Preparing schools for the worst-case scenario

In a hotel conference room last April in New York, Yale pediatrician David J. Schonfeld, M.D., guided 100 school counselors, teachers and administrators through a hypothetical school crisis: the star of a high school play has died of cancer, and classmates hold a fund-raiser in her memory to benefit medical research. When a television news team covers the event, they learn that a second student had died of the same form of cancer. They also report that toxic substances have been found in the soil around the school.

The next day half the student body is absent, and the school is surrounded by reporters; finally, the principal says that she has been diagnosed with another form of cancer.

Working in teams, Schonfeld’s audience had to respond to each stage of the crisis. They discussed how to determine whether there were any health risks to students and staff; what to tell staff, students, parents and the press; and how to support the students, the principal and other staff. The teams had 10 minutes to spring into action, the same deadline many New York City educators faced on September 11, 2001.

In fact, the attacks on the World Trade Center were a major reason for the exercise. New York City school officials had asked Schonfeld, an associate professor of pediatrics with an appointment in the Child Study Center who has been helping schools deal with crises for more than a decade, to train response teams that include educators, administrators, mental health professionals, nurses and safety personnel from the city’s approximately 1,200 schools. Along with Scott R. Newgass, M.S.W., and David Szydlo, M.D., Ph.D., Schonfeld provided more than 50 full-day workshops for teams from throughout the school system. With colleagues at the National Center for Children Exposed to Violence (NCCEV), he also developed guides for talking about 9/11, the anthrax scares, the war in Iraq and death.

Though the participants in the cancer-scare scenario groaned with each mounting crisis, they found the discussion instructive. Most had lived through 9/11, when administrators had to decide whether to send children home amid the chaos. Parents flocked to schools seeking not only their children but also information. News spread by word of mouth, more distorted with each telling. Teachers waited for hours with students who had no way to get home. And educators had to explain to children why this was happening while grappling with their own distress.

“It was hours and hours of dealing with things you never could have anticipated,” said Janet Hughes, a Bronx high school principal. “There were a lot of things on the school level that people were just not prepared to deal with.”

And not only in New York. Educators around the world are thinking more about how to help children cope with disasters, including plane crashes and earthquakes, as well as political violence. Schonfeld has also provided training in England, Sweden and Israel; in March 2003, he provided a series of workshops in Osaka and Tokyo as part of the establishment of Japan’s National Mental Support Center for School Crisis.

Ten years ago Schonfeld was running the School Crisis Prevention and Response Initiative in New Haven, with an eye to designing a national model. Today that model is in place as part of the NCCEV at the Yale Child Study Center. NCCEV grew out of the Child Development-Community Policing Program established by Steven Marans, Ph.D., the NCCEV’s director, and the late Donald J. Cohen, M.D. ’66, who led the Child Study Center from 1983 until his death in 2002.

Schonfeld’s model is broad enough to help guide children through a range of events. It helps educators plan for the needs of children and school staff at a time of crisis. It also aids schools in identifying and addressing symptoms of emotional distress and devising memorial events that are meaningful and healing. And the model emphasizes the importance of letting students vent. “When comments or questions come up naturally, if the teacher is ready for them, there can be useful discussion,” Schonfeld said.

Schonfeld wants to bring mental health needs into the mainstream of pediatric medicine. As the physical health of children has improved, attention in pediatrics has shifted to developmental and behavioral concerns, a relatively new area of specialization. Yale’s Department of Pediatrics recently created a subsection for developmental-behavioral pediatrics, and it is the site of one of nine fellowship programs funded in July 2003 by the Maternal and Child Health Bureau, an agency of the Department of Health and Human Services, for training in the emerging discipline.

In November 2002, the American Board of Pediatrics offered the first exam for certification in the field, but Schonfeld wasn’t immediately eligible to take it, despite his obvious familiarity with the topic. He, along with other members of the subspecialty board, had to take a different test—one that they hadn’t written themselves.