Exposure to community and interpersonal violence is a public health crisis and adversely affects many children in our country and in our communities. A national study of 7–12th graders revealed that

12 percent of youth had a knife or gun pulled on them in the past year

5 percent had been stabbed or cut

1.5 percent had been shot at.¹

There are some children who are at greater risk for violence, including

boys

older children

children with early behavioral problems

youth living in urban areas

children with lower socioeconomic status.²

Following direct exposure to or after personally witnessing a...

Support for Students Exposed to Trauma (SSET) is a series of ten support groups that use a structured approach to reduce distress resulting from exposure to violence. It includes a wide variety of skill-building techniques. These techniques are geared toward changing maladaptive thoughts (i.e., toward challenging negative thinking, stopping automatic negative thoughts, distracting from negative patterns of thinking) and promoting positive behaviors (i.e., improving social skills, increasing pleasant activities, decreasing avoidance of difficult situations or thoughts).

Each lesson follows a similar format:

Lessons are structured. The agenda set for each lesson includes an independent practice review, teaching new skills or...

The goals of the SSET program are to

reduce symptoms of PTSD and other related problems

build resilience

build peer and parent support.

Each of these goals needs to be tailored to the individual student. A review of the screening questionnaire will help to show student strengths and weaknesses and help this planning process.

The initial goal of SSET, then, is to decrease the PTSD, depression, and general anxiety symptoms that are interfering with each student’s functioning. For example, if a student who has undergone a traumatic event is experiencing intrusive thoughts of the event, difficulty sleeping, general anxiety, poor...

SSET is intended for middle school students who have experienced a significant trauma and who are experiencing considerable distress related to that event. We recommend using a screening instrument among as many students as possible in the student body in order to identify students in need of this program. We usually use a version that includes

a scale assessing exposure to community violence (but not violence at home) and other traumatic events

a scale assessing anxiety and nervousness related to that exposure.

There are many different scales that would be appropriate for this process, and each has its own guideline...

Identify where the groups can take place and ensure that the space is available for the entire 10-week period. The space should include a table and be large enough to accommodate 8–10 people. A dry-erase board or easel is needed for group activities. The space should also be private so that others cannot hear the discussions. If possible, select a room with a large table that students can sit around; this helps make students feel comfortable and differentiates the setting a bit from a traditional classroom.

Each school may have a preference for when the groups are held. Some...

Working with stress or trauma survivors requires sensitivity and patience. There are several points that are important to keep in mind:

Students who have been exposed to violence and who are symptomatic may be guarded and slow to trust. Careful explanation of group procedures and rationales for all the components of the program can help to build trust and gain compliance. Make sure that all group members understand the concept of confidentiality, and try to build a cohesive group that feels safe to all group members.

Such students may overreact to real or perceived injustices, so group leaders need to...

The SSET program is built to help address a specific trauma or violent experience in each student’s life. However, it is typical for students to have experienced several traumatic events of different types at various points in their lives. For example, students often had prior experiences with

being bullied

car accidents or sudden injuries

the sudden death of a family member or friend

a serious, life-threatening illness

being abused by a trusted caregiver (see discussion below)

witnessing domestic violence at home.

Therefore, group leaders often have to help students “choose” what they will focus on in the group lessons. The...

When students are hesitant to share information about themselves and their experiences, it is important to provide some of the following types of support and encouragement:

Validate that it can be difficult to talk about an experience with violence or trauma, especially when doing so is new.

Remind students that beginning to share their experiences is the purpose of the group and one of the main ways that they will start to help themselves feel better.

Break down the disclosure into a smaller piece. For example, ask students to share any small part of their experience or write something down...

It is essential to remember that the group exists to serve the purpose of supporting students with trauma experiences. The focus of the groups should always be on the students’ experiences (and not those of the leader).

Given that SSET leaders are working and sometimes living in the same communities where these students experienced traumatic events, it is likely that group leaders will also have some of their own trauma experiences with the same or entirely different events. But it is usually not that advantageous for group members to hear about their group leaders’ personal experiences. To think this through,...

