The Important Role of Schools Following Disaster Events

 

After disaster exposure, children are at risk for developing physical health problems, mental health symptoms, and difficulties in school. The hallmark mental health symptom observed among children after a disaster is post-traumatic stress (e.g., flashbacks, nightmares, avoidance of reminders of the disaster, hypervigilance). Some children report elevated distress that may benefit from mental health service interventions. For instance, five to nine months after Hurricane Maria in Puerto Rico, Orengo-Aguayo and colleagues evaluated 96,108 children (Orengo-Aguayo et al., 2019). They found that 6,900 (7.2 percent) reported clinically significant posttraumatic stress symptoms, meaning distress symptoms high enough that they might warrant clinical intervention.

Schools are ideally positioned to address children’s needs after disasters. Children spend the majority of their days in school, and families schedule their days around school times. Schools provide shelter, medical services, and food before and after disasters. Schools also often connect children and families to vital resources outside of school. However, there are large disparities in what schools are able to offer in terms of physical and mental health support, and the COVID-19 pandemic exacerbated disparities between schools (The World Bank, UNESCO, and UNICEF, 2021). In this commentary, the authors argue for three key ways schools may support children exposed to disasters and offer actionable suggestions for supporting children in underresourced schools.

 

Guiding Principles

To support children after a disaster, the authors suggest that (1) schools serve as a key screening site for postdisaster symptoms, (2) schools should provide tiered support to children, and (3) when possible, services should be administered in schools. Following, the rationale for these suggestions is described.

 

Schools Serve as Key Screening Sites for Postdisaster Symptoms

Schools are an important site for reaching children after disasters. Postdisaster screening tools for children are brief, free, evidence based, and require minimal training to administer (e.g., the Pediatric Symptom Checklist, the Strengths and Difficulties Questionnaire) (National Center on Safe Supportive Learning Environments, 2021). Screening children for the physical, mental, and school-related sequelae of disasters matters and can provide data to inform postdisaster interventional efforts in schools. Postdisaster symptoms may be chronic and influence children’s trajectories into adulthood. Further, understanding the copresentation of symptoms matters because children who report comorbid symptoms (e.g., post-traumatic stress and depression) may experience greater symptom severity, a prolonged course of symptoms, and a recurrence of symptoms (Lai et al., 2013). Assessing symptoms quickly through school-based screenings can inform treatment interventions, reduce the impact of psychological symptoms, and improve recovery.

Schools are an ideal location for screening because of staff expertise. Staff members (e.g., teachers, school counselors, education leaders) understand child development. Staff members are able to identify behaviors that may differ from typical development. In addition, staff members have preexisting relationships with children and families in their schools. Thus, they are also well-positioned to understand when a disaster has changed a young person’s behavior and circumstances or created distress for a child. Staff are also well-positioned to implement and refer children to additional supports, as they often have existing relationships with caregivers and community services.

 

Schools Provide Tiered Support to Children

After screening children, it is important to recognize that children respond in varied but predictable patterns of distress following disasters (Lai et al., 2021). The majority of children exposed to disasters are resilient in that they may report initial elevations of distress, but this distress dissipates over time. However, across studies, it is clear that a small percentage of children will report chronic distress following disasters. Early screening is able to identify children most likely to fall into these different patterns.

Meeting these varied needs of children after a disaster requires stepped-care models. Stepped-care interventional models stratify youth to match service intensity with youth needs, optimizing resource allocation and cost-effectiveness. This approach is important because although school resources are often limited, resources are even more constrained in postdisaster environments. In addition, timely and effective postdisaster interventions decrease the likelihood that children will experience persistent and severe mental health distress. For instance, youth with the highest needs should receive the most intensive and costly interventions. At the same time, supportive and low-intensity supports (e.g., coping skills training) should be provided to children who report mild distress following disasters.

Providing tiered levels of support is common in school settings. For example, Chile’s national school-based mental health program, Skills for Life, screens students in elementary and middle school and provides tiered interventions informed by screening data (Guzmán et al., 2015; Canenguez et al., 2023). When an 8.8-magnitude earthquake hit the country in 2010, screening data were available to evaluate children’s pre- and postdisaster functioning (Dutta et al., 2022).

