Deborah Howell (Host): Whether they've experienced a shooting directly or are affected by the constant coverage, tragically, kids today are growing up in a world where safety at school is no longer guaranteed. In this episode, Dr. Ioana Pal, Adolescent Psychologist at the Stramski Children's Developmental Center at Miller Children's and Women's Hospital will explore the emotional and psychological toll school shootings have on children and teens.

Welcome Dr. Pal.

Ioana Pal, PsyD: Thank you so much for having me, Deborah.

Host: Lovely to have you back. I'm sorry, the topic is so heart wrenching, but we do need to cover some things and get some information out there. So, how do school shootings impact children and teens, even if they haven't experienced one firsthand?

Ioana Pal, PsyD: I think this day and age with media everywhere, right, I think a lot of kids, teens, adults, can't really hide from seeing it. So I think sometimes hearing about it, seeing something about shootings in the news, reading about it on social media, or actually experiencing this unfortunate event, like school shooting can have a lasting effect physically and mentally, which is why it's important I think, for us to discuss and more people to discuss this topic.

But it depends on so many factors, how old a child is, what their previous experience has been with violence or fear, or even death. So it can't really be said how one child experiences shootings versus another, even if, let's say they're in the same area geographically or at the same school or in the same city.

Host: Absolutely. Our kids are unique for sure. Are certain age groups more vulnerable to the emotional effects of school shootings?

Ioana Pal, PsyD: I think again, it's one where it really depends on age. All kids, all age groups can be affected by violence, fear, death. The vulnerability depends on so many factors. However, I think it definitely, is something to say about socioeconomic status and specific geographic area. And that's not to say that certain schools are at risk versus others, but there may be more violence in the area or more propensity for events that can be perceived as violent, right? So, I think it depends on socioeconomic status and geographical area. Although sometimes school shootings occur regardless of area, right? There's no label on someone who wants to make that kind of damage. Resources really depend on what's available in the area, how adults explain or deal with school shootings or news of such events also impact how kids or teens think about their safety. So again, age groups may be more vulnerable, the younger the child is, but also areas where there's not a lot of talk or you know, let's call them more safe areas, right? More privileged areas can still experience shootings or violence or acts of aggression.

And I know we're focusing on school shootings as the topic, and there are too many, even this year to talk about, but school shootings as a statistic, they make up a small number, a small percentage of shootings compared to those outside of school or general gun violence. So even though we're focusing on it and one school shooting is one too many, I do want to emphasize that for the most part, schools in general are safe grounds, for the most part. So I think, like you were asking me, in the beginning, I think how media portrays things and how much attention we give to specific areas, specific shootings, specific states, right or cities when this happens, it really depends on the attention and how much sensitivity we give to those events as well.

Host: So let's drill down on that a little bit. How do repeated news stories and social media coverage affect kids' mental health?

Ioana Pal, PsyD: When we have stories in the news on YouTube, right, a lot of kids today get their information on social media and YouTube. So sometimes repeated stories from different angles, different news sources, different ways of portraying information is going to have to have a different impact.

So repeated news stories, can be just that, oh, I read about this, I saw this, and I'm okay, because it was far, far away from where I am. Let's say one child looking at the news or reading about it. However, repeated news stories or what we see in terms of even deaths that occur with school shootings or injuries can have a secondary traumatic stress impact on kids, what we might call vicarious trauma.

So a lot of the repetition of, wow, we're not safe anymore, or I don't want to go to school anymore. How come this happened again, can definitely impact kids, teens, staff, parents. It's not just one person or one group, but that vicarious trauma can have lasting effects and that can manifest in many different ways.

But just hearing or seeing the news, how it happens. I think this year alone, I don't know all of them, not all the data, but I think there's been like over two dozen shootings across the country. Most of them on college campuses, but definitely in the K to 12 schools as well. So just hearing about it, even if it's far away, can definitely affect kids in terms of how they think or feel about safety. It can definitely have like a numbing response. Some kids just don't respond. They're kind of frozen because they don't know how to internalize it. And the obvious one in terms of heightened fear and worry, right? So, it really depends on the child, on the family, how much conversation there is around this topic.

