TRAUMA

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Running head: TRAUMA/PTSD IN SCHOOLS

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TRAUMA/PTSD IN SCHOOLS

 

 

 

 

 

 

 

 

 

 

 

 

Ethical and Legal Issues Related to the Trauma/PTSD Population in Schools

Sally Student

 

Ethical and Legal Issues Related to the Trauma/PTSD Population in Schools

School psychologists are faced with numerous ethical and legal issues. The vast majority of their clientele are minors under the age of 18. With any career, one that involves working with underage children will require specific laws, guidelines, and regulations about how to handle specific situations. They work with not only the general education population in a school building but also the special education population, and everyone in between. They have to be able to adapt to new situations and be able to think on their feet when a crisis spontaneously happens. Children who suffered a trauma that creates post-traumatic stress disorder (PTSD) are one example of a special population that school psychologists have to be able to work with. It can be the result of various reasons such as abuse, natural disasters, terrorism, or anything that the child deems traumatic.

Literature and Research

PTSD is a mental health condition that interferes with an individual’s daily life. It is caused by a traumatic event that affects a person’s ability to function normally in their day-to-day life. Not all people who experience a traumatic event will experience PTSD and with proper treatment, they can adjust after a short period of time. Those who can’t cope may experience severe symptoms such as anxiety, uncontrollable thoughts, nightmares, and flashbacks. Others may experience arousal symptoms such as irritability, shame, trouble concentrating, trouble sleeping, being easily startled, and self-destructive behavior. The self-destructive behaviors may include drinking, excessive drug use, driving under the influence, and self-harm. Any person can develop PTSD and it’s not biased to age. Adults as old as 80 can develop post-traumatic stress disorder and children as young as two can as well. Symptoms can occur within three months to several years after the event. School-age children experience PTSD differently than adults, which school psychologists need to be aware of. Preschool age children are less dependent on verbalization and abstract thought. They regress with developmental skills such as language and may show aggression towards others (Margolin & Vickerman, 2007).

Family Violence

Family violence is one example of a traumatic event that can cause PTSD and it’s an issue that school psychologists need to be vigilant about. According to Margolin and Vickerman (2007), “Youth’s exposure to violence in the home occurs at high rates and often is noted as one of the most common and severe adverse events during childhood” (p. 613). It occurs at high rates because family violence can take many forms. Domestic violence, emotional abuse, and physical abuse can be referred to as family violence. There is also a degree of severity ranging from mild shoving and hitting to an incident that results in hospitalization and death. Family violence, regardless of severity, impacts a child more so than other traumas because their home is no longer a place of safety. Family violence is considered one of the most severe forms of trauma because unlike other traumas, the child is unable to seek comfort in their family. Their family is the source of distain and stress. Symptoms are more likely to occur when the trauma is a result of a loved one inflicting the pain as well. Children, who still love their parents, will have confusing feelings of hatred that can cause guilt and anxiety. Emotional abuse from a family member will cause children to have negative perceptions of themselves; they will have low self-esteem and low self-worth. They will form disorganized attachments when the parent is both the source of safety and danger within the home (Margolin & Vickerman, 2007). Children might also have over-estimations about danger and have intrusive thoughts about safety.

If the abuse is not caught early it could create prolonged trauma exposure that will manifest within a child, causing PTSD or PTSD like symptoms. When children show cognitive symptoms by being exposed to violence it can have serious implications for their ability to function in school (Margolin & Vickerman, 2007). They will have slower processing of incoming information and become hyper vigilant. The hyper vigilance can cause misinterpretations in social cues and confuse normal behavior with aggression. The majority of their interpersonal relations will be centered around aggression because that’s what’s seen at home. Once their home life starts to affect their school life, a teacher will refer the student to the school psychologist to determine if they have a behavioral problem and if so what’s the cause of his or her distress. Family violence can go unnoticed for years until physical or mental symptoms surface. Which means, a school psychologist will need to be able to find the root of the problem as quickly as possible.

