Exercise developed and produced by:

Johns Hopkins Center for Civilian Biodefense Studies

National Memorial Institute for the Prevention of Terrorism

Office of Justice Programs, National Institutes of Justice, U.S. Department of Justice

The Alfred P. Sloan Foundation

The Role of Schools in Meeting Communities' Needs During Bioterrorism

Transcript  [Listen to this talk] [View the slides]

DR. SCHOCH-SPANA: We're next going to hear from Dr. Bradley Stein, who's a natural scientist with Rand. Also, an Assistant Professor of child psychiatry at the University of Southern California. His current research activities include the development of mental health recovery guidelines and technical assistance materials for schools nationwide for use in response to a school-related violent event. Thank you very much for coming out to the east coast.

DR. STEIN: Well, thank you very much. I look forward to having the opportunity to talk with you this morning a little bit about the role of schools in meeting some of the challenges and responding to bioterrorism. I'd like to start off by thanking Monica for bringing this wonderful summit together, and allowing me the opportunity to share some of our ideas with you. I've really enjoyed this morning, and I feel I'm following a very thoughtful group of speakers and those in the audience. Of course, by doing so what you may find is some of the ideas I'm going to share with you may reflect themes that you've already heard discussed this morning.

In the next ten minutes, what I'd like to do is really discuss why schools are a natural place to support children and families in the community. I'm going to argue, however, that there are some important differences between bioterrorism and the other types of disasters that schools may be prepared for, and discuss the implications of some of these differences.
Based on these differences, I'd like to take a little time to talk a bit about how we may want to go about improving the tools that schools have available to meet the psychological challenges that may arise related to a biological event. And finally, I'd like to argue that for this to really work, that schools must be a full and active partner in a community-wide public health response to any event involving a biological weapon.

Many of the ideas I'm going to share with you today draw on work that we've been doing under the umbrella of the Rand Center for Domestic and International Health Security, projects such as Monica mentioned, including a review of mental health issues and school safety plans, working very closely with the Los Angeles Unified School System to develop and evaluate a school-based mental health intervention for traumatized students, and the writing of a white paper based on a series of expert interviews, outlining some of the behavioral health issues and strategies related to bioterrorism preparedness and response. For those of you who want more information about the center, there are packets available outside by the registration desk that give information about the broad range of activities going on in this multi-disciplinary center.

Schools are a natural place to think about supporting children and families in a bioterror event. On any given day across America, over one out of every five Americans is an K-12 school as a student, as a teacher, as some other type of staff member or volunteer, but schools have an immediate and direct effect on a much larger group of people in a disaster. After disasters when parents are asked what was important to them, time and again they answer where were my children, and are they safe? And parents are going to look to schools to answer that question.

Finally, if you want to know about the role the schools are likely to play in any future event, one of the best places to look is the past. You see the local school districts responding to events in their community. The Oklahoma City Public Schools which screened thousands of students and provided support services following the bombing of the Federal Building. The New York City schools where there's evidence that over half of the kids who received some sort of counseling in the months after September 11th, received it through the schools. And the schools in the Washington, D.C. area, which during and after the sniper attacks played a very important role in supporting the children and families of the communities in this area. But the role of schools really goes beyond responding to a traumatic event in their own back yard.

I'd like to share with you some data from the national surveys we conducted at Rand after September 11th. The first, which was conducted just three to five days after the attacks, was one of the first studies to really document the wide-spread psychological impact of the attacks across the country.

We went back to many of the same parents in November, and among other things, asked what their children's schools had been doing to support children and families in response to terrorism. As you can see on this slide, nearly two-thirds of the almost 400 parents we talked with across the country in November told us that their child's school had been active in supporting children and families after the attacks. Schools had held special assemblies and classroom programs in response to terrorism. They had provided counseling to their students and children. And they had provided materials and information to assist parents in helping their children cope. So schools are important, and their role really isn't limited to an event which happens right down the road. But a bioterror event may be quite different than many of the other crisis events that schools and other community planners commonly think about and prepare for; such as, natural disasters, earthquakes, tornadoes and other disasters that schools at least give some thought to, such as shootings on campuses and explosions.

When we compare these other types of crises with bioterrorism, as people have already mentioned this morning, we note there are very important differences, including the speed at which the event results in an effect on an affected population. The ability to identify the site of the event, the public's knowledge of the event's boundaries and scope, and who is really likely to be at risk, the familiarity with the type of the event. Dr. Norwood spoke this morning that biological events raise some very primitive fears in all of us about being attacked by something unseen and unknown. And the distribution of affected people, and where they might be geographically. So we see that bioterrorism differs on some very important dimensions from other crises that schools are accustomed to dealing with.

These differences have led many people to suggest that the behavioral and psychological issues are likely to be somewhat more complicated and more widespread in a bioterror event than in many of the other crises that schools and communities commonly face and plan for.

So what do these differences imply? What do these differences between bioterrorism and other crises imply for schools? Well, there are a number of things, but I'd really like to take the time I have available to focus on two that I think are critically important to think about.
First of all, we all need to think very hard about whether the tools now available to schools, the materials they send home, the counseling or debriefing services that they commonly provide, which are really two of the things that schools are most likely to do, to whether these interventions are appropriate and effective for helping children and families cope with the psychological challenges of bioterrorism.