Evidence-informed ways to support children after a disaster include Psychological First Aid for Schools and Skills for Psychological Recovery (Brymer et al., 2012). Psychological First Aid for Schools focuses on how school staff can help children cope after disasters. Skills for Psychological Recovery focuses on building skills that are helpful after exposure to potentially traumatic events (Berkowitz et al., 2010).

Emerging literature indicates that teachers may be able to effectively offer supportive interventions for children after disaster events. For instance, Wolmer and colleagues (2011) evaluated children exposed to the 2006 Lebanon War (Wolmer et al., 2011). They compared children who received a teacher-delivered manualized protocol to children in a waitlist control group. Three months after the intervention, participating children reported significantly fewer symptoms (n = 754) compared with the waitlist control group (n = 1,152) (Wolmer et al., 2011).

 

Services Should Be Administered in Schools

Services offered to children after disasters should be placed in schools. Situating support within schools reduces barriers to access for children and their families. It is common in nondisaster contexts for schools to refer families to external support. However, many schools lack the resources to implement school-based mental health programs (Soneson et al., 2020). In the chaotic aftermath of disasters, the barriers to accessing care outside of schools may be insurmountable. Accessing services outside of schools requires caregivers to navigate scheduling, child care, and transportation issues, all while trying to recover from a disaster event.

To illustrate why placing services in schools matters, Allison and Ferreira (2017) provided Cognitive Behavioral Intervention for Trauma in Schools (CBITS) to 23 children (ages 10 to 14 years). The CBITS is an evidence-based group intervention for children that takes place in schools. The CBITS provides psychoeducation to children about trauma and trauma-related symptoms and teaches children skills to reduce symptoms of post-traumatic stress and depression. All of the children in their study completed all 10 weeks of the CBITS program. After completing the CBITS program, the average number of post-traumatic stress symptoms reported by the group was reduced by 29.3 percent. Additionally, the average number of depressive symptoms reported by the group was reduced by 46.9 percent (Allison and Ferreira, 2017). This is promising evidence that placing services in schools may reduce treatment barriers and symptoms.

As a comparison point, Yasinski et al. (2018) conducted a study with 108 children. Children were offered Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), another program shown to reduce trauma-related symptoms. However, the key difference in the study by Yasinski and colleagues is that the program was offered outside of schools in a community mental health clinic. In this study, one-quarter of the children did not complete treatment. Although these two examples are not directly equivalent, they illustrate how choices about how services are delivered may affect the number of families able to access treatment.

In the long term, schools in disaster-prone areas should consider integrating services into the school system, such as with school-based health centers. School-based health centers promote child health by facilitating care coordination across physical, mental, and behavioral health services. The existence of this type of infrastructure before a disaster would support rapid identification and referrals after a disaster.

 

Conclusion

Schools are an important site for community recovery after disasters. The guiding principles in this commentary leverage the strengths of schools as critical sites of support in children’s lives. At the same time, it is important to underscore that some schools are more vulnerable to disaster losses and a difficult recovery following traumatic events. As outlined in the 2022 US Government Accountability Office report on disaster recovery, some schools are at heightened risk for emotional, academic, financial, and physical difficulties following a disaster (Nowicki, 2022). Additionally, it is worth noting that some schools are better than others at fostering a sense of belonging for certain populations, such as racially marginalized or immigrant students, with implications for how well-positioned some schools are to support students after a disaster occurs (Lowenhaupt et al., 2021; Rodriguez and Wy, 2024). Implementing the strategies presented in this commentary requires collaboration between educational and mental health policy makers to ensure that schools have the capacity to respond in the aftermath of disasters. Policies that support schools at the highest risk for slower recovery are needed to address the resilience and health of our children.

 

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Schools are critical to disaster recovery. A new #NAMPerspectives commentary highlights how schools can support children’s mental health and resilience post-disaster. Learn more: https://doi.org/10.31478/202412a #DisasterRecovery #ChildHealth

After disasters, schools can offer life-changing support. Explore how tiered interventions and in-school services can help children recover. Read the new #NAMPerspectives commentary: https://doi.org/10.31478/202412a #MentalHealth #Education

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References

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