Handle With Care is a program designed to establish communication between schools and first responders. When children return to school after experiencing a traumatic event– such as a car accident or the death of a loved one– their teachers are often unaware and unable to offer the support they need. Handle With Care was designed to bridge the gap, helping teachers know when to offer support during these stressful and challenging moments in children’s lives.

Handle With Care asks first responders to submit a notice to the child’s school when they respond to a scene where a child is present. No details about the event are provided, only the child’s name, age, grade level, and the phrase “Handle With Care.” When the designated school official receives the notification, they forward it to the child’s teachers, who can monitor and support the child as needed. For instance, if the student arrives at school without their homework, the teacher can offer an extension. Similarly, if the student does poorly on a test, the teacher can allow them to retake it for full credit.

With a Handle With Care notice, teachers are prepared to watch for common signs of trauma. If the student exhibits a significant behavioral, academic, or social change, displays signs of mental health concerns such as depression, or needs additional support, the teacher can refer the child to a school counselor or social worker, who can offer ongoing mental health support.

Trauma Is Not Rare

Trauma is far from a rare occurrence. A survey across 34 states found that 57.8% of American children experienced at least one adverse childhood experience (Giano et al., 2020).

Adverse childhood experiences, or ACEs, refer to broad categories of potentially traumatic events – like witnessing or experiencing violence and abuse or growing up in a family with mental health or substance use problems (CDC, 2021).

However, exposure to an adverse childhood experience does not predict a child developing trauma. Safe and supportive environments are essential to mitigating the mental and physical health challenges that often follow exposure to traumatic events (CDC, 2021). The result is a healthier future generation with decreased risk of experiencing socioeconomic struggles (CDC, 2021).

Impact of Trauma on Children

A few examples of traumatic events include poverty, divorce, the loss of a loved one, and severe illness (SAMHSA, n.d.). Younger children, including those in preschool and elementary school, may have nightmares, have difficulty sleeping, become anxious, and fear being separated from their parents. Meanwhile, middle and high school students are at risk of developing depression, eating disorders, and self-injurious behaviors.

After a traumatic event, students may have difficulty concentrating, leading to lower grades (Maynard et al., 2019). They may also struggle to regulate their emotions and become increasingly upset or angry, which may lead to fights or refusal to follow directions (Maynard et al., 2019). Students may also miss more classes, contributing to absenteeism and, potentially, suspensions (Maynard et al., 2019).

Nevertheless, not every child exposed to a traumatic event will become traumatized.

Positive childhood experiences, or PCEs, are essential to countering the effects of trauma and are correlated with lower rates of depression and better mental health in adulthood (Bethell et al., 2019). PCEs help children form strong relationships, develop a positive self-image, experience a sense of belonging, and build skills to cope with stress in healthy ways (The HOPE National Resource Center).

Tufts Medical Center identified four building blocks that promote positive experiences, helping children to grow into healthy, resilient adults:

• Relationships within the family and with other children and adults through interpersonal activities
• Safe, equitable, stable environments for living, playing, and learning at home and in school
• Social and civic engagement to develop a sense of belonging and connectedness
• Emotional growth through playing and interacting with peers for self-awareness and self-regulation

Need for Trauma-Informed Schools

For many kids, schools are the only place where they feel safe. Schools provide a consistent environment where many children have grown to trust their teachers and develop a strong sense of community. Schools profoundly influence their communities, serving as one of the most important places of socialization for children – aside from their homes.

Understanding trauma and its impact on students is essential to amplifying the positive impact schools have. Trauma-sensitive approaches ensure that all children can feel safe and confident in their ability to learn and connect while developing resilience (NEA, n.d.).

Handle With Care is grounded upon the Substance Abuse and Mental Health Services Administration’s trauma-informed approach, which relies on the four “R”s: realize, recognize, respond, and resist traumatization (SAMHSA, 2014).

Realize the widespread impact of trauma and understand potential means of support.
When students fail their tests following a traumatic event, it may not be from a lack of effort. Sleep deprivation, difficulty concentrating, and growing anxiety may contribute to a student’s declining grades.

Recognize the symptoms of trauma.
A few signs include poor focus, difficulty sleeping, absenteeism, disruptive behavior, and irritability.

Respond by using research on trauma to develop trauma-sensitive policies, procedures, and practices.
After receiving a Handle With Care notification, teachers may offer more time on tests, flexibility on assignment deadlines, and allow students to rest in the nurse’s office, among many other ways of showing grace during stressful periods.

Resist re-traumatization by implementing trauma-sensitive approaches and processes.
Not realizing that a child has experienced trauma may inadvertently lead to stressful environments where the child is overwhelmed or reminded of painful memories. For some children, this may occur when a teacher or school administrator abruptly yells at them or reacts harshly to mistakes, like missing homework. Trauma-sensitive environments do not discount the importance of accountability by any means – but often seek to integrate as much empathy and grace as the student needs.

What Sets Handle With Care Apart?

At their core, trauma-informed schools aim to shift attitudes about student behavior and grow their understanding of how trauma manifests (Avery et al., 2020). So often, trauma can look like misbehavior, but teachers have no way of distinguishing the two without knowing when a traumatic event occurs.

Handle With Care holds the missing puzzle piece that prepares teachers for when a student’s entire life may have changed overnight. No details of the incident are shared – not even the incident type – just the three words “Handle With Care” to alert teachers.

While some students may be absent, for others, schools may be the only place where students know they will be able to eat, and many other families may not be able to miss work. Unfortunately, for far too many students, Handle With Care notices are not a rare occurrence – the child might be repeatedly exposed to traumatic events, like community and domestic violence.

So, when students return to school, their schools must be prepared to support them. Handle With Care can cultivate healthy and safe learning environments by providing trauma-informed training and being armed with ways to respond if a child demonstrates signs of trauma.

Vitally, just as not all children exposed to trauma will become traumatized, Handle With Care does not mandate a response. The program is custom-tailored to the student, recognizing that they may not show any signs of trauma or that their challenges may be isolated to one specific area – like attendance or grades. For every student, including those demonstrating severe signs of trauma, Handle With Care prepares schools to support children and their academic, social, and emotional needs best.

How Did Handle With Care Start?

The first Handle with Care program was piloted at a small school in Charleston, West Virginia, in 2013. Approximately 500 students were enrolled in Mary C. Snow West Side Elementary School, and 93% were from low-income families. The school markedly struggled with performance, ranking 398 out of 404 elementary schools in West Virginia for poor performance. The community was also plagued by drug use and violent crime.

The West Virginia Defending Childhood Initiative, commonly called “Handle With Care,” was created with the specific needs and issues of children in West Virginia. The initiative followed the collaborative efforts of key stakeholders and partners with three goals in mind. They strived to prevent children’s exposure to trauma and violence, mitigate the adverse effects experienced by children’s exposure to trauma, and increase knowledge and awareness of this issue.

Since 2013, several cities, countries, and states have followed in their footsteps with the hopes of promoting safe and supportive homes, schools, and communities that protect children and help traumatized children heal and thrive.

At its core, Handle With Care is designed to help students succeed, relying on school-community partnerships and improved communication and collaboration. 

Why Might A Notice Be Sent

A Handle With Care notice may be sent whenever a child witnesses a potentially traumatic event. Below are a few examples:

• Evictions and forced displacement from the residence
• The sudden death of an immediate family member or guardian of the child, of which the police are made aware
• The arrest of an individual who resides with a student
• An incident of assault or sexual assault
• A severe motor vehicle accident that causes bodily injury or death
• A mass shooting
• A fire that causes severe property damage, bodily injury, or death

However, the above is not an exhaustive list. First responders have the ultimate discretion and may send a notice for any incident that they believe may lead a child to experience trauma.

A Bird’s Eye View of Who Is Involved

First Responders: First responders are the link that allows schools to know when a traumatic incident occurs. They are responsible for sending the Handle With Care notice to their school’s designated contact person, who may be the principal, counselor, attendance clerk, or alternative official, depending on the school district’s best fit. While some departments rely on emails and secure messaging portals, several have the form on their terminals. Officers and EMTs are then asked to send the child’s name, age, and school with the three words Handle With Care – never any details of the incident.

Teachers: The teachers receive the notice the next morning once the student returns to school. They are then asked to monitor the student for signs of trauma, as detailed in their training. Handle With Care does not mandate an active intervention, and teachers are not asked to step beyond their ordinary duties. Teachers are only asked to provide additional support if they notice the child is struggling. They may offer additional time to complete assignments or more frequent bathroom breaks.