Community Violence

Community violence is another type of trauma that can cause PTSD. Juveniles are two times more likely than adults to be victims of crimes and adolescents who have witnessed violence and experienced it personally meet lifetime criteria for PTSD (Saltzman, Pynoos, Layne, Steinberg, & Aisenberg, 2001). Educators and health care professionals are particularly concerned with child victims of community violence because of the impact it has on their development and schoolwork. Adolescents exposed to community violence are at an increased risk for adverse psychosocial difficulties such as reduced academic achievement, delinquency, high-risk sexual behaviors, and substance abuse and dependence. Saltzman et al., (2001) argued that “trauma in adolescents has been linked to long-term developmental disturbances, missed developmental opportunities, delayed preparation for professional and family life, and disruptions in close relationships” (p. 291). Community violence is also linked to family violence and fatal accidents that result in death.

Children who are a part of violent communities have dual burdens of loss and post-traumatic stress symptoms that that complicate grief reactions. These children also develop maladaptive coping mechanism and involuntary stress responses. The children develop intrusive memories, avoidance of social cues related to death or the deceased, and unresponsiveness to other peoples’ grievance and sorrow. Exposure to violence also creates feelings of helplessness and depression among youths. Involuntary responses composed of uncontrollable crying and involuntary intrusive thoughts that can interfere with developing healthy relationships and focus throughout the school day (Epstein-Ngo, Maurizi, Bregman, & Ceballo, 2013). Many children who are a part of impoverished communities develop maladaptive coping mechanisms and behaviors because they don’t have appropriate support to develop resiliency.

Implications for School Psychology Practice

School psychologists can help alleviate the stress of PTSD and trauma for students once they acquire the appropriate research on the mental illness and specific details about the student’s individual circumstance. Evidence-based interventions are successful because they have data that provides evidence that those practices were successful and have appropriate positive outcomes. Without evidence, the involving parties will be unable to discern the validity of their interventions and their knowledge and can be discredited (Gutkin, 2002). A school psychologist can help reduce anxiety and behavioral problems by providing counseling and positive coping strategies. School psychologists can effectively assess students’ wellbeing and implement strategies that not only work in schools but also outside the schools as well. Students’ grades will improve and unhealthy social relationships will be addressed.

One-On-One Counseling

One way a school psychologist can make a valid decision whether or not a child comes from a violent household is by scheduled one-on-one counseling sessions. When a relationship is established with a student, he or she will be more inclined to tell the school psychologist about his or her family situation at home. It’s better to hear directly about situation from the child who’s suffering because they will be more inclined to tell the truth than someone else in the household. At first, building a relationship will be more important than finding answers because the right atmosphere needs to be created where the student feels at ease and relaxed. With the right atmosphere and a strong relationship with the school psychologist, there will be enough trust with one another and the student will feel more comfortable revealing his or her situation.

One-one-counseling can also help with the trauma and PTSD population because it provides a safe base for the child. With children who are a part of violent communities, they feel safer at school and feel more inclined to distress with a third party person such as a school psychologist. School psychologists can give advice, implement strategies to improve test taking, and provide consistency in an erratic situation. Counseling sessions can also provide information that can be useful for teachers to help the student perform at grade level.

Trauma and Grief-Focused Treatment

Trauma and grief-focused treatment was adapted from intervention programs developed by members of the UCLA Trauma Psychiatry Service (Saltzman et al., 2001). The importance of proper grieving strategies during a traumatic event and the lack of data supporting it inspired the treatment protocol to be made. The treatment is a school-based trauma and grief focused psychotherapy group that is intended for students who have PTSD and functional impairment. The group provides a second community where students feel safe and not isolated by their trauma. The treatment focusing on improving students’ GPA scores because of the large impact PTSD has in grades. As a result, the group therapy is associated with significant improvements in PTSD symptoms, complicated grief symptoms and improvement in GPA. The trauma group helps children return to normal developmental trajectories by reducing trauma-avoidant behaviors (Saltzman et al., 2001). Most of the children in the group therapy had the belief that “bad things happen to the people around [them]” and as a result avoided school dances, graduation ceremonies, and play dates. With group discussions centered on the topic of avoidance and the help of peers and the school psychologist, those thoughts were able to be addressed and reconciled.