A decision to run the SSET support program should begin with deciding whether there is adequate clinical backup available within the school or school district. Beginning with screening students for the group, there will be times during the course of the SSET groups that you need clinical backup support or have questions about the concepts you are delivering in group. Each group leader should have a designated clinician for SSET—a school counselor, consultant, or school-district social worker—who can be on call for you while you are running the groups. The clinician should be available to assist with any...

There may be times when a student’s level or spirit of participation or reactions in group do not meet your expectations and may impact the group as a whole. Some guidance follows for managing these issues if they arise.

A variety of factors (e.g., comfort level with discussing personal information, issues of trust, accustomed role in a social group) may influence a student’s responses and reactions in group. Although it can be disconcerting when a student puts on a brave façade or front, as if what happened or what is being discussed is “no big deal,” it is important that...

Although the SSET program is designed for groups of students, it is most effective when the group leader thinks about each student’s problems and the corresponding goals in the group (see Table 5). The “Problems/Goals Worksheet” found in Figure 4 on the next page facilitates the conceptualization of needs for each participant. We recommend that group leaders complete this worksheet for each participant prior to the second or third group meeting. Review and modify the individual worksheets during supervision and periodically throughout treatment....

Unlike most academic homework, independent practice for the group involves asking students to do things that may make them feel very uncomfortable. Although this is part of what helps students eventually feel better, it is important to acknowledge how difficult it may be and to know that homework compliance is typically low for a variety of reasons:

the discomfort of facing fears

a lack of time (due to academic homework, after school-activities, sibling-care responsibilities, etc.)

not understanding homework instructions

logistical issues, such as transportation.

While it is important to troubleshoot obstacles to homework completion and try to motivate students to...

By the tenth lesson, the SSET group normally feels safe, and trusting relationships have formed within the group. Thus, the prospect of the group ending can be difficult for students and SSET leaders alike. The final lesson focuses on ending the group and looking to the future. However, students often raise the following question:

“If I have a problem, can I come and talk to you about it?”

Here is a suitable answer:

“You need to consider me from here on out as a regular teacher/school counselor, not your SSET group leader. Once SSET is over, you can come to...

If you have difficulty thinking of an example of a stressful situation, the list below may help you. While it is always preferable to use examples relevant to the students in your group, you can always use one of the following examples if you have trouble thinking of something more personal:

1. You failed a test.

2. One of your friends tells you that your boyfriend/girlfriend was talking to another girl/ boy.

3. You have to walk in late to a class.

4. You come home and you can tell that your mom is drunk.

5. Your parents are yelling loudly at one another or...

Build trust and group cohesion while giving students information about what to expect in the group.

1. Students will increase in their trust for one another and their group leader.

2. Students will verbalize the reason for attending the support group.

3. Students will increase in their comfort in the group.

4. Students will know what to expect from the group.

1. A bag of M&M candies or similar multicolored candy.

2. A confidentiality statement (for example, the “Confidentiality Contract,” p. 128) to be signed by all group members.

3. Index cards (with prewritten questions for the M&M Game).

4. Copies of the “Why I Am Here” worksheet...

Teach students about the normal or common problems that we have after a traumatic experience. Teach them one skill (relaxation) that they can use to calm anxiety.

1. Students will increase understanding about negative thoughts, feelings, and actions that resulted from their experience with stress/trauma/violence.

2. Students will feel more “normal” as a result of understanding commonalities in reactions to trauma.

3. Students will have hope that the support group will help them reduce some of the negative thoughts, feelings, and actions related to their experience.

4. Students will have a sense of support from their peers in the group.

5. Students will experience increased...

Teach students a common language to describe their level of feelings and to teach them that their thoughts can fuel their feelings. Introduce a skill for challenging their unrealistic thoughts with helpful thoughts.

1. Students will increase their ability to observe their own thoughts.

2. Students will increase their ability to challenge thoughts that are getting in their way.

3. Students will experience less anxiety by decreasing some of their unrealistic thinking and increasing helpful thinking.

