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Counseling, bereavement skills come to the fore
On a recent typical sunny Southern California day, 1,900 students at a San Diego-area high school were making their way from one class to their next when a classmate randomly fired a .22 caliber handgun, killing two students and wounding 13 others. As a nation gasped at what seems to be an all-too-common story, students, parents, and teachers at Santana High School in Santee, CA, struggled to make sense of it all and grieve for two lives that were cut short without apparent reason.
Fifteen-year-old Charles Andrew Williams, whose slight frame and baby face belied the violence he is accused of wreaking on his school, is charged with a number of crimes related to the Mar. 5 incident, including two counts of murder in the deaths of 14-year-old Bryan Zuckor and 17-year-old Randy Gordon.
The details of the tragedy and accompanying images of wounded and distraught students are what captured the front pages of newspapers and lead television news broadcasts across the country throughout the week. But as the days passed and students returned to school, national attention turned elsewhere. Those left in the shooter’s wake — not just those who were physically injured, but also those whose psyches had been shattered — face a long, difficult road as they begin to reconcile the world they once knew with the frightening world they have been thrust into.
Noreen Carrington, LMFT, director of bereavement and volunteer services for San Diego Hospice, was going about her normal duties of running the hospice’s large bereavement program when word of the shooting came in that Monday morning.
At Sharp HospiceCare in nearby La Mesa, four employees whose children attended the school scrambled to locate their teenagers. "We heard about the shooting through word of mouth, and we spent much of the day waiting to hear from members of our hospice family to call and tell us their kids were okay," says Laura Grayson, MSW, bereavement coordinator for Sharp HospiceCare.
Yet, as both organizations wondered how a tragedy like this could touch their community, they understood their responsibility to provide expertise in grief counseling. Officials at San Diego Hospice and HospiceCare didn’t wait for a phone call from school officials. Instead, they contacted the school Monday afternoon and offered their grief counseling services. After all, bereavement care and grief counseling are key components of the hospice mission, and those close to the shooting would definitely have grief issues to work through.
School officials accepted San Diego Hospice’s services, while the onslaught of volunteers prompted school officials to place HospiceCare counselors on a waiting list for on-campus counseling. That did not preclude them from helping, though. HospiceCare counselors were stationed at two of the local hospitals to provide counseling to family members of the injured who were being treated in the emergency rooms and surgery.
"The community really responded," says Carrington. "On Wednesday, the first day students came back, there were about 200 counselors. We sent five."
To the school’s credit, it had a disaster plan in place, and it was already in full gear when hospice counselors arrived, says Carrington. The plan included mobilizing teams to provide crisis intervention for students, parents, and teachers in need of it. Crisis counselors were placed in each classroom the Wednesday after the shooting, where they spoke with students and gave them an opportunity to share their feelings.
"We were there to support that plan," says Carrington.
Focus on support, not therapy
Still, Carrington and other hospice counselors realized that their expertise was not completely compatible with the needs of students, parents, and teachers. For the most part, hospice bereavement programs deal with family members and friends who have had time to prepare for the death of a loved one. The focus of bereavement care is usually helping the bereaved begin the mourning process.
The focus is much different, says Grayson, when counselors are faced with those who are grieving as a result of a sudden and traumatic loss. Counselors had to deal with the victims’ immediate needs. At Grossmont Hospital and Sharp Memorial Hospital, where seven victims were taken, including one victim who died, counselors met with family who were not only struggling to understand why the incident occurred, but to get information amid the chaos of both emergency rooms.
"What we saw was primitive, raw fear," says Grayson. "Of course, there were the understandable questions of whether their child was going to be all right. Most were in utter disbelief. They just kept asking: Why?"
Recognizing the difference, counselors shifted their focus away from the way they normally address grief. Most of the time, counselors just listened and confirmed people’s feelings. "They were told: This is a tragedy and you’re right to feel the way you do. What can I do to help?’" Grayson says.
Counselors acted as liaisons, linking families with medical staff to get updated information. They also provided a calm environment where families could wait, away from the crush of media trying to chase down the day’s big story.
The next day, a memorial service was held at nearby Sonrise Church to give residents of Santee an opportunity to pray and grieve for the dead and injured students, as well as for the remainder of the student body, which had been deeply traumatized by the incident. Three counselors and a social worker from HospiceCare attended the service as part of a crisis intervention team.
