Lisa Baron, Director Center for Trauma Care in Schools
With school-based clinician caseloads jam-packed to meet productivity goals, and the juggling act required for frequent scheduling conflicts, school-based clinicians often are reluctant to do the extra leg-work required to run groups. But schools value groups because more students can be served, and the chance for students to share experiences with one’s peers, guided by the expertise of a mental health professional, is invaluable to students’ social-emotional development.
When groups do happen, most of them are unstructured and somewhat generic “social skills” groups because there are few opportunities for training in evidence-based practices (EBPs) and little time to do the prep work required for an EBP. Evidence-based treatment groups require the clinician to be trained and supervised in the model. The barriers to leading EBP groups in schools are very real. These barriers are especially salient for trauma groups due to the sensitivity of the events discussed and sometimes disclosed in group. Once trained, multiple students need to be recruited to fill what would normally be a one-on-one clinical hour, and active consents for both screening and group participation need to be obtained. Then there’s the hunt for confidential space large enough for the group, and finding a time that works for multiple students during the school day without encroaching on core instruction time. Add group prep time, billing and progress notes for multiple students to the mix, and it’s no wonder that clinicians opt for individual treatment over groups. Finally, and especially in the case of trauma groups, there is the emotional toll of hearing about some of the heartrending things that have happened to the children you work with and care about.
Clinicians are usually eager to be trained in EBPs, but they struggle with implementation barriers. Given the value of these groups to the schools and the students, how can we make it more likely that clinicians will actually run them?
1) Have materials ready to go: Clinicians have little time to organize group sessions. The Center for Trauma Care in Schools offers training and implementation support in Cognitive-Behavioral Intervention for Trauma in Schools (CBITS) and its adaptation for younger students, Bounce Back. These are evidence-based, 10-session groups designed for use in schools with urban students. CTCS distributes binders at the trainings with all needed handouts and worksheets. Because CTCS collects data about these groups, reminders are emailed to all participants, and there is a data collection protocol established to minimize disruption to clinicians’ busy schedules.
2) Provide ample support: CTCS has piloted a mapping project to locate multiple clinical “assets” in a school. Having a co-leader (who may or may not have been trained in the EBP) reduces the amount of work required by a single clinician to do the pre-group work of obtaining parent permissions and screening the students. A second person also helps round-up the students for group and assists with group activities. CTCS has created an on-line tracking form for clinicians to register their group to receive implementation support from the Center. Regular consultation calls with national experts are also available to help clinicians navigate through the 10 sessions.
3) Show appreciation: Participating clinicians are featured in the CTCS newsletter Center NOW that showcases the important work they are doing. At the end of the group, clinicians receive a “thank you” grab bag full of self-care items.
CTCS data shows that, in general, clinicians who have run one CBITS/Bounce Back group are more likely to run more groups in the future. It seems the biggest barrier is simply getting the first group under your belt. Clinicians tell us that once they get into the content of the groups and see how much students value the support and describe how they are using the skills they are learning about how to better regulate their emotions, etc., they feel the group formation hurdles are worth the effort. Students from elementary to high school discover that they are not alone in their suffering; that others have experienced similar, painful events. The groups help them to learn and practice important skills with their peers that help them succeed in school and in other parts of their life. Evidence-based groups, whether focused on trauma or building other types of coping skills, are fertile ground for powerful experiences that individual therapy alone cannot provide. We owe it to time-strapped clinicians to find ways to minimize the barriers to forming and leading evidence-based groups so that they can know that their extra efforts are more likely to have a lasting impact on children’s ability to succeed in school and in life. Our students certainly deserve no less.