Ethical and Legal Issues

When working in a school setting, there are multiple ethical and legal issues that arise on a daily, weekly, or monthly basis. With ethics, the question that always arises is, how closely should the ethical standards be followed? There are two sets of ethical codes made by the National Association of School Psychology (NASP) and the American Psychological Association (APA). The ethical principles serve to guide the conduct of psychologists and provide them with the resources needed to remain professional. They aren’t set laws, but if a school psychologist chooses to go against the ethical code it will have major repercussions at the student’s expense. The ethical principles weren’t designed to solve all ethical dilemmas that may arise during practice (Nagle, 1987). Which means, there’s room for ethical dilemmas such as confidentiality, the rights of the individual vs. the rights of others, ethical decision-making, and competence. The law can also prevent a psychologist from performing his or her job effectively.

Confidentiality

One-on-one counseling sessions with a student can become difficult when legal and ethical issues prevent the process from going smoothly and efficiently. Principle 1.2 Privacy and Confidentiality in the National Association of School Psychologists Principles for Professional Ethics states that school psychologists need to respect the right of the individual to self-determine whether to disclose information (Jacob & Decker, 2010). There will be many times where the student’s wishes goes against what legally needs to be done by a psychologist. School psychologists are mandated reporters and ethically, a student can easily feel betrayed if a school psychologist is required to report to child protective services (CPS) or another family member about the particular crisis. According to Jacob & Decker (2010) under standard I.2.3 in the NASP ethical code, it’s advised to inform the student about the boundaries of confidentiality. There should be an understanding regarding the type of information that will be shared by a third party. However, the decision is made to delay the discussion and go against the ethical code, because it may prevent the student from sharing important information.

Another ethical dilemma that arises with confidentially in working in a school setting is that there are multiple professionals who care about the wellbeing of the child. In middle school and high school, a child has multiple teachers who may be concerned and want to specific details about what is causing their student to behave erratically. Even if those colleagues are friends and might feel betrayed it’s important to maintain a need-to-know relationship. Under Standard I.2.4 school psychologists must respect confidentiality and not reveal information to third parties such as teachers or students, without the agreement of the child or guardian. It’s important that family violence situations remain confidential. If that information gets out to the school the child may become embarrassed, lose trust that was built, or may be subject to bullying.

Competence

School psychologists need to be able to determine whether or not they are able to handle a given situation regarding a student. It’s impossible for a school psychologist to know how to handle every possible situation that can arise in a school. Therefore, he or she may be faced with a problem that schooling or training have prepared them inadequately (Warnath, 1956). Competence is an issue that the experienced and inexperienced school psychologists will face in schools. Practicum is designed to provide students with opportunities to implement what they learn in the classroom with field-based experience. They can practice ethical dilemmas with the guidance of a supervisor or professor (Nagle, 1987). However, practicum hours won’t expose a student to a wide range of issues.

Although trauma/PTSD is an important mental health issue, it isn’t a topic that school psychologists are exposed to often. Inexperienced psychologists aren’t exposed to trauma cases and have yet to gain the expertise and knowledge to assess such a child. The APA code of conduct states that a psychologist should only provide services within the boundaries of their competence, education, training, supervised experience, and professional experience. Standard II.1.1 in the NASP ethical code states that school psychologist should recognize their strength and limitations of their training and experience (Jacob & Decker, 2010). Those who don’t have the necessary competence to oversee a child with PTSD should refer a student to a different school psychologist or provide information for outside sources that can have the child and family appropriately. Cognitive Behavioral Therapy (CBT) is a treatment measure that is often used for PTSD cases. Some school psychologists are informed on the subject and are able to use aspects of the therapy. However, they cannot promote that they are a cognitive behavioral therapist.

