Psychologists have been helping the community of Uvalde, Texas, try to cope and heal after the horrific May 24 shooting at Robb Elementary School that left 19 children and 2 teachers dead.
That includes both acute and longer-term interventions. In the immediate aftermath of the shooting, psychologists from the University of Texas at Austin were among those volunteering on-site to help. The team worked at a walk-in clinic located within a mental health center two blocks from the school, where two mental health professionals were based every day. These included at least one bilingual Spanish-English speaker, said pediatric psychologist Jeffrey Shahidullah, PhD, assistant professor at UT Austin’s Dell Medical School, who staffed the weekend walk-in clinic hours.
In the days following the shooting, children, parents, and first responders came in to unload emotionally and get support, Shahidullah said. Children displayed a range of reactions including acting disoriented, confused, frantic, and panicky, while others seemed emotionally shut down—not surprising, since “sometimes trauma symptoms don’t really hit until 3 to 6 months later,” he said.
The main approach the team used was psychological first aid, an evidence-based intervention developed by the National Child Traumatic Stress Network, or NCTSN. It aims to ascertain child and family needs and provide immediate practical assistance, support, and resources in the wake of disasters. The team also assessed children holistically for factors that could exacerbate or mitigate their coping abilities, Shahidullah said.
“We’re trying to do a whole-person assessment—to determine risk factors for each individual child,” he said. That includes factors related to the trauma itself—whether the child was actually on-site or heard about the incident secondhand, for example—and other factors like family environment and previous levels of trauma.
The team is also identifying child and family resiliency factors—personal and community-level strengths that families can tap into, Shahidullah said. That could be actions as diverse as connecting with faith-based communities, spending time with friends, or engaging in other pleasurable activities—“things that are routine-based and provide a sense of worth and enjoyment,” he said. While the work is by its nature short term, the aim is “to help provide families with as much stability in the next weeks and months as possible,” he said.
Beyond the immediate months following the shooting, the team also plans to assess what they can do to help strengthen the community over the long term, Shahidullah added. “We don’t just want to put a Band-Aid over it and leave,” he said. “We need to create a trauma-informed community, because the situation doesn’t end once the traumatic event is over.”
Training those on the ground
Others are providing training to help the Uvalde community develop those longer-term tools and resources. A main force in this work is clinical psychologist Julie Kaplow, PhD, ABPP, who with colleagues at the Trauma and Grief Center at the Hackett Center for Mental Health in Houston began working on a number of fronts to help build and reinforce Uvalde’s community resilience.
Kaplow’s team was heavily involved in establishing the Santa Fe Resiliency Center after the high school shooting in Santa Fe, Texas, in May 2018. Using lessons learned from that work, the team coordinated trainings for all school counselors in the Uvalde school district in two evidence-based group treatments for trauma and traumatic loss: Bounce Back, for children K-5, and Trauma and Grief Component Therapy (TGCT-A), for older children and teens. (Bounce Back is a 10-session cognitive behavioral skills-based group intervention to teach elementary school children how to cope with and help recover from their traumatic experiences. TGCT-A is a manualized group or individual treatment program for older kids and teens who have been exposed to trauma or are traumatically bereaved that can be implemented in a variety of service settings, including schools, community mental health centers, and clinics.)
“Many of the school counselors felt ill equipped to handle the trauma and grief that they were going to be seeing and had not necessarily been trained in evidence-based practices for treating that,” Kaplow said. The training should help to fill those gaps, she said.
In addition, her team is helping to train all school staff in Uvalde on how to identify trauma and grief in students. “Often, school is the primary place where children experiencing high levels of posttraumatic stress are discovered,” she said. “We’re trying to teach those who are likely to encounter these children about what trauma can look like so they can make appropriate referrals,” she said.
Through an affiliated group practice managed by Kaplow called the Lucine Center, her team is also offering no-cost trauma- and grief-informed teletherapy to any Uvalde-area children and teens in need of this form of intervention. While in-person meetings are optimal following a tragedy like this, “we’ve heard from a number of providers that many children impacted by the shooting have been too terrified to leave their homes,” she said. “So we are hoping that this is an effective way of reaching them.”
Another plan is to host educational town hall-style meetings for parents and caregivers to help them understand their children’s potential reactions and behaviors over the coming months and how to help these youngsters integrate back into school, Kaplow said. Training volunteer clinicians is also on the docket, because many have not worked in such intense settings before, she said. Besides making sure these clinicians understand trauma- and grief-informed best practices, the training will include information on how to prevent secondary traumatic stress and compassion fatigue among mental health providers. “We want to build in those supports ahead of time,” Kaplow said.
In response to the Uvalde tragedy, Kaplow’s team has also developed a handout for caregivers in general about how to talk with their children about school shootings. “The ripple effects of this tragedy extend well beyond Uvalde,” Kaplow said. “We have received many questions and concerns from parents and caregivers across the country whose children are now scared to return to school.”