1. Copies of the “Fear Thermometers” worksheet (pp. 142–145).

2. Comic strips, video clips, or other examples that demonstrate how thoughts affect feelings.

Copies of the “Noticing Your...

Teach students to challenge their negative thoughts and replace them with more-helpful thoughts.

1. Students will increase their ability to challenge thoughts that are getting in their way.

2. Students will increase their ability to generate helpful thoughts.

3. Students will experience less anxiety as a result of mastering these skills.

1. An extra chair to designate as the Hot Seat.

2. Copies of the “Questions You Can Use to Argue Against Negative Thoughts” worksheet (p. 150).

3. Copies of the “Hot Seat Exercise” worksheet (pp. 151–152).

4. “Return to Class” slips (filled out).

1. Have scenarios relevant to the group members prepared to use as examples...

Help students recognize people, places, and/or situations that they may be avoiding in response to their traumatic event. Teach them skills to decrease their anxiety in these situations so that they are able to do everything they once did or want to do.

1. Students will be able to identify trauma-related avoidance.

2. Students will decrease their anxiety and increase their sense of confidence and mastery by gradually approaching trauma reminders in safe situations.

3. Students will increase their skills for coping with anxiety in these situations.

1. Copies of the “Steps Toward Facing Your Fears” worksheet (p. 155).

2. Copies of “Facing Your Fears...

Help students begin to process their traumatic experience through writing about it and sharing their story with the rest of the group.

1. Students will understand why it is important to write about and share their traumas.

2. Student will write a newspaper-style story about their traumatic events.

3. Students will read their stories to the rest of the group.

4. Students will support one another during the sharing process.

5. Students will feel less anxiety when they think about the trauma.

1. Copies of the “Writing a Newspaper Story” worksheet (pp. 162–163).

2. Copies of the “A Newspaper Picture” worksheet (p. 164).

3. Copies of the...

Help students begin to process their traumatic experience through writing about it and sharing their stories with the rest of the group.

1. Students will understand why it is important to write about and share their traumas.

2. Students will write a personal story about their traumatic events.

3. Students will read their stories to the rest of the group.

4. Students will support one another during the sharing process.

5. Students will feel less anxiety when they think about the trauma.

1. Copies of the “Personal Story” worksheet (pp. 170–171).

2. Copies of the “Personal Story Picture” worksheet (p. 172).

Copies of the “Facing your...

Teach students skills required to solve real-life problems.

1. Students will learn about the link between thoughts and actions.

2. Students will learn to brainstorm solutions to a problem.

3. Students will learn to evaluate the pros and cons of various solutions to problems.

4. Students will begin to apply skills to problems in their own lives.

1. Copies of the “Problem Solving” worksheet (p. 178).

2. Copies of the “Facing Your Fears” and “Hot Seat Exercise” worksheets (pp. 179–181).

3. “Return to Class” slips (filled out).

Compile a list of real-life problems faced by students in the current group. Prepare to use these as examples...

Increase students’ competence in challenging negative thoughts and handling real-life problems.

1. Students will build additional competencies and fluency in challenging negative thinking through practice.

2. Students will build additional competencies and fluency in solving real-life and interpersonal problems.

3. Students will take steps toward solving some problems in their own lives via a combination of these two skills.

1. Copies of the “Evaluation Form” (pp. 184–185).

2. “Return to Class” slips (filled out).

1. Consider each student’s continuing problems and symptoms and plan to address them in the remaining two sessions.

2. Consult with supervisor on the need to refer any students into counseling or...

Help students review and celebrate their progress and consolidate skills they have learned.

1. Students will identify positive changes/progress made during the group.

2. Students will anticipate possible future challenges.

3. Students will consider ways to apply skills to future situations.

4. Students will celebrate graduation from SSET.

1. Copies of the “Note to Self” worksheet (p. 188).

2. Copies of the “Certificate of Achievement” (p. 190), signed by the group leader.

3. Special snacks, gifts, treats, and/or party supplies.

4. “Return to Class” slips (filled out).

1. Review “Ending the Group” (p. 47).

2. Review individual students’ progress.

3. Have at least one genuine positive statement in mind regarding each...