Teachers’ Reports of Outreach to School-Based Providers of Mental Health Services following the 2013 Boston Marathon Attack

Oct 4, 2016

On April 15, 2013, two bombs exploded at the finish line of the Boston Marathon in downtown Boston that injured over 260 runners and spectators and killed three spectators, including an eight-year-old boy. In the days that followed, residents in the Boston metropolitan area endured an intense and unprecedented manhunt for two suspects. Large portions of the city and surrounding areas were closed, roughly 1 million residents were warned to shelter in place, a police officer was slain, a door-to-door search was conducted, and a violent shoot-out took place in a suburban neighborhood. This course of events was extremely frightening for local children, and those directly exposed to the attack and manhunt exhibited increased rates of posttraumatic stress and psychological distress. Within schools, teachers were confronted with the mental health needs of children exposed to these events. An earlier study of K–12 teachers in the Boston area who were surveyed after the Boston Marathon attack found that those who perceived their classes to have greater exposure to the events observed elevated symptoms of psychological distress among their students and reported providing more classroom-based supports.

While this study was very helpful, there continues to be an urgent need to understand the role of school staff in responding to disasters and, in particular, how children with mental health needs can be effectively connected to supports. In this regard, teachers might be central to identifying and supporting children in need of mental health services post-crisis, as well as to deciding whether to refer children to social workers and other mental providers.

In a recent issue of the journal Children & Schools, published by NASW Press, Jennifer Greif Green, PhD, Ziming Xuan, ScD, SM, MA, Lana Kwong, MPH, Melissa K. Holt, PhD, and Jonathan S. Comer, PhD, reported their findings from a study of teachers’ reported outreach to school-based mental health services providers following the 2013 bombings. The study extended the earlier results to specifically investigate factors associated with teachers’ reported outreach to school-based mental health providers (social workers, psychologists, and counselors), as well as their provision of informal mental health supports. In this study, they examined characteristics of school staff, perceived mental health need, and resource availability; these factors have previously been identified as important predictors of service provision. In particular, they examined the relative importance of two categories of teacher perceptions of student need—exposure to the attack and classroom-wide psychological distress—and their association with mental health supports. This study was the first to examine whether teachers’ perceptions of event exposure and distress are associated with their facilitation of mental health services access following a specific mass crisis. They therefore proposed two research questions:

  1. To what extent was teacher outreach to mental health providers following the 2013 Boston Marathon attack associated with (a) teacher demographic factors, (b) perceptions of event exposure, and (c) perceptions of classroom-wide psychological distress?
  2. To what extent was teacher provision of informal supports following the 2013 Boston Marathon attack associated with (a) teacher demographic factors, (b) perceptions of event exposure, and (c) perceptions of classroom-wide psychological distress?

Boston-area K–12 teachers were recruited between June and September 2013 to participate in a study that assessed their perceptions of their students’ experiences during the week of the Boston Marathon attack, their observations of student psychological distress, and their provision of mental health supports and service referrals. Eligible participants were K–12 teachers in any Massachusetts school (including private, parochial, and public). Also, the researchers sought to recruit teachers who represented schools with a variety of levels of exposure to the events.

After gathering and analyzing the data from the survey the researchers report that the results suggest that in the aftermath of the Boston Marathon attack and manhunt, teacher reports of outreach to school-based mental health providers were associated with their observations of heightened classroom-wide psychological distress, belief that students were directly exposed to the manhunt, and report of teaching a greater number of students per week. Notably, teachers’ reports of contact with mental health providers were significantly and independently associated with perceptions of both student distress and exposure, indicating that these perceptions dually influenced teacher outreach. This result was consistent with previous research, which found that services use is related to both mental health needs and disaster exposure.

In particular, teacher perceptions of student exposure to the manhunt were associated with increased reports of contacting service providers, unlike beliefs about exposure to the bombing itself. This result was consistent with findings from another study that identified exposure to the manhunt as particularly powerful in its association with child psychological distress. Because the manhunt differentially affected entire communities, teachers in neighborhood schools might have had greater awareness of their students’ exposure, and teachers in affected communities might have been more likely to organize their resources around this event. Teachers who work with more students during the course of a week were also more likely to report contacting mental health providers. The researchers hypothesized that teachers with a large student load have a lower threshold for referral or consultation with mental health providers in their schools, or perhaps they work in larger schools and therefore have greater access to mental health professionals.

It is interesting to note that teacher provision of informal supports directly to students (that is, talking to students one-on-one about their well-being) was not associated with any of the factors included in the current analysis. Other studies have explored interpersonal and contextual factors that are associated with informal support provision by teachers. Given the relational qualities that are central to teacher–student interactions around mental health and emotional needs, it might be that referrals and consultation with providers are related to more “objective” concerns about exposure and distress, whereas decisions about informal supports are influenced by individual differences and interpersonal relationships.

However, teachers were more likely to report that they had contact with colleagues and parents when they perceived greater psychological distress among their students. In addition, teachers with more students in their classes reported more frequently contacting other teachers, whereas those with fewer students more often contacted parents. This distinction may be because teachers with larger numbers of students in their classes are more likely to work in schools where students rotate between classes and therefore have more colleagues to contact. In contrast, teachers with fewer overall students might more easily build relationships with parents. Teachers of younger students were also more likely to reach out to parents. While perhaps unsurprising, these types of structural characteristics appear critical to consider when addressing the available time and resources that influence the types of support services that teachers access, and this information can contribute to understanding the broader picture of mental health services contact within a school.

Finally, inconsistent with prior research, teacher reports of available school counseling services were not significantly associated with their reported provision of mental health services or supports. Although the measure of counseling services included in this study provides only a crude indicator of schoolwide mobilization of mental health resources, this nonsignificant finding raises questions about the extent to which service referrals provided by teachers are associated with their knowledge of available school-level mental health resources.

The researchers call for more studies in this area. They also point out that the study results indicate the importance of attending to teacher perceptions of their students’ emotional well-being and trauma exposure. As teachers are often a primary source of mental health supports and service referrals in schools, understanding their beliefs about student event exposure and distress following mass crises can provide school social workers with important information to guide teacher training and the dissemination of information about school resources. For example, school social workers can begin by asking teachers about their perceptions of student exposure and whether they have observed students experiencing distress. School social workers can use this information to identify areas in which teachers and students need support. To improve the effectiveness of referrals, school social workers can train teachers to understand the effects of disaster on school-age youths and in how to detect students who might need mental health services.

The researchers further note that several programs and guidelines exist to assist schools in planning for and responding to such crises, and that in general, increased integration of mental health services and supports into schools has the potential to decrease stigma, increase teacher comfort reaching out to students, and improve access to supports. These efforts can provide a critical foundation for responding to students in the event of a crisis.