Trauma – guidance for 11-16 year olds

Reactions to a traumatic experience can differ greatly from person to person. It is important to understand that just because a child/young person has experienced a traumatic event, this does not mean that they will inevitably suffer severe emotional consequences as a result.

Factors that influence how much children and young people react to a traumatic event include; their age and their ability to understand the event, the nature of the event, how quickly they can return to a normal lifestyle, their support network and the people around them.

Experiencing or witnessing a traumatic event can make a child or young person think that the world around them is no longer a safe and predictable place; this can be very frightening. Specific reactions can differ greatly but often seem to consist of a contradictory cycle of trying to avoid reminders, but at the same time re-experiencing the event in many ways over and over (nightmares, re-enacting).

School children may become moody, blame themselves, become angry and aggressive, or with-drawn. Adolescents may also become angry and upset, withdraw from friends and social activities. Their sleep and eating patterns may also change.

Coping with trauma is a complex challenge, and reactions to an event can therefore be very different and unpredictable.

Here’s a general guide to help you know how best to support your young person if they are experiencing trauma. This is not an exhaustive list; young people may experience symptoms which may not be included in this guide. If in doubt advice and guidance is available from the services listed below.

• If a young person is struggling to cope after a traumatic event, it is important they let someone know and get help, support and advice. Encourage them to talk to someone they trust such as a parent, carer, teacher or GP.
• There are many strategies and techniques to help with coping with flashbacks and anxiety – see some tips here.
• Some people find it helpful to keep a log of when they experience trauma symptoms (such as flashbacks) to notice if there are patterns or triggers (things or situations that are more likely to make a flashback happen). Notice patterns or triggers, might help the young person to make a plan of how to manage these situations if they come up.
• Having hobbies and interests and spending time with friends can be really helpful when experiencing symptoms of trauma as they can be a good distraction. Encourage the young person to plan regular time to do activities and see friends.

Young Minds gives free, relevant, practical information about a range of mental health issues in children and young people. View the Young Minds guide to trauma.

The typical events of this nature that children and young people experience tend to be situation specific, short term and can be managed with the love and support of parents/carers.

It is common for children and young people to experience or situations which are distressing, confusing or frightening as they develop through childhood and adolescence.  Examples of situations that may cause / contribute to a young person feeling distressed might be:

• Adjusting to changes (such as a new school)
• Friendships or relationship issues
• Episodes of being teased or bullied (including being or feeling left out or excluded)
• Being physically poorly or in pain
• Family breakdown or conflict
• Grief or loss (of a pet, family member or friend)
• Accidents (e.g., breaking an arm)
• Unexpected events
• Watching age / developmentally inappropriate material (e.g., films, games)

What you might see or a young person might report:

• Being clingy and not wanting to be separated from a parent / carer
• Not wanting to be left alone
• Seeking verbal reassurance and checking things are okay
• Not wanting to go to school
• Avoidance of seeing friends or doing activities they ordinarily enjoy
• Having mild sleep disturbance (e.g., bad dreams or difficulties getting to sleep)
• Feeling tired or appearing lethargic and unmotivated and disinterested
• Appearing withdrawn and less communicative
• May appear more challenging or oppositional / argumentative
• Crying
• In young children you may see a slight regression in behaviour such as wetting/soiling

If families or professionals are concerned that a young person is experiencing any of the issues above support is available, this includes:

Kooth

Kooth is a free online counselling and wellbeing support service, which is available to all young people aged 11-25 in Portsmouth.

Young people can access self-help resources, moderated peer support and professional support from counsellors.

There are no waiting lists or referrals, young people can visit Kooth.com and register anonymously.  The site is available 24/7 with counselling available 12pm – 10pm on weekdays and 6pm – 10pm on weekends, all year round.

Support in schools

All secondary schools have a named Mental Health Lead and within schools there is a range of pastoral support available.  Schools also work with other professionals in order to gain advice and guidance on how best to support children’s social and emotional needs. These services may include the Portsmouth Educational Psychology Team, the Multi Agency Behaviour Support Team and the Inclusion Outreach team.

Within many schools, pastoral support may be provided by Emotional Literacy Support Assistants (ELSAs)

ELSAs are teaching assistants or learning mentors in schools who have been trained by Educational Psychologists to work with children who are showing a wide range of emotional or social needs for example; anxiety, low self-esteem, problems with anger etc. Through individual (and small group) support programmes ELSAs help children to develop their social and emotional skills.

Support will also include Mental Health Support Teams (MHST’s) who are available in all secondary schools.

MHST’s support children and young people with mild to moderate mental health problems including trauma. They use cognitive behaviour therapy informed interventions to make changes in the way young people think and behave, improving their outlook on life.

The school should make contact with MHST for consultation and support for MHST referral where appropriate.

For professionals such as GPs they should encourage young people to register with Kooth and to link in with the school-based support described above.  The CAMHS Single Point of Access is also available for consultation and advice.

Available: Monday to Friday: 9am – 5pm.

Please contact: 0300 123 6632.

The degree to which a young person reacts to a difficult or distressing event lasts longer than a couple of days/weeks and causes the young person distress or might have some mild impact on their ability to cope with everyday life such as going to or coping at school, seeing friends or taking part in leisure activities.

