For more crisis information please visit the NASP Web-Site
Additional crisis links
Resources for Coping with Our National Tragedy

Stephen E. Brock, Ph.D., NCSP

California State University, Sacramento

and

Shane R. Jimerson, Ph.D., NCSP

University of California, Santa Barbara

Healing from trauma is not serendipitous; it does not simply occur with the passing of time or because children are inherently resilient. There is, in fact, nothing simple about childhood trauma.When ignored, the memories and distress do not go away. (Monahon, 1993, p. 179)

Coping with the loss, death, and grief associated with the terrorist attacks of September 11, 2001, is a process, not an event (National Association of School Psychologists, 2001a; Pfohl, Jimerson, & Lazarus, 2002; Wolfelt, 2002). Thus, it is critically important for professional educators working with acutely traumatized students to continually consider how to help youth deal with lingering reactions to these national tragedies. In particular, the one-year anniversary of these attacks will present unique challenges to this coping process. This article identifies these challenges, and presents ideas and resources to facilitate healthy coping and healing. These suggestions will be especially important for educators working with students who either witnessed the events of September 11^th or had close relationships with victims of the attacks. However, this article also gives guidance to educators working with students who were not acute psychological trauma victims.

The intensity of traumatic memories and crisis reactions typically fades over time. However, memories of a traumatic event never completely go away, and a variety of life events can re-trigger intense reactions to the trauma (Young, 1998). For example, it is not unusual to observe sudden changes in behavior and emotions as survivors approach the one-year anniversary of a traumatic event. This "anniversary effect" may find survivors (including both adults and children) re-experiencing many of the same intense feelings and reactions that were associated with the original trauma. Individuals who have, as a result of the traumatic event, developed Post-traumatic Stress Disorder (PTSD) are particularly vulnerable to the anniversary effect. The person with PTSD may be symptom free for many months, but then begin to display related symptoms as anniversary events approach. Not surprisingly, existing symptoms tend to occur more intensely and frequently at these times (Matsakis, 1994; Smith, 1996). This reality can come as a surprise to both trauma victims and their caregivers who may have just begun to believe that their lives have returned to normal (National Institute of Mental Health, 2001; National Organization for Victim Assistance, 2001). Cynthia Monahon (1993) has suggested that underlying a child’s anniversary reactions is the fearful sense that the trauma might recur. This fear may be especially acute on the anniversary of last year’s attacks given that national leaders have suggested future acts of aggression to be a very real possibility. Thus, it is particularly important to be prepared to help our young people cope.

As the anniversary of last September’s attacks approaches, educators should expect that children they care for, as well as themselves, may display many of the same crisis reactions demonstrated immediately after the attacks. Thus, to the extent that initial reactions were acute there will be more of a need to prepare for anniversary reactions. Conversely, to the extent that initial reactions were minimal there will be less of a need for such preparation.

Not surprisingly anniversary reactions appear to occur more frequently among individuals with greater exposure to the traumatic event (Morgan, Kingham, Nicolaou, & Southwick, 1998). They may include emotional numbness, fear, guilt, anger and resentment, depression and loneliness, isolation, physical symptoms of distress, and an inability to maintain normal activities (Office for Victims of Crime, 2001). Other relatively rare anniversary reactions include suicidal and homicidal thinking, and psychosis (Gabriel, 1992). In some cases, anniversary reactions may indicate unresolved grief or incomplete mourning (Azarian, Miller, McKinsey, Skiptchenko-Gregorian, & Bilyeu, 1999; Gabriel, 1992; Smith, 1996).

It is possible for the anniversary to trigger delayed onset PTSD. Given this possibility, educators and other caregivers should be especially sensitive to symptoms of this disorder. According to the American Academy of Child and Adolescent Psychiatry (2000), these symptoms include:

• School refusal and excessive "clinging"
• Persistent fears related to the catastrophe
• Sleep disturbances such as nightmares, screaming during sleep, and bedwetting
• Irritability and loss of concentration
• Being easily startled and jumpy
• Atypical behavior problems
• Physical complaints for which a physical cause cannot be found
• Withdrawal from family and friends
• Sadness, listlessness, and decreased activity
• Preoccupation with the events of the disaster

Especially when displayed by youth who were physically (e.g., eyewitness to the crises) and/or emotionally (e.g., had a close relationship with a victim) proximal to the attacks, anniversary reactions may signal the need for referral to a mental health professional (Brock, 2002; National Association of School Psychologists, 2001, September).

