Resilient Schools: A Back to School Guide During a Pandemic

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Resilient Schools: A BACK TO SCHOOL GUIDE DURING A PANDEMIC

Caelan Soma, PsyD, LMSW


Resilient Schools: A Back to School Guide During a Pandemic

Caelan Soma, PsyD, LMSW

Made possible, in part, thanks to the O.P. and W.E. Edwards Foundation

ISBN: 1-931310-76-9 ©2020 SKU SB014D

13725 Starr Commonwealth Road, Albion, Michigan 49224 www.starr.org


Thank You Thank you to my trusted colleagues and friends who took the time to thoroughly answer my questions about their own personal and professional experiences related to Covid-19 that helped shape this resource. I appreciate you all. The children in your care are so lucky to have you championing for them! Sam Lynch Jennifer Dalziel Cathy Coccia Mandi Knotts Kelly Waterstredt Danielle Truesdell Kim Wagner Sarah Slamer-Wasil


CONTENTS

RESILIENT SCHOOLS: A Back to School Guide During a Pandemic

Dr. Caelan Soma, Starr Commonwealth Chief Clinical Officer and Senior Trainer, and author of this book.

Dear Child Advocates, Educators, and Readers, In the days that followed the shocking news of COVID-19 and the outbreak of a global pandemic, the lives of practically every child, family, community and professional throughout the world changed. With the closure of schools, stay at home orders, layoffs, an economic recession (and fear of collapse), and essential healthcare providers and others being asked to show up to aid the thousands of individuals becoming extremely ill and dying, stressed and traumatized children have been cut off from the teachers, counselors, and advocates who supported them when perhaps their families or caregivers could not. In this respect, it is not surprising that many refer to the months and years that will follow the COVID-19 pandemic as a “trauma tsunami.” I know my own organization,

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Starr Commonwealth, will be ready. In response to COVID-19, I myself began to go through the very stress responses I have been helping children, caregivers and professionals address throughout my career. I entered crisis mode. I felt an immense pressure to do something immediately, but where do I start? I knew I needed to focus on my family and my children first, but what about all of the children who now couldn’t follow up on their mental health services at our clinics? What about the children served by our school partners who couldn’t be reached and didn’t have anybody? I didn’t know how safe simply going to the store would be, let alone working with children and families, and I was left with more questions than answers.


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RESILIENT SCHOOLS: A Back to School Guide During a Pandemic

In my role as the Chief Clinical Officer, I am responsible for Starr Commonwealth’s behavioral health services, as well as our professional training and coaching content for practitioners who rely on Starr Commonwealth to be the leader in trauma-informed and resilience-focused practice. As our leadership team started daily check-in calls, we were consumed by the immediate needs of our employees, and the children we serve, while also helping create materials to advocate at a national level for resources surrounding the COVID-19 pandemic as a traumatic experience. The days were long, and there seemed to be no end to the work. My own children asked me questions between my meetings about schools closing, seeing friends and how to do math problems I couldn’t solve. My muscles were tense, I had a lump in my throat, and there was the feeling like a brick in the pit of my stomach. How in the world could I be present for my daughters, help them with school, and produce the content that I knew professionals were waiting for from Starr? One moment I was panicking and frozen, the next moment I was amped up, ready and anxious. I was often “on” from the moment I woke up until I was able to fall asleep. I only now remember my friend and CEO saying, “This is not a sprint, it is a marathon, so pace yourselves.” At the time, I tried to believe that what she said didn’t apply to me, because I was supposed to be the leadership, and the parent, who had things under control. I was, in fact, stressed out. I was scared. I was moving constantly and I was anxious. I was sprinting. I needed to respond and do something – and I needed to do it now. My “guilty” mind went to thoughts about days when I wanted desperately to get into medical school, to work on the front lines with patients–to help. I hadn’t had those thoughts in years. I love my job, but I secretly wished that during