But without any doubt, there's going to be some anticipation of something horrible that might happen just because you see it or hear about it, or unfortunately have experienced it already before.

Host: You mentioned some kids freeze. What signs of stress or trauma should parents and teachers watch for in children after a school shooting?

Ioana Pal, PsyD: I think it's been covered a lot in terms of media, about what happens when an actual shooting occurs, If the kids are on campus. So we're talking if it happened on a specific campus. There's more about the actual stress and trauma on top of actual injuries or gunshot wounds.

But if we're talking about the stress and trauma of kids who either experience that vicarious trauma or just experience increased anxiety; I think we just need to look for anything that's out of the ordinary. So any behaviors that are changing, any symptoms like somatic symptoms, for example, more headaches or headaches all of a sudden, stomach aches for the younger kids, they'll complain more of Mommy, my head hurts or my stomach hurts. Not being able to sleep, not necessarily being able to verbalize their fear, but transferring that fear into a physical symptom. So parents should definitely look out for those type of presentations. Sometimes kids will avoid school or say they are scared to go to school because they don't feel like they could be safe.

Sometimes that stress or trauma can be transformed into nightmares or flashbacks, especially if it's been somewhere, near the child experiencing those symptoms or it happened at their school. Other times isolation. And sometimes kids will, become curious about school shooting. So you go from one extreme of freezing and not being able to do anything and not knowing how to react, to the opposite, where kids will start googling, researching, looking into statistics, in a hope of finding out how they can stay safe.

So changes in behaviors and again poor academic performance. You know, if kids are fearful, if they're not feeling safe at school or they're missing school, they're going to miss out on their academic achievement. And the bigger one, Deborah, I think is trust. I think not a lot of it is talked about in the news, in terms of trust, but once a child knows they're going to school, it's safe, there are adults there who keep them safe when their parents are not there and something tragic like school shootings or bullying or other kinds of aggression or violence happen on campus; kids lose trust. And it's very important to be able to explain why something isolated happened and how everyone's going to deal with it and ensure that safety measures are still in place and have honest conversations.

But trust is a big one. So as much as we want to say, you know, stress, trauma, physical symptoms, all these are important and we should deal with them. I think, going back to you have to trust me. I'm taking you to school. It's going to be safe. And say why and how? Because kids are not just going to buy it if they saw something disturbing on the news or they experienced it themselves.

So that trust needs to be rebuilt.

Host: And what can parents say or do to really help our children feel safe again?

Ioana Pal, PsyD: The open communication, for the most part, I think parents are probably even more scared than the kids. So I think sometimes we just need to remember that it's okay to say I'm scared too, but here's what the school's doing to make sure this doesn't happen again. And obviously we're not covering what types of school shootings, but whether it's someone from that school or a complete stranger is going to have a different effect on how you communicate and explain about what happened.

But communication is the key and really having a plan, in terms of potential threats and how school staff deal with it, whether or not this was like a one time thing that happened to this particular campus versus this is the third on the same campus or in the same area. Right. Usually all schools have safety measures in effect, and they know how to deal with hypothetical situations.

But of course, you know when it happens, sometimes you just have to kind of roll with it and see what you can do until like law enforcement arrives or whoever needs to be on site. But parents definitely need to ensure that they don't brush over. If a child has lost trust or a child is scared, they really need to have a conversation, not simply say, you are fine. Everything is fine. Because if they don't feel it, that answer is not enough.

Host: Yeah, we do need to listen and listen a lot.

Ioana Pal, PsyD: Absolutely.

Host: What's the difference between say, a normal fear response and something that might require therapy?

