Inc.; Child Welfare Information Gateway

Presents information from a review of current research linking protective factors to well-being for children exposed to domestic violence. Topics include individual skills and capacities that can improve the well-being of children exposed to violence; how parents, guardians, and others can contribute to the well-being of these children; creating supportive communities; and strategies for practitioners. This publication is part of a series of five factsheets for practitioners exploring the importance of protective factors in working with in-risk populations served by the Administration on Children, Youth and Families.

Supporting Children, Parents & Caregivers Impacted by Domestic Violence
National Center on Domestic Violence, Trauma and Mental Health (2019)
Provides information for domestic violence and child welfare professionals and others working with children and families impacted by domestic violence. The website includes links to a 2014 webinar series on trauma-informed services for children and adult survivors of domestic violence and additional tip sheets and resources.

Young Children in Foster Care: Supporting Young Children Who Witness Domestic Violence
Early Childhood Consultation Partnership (2019)
Addresses how to support young children who have been exposed to domestic violence and offers information for infants and toddlers who have been affected as well as strategies for working with children of preschool age.

State and local examples

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Responding to Children Exposed to Domestic Violence

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The following research studies and policies address a variety of collaborative programs that respond to children exposed to domestic violence. Resources include State and local examples. Office on Child Abuse and Neglect, Children's Bureau Selleck, Kristen.;Newman, Jeannie.;Gilmore, Debra. Research shows that children exposed to domestic violence are at increased risk of being abused or neglected.

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6 Most Causes of Domestic Violence - Justice Class Action Settlement

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Domestic violence is a crime that can happen to anyone, regardless of age, race, religion, or sexual orientation. It occurs in all socioeconomic classes and affects people from all walks of life. Domestic violence may include physical abuse such as hitting, kicking, choking, emotional abuse such as threats and intimidation, and sexual assault like forced sex acts. The victim often suffers physical harm and psychological trauma that can result in post-traumatic stress disorder (PTSD). PTSD can be caused by one traumatic event or repeated exposure to harmful stimuli.

The six most common causes of domestic violence are:

A history of family abuse, substance use problems.

Substance use problems

Mental illness.

Financial difficulties.

Access to firearms for self-protection or aggressiveness against the partner or children.

A desire to control the victim.

Many of these issues are closely linked to abusive behavior, but not all abusers have them.

1. A History of Family Abuse

Domestic violence is often generational. If the abuser witnessed, experienced, or was otherwise exposed to violent behaviors in childhood, it can be more likely that domestic violence will occur later in life. However, not all abusers who witnessed family violence were victims themselves; several other risk factors include mental illness and substance use problems.

2. Substance Use Problems

According to a study in England, substance abuse was linked to about 44% of reported domestic violence cases, and alcohol 12% of those cases. The Survey found that more than a third of all female victims of violent crimes were attacked by a partner who abused alcohol or other substances. Furthermore, abusers who drink heavily are more likely to be violent toward their partners.

3. Financial Difficulties

Economic problems can lead to stress, which can result in domestic violence. The abuser may feel like he does not have complete control over finances; this stress can lead to abusive behavior. Domestic violence is about power and control; the abuser may use financial problems as an excuse to be aggressive toward his partner or children.

4. Mental Illness

According to the National Institute of Mental Health, "Mental disorders are common in people who commit violent acts; however, violence is not always caused by mental illness." Research suggests there is a link between mental illness and domestic violence. However, the connection isn't clear yet because research is ongoing. While experts agree that mental illness can raise the risk of violence, most people with severe mental health conditions are not violent.

People living with depression or other mood disorders may be at greater risk for domestic violence because they often struggle with poor impulse control and have impaired judgment. Furthermore, many people who abuse their partners also have clinical conditions such as borderline personality disorder, antisocial personality disorder, and narcissistic personality disorder.

5. Access to Firearms

The presence of a gun in the home increases the risk of homicide and suicide. A gun in the house also increases the risk for domestic violence. Firearms are the most common method of suicide.

In domestic violence situations, the abuser may use the gun to threaten or intimidate the victim. The presence of a firearm in the home also increases the risk that the victim will be killed.

6. A Desire to Control the Victim

The abuser may want to control his partner by using threats, isolation, financial abuse, or other methods. He may also try to control her children (if there are any in the relationship). He often wants power in all aspects of their lives. The abuser will have an intense need to know where she is every minute of the day and night, and may become extremely jealous. This desire to control the victim can lead to domestic violence.

While these are some of the most common causes of domestic violence, it's important to remember that not all abusers have these risk factors. Many abusers do not have a history of family abuse, mental illness, or substance use problems. Abuse is about power and control, so an abuser may have no risk factors- yet still be dangerous.

There's Hope for Domestic Violence Victims

Even though domestic violence is a devastating and all-too-common experience, victims have hope.