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this pandemic I was a doctor, a nurse, a respiratory therapist – there, in the hospital holding the hands of patients and reassuring them that everything would be alright, moving quickly from one patient to the next. Sometimes I felt sad and downright angry that I wasn’t putting on a pair of scrubs and heading into the hospital. Other times I was thankful I was able to be home with my family. I was always determined, however, do to something – to make a difference in the midst of everything going on with the COVID-19 global pandemic. I am proud of Starr Commonwealth – we are making a difference. But what else, I continue to ask myself, is needed? In an effort to do more, I began writing down everything I knew about trauma and resilience and tried to connect it specifically to the COVID-19 pandemic. I wrote in between Zoom meetings, I wrote in the evening while sitting with my kids watching movies, and I went for long walks to clear my mind hoping for more inspiration as to how to capture this information in a way that would be meaningful for others. I collected articles that included emerging statistics about the impact of COVID-19 on the mental health of adults and children, I read, and read, and read some more. I sent emails to trusted colleagues and friends who work with children in school and clinical settings. I asked them questions like, “What has been the hardest part for you?” and, “Has there been a best part in all of this?” “What do you want the children and families you serve to know?” “What do you need most?” “What worries you?” The responses they sent, almost immediately, connected to what I myself had been feeling. They were heartfelt and filled with worry, fear and concern for the children they serve. I also collected responses from the almost 100,000 practitioners who downloaded Starr’s free courses: Trauma Informed Resilient Schools and Children


CONTENTS

RESILIENT SCHOOLS: A Back to School Guide During a Pandemic

of Trauma and Resilience, about how the courses helped them, and what else they needed from Starr to feel supported. After several weeks of this race – caring for my family, non-stop Zoom meetings, emails, and writing in every spare minute I had, I hit a wall. Here I was, after weeks of activation and hypervigilance to “help”, and my body shut down. After weeks of prolonged and exaggerated stress, I collapsed. I was tired, I had a headache for a week and I had no idea what to do with all of the content, information, feedback and case examples I had collected. More than anything, I was mad that my body was stopping. My mind wanted to keep moving. The next morning, I took a walk with my dogs. I listened to my daughters and my body. “No more work, Mom.” I finally listened. That weekend was Mother’s Day weekend. I slept in, my kids made me waffles, we painted rocks, wrote positive messages on postcards for seniors in a local nursing home, and made heart shaped sugar cookie care packages for my most favorite moms in our neighborhood. It was just what I needed. It all seemed so clear. The very things I teach to promote resilience in the face of adversity restored me. I was then able to put together the ideas

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that had been swirling around in my mind since this all began. Even though I knew the COVID-19 pandemic was nowhere close to being over, and I knew that the struggles for many children and families is just beginning, I felt like I could make sense and meaning out of how I could contribute despite all of the challenges. I called a trusted colleague (and friend) and I asked her to help me talk it through. She knows who she is, and I am so grateful for her guidance. She helped me conceive this comprehensive resource – a “guidebook” for the COVID-19 pandemic that could help child-caring practitioners navigate through this time of uncertainty and fear. This resource complements all of Starr Commonwealth’s existing eLearning courses, intervention programs, tools and resources. This is the resource you have in your hands today. It is my hope that it provides you with information, guidance and understanding that will help you and the children and families you serve understand the impact of COVID-19, and to find resilience and hope during these unprecedented times.

Dr. Caelan Soma, PsyD, LMSW, ACTRP Starr Commonwealth Chief Clinical Officer


RESILIENT SCHOOLS: A Back to School Guide During a Pandemic

CONTENTS I ntroduction

ection I: COVID-19 as a Traumatic Experience S Distinguishing Grief and Trauma Trauma Exposure During COVID-19 Common Symptoms and Reactions of Trauma Types of Trauma Understanding the Physiology of Trauma COVID-19 and the Circle of Courage®

ection II: COVID-19 Response S

Crisis Response Repressive Coping Defusing (for adults and children) After the Crisis: Reflection and Process Special Topics Media Heroes Secondary Wounding Memorials