And second, to the point I made earlier, that schools must really take an active role in ensuring that they're an integral part of a community-wide public health effort related to bioterrorism, not an after-thought.
To the first point. An obvious place to begin developing and refining the tools to help children and families in the face of bioterrorism is to build on the tools that schools already use, that the question is how do we tailor them for bioterrorism and evaluate their usefulness, not just take what we know now and send it out there and say well, you know, we've been doing this for a long time, so let's continue to do it.

Some might argue that this can't be done, but I'd like to suggest that we can make a good start by examining and evaluating the impact of these tools in situations that may serve as analogs to an event involving a biological agent. Analogs include some of the things that we've heard about already, and that we're going to hear about this afternoon.

Infectious disease outbreaks. Meningitis is one example. It certainly is something that schools are very alert to, but there are other examples of acute outbreaks both in this country and abroad that we may be able to learn from.

The schools' role in the sniper attacks in the D.C. area is certainly another example. And unfortunately, some areas of our country are terrorized by acts of random violence on an ongoing basis. These areas may also serve as a very good analog for some of the things we need to learn about. In all of these situations, the questions we need to ask include what are the schools doing, and when in the course of the event did they do it? What impact have these actions had? And by learning this, can we improve the tools available to schools?
And finally, do parents, children and others in the community perceive the school's action as helpful, or is there something that the experts feel needs to be done, and the community wants something else?

I'm not suggesting answering these questions is going to be easy. And the answers we get won't be perfectly applicable to bioterror events, but the answers will allow us to begin building an evidence base where currently almost none exists for strategies that schools can use to meet the psychological challenges of bioterrorism.

The last issue I want to address is the importance of schools as an active partner in an integrated community-wide response to bioterrorism. As we all know, the vast majority of children in this country are in school, so any plans to ensure our children's safety in the event of something that involves a biological agent must begin with schools. School safety plans, which are mandated in most states, and really form the architecture of a school's response to any crisis, really need to include strategies for keeping children safe in the event of an attack with biological weapons. I think you're starting to see that now. One great example just last week is the announcement by the Fairfax County schools of plans to shelter in place in the event of a biological or chemical event.

It's likely that in the next several months the Department of Education is going to recommend the strategy for schools across the country, but this is more complicated than it sounds. Implementing such strategies will require substantial planning by the schools, and it's also going to require substantial resources for the schools to be able to implement.

Remember as my slides earlier suggested, in the case of a biological weapon, it may not be obvious when an attack has occurred, who is at most risk, or when the danger is passed. As a result, schools and the rest of us really need to consider what it means to discuss and ensure children's safety on an ongoing basis in the situation where there's great amount of uncertainty about the level of risk.

The second major role of schools is likely going to be communicating with parents, both in advance of an event, as well as after an event. Since September 11th, not only do parents want to know their children are safe, parents want to know how schools are planning to keep their children safe. And schools really need to make sure parents are aware of any plans. And optimally, parents should be participating in the discussions of such plans as they are made, and as they are implemented. As part of these activities, schools may also play a very important role in educating much of the public about things community members can do to protect themselves in the case of bioterrorism.

Finally, and again I'm going back to a point you've heard before. Because of the ongoing nature of any event involving a biological weapon, schools need to think about and plan for an ongoing dialogue with parents about children's safety. The best way so to begin and sustain this dialogue will probably vary from school to school, and district to district. The challenge is going to be to balance consistency across communities or districts with flexibility.

Now for those of you who are familiar with schools or have worked with them before, you've probably already recognized that many of these tasks are going to be quite new for schools. They create an entire new set of demands on teachers and on school staff, in addition to what we're already asking them to do.

We need to be sure that they're provided with the support they need to meet these new demands. But in addition to those resources, in many cases the things I'm discussing are things that schools are not going to be able to do in isolation, which really brings me to my last point.

Schools cannot and should not make decisions about the safety of children and what should be communicated with parents in a vacuum. Instead, schools will need to be part of a joint community decision-making process. In any event with a biological weapon, there's going to be a substantial amount of uncertainty. And for a period of time, the level of risk may actually be unknowable. Schools aren't going to be able to ensure children are safe and effectively communicate with parents unless they're a full partner in the overall community response, because schools are going to be critically dependent upon these other organizations in their community for receiving the information, and receiving it in a timely manner. So for schools to be successful in this critical new role, they really must become full partners in the overall community response to bioterrorism.

I'd like to now get to the point that Kathleen said, is what does this mean, and how do you operationalize it? I mean, these are very wonderful sentiments. How does that happen? Well, I think three things that are very concrete things that I hope all of you can take back to your communities include, one, schools should be part of emergency management agency planning to allow input from community partners into the school's crisis plans, and at the same time to allow other plans in the community to be informed by what schools know about children and families. Also, as I said, schools may provide one of the best ways to communicate with much of the public about these plans.

Second, schools should actively participate in emergency management community drills and tabletop exercises. That's the only way you're really going to refine the school's role in the community's response to bioterrorism, and really find out where the gaps are, and how to make this system work.

Finally and optimally, have a seat at the table in the community's incident command structure so that in the event of a crisis where these decisions are going to have to be made in the face of changing information, schools can participate as these decisions change over time.

I've discussed many of the issues faced by schools in preparing for and responding to any event involving a biological weapon. Bioterrorism presents schools with unique challenges in an environment that will be characterized by uncertainty and lack of information. But schools have a history of rising to meet the needs of children and family during crises. I think it's imperative that we now work together to provide schools with the support they need, the information they need, and the tools they need to be better prepared to face the new challenges posed by bioterrorism as part of community-wide public health response. Thank you.

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