Trauma/Grief and Loss Counseling Services through the San Francisco high school-based Wellness Centers

RAMS, Inc. has had over a decade of partnership with the San Francisco Wellness Initiative, a collaboration between the San Francisco Unified School District (SFUSD), SF Department of Public Health / Community Behavioral Health Services (SFDPH-CBHS), and Department of Children Youth and Families (DCYF). The Wellness Initiative has established Wellness Centers in, currently, 16 of the public high schools in San Francisco. The Wellness Centers provide free, on-site, confidential health services to students including behavioral health counseling, nursing services, support and empowerment groups, and connections to health resources in the community. RAMS, specifically, is the core behavioral health services provider  with on-site counselors/therapists, clinical case managers, and an intern training program that recruits graduate students annually, to provide support  to over 1,500 students a year.  Over the course of our work, they have experienced a high volume of students regularly affected by frequent acts of community violence that occur several times (sometimes more) a year.  Each violent act simultaneously affects bands of students at several high schools at once and the volume of the problem outweighs the capacity of the Wellness Centers’ staff.  In response to this need, the Trauma/Grief & Loss Counselor (TGL) position was proposed by RAMS and funded through the Mental Health Services Act (MHSA) / SFDPH-CBHS in 2009.  The TGL Counselor is integrated, and is available to all 16  Wellness Centers and provides immediate response to and intervenes in schools when students or faculty are affected by school-wide crises, such as neighborhood violence or deaths of students and teachers.  The TGL Counselor provides debriefing, de-escalation, training, and short and long term group therapy. The TGL Counselor possesses a Master’s degree (mental health field), is bilingual & bicultural, and has clinical expertise in working with adolescents and trauma/grief & loss issues. 

Students are recruited for Trauma/Grief & Loss services in several ways. Following an incident of community violence or other tragedy (i.e. suicide or death of teachers) there is subsequent debriefing and containment at a school(s), after which students may directly agree to on-going group support.  The Wellness Center staff also may identify students who have been referred to them by teachers or academic counselors; and have exhibited symptoms of trauma; or have admitted some experience with being victims or witness to violence.  Staff will request TGL group services for these students. TGL services average about six groups per semester.

The curriculum for the Trauma/Grief and Loss groups is a combination of Trauma-Focused Cognitive Behavioral Therapy (Cohen, Mannarino, & Deblinger, 2006) and the Seeking Safety models (Najavits, 2007).  Both models are present-focused and components-based and aim to help group members learn new skills to cope with and manage symptoms of trauma.  Both have evidence that support their efficacy.

For the 2011-12 school year, the TGL Counselor provided services to 90 students and facilitated 11 groups at nine school sites.  The participant demographics were: 51% Latino, 25% African American, with the remaining being Filipino, Multi-racial, Caucasian and Other.  Approximately 70% of the youth had recently experienced the death of a family member or someone close to them while others had issues relating to immigration or other trauma (i.e. suicide or domestic violence).   

To evaluate the effectiveness of the services, students are administered a pre- and post-test during their participation,  based on the Child PTSD Symptom Scale (CPSS) (Foa, et al.,2001) which measures their level of PTSD symptomology on a 1- 51 scale.  Students rating over 15 are considered to be above the clinical PTSD range.  The Wellness Initiative’s research partner, ETR (Evaluation, Training, Research) Associates collects the test data and reports annually on the outcomes. Consistently, the results have been promising.  In the 2011-12 group evaluation survey, 100% of the participants reported a decrease in their PTSD symptoms with an average 16-point drop.  Furthermore, 92% of group participants, at intake, were above the PTSD range; at the end of the group, only 44% of these students measured above the PTSD range.   

It is these hopeful outcomes that support our commitment to serving San Francisco’s youth in the Wellness Centers.  RAMS continues to solicit feedback from students about services to identify and further strengthen culturally competent, consumer-driven programming and how to effectively support youth experiencing trauma symptoms.
Photo credit - by FotoRita on Flickr