Support for Students Exposed to Trauma (SSET)
The information in this program outline is provided by the program representative and edited by the CEBC staff. This program has been reviewed by the CEBC in the following Topic Areas:
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
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.
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
The essential components of Support for Students Exposed to Trauma (SSET) include:
- 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.
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.
Weekly 45-minute to one-hour group session (one school period)
This program is typically conducted in a(n):
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.
Support for Students Exposed to Trauma (SSET) has materials available in a language other than English:
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
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.
Education and Training Resources
There is a manual that describes how to implement this program, and there is training available for this program.
- Lisa Jaycox
Training is obtained:
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.
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
This program has been reviewed and it was determined that this program lacks the type of published, peer-reviewed research that meets the CEBC criteria for a scientific rating of 1 – 5. Therefore, the program has been given the classification of "NR - Not able to be Rated." It was reviewed because it was identified by the topic expert as a program being used in the field, or it is being marketed and/or used in California with children receiving services from child welfare or related systems and their parents/caregivers. Some programs that are not rated may have published, peer-reviewed research that does not meet the above stated criteria or may have eligible studies that have not yet been published in the peer-reviewed literature. For more information on the "NR - Not able to be Rated" classification, please see the Scientific Rating Scale.
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. doi:10.1007/s12310-009-9007-8
Type of Study: Randomized controlled trial
Number of Participants: 76
- 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 comparison groups, outcomes, measures, notable limitations)
This study tested the efficacy of the Support for Students Exposed to Trauma (SSET) program for reducing posttraumatic and depressive symptoms in middle school youth. 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 at the 6-month follow-up showed no significant differences between the SSET group and control group on the self-reported posttraumatic stress disorder (PTSD) measure. Limitations include small sample size, generalizability due to ethnicity and socioeconomic status of participants, and length of follow-up.
Length of postintervention follow-up: 3 and 6 months.
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.
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. Santa Monica, California: RAND Corporation.
Date Research Evidence Last Reviewed by CEBC: March 2016
Date Program Content Last Reviewed by Program Staff: March 2016
Date Program Originally Loaded onto CEBC: June 2015