School Shooting in Uvalde, TX: What Clinicians Need to Know

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After a school shooting in Uvalde, Texas, Tali Raviv, MD, associate director of the Center for Childhood Resilience at Ann & Robert H. Lurie Children’s Hospital in Chicago, discussed strategies for clinicians to help their clients manage high-profile incidents of violence.

High-profile incidents of violence — such as the May 24, 2022 shooting at Robb Elementary School in Uvalde, Texas in which 19 children and 2 teachers were shot — can instigate a trauma-ripple effect. The graphic details, the description of the shooter dressed in tactical gear and carrying 2 AK 15 rifles, and images of grief-stricken parents and neighbors can all be linked to trauma symptoms, anxiety, and intrusive thoughts, even for individuals without a direct connection to the incident. At times like these, clinical experts in psychiatry can offer their expert support, both to individuals who are experiencing trauma symptoms, and to institutions — such as schools and workplaces.

Tali Raviv, MD, associate director of the Center for Childhood Resilience at Ann & Robert H. Lurie Children’s Hospital in Chicago, offers guidance on how psychiatric professionals can respond to the effect of highly-publicized violence and trauma on both parents and children.

How can clinicians help their clients who are parents cope with the recent school shooting in Uvalde?

Dr Raviv: This type of incident really shakes everyone’s sense of safety, particularly those who are parents and those who may have had pre-existing experiences that put their safety and their loved one’s safety at risk. I think the most important thing is to open up the conversation and ask the question: How are you coping with the news? And it’s not just this tragedy. We’ve had several recent high-profile instances that really can shake all of us in terms of the way we make meaning of the world and how safe we feel in our own cities. So, the first thing is just making sure to ask everyone that comes into their offices how they are coping and how much is this affecting them, and then screen with the typical questions we ask: Are they having intrusive thoughts? Are they having difficulty sleeping? Have they had any thoughts of self-harm? Have they been more tearful? Have they found themselves worrying a lot more about the safety of their loved ones and their children in particular? I think all of those awareness questions are the first step.

Tali Raviv, MD

I think the other important thing is to really encourage, as much as possible, routines that clients already know are helpful to them in coping with stressful situations. Also, ask about who their social supports are. I think especially for parents we know that it’s important to have other adults to talk to because the way that parents are coping is going to impact how available they are for their children. So, encouraging them to take care of themselves, to check in with themselves, and to utilize their existing social support and coping rituals before trying to connect with their children.

What can clinicians do to help children cope?

Dr Raviv: I think it’s a lot of the same things I mentioned, but of course, in a more developmentally appropriate way. Ask them: What have you heard about this? Is this incident something that you’re thinking about? Is this something that adults around you are talking about?

We should all assume that children have had some exposure to either news about this incident or have heard other adults talk about it. Sometimes the half-conversations or half-truths that children hear can blur reality for them and so they may feel even more threatened than they need to be. For example, young children may hear about this incident and think it’s the school down the street, when in reality it’s many states away.

For young children and older children, it might be helpful for them to do something tangible — writing cards and letters, or fundraising. For older students, if it’s consistent with their belief system, they can do some advocacy and getting involved in movements for gun control. Because I think, for a lot of us, [incidents like] this makes us feel really helpless and hopeless — and studies have shown, especially for young children, having concrete ways of helping can help clients feel like they have more control over these types of situations.

Schools may be having more lockdown drills as a result of this incident. What can be done to make students less anxious?

Dr Raviv: Definitely for students that have pre-existing trauma histories this could be a trigger for additional trauma symptoms. For students who have been through other disasters or mass events like this, this is going to shake their sense of safety in a way that is maybe more pronounced than for other students who have not had those experiences. We also know that vicarious exposure, through media for example, can lead to trauma symptoms for adults and for children. Research since 9/11 shows that media exposure is damaging. So, I think limiting media exposure, especially when there are graphic images or really emotional stories, is important to help protect them.

We talk to schools a lot and do a lot of training with schools about if you have to do these emergency drills, how do we do them in a trauma-informed way? Letting students know ahead of time what this is about, having space to debrief, giving parents notification that this is happening so they can talk to their child about it beforehand and afterwards. So, if that is the response from schools to try to do those drills, doing them in a way that is going to minimize the potential harm for kids is really important.

What else can be done during these troubling times?

Dr Raviv: I think that it’s important for clinicians to be routinely screening for trauma exposure. This type of incident really underscores the importance of that because we know that, as an individual is exposed to 1, 2, 3 traumas, that the effect is additive and multiplicative and the effect of that is cumulative so understanding your client’s history of trauma prior to this kind of incident happening is really critical to know who might be at more risk than others. Also, broadening our definition of trauma to beyond what can happen in the context of family and home. Where exposure to violence can include systemic racism, discrimination, and exposure to these types of violent community events.

There are also people who have immigrated to this country as refugees from war, for example, so understanding the context of what your clients have experienced can help understand the impact that these types of incidents can have on them.

Tali Raviv, MD is associate director of the Center for Childhood Resilience at the Ann & Robert H. Lurie Children’s Hospital in Chicago.