Ioana Pal, PsyD: Sometimes it comes down to timing. It varies. Like I said, you know, the presentation could vary in terms of how kids feel, fear, and what they're dealing with internally and sometimes a normal, what we call normal reaction could be scared for a couple days, having a conversation, knowing what the safety measures are at the school, having maybe mom and dad, linger a little bit longer at drop off and make sure that children go in and kids feel like Mom is watching me, everything's okay. Right? So those are some things that can happen as normal aftermath. And if it lasts very little time and there's no significant disruption to day-to-day activities, I would say that's a normal fear response. Whereas something that might require therapy could be lingering anxiety, even depression or suicidal ideation, grief, even survivor's guilt. Sometimes kids who survive these events will feel extremely bad about what happened, but more so feeling guilty that they lived and their friends didn't. So, it's got different layers, but when it lingers, when it's affecting day-to-day, activities, when it prevents a child from going back to school, when there's panic, academic difficulties and it's very different then, you know, I'm getting a bad grade here and there. So there's a difference, but I think any parent who notices something that's going on for a couple months, should be concerned and should reach out in terms of finding ways to either work as a family and communicate through therapy or find different ways of ensuring their children are feeling okay sometimes decreased load in terms of homework can help. But when things are impacting day to day, that's when parents should really listen, like you said, and pay attention and be aware and try to do something. Even if it is just saying, what can I do? Well, how can I make this better? Tell me what would help you right now.

And sometimes, a lot of times kids know what they need, or at least what they think would help.

Host: I know probably some kids they'd want to avoid the news or conversations about violence. Should parents encourage them to be informed or not?

Ioana Pal, PsyD: Again, I think it really varies on the age of the child and how much conversation there's been about the topic before. I don't think exposure to too much is necessary. I think sufficient information to know about the world, to know about an event and then discuss or watching it together, could be more beneficial than completely preventing a child from watching the news or having them watch too many, news sources.

Right? So I think parents should use their judgment in terms of what's healthy. If they're watching the news together, I think conversation needs to happen. But preventing all of it, it's also not healthy because then you are letting a child's imagination take over and maybe what they're imagining is a lot worse than what's out there.

Host: Oh, I didn't think of that angle. That's a good one, Dr. Pal. So what coping strategies can children and teens use to manage anxiety or fear?

Ioana Pal, PsyD: As I mentioned, therapy could definitely be helpful in terms of helping improve coping strategies, kind of mindfulness exercises, talking about feelings, but sometimes even outside of therapy, things can be therapeutic, like drawing, talking, writing about our feelings, doing games as a family and taking turns expressing how everyone feels, not just the one child, maybe in the family who's more anxious, having open communication, but also opportunities to discuss, you know, and having the time, not doing it quickly while you're picking up milk at the store, but maybe, you know, having eye contact and saying, okay, we have 20 minutes to talk about anything that's bothering you right now. But building on that resiliency is going to take some experiences, some positive, some fear based, some difficult conversations. But that's what builds resiliency, is learning from something, learning from a mistake, learning from an event, and knowing that next time or in a similar situation, this is what I can do. I can talk to an adult. And that's what I said. In terms of school shootings, what's really important is communication, but it's also very important for schools to have really strong ties to the community, to law enforcement, and for parents to know exactly what they can do and maybe bond through curiosity about what should happen or what can happen in those situations. But coping strategies could be going to bed with a peaceful mind, right? It could be just, let's have a bedtime routine where we know how to calm our bodies, calm our minds so that we can get good enough sleep so that anxiety doesn't live there overnight.

Sometimes coping strategies, involve having a fidgit toy, going to school, having a friend to walk into the school with, if they're fearful of just being in the school on campus. So coping strategies can be anything from formal therapy to ways parents can help their kids be more mindful about how they present when they're anxious.

Are they freezing? Are they being more aggressive? Are they raising their voices even though they're scared? They might appear more aggressive, but sometimes fear comes in different shapes. So we just need to listen, like you said, and we need to pay attention and know when to have time out.

Host: And now for the parents, how can I take care of my own mental health while supporting my child through this?

Ioana Pal, PsyD: I think a parent needs to acknowledge that they're scared. I don't think there's any parent out there who can say, I'm not worried. It's not going to happen. I mean, maybe if a parent is more in a denial state of mind, or they don't want to appear fearful to their children. They might say that, but I doubt there's a parent out there who doesn't feel like they can do something or they learn more about what they can do. So parents need to stay informed. They need to find out what the resources are in the community, maybe attend school meetings regarding this topic, maybe connect with other parents. And I think also being aware of their own biases and own beliefs because sometimes that can get in the way of talking to kids.

