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Grief and trauma training is unexpectedly healing for school district staff in Texas

MARY LOUISE KELLY, HOST:

It's been more than a year now since kids across the country returned to classrooms during the pandemic. Many students are still struggling to have some sense of normalcy in their lives. That is especially true for children who have recently lost loved ones. But educators often don't feel equipped to support kids who are grieving, which is why the second-largest school district in Texas decided to send their mental health staff to a special training on grief and trauma. NPR's Rhitu Chatterjee has the story.

RHITU CHATTERJEE, BYLINE: If you ask social workers and therapists working for the Dallas Independent School District about what the past couple of years have been like, this is what they'll tell you.

MONICA MUNOZ: I was seeing multiple students every single day who were at least acutely suicidal.

KRISTINA MCCRAY: And I've also noticed, like, crime where there is students being involved in, like, drugs, selling and using.

HECTOR SOTO: I had a scholar who lost a grandparent and then they lost a brother to homicide, and then they lost a friend to a car accident.

DIANNE BIPPERT: So many people have been lost to the pandemic, and you can still feel that loss from people. They just are surviving, I think.

CHATTERJEE: Monica Munoz, Kristina McCray, Hector Soto and Dianne Bippert are all school-based mental health care providers in this urban school district. And they've often felt overwhelmed. So when the district offered them a chance to take this new training, they were quick to sign up. And so one morning in early November, 80 school-based social workers, therapists, psychologists gathered in a conference room in an old administrative building in East Dallas.

MARISA NOWITZ: Good morning, everybody. We're going to get started in two minutes.

CHATTERJEE: The people doing the training are from the Meadows Mental Health Policy Institute in Houston. Julie Kaplow directs the grief and trauma program there and has spent years researching the impact of grief on children.

JULIE KAPLOW: So I know I'm dating myself here. Does anyone recognize this lady?

UNIDENTIFIED PERSON #1: I think I...

KAPLOW: So she is the Wendy's commercial lady. She used to be saying, where's the beef? She's now our mascot. She's saying, where's the grief?

CHATTERJEE: Kaplow says, as a society, we don't talk about grief, despite how universal the experience is.

KAPLOW: It's the most distressing form of trauma among adults and youth. If you were to ask anybody what is the hardest thing that's ever happened to you, the vast majority would say it was the death of my mother, my brother, my best friend.

CHATTERJEE: And yet, Kaplow knows that a lot of the folks in this room, even though they're social workers and therapists, don't know much about what grief looks like in children, how it affects them, how it plays out over time.

KAPLOW: Children's grief is not a mini me version of adult grief. The way that children grieve looks very different than how adults grieve.

CHATTERJEE: She tells them that no two kids grieve the same way. Some obsess about how their loved one died. Others have fantasies of being reunited with them, which puts them at a higher risk of suicide. Some struggle with existential pain. But often kids don't have the words to understand or express what they're going through, so it shows up in their behaviors. They act out, become hyper vigilant, struggle to focus. Kaplow says about 10- to 20% of kids are at risk of developing prolonged grief disorder, which keeps them stuck in grief. And those who've lost a parent or caregiver are at a greater risk of all kinds of long-term problems at school, in their relationships and are more likely to develop symptoms of mental illness, including PTSD. And the pandemic, she says, has put many more kids at risk of these complications.

KAPLOW: The last numbers I saw, we have about 290,000 U.S. youth who've experienced the death of a caregiver due to COVID.

CHATTERJEE: And Latino and African American kids - that's the vast majority of students at the Dallas Independent School District - have been disproportionately affected by these deaths. The pandemic has also exacerbated other traumas and stress in their lives. More families have lost income, more lives lost to gun violence, car accidents and other causes. Kaplow's colleague, Marisa Nowitz, introduces an intervention designed to help kids heal from grief and trauma.

NOWITZ: It's been around for many, many years. It's been used after the war in Bosnia. It's been used after Columbine.

CHATTERJEE: Nowitz says the treatment works well in the school setting and starts with teaching kids the words to understand grief.

NOWITZ: We want to describe grief reactions in kid speak, help the kids get broader vocabularies for labeling their grief reactions, explain how they may change over time, explain the purpose of grief and mourning.

CHATTERJEE: Her colleague Stacey Brittain talks about using the feelings thermometer. It's a colored chart showing different emotions that's included in a thick manual given to every participant.

STACEY BRITTAIN: We're going to start using that every session for check in. How are you feeling? Rate the level, the intensity of the emotion or emotions that you're feeling this day.

CHATTERJEE: The participants then practice this in breakout groups.

UNIDENTIFIED PERSON #2: Frustrated, calm, happy - color that emotion that you're feeling the most right now.

CHATTERJEE: And this paves the way for therapists to teach kids healthy ways to cope with their pain so they don't turn to self-harm or drugs or violence. The next day, Kaplow shares tools to use with kids in more complicated circumstances.

KAPLOW: So many of the kids that we work with have what we call ambivalent losses. This might have been a person who they may not have had the most healthy relationship with, but they're still grieving.

CHATTERJEE: She says these ambivalent losses often confuse and distress children. And a simple exercise can help.

KAPLOW: This exercise is designed to help with acceptance of negative traits or behaviors of the person who died while holding on to more of those positive memories.

CHATTERJEE: As she speaks, her colleagues give each group a big plastic bowl, a jar of water and a handful of stones and popsicle sticks.

KAPLOW: When we do this exercises, we have each child, adolescent write down on two of their stones two negative traits or behaviors of the person who died. Popsicle sticks - we want the kids to write down two positive traits or behaviors.

CHATTERJEE: Then they'll throw the sticks and stones in the bowl before pouring the water in.

KAPLOW: We pour the water in. The stones remain on the bottom, and you can go to town with the metaphors here.

UNIDENTIFIED PERSON #2: And let the positive rise.

CHATTERJEE: As the participants practice this, many, like therapist Tamika Johnson, talk about people they've lost.

TAMIKA JOHNSON: My cousin, who lived a dangerous life, and he wouldn't change, but I could tell that he loved his family.

CHATTERJEE: Later, sitting outside, Johnson tells me that working with grieving clients used to make her anxious. She felt ill-equipped, and it didn't help that, like many of her colleagues, she, too, has recently lost loved ones.

JOHNSON: I lost three relatives back to back to back. One was - died from COVID and one gun violence and the other one was diabetes - three different traumatic experiences for me.

CHATTERJEE: But she barely had a chance to grieve until this workshop.

JOHNSON: To be able to process that and still help others through their healing has been life-changing for me - I think will make me an even more powerful therapist.

CHATTERJEE: That's the power in talking about grief, says Julie Kaplow.

KAPLOW: One of my mentors used to say, you need to feel it to heal it.

CHATTERJEE: And with all the deaths and other losses kids have endured in recent years, she says we must get better at helping kids grieve.

KAPLOW: And what I mean by that is acknowledging that kids have experienced significant losses, that children grieve just as much as adults do and that by addressing it, naming it, bearing witness to it, we can actually produce a lot of healing.

CHATTERJEE: Rhitu Chatterjee, NPR News.

KELLY: And Rhitu's reporting for this story was supported by the Dart Center on Trauma and Journalism. Transcript provided by NPR, Copyright NPR.

Rhitu Chatterjee is a health correspondent with NPR, with a focus on mental health. In addition to writing about the latest developments in psychology and psychiatry, she reports on the prevalence of different mental illnesses and new developments in treatments.