A lawyer can help a victim file for a restraining order and protect herself from future abuse. There are also many shelters and support groups available for victims of domestic violence. With the right help, victims can reclaim their lives and move on from the abuse.

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6 Most Causes of Domestic Violence - Justice Class Action Settlement

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Domestic violence is a crime that can happen to anyone, regardless of age, race, religion, or sexual orientation. It occurs in all socioeconomic classes and affects people from all walks of life. Domestic violence may include physical abuse such as hitting, kicking, choking, emotional abuse such as threats and intimidation, and sexual assault like forced sex acts.

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What Causes Domestic Violence? | Psych Central

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Domestic violence - also known as domestic abuse, intimate partner violence or abuse - may start when one partner feels the need to control and dominate the other.

Abusers may feel this need to control their partner because of low self-esteem, extreme jealousy, difficulties in regulating anger and other strong emotions, or when they feel inferior to the other partner in education and socioeconomic background.

Some people with very traditional beliefs may think they have the right to control their partner, and that women aren't equal to men. Others may have an undiagnosed personality disorder or psychological disorder. Still others may have learned this behavior from growing up in a household where domestic violence was accepted as a normal part of being raised in their family.

A partner's domination may take the form of emotional, physical or sexual abuse. Studies suggest that violent behavior often is caused by an interaction of situational and individual factors. That means that abusers learn violent behavior from their family, people in their community and other cultural influences as they grow up. They may have seen violence often or they may have been victims themselves. Some abusers acknowledge growing up having been abused as a child.

Children who witness or are the victims of violence may learn to believe that violence is a reasonable way to resolve conflict between people. Boys who learn that women are not to be valued or respected and who see violence directed against women are more likely to abuse women when they grow up. Girls who witness domestic violence in their families of origin are more likely to be victimized by their own husbands. Although women are most often the victim of domestic violence, the gender roles can and are reversed sometimes.

Alcohol and drugs may contribute to violent behavior. A drunk or high person will be less likely to control his or her violent impulses toward their partner, so keeping such drinking or drug use episodes to a minimum may be valuable for a person living in a domestic violence situation.

No cause of domestic violence, however, justifies the actions of the abuser, nor should it be used as a rationale for their behavior. These possible causes are only to better understand why an abuser believes it is acceptable to abuse their partner physically, sexually, psychologically or emotionally. Ultimately an abuser needs to get help for their unhealthy and destructive behavior, or find themselves living a solitary and lonely life.

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Domestic violence - also known as domestic abuse, intimate partner violence or abuse - may start when one partner feels the need to control and dominate the other. Abusers may feel this need to control their partner because of low self-esteem, extreme jealousy, difficulties in regulating anger and other strong emotions, or when they feel inferior to the other partner in education and socioeconomic background.

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Students who have experienced bullying or another trauma are more likely to 1. enact bullying onto others; 2. become desensitized; 3. continue to experience bullying if they do not feel safe/that it has not been addressed.

This article also includes how labeling is more likely to "perpetuate" the cycle of bullying versus helping the situation. Instead of stating a student as a "bully" or "victim", it is best to refer to that student or students as "The [student] (or [child]) that bullied..." or "was bullied".

https://www.nctsn.org/what-is-child-trauma/trauma-types/bullying

https://www.nctsn.org/what-is-child-trauma/trauma-types/bullying/effects

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The National Child Traumatic Stress Network

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Being bullied can severely affect a child's or teen's self-image, social interactions, or school performance, and can lead to mental health problems such as depression, anxiety, and substance use, and even suicidal thoughts and behaviors.

Signs that a child is being bulled may be physical, emotional, behavioral, social, or academic. Short- and long-term effects of bullying may include:

Stress, anxiety, and depression

Anger or frustration

Loneliness and isolation

Feelings of rejection, or poor self-esteem

Changes in sleep and eating patterns

Health complaints

Poor relational skills

School avoidance, including missing or dropping out of school

Poor academic performance

Separation anxiety

Self-injury

Eating disorders

Suicidal or homicidal ideas or actions

Youth who witness bullying, known as bystanders, can also be affected. Bystanders may feel guilty about their own inaction, may feel unsafe at school, and can also be at increased risk for depression, anxiety, drug abuse, and absenteeism from school.

Children or teens who have been exposed to trauma and violence may be more likely to:

Bully others

Be more distressed by bullying or appear desensitized to bullying

Be the targets of bullying themselves

The relationship between trauma and bullying is complex. Being bullied can lead to traumatic stress reactions including Posttraumatic Stress Disorder. For example, a 2012 study (Idsoe, Dyregov, & Idsoe, 2012) found that for all students who experienced bullying, 27.6% of boys and 40.5% of girls had PTSD scores within the clinical range. Symptoms were even worse for those students who both bullied others and had been the targets of bullying themselves.

