Framework of the outreach after a school shooting and the students perceptions of the provided support

Figures & data

Table 1 The main elements of the psychosocial support provided to families, students, and school staff according to the level of interventions and phase of exposure and recovery

	Families of the deceased		Students and staff exposed to the shootings
Level of intervention	Immediate and acute phase	Later and ongoing recovery	Immediate and acute phase	Later and ongoing recovery
Individual	• Services of the crisis clinic • Support when visiting the scene of the massacre • Practical assistance	• Services of the crisis clinic • Psychotherapies • Physiotherapies • Practical assistance	• Services of the crisis clinic • Interviews to assess the severity of exposure and available support	• Services of the crisis clinic • Interviews to assess the need of extra support among the most severely exposed • Screening of the possible posttraumatic reactions at 2, 4, 16, and 28 months • Health check-ups, medical assessment • Psychotherapies • Physiotherapies and massage
Family	• Group discussions • Support for families visiting the scene of the massacre • Telephone contact with every family to ensure the sufficiency and appropriateness of support	• Frequent contacts by telephone to assess the unique needs of each family member • Two home visits to assess the family situation and needs • Support in emotionally demanding occasions	• Family evenings at the school	• Professionally led peer support group process
Group	• Information about the services provided by the Kauhajoki Project • Letter providing psychoeducative information and an invitation to join the peer support group process	• Professionally led peer support group process • Support in emotionally demanding situations • Rituals	• Group discussions separately for the staff and students • Common sessions with psychoeducation and rituals	• Group discussions separately for the staff and students • Supervision sessions for teachers • Rituals
Community			• Services of the crisis clinic • Group discussions in the other schools at the area • Parents' evenings in the other schools at the area • Media coverage with psychoeducative and calming content	• Services of the crisis clinic • Reinforced youth work and student welfare • Comprehensive media coverage around the first anniversary • Open doors at the trauma-affected school after moving back to the premises

Table 2 Psychosocial support and care, and therapies for the students of the exposed school

	All students	Severely to extremely exposed students	Mildly to significantly exposed students
Type of the support	T1: n=236 n (%)a	n=20a n (%)a,b	n=216a n (%)a,b	Difference between the exposure groups
Immediate crisis supportc
Reached by immediate (first 24 hours) crisis support	199 (84.7)	20 (100.0)	179 (89.9)	χ ^2=3.96, df=1, p=.047
Immediate crisis support accepted	113 (58.5)	15 (75.0)	98 (56.6)	n.s.
Perceived accepted immediate crisis support as helpful	110 (92.4)	15 (100.0)	95 (91.3)	n.s.
Group and school sessions
Attended the common sessions for the whole school	167 (71.1)	17 (85.0)	150 (69.8)	n.s.
Attended the group sessions	140 (60.6)	18 (90.0)	122 (57.8)	χ ^2=7.92, df=1, p=.005
Acute phases psychosocial supportc
From families and friends	232 (98.7)	20 (100.0)	212 (98.6)	n.s.
From others	179 (79.6)	15 (78.9)	164 (79.6)	n.s.
From Professionals	164 (71.0)	18 (90.0)	146 (69.2)	χ ^2=3.84, df=1, p=.050
Perceived the received crisis support as helpful
Families and friends (T1)	220 (97.8)	19 (95.0)	201 (98.0)	n.s.
Others (T2)	148 (89.2)	14 (93.3)	134 (88.7)	n.s.
Professionals (T1)	114 (78.6)	12 (75.0)	102 (79.1)	n.s.
Professionals (T2)d	83 (89.2)	11 (91.7)	72 (88.9)	n.s.
Professionals (T3)e	76 (73.1)	11 (91.7)	65 (70.7)	n.s.
Psychotherapy or regular meetingsf T1-, T3	60 (25.4)	13 (65.0)	47 (21.8)	χ ^2=18.05, df=1, p<.001
Psychotherapy included EMDR T1-T3	12 (20.0)	6 (46.2)	6 (12.8)	p=.015, exact

n.s=not significant.

a Valid percentages shown (missing data not included).

b Percentages shown within the exposure group.

c Crisis support after the first day and within 2 weeks after the incident, availability of support asked by different sources.

d Answers to the question about perception of professional support at T2 (16 months follow-up), n=123 within those who have received the services.

e Answers to the question about perception of professional support at T3 (28 months follow-up), n=104 within those who have received the services.

f Shows cumulative numbers and percentages across T1 to T3.

Table 3 Sources of the support among the students exposed to the school shootings in acute phase (T1): who provided the most important help and what was perceived as healing element(s)

Main source of the support	n=236 n (%)	Healing elements	Examples
Own family and close relatives	134 (56.8)	• Intimacy • Love	• Intimacy and speaking about normal daily life issues • Mother and her genuine concern and love • I have the best dad in the world
Friends and fellow-students	127 (53.8)	• Peer support • Understanding because of similar experience	• It is easiest to talk to the close persons you can trust • Just being close, total presence, and feeling of understanding without words
Teachers and other school staff	14 (5.9)	• Togetherness • Understanding because of similar experience	• The best help comes from people who had experienced the same tragedy • We feel attached to our school, and that helps us
Crisis psychologists, psychiatrists, and other professionals	61 (25.8)	• Sharing the story • Professionalism • Psychoeducation • Therapeutic interventions • Enhancing safety	• Sessions with the psychiatrist consisted of real listening and deep understanding, not only of being together • The crisis psychologist listened, supported, and forwarded to the medical doctor • Crisis workers provided information about how to cope and how to deal with normal daily life issues and what helps you to continue your life • The groups in which we were together, that was a decisive experience in recovery • The awareness that there are crises workers available if needed, that has helped me
Church and parish	6 (2.5)	• Spiritual consolation	• My own parish and belonging to it, I was allowed to share and leave my worries to God
None or I cannot say	18 (7.6)		• I know that there was all kind of help available. But I did not have time to go, and also the strangeness of others does not help

Note: The percentages do not sum up to 100.0 because students mentioned more than one source of support and reasons as healing elements.

Table 4 The helpful elements of the professional support reported by students of the exposed school at ongoing recovery phases at T2 (16 months) and T3 (28 months) afterwards

Helpful element	T2 n=42 n (%)	T3 n=35 n (%)
Sharing the story   • Forming the narrative, listening, supporting	22 (52.4)	20 (57.1)
Professionalism   • Expertise, neutrality, active support	9 (21.4)	13 (37.1)
Psychoeducation   • Normalizing, teaching self-care techniques	6 (14.3)	9 (25.7)
Therapeutic interventions   • Group interventions, therapeutic relationship   • Medication/EMDR	3 (7.1)	5 (14.3)
Enhancing safety, continuity   • Creating feeling of safety   • Stability of the professionals	2 (4.8)	6 (17.1)

Note: The percentages do not sum up to 100.0 because students mentioned more than one element of support as being helpful. Only answers with argumentation were classified.