Fostering Coping Skills within Johnson County School System
Beginning in January 2020, four second-year medical students from the Quillen College of Medicine’s Rural Primary Care Track began developing a project to make a difference in the rural community where they engaged in clinical learning. The students, Alex Crockett, Nicole Gardner, Isabel Guhde, and Araminta Ray, used the community based participatory research approach taught during the two-semester ETSU course series, Rural Health Research and Practice and Rural Community Based Health Projects, to develop a trauma-informed intervention to foster coping skills within the Johnson County, Tennessee school system.
Based on the students’ interests, Karen Schetzina, MD, MPH, FAAP, a founding faculty member of the ETSU Strong BRAIN Institute (SBI) and the series course director, provided training in childhood adversity and resilience science to the students during the spring semester. The College of Medicine’s Rural and Primary Care Track has a long history of partnering with stakeholders in Johnson County to improve the health and wellbeing of their community. Dr. Schetzina facilitated meetings between the students and community stakeholders to help them understand the challenges facing youth and schools in Johnson County. Again and again, concerns about adversity faced by students, such as food insecurity and unstable home environments, were raised by community stakeholders. Fellow SBI founding member, Julia Bernard, Ph.D., helped to connect the group to one of her faculty in the ETSU Department of Counseling and Human Services, Rebecca Milner, Ph.D., who helped the students and stakeholders refine their intervention idea of providing a toolkit of information and resources to aid the school community in fostering resilience and coping skills. Enter the COVID-19 pandemic. Its arrival not only mandated a transition to an exclusively online learning environment for both the Quillen and Johnson County students, but it also placed new and more extreme stressors and uncertainty on the shoulders of youth, families, and school personnel in Johnson County. While the Quillen students were unexpectedly faced with the challenge of quickly pivoting to adapt their planned intervention to these new circumstances, the project focus on fostering resilience and coping skills was more relevant than ever.
Conversations with community stakeholders in Johnson County helped identify overarching topics such as COVID-19 education materials, stress management and reduction strategies, and financial and community support resources to be included in a resource guide for students, parents, and teachers. Two team members, Alex Crockett and Nicole Gardner began searching for resources and relevant information produced by government agencies such as the Centers for Disease Control (CDC) and Tennessee Department of Public Health, professional organizations including the Substance Abuse and Mental Health Services Administration (SAMHSA), and education professionals and institutions to be included in the resource guide. The team found online databases and resource guides maintained by state and federal government agencies as well as non-profit groups that helped shape the resource guide structure. Specifically, resources from the Minnesota Department of Education and New York University Langone Health played a significant role in influencing the information included in the guide. The team focused on including information from groups with a documented history of working with public school systems and supporting the mental and emotional health of students, teachers, and parents. The students worked to include the best information and research according to reputable sources, with a special emphasis placed on needs identified by community stakeholders during planning phases of the project.The resource guide was divided into sections specifically for teachers and school staff, parents and caregivers, and students. Individual sections of the guide were divided by topic area to provide readers with the ability to quickly scan for resources relevant to their immediate needs. Links to original sources were included within each section and at the end of the guide; however, researchers summarized important techniques, practices, and information into short paragraphs when possible for readers to utilize in place of the original source.
Within sections for school staff and caregivers, information and resources were provided to help them guide students in understanding and processing emotions related to the COVID-19 pandemic. For example, specific lesson plans for teachers were included to help students of various grade levels understand how viruses work and why public health measures help protect our health. School staff and caregivers were also provided with information on how to maintain their own mental, emotional and physical wellbeing, with a special emphasis on the need to care for themselves during the pandemic as well as their students and children. The section for students focused on providing similar lessons through graphic novels and interactive worksheets and activities rather than readings and lesson plans. After compiling and editing the first draft, the resource guide was shared with staff in ETSU’s Department of Counseling and Department of Pediatrics as well as the Johnson County Board of Education. The team received constructive feedback from these groups and made appropriate changes to the resource guide to increase accessibility, readability, and usefulness based on identified needs in Johnson County.
The student team worked with Mrs. Amanda McGlamery, Coordinated School Health Director, and Mr. Jacob McGlamery, a school-based mental health clinician, to provide school staff, caregivers, and students access to the resource guide through the Johnson County Schools website. The group also assembled a calm-down corner kit that they delivered to the Johnson County school system. This kit included a table, bean bag, and a room divider to allow counselors to set up a separate place in the classroom to implement these coping skills. The kit also included a box with fidget toys, children’s books about coping skills, and coloring sheets, so that students could engage in independent calm-down time. The final item provided was a digital Calm Down Corner: School & Home Behavior Management Coping Tool Mindfulness Kit from Wholehearted School Counseling which included coping skills posters, writing prompts, and puzzles that could be printed off by the counselor. The items were carefully chosen based on other calm-down corner models and adapted using community stakeholders’ suggestions to meet the specific needs of the Johnson County School System. The group evaluated the helpfulness of these resources by sending out an ETSU IRB-approved online survey to the educators of Johnson County. Overall, the resource guide and calm-down corner kits were enthusiastically received by the school system. The majority of educators indicated that they had learned something new from the guide, despite nearly all of them having received previous trauma-informed care training. They indicated that the guide contained new coping skills ideas, as well as helpful tips for recognizing trauma in students. The section relating to COVID-19 was especially praised for its helpful resource links and activities to do with kids while stuck at home. Suggestions for future improvement of the guide were to include more Johnson County specific resources, as well as more resources for older students.
The dearth of mental health providers in rural communities and school systems present significant challenges. This project provides an example of how partnerships between academic institutions and rural communities can support mental health and resilience even during challenging circumstances, like the COVID-19 pandemic. This brief pilot study suggests that a trauma-informed coping skills guide with information and resources that are easily downloaded, shared, and accessed was well received by K-12 educators in a rural school system. Since feedback from parents, caregivers, and students was not collected in this study, it is unclear how these resources were utilized or received by these groups, or how lack of universal rural broadband coverage may have impacted access to the online guide. More information is necessary to understand the efficacy of interventions like the online Coping Skills Resource Guide and calm-down corner kits. Strengths of this project included use of a trauma-informed lens and participatory approach with academic and community stakeholders to tailor the intervention to best meet the needs of this rural school community.