From suggestions provided by Brock, Sandoval, and Lewis (2001), the Office of Victims of Crime (2001), the United States Department of Education (2001a; 2001b), and Poland and McCormick (1999), the following list offers anniversary preparation suggestions:

• Prepare your school community in advance for the anniversary effect. Ensure that all caregivers (especially parents) are prepared for a reawakening of intense emotions and reactions. Provide information about reactions that might be displayed by youth and remind the community of available mental health resources. Obviously, this recommendation will be facilitated by collaboration with community mental health resources. It may be appropriate to review recommendations previously offered for helping youth cope with trauma. The NASP document "Children's Reaction to Trauma: Suggestions for Parents" – "Your Reaction to Trauma: Suggestions for Teens" (National Association of School Psychologists, n.d. a) may be helpful.

• School administrators need to ensure that school staff members work together in developing plans for responding to the anniversary. Now is also an excellent time for school staff to revisit safety plans, such as those suggested in the NASP document, "Creating a Safe School Building" (National Association of School Psychologists, n. d. b). In addition, it may be appropriate to develop policies and procedures for the referral of at- and high-risk youth, and to offer staff training in threat assessment and suicide prevention. The NASP documents "A National Tragedy: Preventing Suicide in Troubled Children and Youth. Tips for Parents and Schools" (National Association of School Psychologists, 2001b) and After A National Tragedy: Preventing Suicide in Troubled Children and Youth, Part II. Tips for School Personnel or Crisis Team Members (National Association of School Psychologists, 2001c) may be helpful in this regard.
• Depending on the school calendar, administrators might need to call staff together prior to the start of school to begin preparations. You might also consider including information on any memorial plans in back-to-school communications that go to parents prior to the beginning of the school year.
• One-year anniversaries of crises typically receive significant media coverage and often include imagery of damage and destruction. Excessive exposure to such coverage can intensify the anniversary effect. Thus, it will be important to try to limit students’ exposure to media reports.
• Anticipate, organize, and plan how your school will deal with media inquiries regarding your school’s response to the anniversary. The school that presents itself as professional and prepared will be a powerful source of reassurance and resiliency. The National Association of School Psychologists (n.d. c) offers guidance on dealing with the media at the following website: http://www.nasponline.org/NEAT/neat_media.html.
• As has already been mentioned, the anniversary effect will influence caregivers as well as students. All caregivers need to be acutely aware of the impact of their own anniversary reactions. Especially among younger primary grade children, the distress of significant adults will be directly transferred to the children in their care. Thus, to the extent possible, it is important to maintain a calm and controlled demeanor. Through your actions show students that school is functioning normally.
• Take time to listen and talk to children about what they are experiencing and feeling. Reassure students that adults are doing everything possible to keep children safe. Although it will not be possible to guarantee students will never be attacked, it may be appropriate to explain that to date the attacks on our country have been aimed at buildings that are highly symbolic, not at schools or homes.
• Be prepared for, and tolerant of, a wide range of behaviors. Explain to children that it is understandable to be upset or disturbed.
• Be realistic about curriculum demands. The usual adjustment issues associated with returning to school may be exacerbated during this period. It may not be a good time for intensive instruction or tests. On the other hand it can present an opportunity to begin the school year with a focus on the importance of positive issues such as tolerance, anger management, and global awareness.
• Encourage healthy habits. Provide healthy snacks and ensure that physical exercise is integrated into the curriculum. Reinforce substance abuse prevention activities.
• Help students to identify available trusted friends and adults from whom they can seek support when they feel overwhelmed or panic. Bolstering natural support systems can be a powerful strategy for helping students cope.

• Ensure that caregivers are available to listen to students’ stories. Hold classroom discussions as judged appropriate, but do not force discussion or repeatedly bring up the catastrophic events: doing so may re-traumatize students.
• School support staff and administrators should make special efforts to be highly visible and provide leadership and support during the days and weeks prior to and following the anniversary.

Poland and McCormick (1999) suggest many ways to recognize anniversaries and note the importance of including all affected individuals (parents, students, and staff) in the process. In addition, they suggest that this may be a meaningful time to unveil or dedicate any permanent memorials to crisis victims. Suggestions regarding the development of memorials following crisis events, previously offered by the National Association of School Psychologists (2001d), Brock, Sandoval, & Lewis (2001), and Goldman (1996), are summarized below. In addition, the accompanying handout provides a summary of memorial "do’s" and "don’ts."