ection III: Reintegration S

Supporting a Trauma-Informed Environment and Successful School Reintegration Preparing for Uncertainty & Communication Understanding Trauma’s Impact on Learning Being Curious, Screening Students and Assessing for Risk Prioritizing Social and Emotional Needs Fostering Connections Fostering Physical & Psychological Safety Addressing Fears Children’s COVID-19 FAQ

ection IV: Post-Disruption Recovery S Promoting Resilience What Parents Need to Know

ppendix A

The Circle of Courage® and COVID-19 COVID-19 Frequently Asked Questions PTSD Evaluation Scale for Children and Adolescents Universal Needs Assessment A Blue Print for Back to School Activity Worksheets

eferences R

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RESILIENT SCHOOLS: A Back to School Guide During a Pandemic

CONTENTS contents

Introduction Trauma-informed practices are more critical than ever. We know that pre-pandemic 45% of children in the United States experienced at least one adverse childhood event and 10% had experienced three or more. The COVID-19 pandemic has amplified these numbers, and not just because of the pandemic itself and the sickness and dying that are resulting (although that will affect virtually all children) COVID-19 will also take a toll because of the economic hardships and stress families are experiencing every day. Unfortunately, economic disparity can lead to an increase in instances of exposure to abuse, neglect and domestic violence. As quarantine measures extended, individual states reported similar increases in domestic abuse incidents ranging from 21% to 35% (Wagers, 2020). From March 2020 through May 2020, domestic violence murder/homicides have risen 70% (Gwinn, 2020). Reports from survivors of domestic violence and sexual abuse is that the abuse is happening more frequently and is more extreme. Many are attributing it to the isolation of sheltering in place. Domestic violence hotline callers have increased by 20-25%. However, hospitals and child abuse hot lines are experiencing a decrease in calls (Usher, Bhullar, Durkin et al., 2020). This tells us that much of what is being experienced is not being reported or addressed. In addition, it is now reported that 45% of Americans indicate that the pandemic has impacted their mental health. One third of Americans are now showing signs of clinical anxiety or depression, which is one of the most definitive and alarming signs yet of the psychological toll exacted by the Coronavirus pandemic. These findings are a significant jump from before the pandemic (Census Bureau, 2020; Kaiser Family Foundation, 2020).

“We are going to see increased stressrelated cognitive impairment and diseases and increased toxic stress.” – Dr. Nadine Burke Harris, California’s surgeon general

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RESILIENT SCHOOLS: A Back to School Guide During a Pandemic

CONTENTS contents

Jessica Gold, a psychiatrist at the Washington University School of Medicine in St. Louis, and other experts believe healthcare workers as a group could develop high rates of anxiety, depression, substance use issues, acute stress and eventually post-traumatic stress as a result of what they are experiencing on the pandemic front lines. Because this event is unprecedented, Gold worries the psychological damages will be unprecedented, too.

“We have never had a mental health system that could support the needs of the population in general, let alone the population that will now be in need…Like soldiers coming back from deployment, it will take time for healthcare professionals to process and heal. When the acute medical crisis ends, a mental health crisis could emerge.” – Scientific American (2020)

Many are referring to the wave of devastation that will follow the COVID-19 pandemic as a “trauma tsunami.” This resource will support trauma-informed, resilience-focused care specific to the COVID-19 pandemic, taking both an individual and systems approach. Starr Commonwealth’s theory of change states that “when trauma-informed and resilience-focused adults work within trauma-informed and resilience-focused systems, the well-being and success of children will increase.” While this resource is for all child-caring practitioners including educators, social workers, counselors, psychologists and healthcare professionals it will benefit parents and caregivers too. You will see significant references to educators and schools throughout the content as the education setting is where we can cast the widest net to best reach children. But, we believe the content is important for all adults working with and caring for children to understand.