Looking for those in the fringes
All eyes were upon Santana High School the following Wednesday when students were scheduled to return to class. It was not business as usual, however, as students were allowed the day to talk with counselors and comfort one another.
Hospice of San Diego counselors were part of a platoon of volunteer counselors both in the classroom and roaming around campus Wednesday and throughout the week. Hospice counselors were stationed around campus to provide on-the-spot counseling for students who showed outward signs of struggling.
As Wednesday progressed, mourners and well-wishers built makeshift memorials of cards, pictures, and balloons where their two fellow students fell. As parents dropped off their children, they held on to them, reluctant to let go.
"A lot of kids were fearful of returning to school," says Carrington. "There were a lot parents who were just as fearful. I saw a girl who was injured during the shooting come back with her mother. They arrived later in the day, and you could tell both were having a difficult letting each other go."
It was moments such as this when Carrington and her colleagues were asked to step forward and help. The mother and daughter were ushered to a "safe zone" — a place on campus such as an unoccupied classroom or library — where they could receive counseling.
"We got them both to a safe zone, and the mother was able to feel better about leaving her daughter, and the daughter was able to go to some classes," Carrington continued. "I saw the young lady later in the day. She was surrounded by friends, and they seemed to be supporting her. I saw such courage in these kids, it was incredible. The students were real good at taking care of themselves."
Carrington and other counselors, however, kept a close eye out for students who were not getting support or who were in small groups where no one seemed to be coping well. "Our job was to look out for those on the fringe, those who didn’t have a support group to lean on or whose group as a whole was having a hard time."
As in the frantic moments and hours immediately after the shooting, the focus had not changed. Counselors were still addressing immediate needs, says Carrington.
"This was not therapy; it was support," Carrington says. "They were all trying to make sense of something that didn’t make sense."
For teenagers, the incident made what is already a difficult time in life even more difficult. School is supposed to be a haven of sorts for teenagers, a place were they can measure themselves against the ebb and flow of life and emerge as individuals ready to go out into the world. The shooting, says Carrington, took that safe haven away and robbed them of a great degree of both their innocence and their longing for independence. So, while the vast majority of students don’t bear any physical scars, the emotional scars were deep and fresh that first day back.
In the classrooms, crisis counselors "debriefed" students by asking them to participate in group discussions or activities designed to get them to share their unfamiliar emotions. Some students were asked to write a letter to anyone of their choosing describing how they felt.
"I was told that every child was completely engaged in this activity and that many chose to write to the parents of the two students who were killed," Carrington says.
Wednesday, Thursday, and Friday were a departure from normal school activities. School officials themselves were unsure when the school would get back to the business of teaching. "What I saw was the school taking things day by day," Carrington says.
Meeting long-term needs
Although Santana High School has now taken on the semblance of normalcy, that outward appearance doesn’t mean the students, parents, and teachers are far enough removed from that fateful day to be considered healed.
"What we’ve seen in cases of traumatic loss is that four to six weeks later, you begin to see the true impact of what has happened," says Grayson. "The initial shock that we feel when something like this happens protects us, but when the shock wears off, the feelings and emotions that have been held back begin to surface."
That underscores the need for long-term care for children who continue to struggle. To help address victims’ long-term needs, HospiceCare has opened up its bereavement programs to students and school officials. The hospice recently launched a traumatic loss program designed to address bereavement issues following unexpected deaths, such as automobile accidents and suicide.
In addition, the hospice’s adolescent grief group was offered to students who wished to participate in group therapy with their fellow students and other peers who have lost loved ones unexpectedly.
"We would help these teens talk about loss — not just about the loss of other students, but the loss of trust and innocence," Grayson explains.
The teen grief group is especially valuable to the long-term care of Santana students, says Grayson, because it centers around teenagers talking to other teenagers. "Teens use themselves so much better than they use adults," Grayson adds.
San Diego Hospice will keep an ongoing presence on campus. Counselors, some of whom have become familiar to students, will visit the campus once a week to talk to students who voluntarily seek their help and to those who seem to be having difficulty coping.
Looking back, Grayson and Carrington have nothing but praise for the way their organizations responded and even greater praise for how school officials and the community responded so quickly to students’ needs. The events of the week are still fresh in their minds, making it difficult to assess changes that would improve school access to their programs or make their own counseling more effective. But one lesson seemed to stand out: "In a crisis, everyone wants to do something," Carrington says. "We need to learn how to wait and listen, give what’s needed when needed."