The purpose of memorials is to bring people together to express their grief and at the same time to reduce feelings of isolation and vulnerability. In addition, these activities can help to increase feelings of security. Appropriate memorial activities may include listing the attributes of lost friends or loved ones; developing memory books; distributing memory ribbons; planting a flower or a tree; lighting candles; saying a prayer; creating a mural or collage about the life (lives) of the deceased; and writing a poem, story, or song about the person(s) who died. It is important to mention that each of these requires careful planning with sensitivity to the context and both present and future considerations. For instance, planting a tree may be a wonderful idea, however, the appropriate tree and location must be identified such that (a) the tree is actually able to survive and (b) it is not necessary to cut the tree down in upcoming years because of location selection. Additional recommendations to consider for memorializing September 11, 2001, include the following:

• First, determine if a memorial activity is needed. Not all schools were similarly affected by the events of September 11, 2001. Some found these events to be highly traumatic, but others found them to be only mildly stressful. While there may be a need for special memorial activities at schools that were physically and/or emotionally close (i.e., students had a substantial number of "significant others" involved in the attacks) to the disaster site, there may be no such need at schools that were not proximal to the crises. Providing a memorial activity for students who do not need it may serve to increase their threat perceptions. Conversely, not providing such activities for students who do need them denies them an important venue for dealing with their anniversary reactions.
• Even schools not closely affected by the events may want to consider memorial activities that focus on the ultimately empowering effects of the experience, such as a stronger sense of community, increased civic activism, the desire to help others, a greater appreciation for the rights and responsibilities of American freedom, etc.
• Begin planning now, but keep in mind that this is only the first of many anniversaries. Thus, in your planning, you may want to address responding in the years to come. As was already mentioned, when undertaking such planning, it will be important to ensure that it is a group effort and that everyone (including children with disabilities) is involved in some way. It will be especially important to involve adolescents in most aspects of this planning. On the other hand, it is important to acknowledge that there may be some youth who resist or refuse to participate. The plan should also include appropriate encouragement and alternatives if a youth chooses not to participate. This may be an especially appropriate consideration for youth who were acutely traumatized by the events. Students and staff should not be required to engage in any memorial activity!

• Activities and curricula that target tolerance and bullying may be helpful in the development of "living memorials" designed to address some of the issues that underlie acts of terrorism. Study of religious and political issues may help students to understand the bigger picture and broader issues. The ERIC Clearinghouse on Counseling and Student Services (2002) Virtual Library Collection, Helping People Cope with Trauma, Grief, and Stress, includes a link developed just for this purpose. Teaching Students About Terrorism and Related Resources (AskERIC, 2001) includes access to lesson plans and discussion guides related to the terrorist attacks (in addition to a variety of mental health resources).
• Special interest groups may grow out of students' need to do something to express their feelings. Educators and other caregivers should assist students in planning these memorials. Working together on these projects helps them constructively focus their grief, fears, and anger.
• Make sure that all memorial activities are sensitive to the developmental level of students. For example, while writing activities may be ideal for the development of personalized memorials for older students, drawing may be the activity of choice for younger children. Similarly, engaging in discussions with adolescents regarding their ideas and feelings can be constructive, whereas young children may need to engage in more concrete activities and play, and be provided with scaffolding to help in identifying their feelings.
• It is essential to preview memorial activities with staff, students, and parents. Parents and staff should know what to expect and students should know how to behave. It is critical that school staff closely supervises students during any school-sponsored memorial activity, as it is possible that some students will not know what makes an appropriate memorial. Some students will need to be taught what a memorial is for, how it will be used, and for whom it is intended. It may be necessary to provide appropriate models.
• At the conclusion of any school-sponsored memorial activity, ensure that all students return to a classroom setting and are given a chance to discuss the experience with their teacher or another adult.
• In planning for a memorial, it is also important to address how to meet the immediate needs of youth who have strong behavioral or emotional reactions to the activity. It is important to anticipate a range of emotions and behaviors, and to establish contingency plans and safe places. Clear directions should be given to educators regarding bringing youth in need to an appropriate location for support. School psychologists should be involved in the planning process. This must be established in advance, not created as the needs surface.

While the attacks of September 11, 2001, will never be forgotten, the intensity of the feelings and reactions associated with these crises will fade over time. However, there will continue to be certain events that trigger a re-awakening of these feelings and reactions. Among these events are anniversaries such as September 11, 2002. Professional educators and other caregivers need to prepare themselves, their schools, their students, and their communities for this anniversary effect. With such preparedness, the anxiety associated with a re-awakening of crisis reactions can be minimized.

