Case Notes

The Newtown tragedy and Connecticut’s trauma-informed response

State agencies and the provider community bring existing systems into play to help those affected by the shootings and their aftermath.

By Yvonne Humenay Roberst, PhD

Contributing Authors: Christopher Bory, PsyD; Robert P. Franks, PhD; Jason Lang, PhD; Jeffrey Vanderploeg, PhD

The shootings at Sandy Hook Elementary School in Newtown, Conn. were an unthinkable tragedy. Returning to a sense of security and normalcy is a difficult process for these children and families. When children are exposed to traumatic events, such as school shootings, they are at increased risk for mental health consequences in both the short and long-term. Now more than ever, there has been increased national attention on identifying and implementing the most effective treatments for child traumatic stress.

There has been a range of intensive and comprehensive efforts made in response to the Newtown tragedy by state agencies, providers and other stakeholders across Connecticut. However, before this awful event ever occurred, Connecticut’s state agencies and provider community had begun to build a statewide traumainformed system of mental health care for its most vulnerable children and families. Many of these services and supports have been instrumental in part of the response to the Newtown tragedy. The Child Health and Development Institute (CHDI) is a non-profit institute funded by state and federal agencies and philanthropy, and is just one of the entities in Connecticut who have collaborated with providers and state agencies to help build a trauma-informed system of care. Below is a brief overview of a few collaborative efforts that are responding in the wake of the Newtown tragedy at multiple levels on the continuum of care. It is important to note that many other important initiatives are currently underway and this brief article reviews only a few of those efforts.

Educating Practices in the Community (EPIC)

CHDI, supported by the Children’s Fund of Connecticut, worked in partnership with the CT Chapter of the American Academy of Pediatrics and the CT Chapter of the American Academy of Family Physicians, to develop the EPIC training program to inform pediatricians and other health providers about critical children’s health issues. The EPIC model of “academic detailing,” covers a variety of topics including identifying and screening traumatic stress issues in children. In collaboration with the State Department of Education (SDE), the EPIC “trauma module” has been delivered to pediatricians, school nurses, school psychologists, social workers, teachers and other school staff across the state in the wake of the Newtown tragedy. The module is designed to educate professionals who work with children on the signs and symptoms of trauma as well as link them to community-based resources. Training pediatricians to better identify and respond to children experiencing traumatic stress reactions can help prevent future health and mental health consequences that can adversely impact their development and lead to life-long difficulties.

Emergency Mobile Psychiatric Services (EMPS)

EMPS is a mobile crisis stabilization service for children and an important element of the Connecticut Department of Children and Families (DCF) community-based system of mental health services and supports. There are 15 EMPS sites across the state that collectively provide coverage of every city and town in Connecticut, offering crisis stabilization, brief trauma-informed care, and linkage to ongoing services and supports. The EMPS service is available free of charge to children up to age 18 in Connecticut, irrespective of income or insurance status. Training and quality improvement activities for EMPS are coordinated by the Performance Improvement Center at CHDI.

EMPS clinicians provided mental health support to students, parents and other family members, and school professionals at Sandy Hook Elementary and in the surrounding communities. In the days and weeks that followed, EMPS clinicians continued to provide ongoing support to these individuals and families. In all, more than 40 EMPS clinicians and community-based agency administrators were involved in a trauma-informed mental health response. All EMPS clinicians receive training on understanding child trauma, recognizing symptoms of trauma exposure, and intervening with trauma-exposed youth and their families. In addition, EMPS providers receive training and consultation on issues of secondary trauma and self-care. The EMPS service has been a vital component to Connecticut’s response to the Newtown tragedy and is an integral component of Connecticut’s community-based system of care. Crisis clinicians play an important role in early identification, acute treatment and prevention of long-term consequences following exposure to a traumatic event.

Trauma Focused Cognitive Behavioral Therapy (TF-CBT)

Children and families seeking ongoing behavioral health services in the months and years following the shootings in Newtown have access to a network of treatment providers trained in evidence-based, trauma-focused care. Beginning in 2007, CHDI has worked with the Department of Children and Families (DCF) to disseminate an evidence-based model, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), in community-based children’s outpatient clinics across Connecticut through a combination of state funding and a federal grant from the Administration for Children and Families (ACF). There are currently 22 agencies with more than 250 clinical staff trained to provide TF-CBT. Four of these agencies are within 30 minutes of Newtown. Since 2007, this network has provided TF-CBT to more than 2,000 children and families. TF-CBT, one of the most effective treatments for chronic traumatic stress reactions in children, has become a vital component of Connecticut’s continuum of community-based mental health service system.

Trauma Informed Child Welfare Practice

Connecticut’s child welfare system has been working towards developing a trauma-informed system of care. As part of the ACF funded initiative, DCF is planning a statewide rollout of universal trauma screening and workforce development to help child welfare staff understand and recognize the symptoms of trauma, and to administer a brief, standardized trauma screening tool. All children involved in the child welfare system will be screened for trauma exposure and traumatic stress symptoms, and those deemed at risk will be referred for further assessment by clinicians trained in trauma-focused treatment.

The Connecticut School Based Diversion Initiative Following the Newtown shootings, schools will continue to examine issues of school safety, school climate, student discipline, and access to mental health care. Although Connecticut’s School Based Diversion Initiative (SBDI) was initially developed to reduce the number of children who are arrested in schools and processed through the juvenile courts, a broader goal involves enhancing school linkages to community-based mental health care. SBDI is supported by the MacArthur Foundation’s Models for Change Initiative, the Connecticut Judicial Branch, DCF, and SDE. SBDI offers training to school personnel on recognizing students’ mental health needs and accessing mental health services and supports in the school and the community. In addition to training, SBDI offers disciplinary policy consultation and coordination with community-based mental health services that can help ensure that at-risk students access mental health care and are able to remain in school to graduation.

Focus on Child Traumatic Stress: Next Steps

The children and families, school personnel, first responders, clinicians, and others directly involved with the shootings in Newtown have experienced an unimaginable tragedy. To no one’s surprise, there has been a ripple effect that has reverberated throughout Connecticut and across the nation. A follow-up response takes a network of community-based providers and state agencies to collaborate and coordinate in order to provide effective services to children and families who have experienced trauma. The programs described above are one institute’s efforts to work collaboratively with state partners to build a community-based system of care that is positioned to respond to this crisis on multiple levels.

This collaborative approach is not only important in Connecticut in the wake of the Newtown tragedy, but can also be replicated in other states looking to become more trauma-informed. In the months and years to follow, Connecticut will continue to cope with the aftermath of these events and build upon the foundation of trauma-informed resources and supports in order to meet the needs of the most vulnerable children and families impacted by traumatic stress.

More information about Connecticut’s trauma-focused and other services to support children is available at: