Support for Students Exposed to Trauma (SSET)
About This Program
Target Population: Youth in late elementary school through early high school (ages 10-16) who have experienced traumatic events and who are experiencing moderate to severe levels of PTSD symptoms
For children/adolescents ages: 10 – 16
Program Overview
Designed for implementation by school teachers or counselors, SSET is a cognitive-behavioral and skills-based 10-session support group for middle school children (ages 10-16) who have been exposed to traumatic events (such as witnessing or being a victim of family, school, or community violence, being in a natural or man-made disaster, being in an accident or fire, or being physically abused or injured) and who are experiencing moderate to severe levels of posttraumatic stress disorder (PTSD) symptoms. Its aim is to relieve symptoms of child traumatic stress, anxiety, depression, and functional impairment. It is designed to be used in schools with children from a variety of ethnic and socioeconomic backgrounds and acculturation levels. Delivery of mental health programs through schools can overcome logistical barriers (transportation, scheduling) as well as reduce stigma and reach disadvantaged and minority youth who have limited access to mental health care. Developed as an adaptation of the Cognitive-Behavioral Intervention for Trauma in Schools (CBITS) program, SSET contains many of the same therapeutic elements but is designed to be implemented by school staff members without clinical training.
Program Goals
The goals for Support for Students Exposed to Trauma (SSET) are:
- Reduce symptoms of PTSD and depression
- Build skills and enhance resilience to stress
- Enhance students coping and problem solving strategies
- Impact students' academic performance by improving their attendance and ability to concentrate
- Reduce impulsive or risky behavior
- Build peer and caregiver support
Logic Model
The program representative did not provide information about a Logic Model for Support for Students Exposed to Trauma (SSET).
Essential Components
The essential components of Support for Students Exposed to Trauma (SSET) include:
- Screening
- While not a part of the SSET intervention itself, a screening procedure is recommended for use in the general school population to assist in identifying children who have been exposed to traumatic events and have current moderate to severe posttraumatic stress disorder (PTSD) symptoms.
- If a student screens positively, it is important to meet individually with them to verify their appropriateness for the group.
- A call or in-person meeting with parents/caregivers is recommended before the start of treatment to answer questions, review expectations for child and parent involvement, and obtain consent.
- SSET Group Formation
- SSET groups are designed to be implemented at school preferably during a nonacademic period. Schools may also choose for groups to run after the school day.
- SSET groups meet one time per week for ten weeks.
- Each SSET group is designed to last 45 minutes to 1 hour (one class period)
- SSET groups are typically comprised of 6-10 students.
- SSET Group Content/Key Components:
- 10 sessions in which participants:
- Learn about common reactions to trauma (psychoeducation)
- Practice relaxation skills
- Identify maladaptive thinking and learn ways to challenge those thoughts (cognitive coping)
- Learn problem solving skills
- Build social support
- Process the traumatic event (including gradual exposure to trauma reminders and a trauma narrative)
- Between sessions, children practice the skills they have learned.
Program Delivery
Child/Adolescent Services
Support for Students Exposed to Trauma (SSET) directly provides services to children/adolescents and addresses the following:
- Posttraumatic stress disorder (PTSD), depression, stress, poor coping and problem-solving skills, poor school attendance, poor concentration, impulsive or risky behavior, poor peer and caregiver support
Services Involve Family/Support Structures:
This program involves the family or other support systems in the individual's treatment: A call or in-person meeting with parents/caregivers is recommended before the start of treatment to answer questions, review expectations for child and parent involvement and obtain consent. The SSET manual includes letters home to parents to update on progress and keep parents informed. Phone calls to parents are encouraged as well.
Recommended Intensity:
Weekly 45-minute to one-hour group session (one school period)
Recommended Duration:
10 weeks
Delivery Setting
This program is typically conducted in a(n):
- School Setting (Including: Day Care, Day Treatment Programs, etc.)
Homework
Support for Students Exposed to Trauma (SSET) includes a homework component:
Homework assignments are given each week. Assignments typically ask students to practice cognitive-behavioral skills taught during group. Some assignments encourage students to engage in new behaviors or activities that might be uncomfortable for them. However, lack of homework compliance is not treated as failure.
Languages
Support for Students Exposed to Trauma (SSET) has materials available in a language other than English:
Japanese
For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).
Resources Needed to Run Program
The typical resources for implementing the program are:
- Support of the school principal and administration
- Parental consent
- Training manual
- Regular meeting space
- A whiteboard or large writing pad
- Extra copies of the activity worksheets for each session
- A clinician of record is required so as to work with SSET service providers should any students be identified who require more intensive services or who remain symptomatic at the end of the group
Manuals and Training
Prerequisite/Minimum Provider Qualifications
Service Provider: SSET is designed to be implemented by teachers or school counselors.
Supervisor: Supervisors should be licensed mental health professionals with a Master's degree and experience with cognitive-behavioral techniques.
Manual Information
There is a manual that describes how to deliver this program.