© 2002, National Association of School Psychologists, 4340 East West Highway, Suite 402, Bethesda, MD 20814, (301) 657-0270, fax (301) 657-0275, www.nasponline.org. Published with permission from forthcoming Communiqué, vol 31 #1, Sept 2002.

This paper was developed in conjunction with the National Association of School Psychologists (NASP) as part of NASP's 9-11 Anniversary resource materials, available on the web at www.nasponline.org.

American Academy of Child & Adolescent Psychiatry. (2000, May). Helping children after a disaster. Retrieved May 1, 2002 from http://www.aacap.org/publications/factsfam/disaster.htm

AskERIC. (2001). Teaching students about terrorism and related resources. Retrieved May 21, 2002 from http://ericcass.uncg.edu/virtuallib/stresstrauma/1006.html

Azarian, A., Miller, T., McKinsey, L.L., Skiptchenko-Gregorian, V., & Bilyeu, J. (1999). Trauma accommodation and anniversary reactions in children. Journal of Contemporary Psychotherapy, 29, 355-368.

Brock, S.E. (2002). Identifying individuals at risk for psychological trauma. In S.E. Brock, P.J. Lazarus, and S.R. Jimerson (Eds.), Best practices in school crisis prevention and intervention (pp. 367-383). Bethesda, MD: National Association of School Psychologists.

Brock, S.E., Sandoval, J., & Lewis, S. (2001). Preparing for crises in the schools: A manual for building school crisis response teams (2^nd ed.). New York: Wiley.

ERIC Clearinghouse on Counseling and Student Services (2002, May 15). Helping people cope with trauma, grief and stress. Retrieved May 21, 2002 from http://ericcass.uncg.edu/virtuallib/stressbook.html

Gabriel, M.A. (1992). Anniversary reactions: Trauma revisited. Clinical Social Work Journal, 20, 179-192.

Goldman, L.E. (1996, September). We can help children grieve; A child-oriented model for memorializing. Young Children, 51, 69-73.

Matsakis, A. (1994). Post-traumatic stress disorder: A complete treatment guide. Oakland, CA: New Harbinger.

Monahon, C. (1993). Children and trauma: A guide for parents and professionals. San Francisco: Jossey-Bass.

Morgan, C.A., Kingham, P., Nicolaou, A.L., & Southwick, S.M. (1998). Anniversary reactions in Gulf War veterans: A naturalistic inquiry 2 years after the Gulf War. Journal of Traumatic Stress, 11, 165-171.

National Association of School Psychologists. (n.d. a). Children’s reaction to trauma: Suggestions for parents – Your reaction to trauma: Suggestions for Teens. Retrieved June 2, 2000 from http://www.naspcenter.org/safe_schools/trauma.html

National Association of School Psychologists. (n. d. b). Creating a safe school building. Retrieved June 2, 2002 from http://www.nasponline.org/NEAT/neat_buildings.html

National Association of School Psychologists. (n.d. c). Suggestions for dealing with the media. Retrieved June 2, 2002 from http://www.nasponline.org/NEAT/neat_media.html

National Association of School Psychologists. (2001a). Helping children cope with loss, death, and grief: Response to a national tragedy. Retrieved May 20, 2002 from http://www.nasponline.org/NEAT/grief.html

National Association of School Psychologists. (2001b). A national tragedy: Preventing suicide in troubled children and youth. Tips for parents and schools. Retrieved June 2, 2002 from http://www.nasponline.org/NEAT/syouth.html

National Association of School Psychologists. (2001c). After a national tragedy: Preventing suicide in troubled children and youth, part II. Tips for school personnel or crisis team members. Retrieved June 2, 2002 from http://www.nasponline.org/NEAT/syouth2.html

National Association of School Psychologists. (2001d). Memorials/Activities/Rituals following traumatic events: Suggestions for schools. Retrieved May 20, 2002 from http://www.nasponline.org/NEAT/memorials.html

National Association of School Psychologists. (2001, September). Identifying psychological trauma victims: Tips for mental health professionals and crisis responders. Bethesda, MD: National Association of School Psychologists. Retrieved May 21, 2002, from: http://www.nasponline.org/NEAT/psycht.html

National Institute of Mental Health. (2001). Helping children and adolescents cope with violence and disasters. Retrieved May 20, 2002 from http://www.nimh.nih.gov/publicat/violence.cfm

National Organization for Victim Assistance. (2001). Projections for the future: Long-term stress reactions to trauma. Retrieved May 1, 2002 from http://www.try-nova.org/Victims/future.html

Office for Victims of Crime. (2001, September). OVC handbook for coping after terrorism: A guide to healing and recovery. Washington, DC: US Department of Justice. Retrieved May 20, 2002, from http://www.ojp.usdoj.gov/ovc/publications/infores/cat_hndbk/welcome.html

Pfohl, W., Jimerson, S.R., & Lazarus, P.J. (2002). Developmental aspects of psychological trauma and grief. In S.E. Brock, P. J. Lazarus, & S.R. Jimerson (Eds.), Best practices in school crisis prevention and intervention (pp. 309-332). Bethesda, MD: National Association of School Psychologists.