Children who have experienced trauma are more likely to be bullied and to engage in bullying behavior. In some cases, children who experience trauma may develop social or interpersonal difficulties, making them more likely to become targets of bullying. Studies of Adverse Childhood Experiences, or ACEs, have found that children who report more ACEs are also more likely to exhibit bullying behavior (Sacks, et al., 2014).

Although it is important to identify when a student is being bullied, the power of language can have unintended consequences. Instead of referring to "bullies" and "victims," more appropriate language includes "the child who bullied another student" (rather than "the bully") or "the student who was bullied" (rather than "the victim").

Simply labeling a student as a "bully" or "victim" can perpetuate

a lack of hope or belief that there can be a change in behavior for someone who bullies or a change in the social-emotional impact that results from being bullied.

labels that serve to define a youth's role in the school community and society.

a focus only on the individual without considering the external context in which the bullying occurred, such as in a school with a negative school climate or a home with domestic violence that can influence, perpetuate, and even shape behaviors between peers, students, and the adults on campus.

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Bullying can severely affect a child's or teen's self-image, social interactions, or school performance, and can lead to mental health problems.

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The Impacts of Natural Disasters on Children

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The Impacts of Natural Disasters on Children

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Children who are victims of the natural disasters related to climate change can be anxious and stressed over extreme weathers. They may increase problem behaviors near an anniversary of a
traumatic event.

Problems and symptoms after natural disasters
Physical health problems.
Mental health symptoms and
Lower school attendance and trouble learning.

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Understanding the Impacts of Natural Disasters on Children | Society for Research in Child Development SRCD

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Natural disasters present a significant threat to children's health and well-being. Actions are needed now to mitigate this threat. Greater investments in infrastructure, remediation efforts, and more effective, evidence-based responses will help promote healthy development among children exposed to natural disasters.

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The Traumatic Impact of COVID-19 on Children and Families

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The Traumatic Impact of COVID-19 on Children and Families

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https://www.nctsn.org/what-is-child-trauma/trauma-types/refugee-trauma/effects

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The National Child Traumatic Stress Network

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Events that refugees have experienced related to war or persecution can all be called "traumatic events." It is important to note that children are very resilient and can often cope with difficult experiences and events in healthy and productive ways. Such children may not display any symptoms and may not need service providers to intervene. However, for some children, exposure to traumatic events has a profound and lasting effect on their daily functioning. Exposure to traumatic events can cause the following general symptoms in children of all ages:

Stomach aches, headaches

Crying a lot

Fear or anxiety

Sadness or irritability

Thoughts about the traumatic event that won't go away

Avoiding thinking or talking about anything that reminds him or her of the traumatic event

Acting as if the event is happening right now (when it is something that occurred in the past)

Trouble managing behavior or emotions

Pains in the body that don't seem to have a physical cause

Hopelessness

Nightmares

Trouble paying attention

Trouble falling asleep, or sleeping too much

Getting upset when things happen that remind him or her of the traumatic event

Lack of desire to play with others or take part in activities that her or she used to enjoy

Age-Specific Effects

The impact of exposure to traumatic events on children may be different depending on the child's age and stage of development. There are some signs of distress as a result of exposure to traumatic events that are specific to a child's developmental stage. For example:

Preschool children

Elementary school children

Middle and high school-aged youth

Bed wetting

Thumb sucking

Acting younger than their age

Trouble separating from their parents

Temper tantrums

Aggressive behavior like hitting, kicking, throwing things, or biting

Not playing with other kids their age

Repetitive playing out of events related to trauma exposure

Changes in their behavior such as aggression, anger, irritability, withdrawal from others, and sadness

Trouble at school

Trouble with peers

Fear of separation from parents

Fear of something bad happening

A sense of responsibility or guilt for the bad things that have happened

Feelings of shame or embarrassment

Feelings of helplessness

Changes in how they think about the world

Loss of faith

Problems in relationships including peers, family, and teachers

Conduct problems

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Events that refugees have experienced related to war or persecution can all be called "traumatic events."

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https://www.nctsn.org/what-is-child-trauma/trauma-types/refugee-trauma/interventions

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The National Child Traumatic Stress Network

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Refugee children and adolescents exhibit resilience despite a history of trauma. However, trauma can affect a refugee child's emotional and behavioral development. Mental health providers should consider how the refugee experience (e.g., exposure to hunger, thirst, and lack of shelter; injury and illness; being a witness, victim, or perpetrator of violence; fleeing your home and country; separating from family; living in a refugee camp; resettling in a new country; and navigating between the new culture and the culture of origin) may contribute to a child or adolescent's emotional or behavioral presentation in a clinic, school, or community setting.

When engaging refugee children and families in the treatment process:

Work to build trust with all family members, not only to increase the benefits of treatment, but also to ensure the family will accept your recommendations and referrals.

