Secondary Prevention with High-Risk Children in Elementary School
NCP Clinical Quarterly 2(1): Fall 1991
"Our staff have identified fifty children who appear to need help beyond our classroom efforts to aid their adjustment." This description, given by an elementary school principal to a team of VA consultants serving as part of the National Center for PTSD (NCP) Loma Prieta outreach services, indicated the need for a secondary prevention program in the school. Indeed, the school's staff impressions were accurate, as the children’s response to the Loma Prieta Earthquake and its aftermath were as varied and complex as the event itself.
Distressing events to these children could include their own injury or injury to significant others, being frightened by the temblor and aftershocks, and/or the reactions of parents, siblings, other adults and children. In addition, there could be the stress of displacement, significant damage to their home or neighborhood. Some children lost pets and valued collections, and nearly all children heard the anxious media reports of the "Big One yet to come."
In collaboration with the FEMA funded disaster program, Project COPE, we developed a program for those children identified by the school as being at risk due to the cumulative stress of the earthquake and problems with family disruption and/or dysfunction. After meeting with the prinicpal, it was decided that the children, ages 5-11 would be clustered by age in to four groups. Together with Project COPE staff members Diane Cohan, M.F.C.C., and art therapist, Coeleen Kiebert, M.A., we held several planning meetings to discuss the purpose, activities and the materials required for each age group. A multimodal approach utilizing both verbal and nonverbal techniques was designed to quickly foster an empathic, supportive and empowering environment. In addition, a daily drop in group for parents was offered to provide them with information about the project, information about normal and prolonged stress response syndromes, referral information, and a forum to ask questions about their children.
The parents of 29 students, ages 5-11, gave their consent for their child's participation. The children were clustered by age into four groups that were scheduled four to eight times over a two week period. In an effort to respect the differing needs and capacities of these children, each child was encouraged to express his or her thoughts and feelings about the stress in their lives, how their lives had changed as a result of the quake and other imminent stress, and to express their existing strengths.
Scribbles, lines, shapes, and family and earthquake depictions seemed particularly effective toward helping the children to gradually express, with emotional tolerance, some of the conflicts in their lives. In addition, the depiction of imaginary helpers appeared to energize their own sense of power and reconstruction.
Both the children and the school system responded favorably to the program. Teachers requested consultation frequently and parents were offered a daily drop-in group to discuss their concerns and their child's participation. These meetings gave us the opportunity to provide psychoeducational information regarding normal and prolonged stress response syndromes, and when appropriate, a chance to make referrals.
Data on each child’s exposure and reaction to the earthquake was obtained using a questionnaire developed by the NCP and administered as a program evaluation instrument prior to and six months after the program ended. Eighteen percent (18%) of the children were injured, and more than half of them were exposed to things breaking in their home, or seeing things falling. Sixty-nine percent (69%) feared for their life, and 64% reported crying during the 15 seconds of the initial temblor. Additional data was obtained from a comparison group matched by age and gender. Overall exposure of the intervention group to actual traumatic events was very high.
At nine-month follow-up, the data begins to point to predictors regarding which children would suffer from intrusive thoughts, anxiety, and sleep disturbance. Children whose parents were divorced or separated, or who were either injured, or had to move as a result of the quake, suffered more worrisome symptoms. As a group, these children, as suspected by the school staff, warrant special attention, and we recommend that future community intervention projects identify and target this high risk group. A more detailed presentation of this data was presented to the Society of Traumatic Stress meeting in New Orleans in October, 1990, and is being developed for publication.
Admittedly, conducting an early childhood intervention project might seem unusual for the VA and the NCP. It represents only part of the range of services provided by the NCP outreach services in Santa Cruz and visiting VA consultants from across the nation. From an NCP perspective much was learned from the experience. Most important was the development of an effective model on how to approach a community disaster that would allow for "outside" resources to complement community services. The result of the collaboration between NCP and Project COPE served to mutually empower both agencies and allowed the NCP sanctioned entry into the community's educational, as well the county's system of human resource and health service agencies.
Finally, the school project gave impetus to the formation of a Project Cope school team comprised of eight clinicians. The school team, under the direction of Peter Spofford, COPE Director, and a school coordinator, galvanized a more systematic approach to working within the classroom. A description of the model is available from Project COPE, P.O. Box 962, Santa Cruz, CA 95062.
Bruce Hiley-Young currently works within the National Center’s Clinical and Education division. He served as Disaster Outreach Coordinator for the National Center in Santa Cruz County following the 1989 Loma Prieta earthquake.
Dr. Giles is Chief of Psychology, Department of Veterans Affairs Medical Center, Mountain Home, Tennessee. He served as a visiting clinician and consultant to the National Center’s disaster response project in Santa Cruz County.
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