Who are the guidelines for?
This guideline is intended for assessing the need for psychological support among pupils and students following a serious act of violence in an educational institution. It includes recommended measures and can be used by professionals working with pupils and students. The guideline also provides instructions for situations where there is concern that a pupil or student may pose a risk of committing serious violence in an educational setting, such as a school shooting.
Acts of violence in educational institutions may vary in type and severity. In this guideline, “serious violence” refers to school shootings or other large-scale acts of severe violence, including attempted acts, targeting pupils, students, or staff of the institution.
General instructions
Crisis workers from wellbeing services counties and third-sector organisations provide crisis support immediately after a traumatic experience.
During the first few weeks after an act of violence, the most important thing for a child or young person is to return to a safe and familiar daily routine. For most, the presence of adults and normal activities are enough for recovery, and there are no serious or long-term mental health effects.
A child’s or young person’s age and stage of development, the support they receive from parents and other adults, and what they have seen and experienced all influence how severely the traumatic event affects them. You can remind them that they can ask for help later, even several months afterwards.
If, as a professional, you become concerned about a pupil or student, refer them to student welfare services – such as a school nurse, social worker, psychologist or doctor.
Suicidal behaviour and threats of violence always indicate an immediate need for crisis intervention.
- A protective network must be built immediately around such a child or young person.
- The network should include the child’s or young person’s loved ones, teachers, student welfare professionals, a psychiatric specialist and, if necessary, the police.
- Also pay attention to linguistic accessibility: ensure that the child or young person and their family receive information and guidance in a language they understand, using interpretation if needed, so that seeking help and accessing support is genuinely possible.
Exposure to news and social media coverage of the shocking event should be limited for children and young people to prevent further traumatisation. It is also important to monitor negative group dynamics emerging on social media, so that rumours or ongoing discussions about the events do not increase psychological strain.
More detailed instructions on crisis preparedness and crisis management:
- Crisis preparedness and response in sudden crises (Finnish National Agency for Education, in Finnish)
- School shooting on social media: how to address the issue with children and young people (Finnish National Agency for Education, in Finnish)
- Young person’s mental health in crisis (Mieli.fi., in Finnish)
Psychological first aid
In the early stages of a crisis, “psychological first aid” is an appropriate form of support. Psychological first aid is not a form of treatment as such, but rather a way of understanding, listening to and supporting a person affected by disaster. Psychological first aid providers include non-governmental organisations and social and crisis emergency services in wellbeing services counties.
The Red Cross and Red Crescent have published a guide on psychological first aid. The guide includes advice on communicating with children in a crisis situation.
Guide to Psychological First Aid (pdf, in Finnish, Red Cross and Red Crescent)
Six-step classification for assessing a child’s or young person’s degree of exposure
The degree of exposure to violence is one factor that may influence symptoms. Healthcare professionals can use a six-step classification when assessing exposure. This classification was previously applied in connection with the Jokela and Kauhajoki school shootings. The classification does not include exposure through, for example, video material on social media. It is important to note that such material can also negatively affect psychological well-being.
Therapeutic support should be offered particularly to those with severe or extreme exposure. It is also important to pay attention to the person’s own willingness and motivation for support, and the fact that the need for support may emerge later.
Table: Six-step classification for assessing the severity of exposure to a school shooting
| Degree of exposure | Detailed description |
|---|---|
No exposure |
Did not lose anyone known or significant to them. |
Minor or slight exposure |
Was not at school at the time of the incident and did not lose anyone significant to them. |
Moderate exposure |
Did not witness the event directly and did not have to hide. Did not see the perpetrator and did not lose anyone significant to them, but evacuated independently or as instructed. |
| Considerable exposure | Had to hide or take action to avoid the risk of death. Saw a deceased person or lost an acquaintance. |
| Severe exposure | Was at risk of death or saw someone being threatened. Lost a friend. |
| Extreme exposure | Was at directrisk of death, saw someone being threatened or lost a family member. |
Screening for post-traumatic stress disorder
The recommended time for screening for psychological symptoms to identify post-traumatic stress disorder is no earlier than about one month after the trauma, as screening too soon results in too many false positives.
Wellbeing services counties should arrange routine screening for trauma-related symptoms in high-risk situations among those who have experienced an exceptionally shocking event. More information on post-traumatic stress disorder:
- Post-traumatic stress disorder (in Finnish, Kaypahoito.fi)
- Trauma-related stress reactions and disorders (in Finnish, Kaypahoito.fi)
The screening tool recommended for assessing children and young people is the symptom measurement section of CATS 2.0, available, for example, in the “For professionals” section of the MentalHub.
Suitable tools for screening trauma symptoms in adults:
- Five-question PTSD screening questionnaire (pdf, in Finnish, Kaypahoito.fi)
- Ten-question screening questionnaire for psychological trauma symptoms (pdf, in Finnish, Kaypahoito.fi)
Health care services after a serious act of violence
Active, routine treatment interventions should be avoided during the first few weeks after the trauma.
Individuals found to have severe stress symptoms in the early phase after the incident should be referred for assessment and treatment at a health centre or occupational health services.
Mild disorders lasting 1–2 months can be treated , for example, in primary health care, student health care, occupational health care or in the unit responsible for treating physical injuries, with psychiatric consultations and active monitoring of recovery.
Post-traumatic stress disorder can be treated using several forms of psychotherapy.
- Psychosocial interventions for trauma are provided by various actors in primary health care, specialised health care or the third sector.
- Wellbeing services counties may also offer psychotherapy through outsourced services.
Those who were close to the violent event usually need personal support for recovery, along with longer-term follow-up. If a child or young person has had previous mental health problems, such as depression, suicidal behaviour, fears, anxiety, obsessive-compulsive symptoms, substance use or a tendency towards violence, their situation must be monitored with particular care.
Those with a severe decline in functional capacity, persistent symptoms or poor treatment response should be referred for psychiatric consultation or specialised psychiatric care. Suicidal symptoms occurring alongside post-traumatic symptoms, which are rare but possible, must be urgently assessed in specialised care, in accordance with the relevant treatment guidelines.
THL’s role
THL is a national expert in violence prevention. We support wellbeing services counties and professionals in social and health care by providing guidelines, recommendations, tools, and training. We also develop structures for violence prevention and coordinate collaboration in the field.
Contact details
Development Manager
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