School Personnel: Trauma-informed approaches are typically most effective when implemented schoolwide, and all personnel can recognize signs of trauma and understand potential means of responding. Schoolwide efforts also help to grow students’ perception of their school as a safe and welcoming environment where they feel a strong sense of belonging. Positive words and smiles can often have a vital impact on students as they know they are seen, cared for, and valued.

Guidance Counselors and Mental Health Professionals: School counselors and social workers are only asked to intervene when students demonstrate continued academic performance and behavior challenges. If additional support is required, students may speak with mental health professionals pending parental consent.

Handle With Care in Action

Below are a few examples of common behaviors after a traumatic incident has occurred and how schools with the Handle With Care program may respond the day(s) following a notice:

• Tony falls asleep during a test, and his teacher allows him to visit the nurse to rest. His teacher also offers the opportunity for Tony to make up the test.
• Sara tells her teacher she has a stomachache before an important lesson. Her teacher allows her to go to the nurse and offers Sara a copy of the notes.
• Stan has been late to school for almost a week. Stan’s teacher does not yell or comment in front of the class but asks their school counselor or social worker to call Stan’s guardian to see if they can provide any assistance with transportation.
• Mary argues with a classmate during class. The teacher offers Mary a bathroom break and asks that she return in five minutes once she has calmed down.
• John does not have homework when he returns to school with a Handle With Care notice. His teacher offers him an extension without penalty.
• Emma consistently performs well on tests but fails an important exam. Her teacher offers Emma the option to retake the exam for full credit and tutoring if needed.
• Daniel zones out and does not seem to pay attention in class. His teacher does not pressure him to participate, reminding the class that the day’s notes are available online.

A Note for Parents and Students

Handle With Care notices are typically sent after events that turn your world upside down and leave you with immense stress. This program is designed to support children through challenging situations and is also built with your family’s privacy in mind.

What you share surrounding the crisis is wholly your decision. Your school never knows the details of the incident and will not ask. Other students will never know that a notice has been sent on your child’s behalf.

Handle With Care is not an active intervention but a silent hand to offer support as needed. No responses are mandated, but Handle With Care offers pathways if your child struggles.

Handle With Care has been implemented in at least one city or county in almost every state nationwide. First responders, educators, school administrators, mental health professionals, and parents are just a few of the countless advocates who worked to bring Handle With Care to their community.

While it requires dedication and persistence at times, anyone can bring Handle With Care to their community. If you want to implement the program, this toolkit section will offer a step-by-step guide. If you have any questions or would like more information, please contact Bridges’s Policy Team at policy@joinbridges.org.

It All Starts With a Vision

Before reaching out to your local first responder agency and school district, we recommend connecting with members of your community who may be interested in Handle With Care. You might contact parents, mental health professionals, peace officers, teachers, or school administrators. We recommend starting small with a few core individuals before creating a coalition to support your implementation efforts. A small group can be helpful to coordinate your efforts and develop a plan while relying on a trusted network of support.

Once you meet with your partners, we recommend discussing what Handle With Care is and what results you want to see for your community. We also recommend starting a conversation about any concerns you have about the program and challenges unique to your community you might face, such as a shortage of mental health care providers. Bridges can assist in creating these networks and facilitating the dialogue.

For First Responders

As a member of your first responder agency, you hold a unique perspective within your community. From providing services to offering support in times of crisis, your service has bettered and saved countless lives.

If you are interested in implementing Handle With Care in your community, we recommend speaking to your commander or supervisor. Presentations can serve as a helpful aid to quickly convey the essentials of the program. However, we also recommend using aids as a starting point. Your passion for implementing Handle With Care is arguably the most influential aspect.

Sharing your why can be the deciding factor in bringing the program to your community. Be as specific as possible in sharing how you believe Handle With Care will impact your community. As a frontline responder, your experience speaks volumes.

With your supervisor’s approval, we recommend generating a plan to connect with your local school district, whether with their student resource officer, attendance coordinator, director of counseling and guidance, principal, or another individual you believe is the best fit for your community.

During the meeting, sharing the presentation and any additional information about your community, like rates of crime children are exposed to, can help guide the conversation and demonstrate the value of Handle With Care. We also recommend leaving significant time to answer questions and elicit their thoughts about the program. Handle With Care depends on a strong working relationship between law enforcement and schools. Any reservations or hesitations should be discussed and addressed immediately.