Informed Consent

When working with minors, consent is required from a primary caregiver before services can be implemented. A school psychologist is able to talk to a student in order to defuse a situation, such as a melt down in class; however, immediately after their conversation parents need to be notified. It’s against the law for a school psychologist to counsel or perform assessments on a child under the age of 18 without notifying his or her parent or guardian. When psychologists provide assessments, therapy, or counseling, they need to obtain an informed consent. The informed consent needs to use language that is reasonably understandable and concise, otherwise the school is liable to be sued (Jacob & Decker, 2010). Informed consent is important to prevent negative expectations that a parent can have. When a parent is aware of what is happening between the school psychologist and the child, there can be less anxiety and problematic situations.

The main issue with informed consent is when the parents of a child doesn’t grant the school authority to allow the school psychologist to work with their child. In instances concerning child abuse, parents aren’t going to risk the possibility of getting caught by their child telling the school psychologist of their home situation. In situations with one parent being the abuser or domestic violence, the non-abusive parent might be afraid to give consent in fear of the abuser finding out. Another issue that can arise is when family culture prevents the school psychologist from implementing practices that can be beneficial to the student. Many cultures consider using outside sources as weak and won’t allow their child to talk to a third party outside the home.

Furthermore, school psychologists have an ethical code and state specific laws that need to be addressed. The issues with competence, confidentiality, and informed consent can’t be ignored and are crucial for the wellbeing of the child and the success of treatment. Trauma and the PTSD population in school work well with school psychologist and show significant improvement with group and individual settings. Family violence and community violence are two of many forms of trauma that can cause a child to develop PTSD symptoms. With the help of a school psychologist, symptoms such as depression, anxiety, intrusive thoughts, substance abuse, and self-loathing thoughts can be reduced and eradicated over time. Prolonged trauma is more damaging to a child’s psyche because the child is at constant state of stress which will develop into more severe maladaptive behaviors. With the right treatment and support system from family, peers, and support groups PTSD can be combated and the child can grow up living a healthy, normal well-developed life.

 

References

Epstein-Ngo, Q., Maurizi, L. K., Bregman, A., & Ceballo, R. (2013). In response to community

violence: Coping strategies and involuntary stress responses among Latino

adolescents. Cultural Diversity And Ethnic Minority Psychology19(1), 38-49.

doi:10.1037/a0029753

Gutkin, T. B. (2002). Evidence-based interventions in school psychology: State of the art and

directions for the future. School Psychology Quarterly,17(4), 339-340.

doi:10.1521/scpq.17.4.339.20871

Jacob, S., & Decker, D. (2010). Ethics and Law for School Psychologists (6th ed.). Somerset:

Wiley.

Margolin, G., & Vickerman, K. A. (2007). Posttraumatic stress in children and adolescents

exposed to family violence: I. Overview and issues. Professional Psychology: Research

And Practice38(6), 613-619. doi:10.1037/0735-7028.38.6.613

Nagle, R. J. (1987). Ethics training in school psychology. Professional School Psychology2(3),

163-171. doi:10.1037/h0090543

Saltzman, W. R., Pynoos, R. S., Layne, C. M., Steinberg, A. M., & Aisenberg, E. (2001).

Trauma- and grief-focused intervention for adolescents exposed to community violence:

Results of a school-based screening and group treatment protocol. Group Dynamics:

Theory, Research, And Practice5(4), 291-303. doi:10.1037/1089-2699.5.4.291

Warnath, C. F. (1956). Ethics, training, research: Some problems for the counseling psychologist

in an institutional setting. Journal Of Counseling Psychology3(4), 280-285.

doi:10.1037/h0046685

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