Listen to the family's concerns, acknowledge the importance of their expressed primary problems, and address first the basic or most urgent needs.

Focus on aspects of the mental health services that relate to the family's expressed values, such as supporting a child's academic success.

When you are referring to other services, discuss what the resource can provide for the child or family and, if possible, facilitate the family's contacting the referral.

The interventions listed below have been used within the NCTSN to address trauma among refugee youth and families.

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Refugee children and adolescents exhibit resilience despite a history of trauma. However, trauma can affect a refugee child's emotional and behavioral development.

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https://www.youtube.com/watch?v=1CIC6l7LRDk

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https://www.youtube.com/watch?v=a_rfZY0NFvY

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African Refugee PTSD Relief Through Meditation

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Responding to Trauma in Your Classroom

Bad Behavior or Reacting to Trauma?

Think of a student who challenges you. Have you observed any of these behaviors in that student?

Excessive anger

Unusual startle reactions

Loss of appetite

Extreme fatigue

Physical or verbal aggression

Regular tardiness or absence from class

Perfectionistic, controlling or anxious behavior

Difficulty concentrating

Frequent headaches or stomachaches

Low self-confidence

Irritability

Clinginess

Trouble making friends

Self-harm or suicidal ideation

Hoarding

Risky behaviors (including drug or alcohol abuse or sexual acting out)

Panic attacks

Extreme self-reliance

Running away

Defiance

Alienation from peers

If you've observed even some of these behaviors (or other troubling symptoms), you may have a student who is directly or indirectly experiencing trauma. Trauma can be defined as the reaction to a shocking or painful event or series of negative events. Some traumas require immediate intervention and court-mandated reporting; others go by unmarked. Regardless of whether or not you are aware of the details, there are things you can do to mitigate the effects of trauma for individual students and for all students in your classroom.
Source: Mental Health Connection of Tarrant County
What Causes Trauma?

Trauma affects the ways individuals feel, think and behave. It influences self-perception as well as beliefs about other people and the world.

Though this list is not exhaustive, traumatic experiences can include:

Medical crises

Accidents or injuries (like a house fire or car collision that threatens the student's safety)

Bullying or harassment

Family separation (due to incarceration, deployment, divorce, foster placement or death)

Natural disaster

Abuse (emotional, physical or sexual)

Neglect

Observation of domestic, community or school violence

Substance abuse

Mental illness

Terrorism and war

Instability due to being unhoused

Poverty

Overt discrimination or constant microaggressions

Refugee or undocumented status

More students may suffer trauma-or suffer more trauma-than you can see or know. Trauma is difficult to assess and identify; it's also specific to the individual. An event that may traumatize one person may not traumatize another person. Moreover, the same event may lead to different trauma symptoms in different people.
Source: The National Child Traumatic Stress Network
Responding to Trauma

Proactively applying trauma-informed classroom strategies benefits all students. Students respond positively when educators get to know their individual circumstances, affirm their identities and cultivate empathy in the classroom. Here are some ideas to consider incorporating in your teaching practice:

Establish social and emotional safety in your classroom.

Social and emotional safety is the cornerstone of positive classroom outcomes. Research shows that students need to feel both physically and emotionally safe to learn. Students experiencing trauma, including bias, bullying and social isolation, are more likely to feel unsafe.
Strategies

Classroom contracts

Explicit anti-bullying or community-building curricula

Timely interventions in conflicts and hurtful exchanges

Teaching and modeling of empathy and active listening skills

Create a behavior-management plan that focuses on positive reinforcement.

Discipline and behavior management are central to classroom culture and often present unique challenges for students responding to traumatic events or experiences. Foster compassion for and among your students. Focus on praising students for appropriate classroom behavior, not on punishment.
Strategies

Implement student-generated agreements and contracts

Adopt "zero indifference" (NOT zero-tolerance) policies

Seek out training in restorative justice techniques

Explore stress-management strategies to diffuse tense situations and help students process feelings in the moment

Give students opportunities to demonstrate their strengths

Increase your self-awareness and trauma competency.

Increase your knowledge about trauma and how it may manifest for your students. Remember, students respond to trauma in different ways, and their responses may be influenced by cultural traditions, religious beliefs or familial relationships. Connect with students and their families to identify resources and services that can inform how best to support students who experience trauma.
Strategies

Seek professional development on working with specific identity groups

Share support resources with other educators

Connect with community organizations

Engage in ongoing self-assessment and reflection on your trauma responsiveness

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Trauma can have significant and lasting effects on students. This PD Café will help you learn how to recognize the signs of trauma, better understand the causes of trauma, and take steps to establish social and emotional safety in your classroom.

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Edutopia is a free source of information, inspiration, and practical strategies for learning and teaching in preK-12 education. We are published by the George Lucas Educational Foundation, a nonprofit, nonpartisan organization.