AAP Voices Blog

School is in full swing, but for many students in Uvalde, Texas, and other schools across the nation, that means staying at home. Although some districts have spent millions of dollars enhancing the physical security of their campuses, many parents and children are still apprehensive about returning to school, with many considering homeschooling or virtual options, risking their own livelihoods.

“I have seen first-hand the outcomes and long-term effects that adverse childhood experiences can have on my patients.”

As a pediatrician in Texas, I am concerned with our response and support for child survivors. Communities like Uvalde face many challenges in serving the needs of these children in the aftermath of school shootings and violence. I have seen first-hand the outcomes and long-term effects that adverse childhood experiences can have on my patients.

The U.S. has had more than 2,000 school shootings since 1970 and these numbers are growing. There have been more than 900 school shootings since the tragedy at Sandy Hook Elementary School in Connecticut in 2012. As mass violence events have become common, I believe we need a more organized and structured response to support these communities, schools, and children in their recovery journey.

Many know the mental health consequences of surviving trauma from post-traumatic stress disorder, depression, generalized anxiety disorder, substance abuse, and self-harm. As pediatricians, we are aware of the long-term effects of these adverse childhood experiences that impact a survivor’s physical health and lead to adult causes of death, including stroke, cancer, and heart disease.

Child survivors also face significant delays in their academic progress. These students need additional support programs to maintain their educational trajectory. They are more likely to have unexcused absences and less likely to graduate high school, attend college, graduate from college, and be employed between the ages of 24 to 26.

The Substance Abuse and Mental Health Services Administration published a supplemental research bulletin in 2017 that focuses on mass violence and its effect on behavioral health for both adults and children. This document breaks down the experience of survivors into multiple phases, with suggested interventions at each stage.

SAMHSA recommends screening children to detect the severity of trauma and making individualized intervention plans. The National Child Traumatic Stress Network has well-documented programs and interventions that local communities can implement to improve mental health outcomes. Schools and districts are expected to implement many programs with limited funding, staffing, and resources. To exacerbate this problem, schools also face retention problems for teachers and teaching support staff in the aftermath of a school shooting.

While SAMHSA and NCTSN provide valuable guidance on how communities can tackle mental health issues, I firmly believe that to help these survivors in the long term we need national support to build a robust dual-pronged approach:

1. Preparedness: The Biden administration and The Office of Victims of Crimes already compiles guidelines, mental health resources, and resources for schools, but there are gaps to fill on programming templates, especially for students who plan to return to school virtually. We need to make a standard playbook that can be relied on by future communities facing similar challenges.
2. Execution: Following an event, these communities may need to quickly acquire funding, staffing, and consultation with a multidisciplinary expert panel. Many of the guidelines that SAMHSA and the OVC provide are 40-plus-page documents that require significant time and expertise to digest. When the next event occurs, these communities would greatly benefit from human resources that are already up to speed with what needs to be done.

The most effective way to treat these events is to prevent them altogether. Implementing national programs to guide communities through this process may not save any lives, but I hope that a national effort to bolster these grief-stricken communities will garner bipartisan support where some preventative policies may not.

No community is completely prepared to deal with the aftermath of a mass violence event. These events are a national problem; these communities deserve federal support to recover and heal.

If you or someone you know is experiencing distress concerning an incident of mass violence, call or text the disaster distress helpline at 1-800-985-5990 for support and counseling.

*The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.