Poland, S., & McCormick, J.S. (1999). Coping with crisis: Lessons learned. A resource for schools, parents, and communities. Longmont, CO: Sopris West.

Sandoval, J., & Brock, S.E. (1996). The school psychologist's role in suicide prevention. School Psychology Quarterly, 11, 169-185.

Smith, D.L. (1996). Anniversary phenomena as a function of traumatic events, post-trauma stress reactions, unresolved grief, and psychological distress (Doctoral dissertation, Central Michigan University, 1996). Dissertation Abstracts International. (UMI No. AAD97-09098)

United States Department of Education (September, 2001a). Suggestions for adults talking and thinking with children about the terrorist attacks. Washington, DC: Author. Retrieved May 20, 2002 from www.ed.gov/inits/september11/adults.html

United States Department of Education (September, 2001b). Suggestions for educators meeting the needs of students. Washington, DC: Author. Retrieved May 20, 2002 from www.ed.gov/inits/september11/educators.html

Wolfelt, A.D. (2002). Children’s grief. In S.E. Brock, P. J. Lazarus, & S.R. Jimerson (Eds.), Best practices in school crisis prevention and intervention (pp. 653-674). Bethesda, MD: National Association of School Psychologists.

Young, M.A. (1998). The community crisis response team training manual (2^nd ed.). Washington, DC: National Organization for Victim Assistance.

The recent attacks in New York and Washington, D.C., have provoked discussions in households and schools across America. Many adults are not sure what to say to children who have questions about the tragedies. The following is a guideline from the California Association of School Psychologists.

What we can say to children:

1. Schools are very safe places. What happened in New York and Washington D.C. was not aimed at schools or school children.
2. It is natural to feel upset about what happened today. You may have a lot of feelings. All feelings are okay.
3. If the feelings become too much to handle alone, you should talk to your parents or teachers.
4. If you have ANY questions about what happened ask them. While we may not have all the answers, parents and teachers want very much to try to help children understand what has happened.

What adults can do to help children:

1. Caregivers should always be available to talk to children and answer questions. Many times rumors about a traumatic event are more frightening than the crisis reality.
2. If you do not know the answer do not be afraid to say, "I don't know." Try to avoid speculating. Do not give unasked-for details.
3. Children (especially those under age 8 years) will look to their caregivers, and how they react, to help determine how personally threatening this event was. If caregivers display signs of panic, fear, uncontrolled crying, etc., then children will view the event as much more traumatic. They will be much more likely to become psychological trauma victims.
4. Carefully monitor children's consumption of print and electronic media reports. Always watch such reports with your child. You may need to limit the amount of news reports your child is exposed to. Avoid reportage that tends to speculate and/or sensationalize the event.
5. Do your best not to allow this tragedy to alter your daily routine, and make sure children get appropriate sleep, exercise, and nutrition. This routine can be very reassuring and will let children know that not everything in their life has changed.

What teachers can do:

1. Be available to discuss with your students the crisis events. Answer their questions, but do not give them unasked for details. At the same time, however, remember that teachers are not expected to have all the answers.
2. Some questions are unanswerable. Do not be afraid to say "I don't know" and avoid speculating.
3. Let students know that all feelings are okay and teachers are here to listen. While you do not want to force discussion, you want to ensure that all students know they can ask questions at any time.
4. Remind students that school is a very safe place and that schools and school children were not the target of this act.
5. Do your best not to allow this tragedy to alter your daily routine.
6. If you sense that students need to do something in response to this tragedy, consider making get well cards to the families and survivors of this tragedy. Alternatively, you may consider writing thank you letters to doctors, nurses, and other health care professionals as well as emergency rescue workers, firefighters and police.
7. Do not allow TV or radio reports to be broadcast during class time. However, well-written newspaper articles or responsible TV reports may help children understand this tragedy. Among groups of older students, teachers may consider making them available during recess/break time.

(Prepared in consultation with National Emergency Assistance Team Chairman Philip J. Lazarus)