Program Manual(s)
Manual details:
- Jaycox, L. H., Langley, A. K., & Dean, K. L. (2009). Support for Students Exposed to Trauma: The SSET program -Group leader training manual, lesson plans, and lesson materials and worksheets. RAND Corporation.
Please contact the training contact listed below for more information.
Training Information
There is training available for this program.
Training Contact:
- Lisa Jaycox
jaycox@rand.org
Training Type/Location:
Training consists of reading background materials and the manual, attending an in-person training delivered by a certified SSET trainer. An online training course is also available to augment in-person training.
Trainers typically travel to site requesting training. In addition to the clinical components, the training also addresses issues related to successful delivery of a mental health program in a school setting.
Ongoing consultation from a local clinician with expertise in cognitive-behavioral therapy (CBT) and/or child trauma treatment is recommended.
Number of days/hours:
The in-person training is typically 1.5 days. Online training is also available.
Additional Resources:
There currently are additional qualified resources for training:
An on-line training course and implementation support materials can be found at www.ssetprogram.org
Relevant Published, Peer-Reviewed Research
Jaycox, L. H., Langley, A. K., Stein, B. D., Wong, M., Sharma, P., Scott, M., & Schonlau, M. (2009). Support for Students Exposed to Trauma: A pilot study. School Mental Health, 1(2), 49-60. https://doi.org/10.1007/s12310-009-9007-8
Type of Study:
Randomized controlled trial
Number of Participants:
76
Population:
- Age — Mean=11.5 years
- Race/Ethnicity — 96% Hispanic
- Gender — 51% Female and 49% Male
- Status — Participants were 6th to 8th grade students who have been exposed to traumatic events.
Location/Institution: San Fernando Valley and South Central Los Angeles, California
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to test the efficacy of the Support for Students Exposed to Trauma (SSET) program for reducing posttraumatic and depressive symptoms in middle school youth. Participants were randomly assigned to Support for Students Exposed to Trauma (SSET) intervention group that received treatment immediately or the control group, in which participants received the treatment delayed. Additionally, randomization was conducted separately within each school and track and was stratified by gender. Measures utilized include the Modified Life Experiences Survey (LES), the Child PTSD Symptom Scale (CPSS), the Children’s Depression Inventory, and the Strengths and Difficulties Questionnaire (SDQ)—Parent Report and Teacher Report. Results indicate that at the 6-month follow-up there were no significant differences between the SSET group and control group on the self-reported PTSD measure. Limitations include small sample size, lack of generalizability due to ethnicity and socioeconomic status of participants, and length of follow-up.
Length of controlled postintervention follow-up: 3 and 6 months.
Amin, R., Nadeem, E., Iqbal, K., Asadullah, M. A., & Hussain, B. (2020). Support for Students Exposed to Trauma (SSET) program: An approach for building resilience and social support among flood impacted children. School Mental Health, 12(3), 493–506. https://doi.org/10.1007/s12310-020-09373-y
Type of Study:
Randomized controlled trial
Number of Participants:
75
Population:
- Age — 7–13 years (Mean=11.43 years)
- Race/Ethnicity — Not specified
- Gender — 49 Male and 26 Female
- Status — Participants were children living in flood-affected rural areas selected from 5 public sector elementary schools located in three rural union councils.
Location/Institution: Southern Punjab, Pakistan (Band Bosan, Nawab Pur, and Shershah)
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the initial effectiveness of the Support for Students Exposed to Trauma (SSET) in reducing PTSD symptoms and building resilience and social support among children living in flood-affected rural areas of Southern Punjab, Pakistan. Participants were randomly assigned into SSET and control groups within each school (one intervention and one control group in each school). Measures utilized include the Child Revised Impact of Events Scale-13 (CRIES-13), the Child PTSD Symptom Scale (CPSS), and the Child and Adolescent Social Support Scale (CASSS). Results indicate that there was a significant reduction in PTSD symptoms, an improvement in resilience, and an improvement of perceived social support in the SSET group. Limitations include the lack of an active comparison group; sample size suggests the need for replication using a larger sample size in different contexts within Pakistan and in other disaster-prone, low-resource contexts in order to ensure generalizability; lack of follow-up; and reliance on self-report measures.
Length of controlled postintervention follow-up: None.
Additional References
Jaycox, L. H., Kataoka, S. H., Stein, B. D., Wong, M., & Langley, A. (2005). Responding to the needs of the community: A stepped care approach to implementing trauma-focused interventions in schools. Report on Emotional and Behavioral Disorders in Youth, 5(4), 85-88.
Contact Information
- Lisa Jaycox, PhD
- Agency/Affiliation: RAND Corporation
- Website: www.ssetprogram.org
- Email: jaycox@rand.org
- Phone: (703) 413-1100 x5118
Date Research Evidence Last Reviewed by CEBC: July 2023
Date Program Content Last Reviewed by Program Staff: July 2020
Date Program Originally Loaded onto CEBC: June 2016