And sometimes, if we're busy, if we don't have time. But I think we always make time for something like this. This is very important and too many kids are affected, by this tragedy of school shootings, gun violence in general, aggression in the community, and I think what parents can do at a minimum is really just find out how much bullying is happening in the schools.

I know this is not exactly related, but sometimes violence that springs from the campus; when school shootings happen by children or staff at a specific school, they start with bullying. They start with unkind words and, I think parents can educate themselves about what the measures are at school.

Parents can take care of their own mental health so that they have healthy reactions. What I'm thinking of here, Deborah, and I'm sure you've seen this too, if not in the news or personally, but we're in a time where sometimes parents, because they're not taking care of their own mental health, they're reacting or responding in childish ways, in more aggressive ways, sometimes their than their own kids.

So what kind of role models are we for the children if we can't have appropriate reactions or know when we need to cool off before we respond to another parent or staff. We need to be able to have our own awareness, be in sight and sometimes it's hard if you are working, if you're a single parent, if you don't have the resources sometimes, and that's not an excuse, but sometimes it's a little bit harder to find out what all the resources are in the community. Sometimes with all the privileges and living in the appropriate geographical area, doesn't mean you have the cool, it doesn't mean you react appropriately. So I think parents can do a lot more for themselves and if not for themselves, but for their kids to become better role models in how they talk, how they present themselves, what body language shows to a child or how dismissive they may be of other people.

Right. There's not enough we can say about self-care. It's important for all of us no matter what the topic is. When we sleep well, eat well, exercise, have enough time to do pleasant activities and kids see that; they are kinder to themselves and they're kinder to other kids. And I'm not saying it's a blank prescription, but kindness will definitely help in preventing those school shootings or minimizing the number of how many of those we hear about, every year.

Host: 100%. I'm totally with you on that. And what kinds of resources or support are available for families at Miller Children's and Women's?

Ioana Pal, PsyD: We have different departments and different clinics. Obviously at  Stramski, we do a lot of evaluations and we work with other community members, community agencies, in terms of providing support, whether that is making referrals for individual therapy, referring parents and children to grief counseling or providing trainings across Miller Children's. We have various psychologists, not just myself, who can provide education, assessment or brief counseling. We don't do a lot of therapy, at the hospital, but we connect very well with other mental health agencies. The Guidance Center here in Long Beach is one such partner and we have, interns, fellows and other psychologists who work both here at the hospital and the Guidance Center. So we are able to build bridges between us and the Guidance Center to quickly get parents and kids to therapy as needed, to kind of work on coping strategies, coping skills like we were talking. But I think we also do a really good job with connecting with other schools. So we have very strong relationships with Long Beach Unified and other school districts, but we sometimes help parents advocate for their kids or for what they want. So sometimes we help the parents have those conversations with the school in terms of finding the information, maybe even helping the school.

Sometimes parents become advocates so much more than they thought they could be, just by knowing that they have so much to offer. I have a parent who actually joined an organization that it's all about supporting other parents. And together they were able to advocate and help raise funds for another school therapist, school counselor, so that their kids could benefit from having that resource.

So sometimes we're not it. But we can be the bridge to whatever that it may be for families and schools in the community. So we try to connect and stay abreast with all information, but sometimes we can just play a role in kind of guiding or holding someone's hand to do what they were meant to do as a parent.

They already know what to do, but sometimes just saying, you know, go further and you can help not only your child, but other kids at the same school.

Host: Right. Well, Dr. Pal, thank you so much for being on the podcast today, and thanks for all the great information to help our kids feel safer at school.

Ioana Pal, PsyD: Thank you, Deborah.

Host: And you can learn more about the Stramski Children's Developmental Center and other mental health resources at Miller Children's and Women's at MillerChildren's.org/stramski.

That's all for this time. I'm Deborah Howell. Have yourself a safe and happy day.