If both your first responder agency and school district agree to implement Handle With Care, you have completed a significant milestone. Your next step will be to identify how to implement the program. Congratulations!

From this point forward, your department and school district will connect with the Region 11 Education Service Center (ESC) and enroll in the program. Region 11 ESC hosts the software for Handle With Care, and enrollment is cost-free. From there, your department will have a unique portal for your first responders to submit Handle With Care notices, and the school district can start receiving the notices immediately.

While the department and school district are enrolling, your agency will need to decide whether to utilize training from the resource section, to create your own training, or to use training from an additional organization. The department will need to begin training first responders, and depending on the source, training could take as little as five minutes.

Handle With Care notices only take seconds to send and should also be a matter of habit. We recommend sharing reminders, posting flyers in shared rooms, like the breakroom, and offering cards that first responders can carry with them. Tracking the number of notices sent can also help identify when fluctuations occur.

For School Employees

Working within a school and interacting with students day after day can offer a unique perspective on student needs and challenges they may be experiencing. It can also be a powerful reminder of how differently trauma can manifest and how common exposure to trauma can be for youth.

If you want to implement Handle With Care in your school, we recommend speaking with your principal and their administrative team. Presentations sharing an overview of the program are a helpful starting point, but including your why can be the difference in implementing the program.

As a member of your school district, you have likely heard about trauma-informed care and many programs to support children who have experienced trauma. What sparked your interest in Handle With Care? How do you believe it would impact your community? The importance of sharing your passion and experience cannot be understated.

Following your meeting and approval from your supervisor, we recommend meeting with your student resource officer or an individual within your local first responder agency whom you believe may be interested. Sharing a presentation can be a helpful way to guide the conversation and share more about the program. However, we also welcome adapting the presentation for information specific to your community.

Your meeting is also an important time to answer questions and hear any concerns the department may have. A collaborative partnership is essential to cultivating a successful working model for Handle With Care by ensuring all parties are willing and interested in implementing the program.
If both your first responder agency and school district agree to implement Handle With Care, you have completed a significant milestone. Your next step will be to identify how to implement the program. Congratulations!

From this point forward, your department and school district will connect with the Region 11 Education Service Center (ESC) and enroll in the program. Region 11 ESC hosts the software for Handle With Care, and enrollment is cost-free. From there, your department will have a unique portal for your first responders to submit Handle With Care notices, and the school district can start receiving the notices immediately.

After enrolling, the next major step is training. Your district will have to decide whether to utilize training from the resource section, develop its own training, or outsource training from a community partner. They will also have to decide who will train staff. Current training through Bridges would take about thirty minutes. Other partners offer a completely virtual two-hour training that can be completed at the educator’s pace.

Finally, we recommend offering information to parents as part of your efforts. All included in the resource section, posters around the school, flyers to send home, and sections in newsletters sent home can all be helpful ways of distributing information about Handle With Care to parents.

Bridges’s Role

Implementing a community-wide program such as Handle With Care can seem incredibly challenging. Even hearing about the program can spark countless questions. Bridges is here to help you succeed. 

Throughout the process, we are here to answer any questions you may have. We offer brief meetings to discuss concerns and logistics for implementation. We can also host virtual presentations on Handle With Care for your team. Lastly, if your department or district is ready to enroll, we can connect you with Region 11 ESC and community partners for training.

Please reach out with questions and challenges you may be experiencing by contacting our Policy Team at policy@joinbridges.org. We can help you with the process from the exploration and planning stages to execution and evaluation.

Questions for Your Community

As you begin the implementation process, we recommend bringing these questions to your team.

• From your school district, who will receive and distribute notices?
• Will your community implement Handle With Care within public, private, or charter schools, or a combination of the three? If private and charter schools do not agree to implement Handle With Care, what will your first responders do if the child at the scene attends a private or charter school?
• Would the community’s fire department or emergency room also be interested in sending Handle With Care notices?
• What wraparound services are in place to provide children with additional support if needed?
• Which mental health provider or agency will provide in-school services?
• How will your community share information about Handle With Care? Would meetings like community forums, flyers posted within schools, or another method be more effective?