Examples of situations or events that may cause / contribute to a young person feeling distressed might be:

• Being routinely teased or bullied (including being or feeling left out or excluded)
• Grief or loss (including romantic relationships ending)
• Witness or experience of conflict (at home or school)
• Witness or experiencing an accident or injury
• Family and relationship stressors (family breakdown parent / sibling ill-health, financial or social stressors)

As well as the features above, the following might also be present:

• Disrupted sleep (difficulties getting to or staying asleep, waking very early in the morning and not being able to get back to sleep)
• Seeking physical or verbal seeking reassurance or wanting to withdraw from social contact and communication
• Resistance to doing things; appearing unmotivated and disinterested
• Emotionally labile; frequent changes of emotion, more sensitive (e.g., irritable, upset, confused)
• May seem more on-edge or jumpy at times at other times may seem to be ‘in their own world / day dream type state’
• Overthinking and appearing preoccupied or concerned by the triggering event – more aware of anything related to the triggering event

Thoughts or urges to harm self or some thoughts to end life; some infrequent or superficial (not requiring medical attention) self-harm may occur. Please note that not all young people who engage in self-harm behaviour are depressed or suicidal. There are many reasons why a young person may engage in self-harm behaviour.

If families or professionals are concerned that a young person is experiencing any of the issues above support is available, this includes:

Kooth

Kooth is a free online counselling and wellbeing support service, which is available to all young people aged 11-25 in Portsmouth.

Young people can access self-help resources, moderated peer support and professional support from counsellors.

There are no waiting lists or referrals, young people can visit Kooth.com and register anonymously.  The site is available 24/7 with counselling available 12pm – 10pm on weekdays and 6pm – 10pm on weekends, all year round.

Support in schools

All secondary schools have a named Mental Health Lead and within schools there is a range of pastoral support available.  Schools also work with other professionals in order to gain advice and guidance on how best to support children’s social and emotional needs. These services may include the Portsmouth Educational Psychology Team, the Multi Agency Behaviour Support Team and the Inclusion Outreach team.

Within many schools, pastoral support may be provided by Emotional Literacy Support Assistants (ELSAs)

ELSAs are teaching assistants or learning mentors in schools who have been trained by Educational Psychologists to work with children who are showing a wide range of emotional or social needs for example; anxiety, low self-esteem, problems with anger etc. Through individual (and small group) support programmes ELSAs help children to develop their social and emotional skills.

Support will also include Mental Health Support Teams (MHST’s) who are available in all secondary schools.

MHST’s support children and young people with mild to moderate mental health problems including trauma/post traumatic stress disorder. They use cognitive behaviour therapy informed interventions to make changes in the way young people think and behave, improving their outlook on life.

The school should make contact with MHST for consultation and support for MHST referral where appropriate.

For professionals such as GP’s they should encourage young people to register with Kooth and to link in with the school-based support described above. The CAMHS Single Point of Access is also available for consultation and advice.

Available Monday to Friday, 9am – 5pm

Contact: 0300 123 6632

Young people are displaying signs of trauma/Post Traumatic Stress Disorder. These difficulties cause significant distress to a young person and significantly disrupt daily coping such as school / college, socialising and even self-care activities (e.g., sleep, bathing, eating).

Despite trying previous advice in the Getting Advice/Getting Help stages, the young person still experiences trauma symptoms at least 1 month after the traumatic event. Examples of situations that may cause / contribute to a young person feeling low in mood or depressed:

• Severe / chronic bullying or abuse (including neglect, emotional, physical, sexual)
• Social or family financial stressors (such as family breakdown, conflict or parental / sibling ill-health)
• Grief or loss
• Witnessing or experiencing a traumatic event
• Witness or experiencing an accident or injury
• Overwhelmed by pressures and stressors including individual factors e.g., health, social factors e.g., relationships, occupational factors e.g., school / college and environment e.g., living circumstances

What you might see or a young person might report

As well as the features in Green and Amber, the following might also be present:

• Flashbacks of the traumatic event (sudden / unexpected memories or recalling aspects of the traumatic event without warning or trying)
• Children may re-enact the traumatic event repeatedly in their play
• Disrupted sleep; nightmares / night terrors (that may or may not be linked to the traumatic event)
• Hypervigilance to threat and danger
• Isolating self from friends and family
• Episodes where young person appears non-reactive / shut down / in a daydream type state
• Poor memory or recall as well as periods of confusion or feeling spaced-out – may report things not feeling real
• Withdrawn and uncommunicative or not wanting to be left alone at all – this may seem uncharacteristic or age inappropriate for some teenagers
• Refusal to leave the house or attend / take part in activities such as school, hobbies, interests, seeing friends
• Significant impact on health and wellbeing such as not sleeping or eating for a sustained period of time. May show signs of physical compromise as a result.
• Appearing uncaring or unbothered about people or activities they previously would have cared about – may not honour commitments or responsibilities which is uncharacteristic
• May on occasion becoming agitated, distressed, oppositional or aggressive towards others
• Reactive and impulsive behaviour such as running away which may place them or others in danger
• Feeling hopeless about the future – not being able to see a future and appearing to give up on dreams, goals and hopes
• Thoughts, feelings, urges, plans or intent to harm self or end their life or harm others. Please note that not all young people who engage in self-harm behaviour are depressed or suicidal. There are many reasons why a young person may engage in self-harm behaviour.

Support available

Child and Adolescent Mental Health Service (CAMHS)

If families or professionals are concerned that a child is experiencing severe and enduring mental health issues that are impacting daily life then they can contact CAMHS Single Point of Access for consultation and advice.

Following on from this consultation if indicated CAMHS will require a written referral from a professional (this can include any professional that knows the child).  Once a referral is received into the CAMHS single point of access team they will aim to contact the family by phone to further triage the concerns. The outcome of this triage may be that the child is offered an initial appointment for further assessment, the outcome may also be signposting to other services mentioned earlier in this guidance.

CAMHS provide evidenced based treatment for mental health disorders. This can include medication and talking therapies on a 1-2-1, group or family basis. They offer face-to-face, web based, and telephone support on a needs-led basis.

Available Monday to Friday, 9am-5pm.

Please contact: 0300 123 6632.