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RESILIENT SCHOOLS: A Back to School Guide During a Pandemic

CONTENTS contents

Fortunately, the connection between trauma and emotional regulation, difficulty with learning and the overlap in symptomology with other mental health problems has become better understood over the past decade, and many trauma-informed assessment and practices have already been put in place in schools, agencies and community organizations. This global pandemic is going to require as many child caring adults and practitioners as possible to understand the impact of stress and trauma, and be equipped with tools and resources to address it.

Starr Commonwealth’s Theory of Change If trauma-informed and resilience-focused adults work within trauma-informed and resilience-focused systems, the well-being and success of children will increase.

Educators and practitioners are accustomed to being able to provide answers to children and families. COVID-19 has brought such uncertainty that many professionals themselves are feeling a sense of helplessness. They have been working in a heightened state of stress due to changes in the way they teach and provide support and interventions, all while managing the stress surrounding caring for their own families. Many will have also experienced their own personal exposures to loss, grief and trauma related to the pandemic. The re-opening and reintegration of school and society bring a plethora of uncertainty and unpredictability, including how to do more with less resources if (and likely when) budgets are cut. Educators do not know what to expect or how much notice they will have to prepare. Healthcare providers aren’t certain when their families will feel comfortable bringing their children back into clinics for well-visits, and many children and their parents and caregivers do not have access to trauma-informed mental health practitioners. This resource is for their own well-being as well. Resilient Schools: A Back to School Guide During a Panemic was conceived as a way to package Starr’s 107-year history of trauma-informed, resilience-focused work with children, families and communities, along with thousands of survey responses and hundreds of conversations and meetings with educators and child caring practitioners who work in various settings.

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RESILIENT SCHOOLS: A Back to School Guide During a Pandemic

We asked questions such as: hat has been the hardest W part for you about the COVID-19 pandemic? W hat worries you most about the children and families you serve? hat do you need most from W your administration or school leadership? hat do children, parents W and caregivers need most? hat do you want children W and parents to know about your desire to support them? f all that you have done to O help children and families, what has worked the best? hat do you think children W will need most when they return to school?

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CONTENTS contents


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RESILIENT SCHOOLS: A Back to School Guide During a Pandemic

We Listened

We hope this resource provides answers to questions and worries, along with a road map for moving forward in our most uncertain times. The goal of this resource is to provide all child-caring practitioners with what matters most as they respond to the impact of the COVID-19 pandemic, as schools reintegrate, and as society re-opens and moves to post-disruption recovery support to help mitigate stress, process trauma, foster healing and champion resilience. We also hope that this eBook, which is embedded with additional resources, will encourage our readers to take the next step and access Starr’s other training resources and services. This eBook is divided into several sections that can be explored sequentially or as references and guides to particular needs. First, “COVID19 as a Traumatic Experience” is presented. Everyone has been impacted in some way by the COVID-19 pandemic. But just like all trauma, the way each of us perceives and therefore experiences the pandemic is dependent upon many variables. Next, “Crisis Intervention” is presented, which includes a very helpful defusing process Starr has successfully implemented with both children and adults. This section provides

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a recovery timeline to provide crisis response to adults and children, including scripts for the process. Then, “Reintegration” is discussed, including how to implement and support a trauma-informed, resilience-focused approach to reopen schools, reintegrate, and support online learners. Finally, “Post-Disruption Recovery Strategies” to mitigate stress, process trauma and promote healing and resilience are shared. A section for parents is also included in the eBook, with additional resources. The appendices also contains information to support the resource content, and these resources are embedded as links throughout the book, wherever appropriate. Case examples and personal accounts from children, parents, educators and other child-caring practitioners are also provided throughout. It is also worth noting that Starr Commonwealth, just like our education and clinical partners, do not pretend to have all the answers to many questions. Trauma-informed practice begins with having a curious and open mindset. Sometimes the “answers” simply only exist through the process of seeking them. We hope that our readers will reach out to us to seek our continued support, to enrich this conversation, and to help us refine this resource for others.