Resource: Active Shooter Drills Research: An Annotated Bibliography

Introduction: The original ask was specifically: “Department of Health and Human Services consider drafting a literature review of the effect that trauma has on students (including but also beyond research related to active shooter drills).” HHS colleagues who met to discuss this ask confirmed that a review of the literature on overall trauma and stress in school-aged children is not helpful to the purpose of the Executive Order and Executive Action (EO and EA), and a focus on mental health and active shooter drills is sufficient for informing the community. The below text are the key articles and research on active shooter drills and health/mental health from experts in the field. To complete the ask, staff from various HHS agencies added annotated context to the citation list and identified if there were missing or incomplete areas of science to add.

Content: In the Fall of 2024, HHS staff reached out to experts in active shooter drill research. The experts identified the below list, recognizing that the National Academies of Science, Engineering and Medicine (NASEM) is developing a similar and more complete product, which will include information from the community and relevant partners. Therefore, this was developed to meet an immediate need for the public, identifying the best research results regarding active shooter drills and student mental health, and where the research is missing, via an annotated bibliography. Additionally, it was deemed appropriate to include current prevention resources sponsored by the relevant HHS agencies, included at the end of this document (see Appendix B). Special acknowledgment to the National Child Traumatic Stress Network for their assistance in identifying research expertise and essential research texts.

Methods: Given the small corpus of research in this field, the variety of situations within that research, and the urgency of the ask, HHS agency staff solicited non-governmental experts in the field for their best bibliography and essential texts regarding active shooter drills. Next, HHS staff read through the texts in the bibliography, summarized their data, methods, relevance, key populations and settings, and ultimate findings. Some papers included citations not in the bibliography but would be important to include in the final product; in these cases, the staff assigned to review a given paper extracted the relevant primary source, reviewed it, and added it to the annotated bibliography. In addition to adding texts to the annotated bibliography, staff identified texts from the original list which might need to be excluded from the final product (Appendix A). Finally, HHS staff identified products related to preventing violence, injury, and harms in schools and relevant community settings (Appendix B). This is intended to be a resource for school leaders, parents, community leaders, and children to prevent violence.

Results: The original bibliography included 26 papers. Within those 26 papers, five were recommended for exclusion based on availability of the paper, relevance of results to active shooter drill research in today’s context, relevance to mental health outcomes, and duplication elsewhere in the bibliography. These are listed in Appendix A with reasons for exclusion for each paper. Three additional papers were recommended for inclusion by HHS staff, found as citations within papers from this bibliography. Those papers are noted with an asterisk (*) below. The resulting annotated bibliography includes 24 papers plus linked resources from HHS-sponsored agencies to prevent school-based and community violence.

Conclusions and Discussion:

Overall, the annotated bibliography brought to light the following key points:

• There seemed to be concerning consensus that drills involving simulations, high intensity or fear tactics were harmful to the students. Although drills related to simply practicing behaviors of lockdown while informing the students it was a drill did not seem to have the same consensus of negative results on the student and their fear. There is not enough high-quality research to identify if all types of active shooter or lockdown drills contribute to or cause stress among school-aged children, in either a negative or positive way.
• Some of these publications were authored or endorsed by professional organizations relevant to school settings and school-aged children, such as the American Federation of Teachers, the American Academy of Pediatrics, the National Association of School Psychologists, and the National Association of School Resource Officers. These organizations authored these reports to inform the best options for school-aged children.
• Several of the studies from this bibliography were from the same one or two interventions (articles 17, 18, 19, and 20). These were the majority of positive and neutral reports of mental health indicators.
• Some individual studies, although the studies have their limitations and are quasi-experimental, indicate active shooter drills do not create additional or measurable stress among school-aged children, and may mediate some stressors by providing protective information or skills and a sense of preparedness. However, several studies indicate the drills do not increase perceptions of safety.
• Some students and school-based employees may find appropriate active shooter drills helpful in their preparedness. However, this is not a universal finding—it only appeared in a few papers where the drills seemed to be observed by the researchers, and therefore might have been a result of the type of drill and preparation being practiced.
• Researchers and experts are calling for more research in all school-aged populations and school settings, and with rigorous research methods to identify the impact of the active shooter and lockdown drills, and to identify differences between the types and structures of drills.

Annotated Bibliography

*1. American Federation of Teachers. (2020). AFT resolutions: Opposition to active shooter drills. Retrieved from https://www.aft.org/resolution/opposition-active-shooter-drills.

In this resolution, the American Federation of Teachers (AFT) issued a statement claiming that there is a lack of evidence to support the idea that active shooter drills save lives, and anecdotal data shows that they can be traumatizing. The statement closes with “...the American Federation of Teachers will oppose the practice of any form of active shooter drill that utilizes the firing of blank ammunition, use of fake blood, the simulation of death or any other potentially traumatizing actions.”

2. Bonanno, R., McConnaughey, S, & Mincin, J. (2021). Children’s experiences with school lockdown drills: A pilot study, Children & Schools, 43(3) 175-185. https://doi.org/10.1093/cs/cdab012

The purpose of this study was to understand how children ages 8-11 describe their own experiences of lockdown drills, including related thoughts, emotions, beliefs, and sense-making. This information is intended to inform school personnel about student needs, allowing them to modify protocols accordingly. A convenience sample was recruited by word-of-mouth, fliers, and social media posts. It included nine Caucasian children, ages 8-11, who lived in a New York City suburb across seven schools and six school districts that ranged in diversity from 11-53% non-White and 15-55% “economically disadvantaged.”

Thirty-minute to one-hour interviews using developmentally appropriate language, rapport-building, and “joint meaning-making” (informed by Rubin and Rubin’s responsive interview approach and Clark’s methods of child-centered inquiry) were conducted individually with each child. Parent consent and child assent were obtained, and audio recordings of the interviews were required for participation. Children were asked open-ended questions and to complete sentence-completion exercises, and they were given the option to draw to help the interviewer better understand their experience, which all children accepted. Researchers used an inductive analytical approach, in which they examined interview transcripts and recordings, discussed emerging concepts and themes, clarified their meanings, and synthesized accounts. This analysis resulted in codes and a codebook with code definitions, which were applied to the entire data set by separate researchers, who then compared and cross-checked their coding results, discussing inconsistencies until consensus was reached. Consensus summaries of the code groups that closely fit the data were developed and arranged into a cohesive narrative. As with all qualitative studies, results were not generalizable to a broader population, a limitation exacerbated by the racially homogeneous sample. A more diverse sample was sought, but recruitment was interrupted by the COVID-19 pandemic.

All participants understood the purpose of lockdown drills as an effort to keep them safe from a person who might enter their school. Drills described by children were consistent with “traditional” single-option protocols, including “locking the door, moving students out of sight, and requiring students to remain quiet within the room.” While not all participants described feeling fear during drills, almost all mentioned fear in their interviews, and three described fear as their primary emotional response during drills. Coping strategies to navigate fear, such as reassuring oneself that the procedures were only a drill, were described. More than half of the participants described feeling frustration with the disruption and fear they experienced from the drill. Three participants questioned the need for drills to come without warning. All but one participant demonstrated an understanding that the purpose of lockdown drills was to increase safety, although two children, both of whom endorsed feeling afraid during drills, were unsure if the drill prepared them for a real incident. Results indicated that some students who need support to cope with fear of lockdown drills were not receiving it. Further, authors concluded that, given that most participants were already aware of potential intruder threats, students should be made aware that these threats are rare. Finally, they concluded that schools should engage in more child-centered activities surrounding school lockdown drills, encouraging school staff to listen to students more carefully about their experiences with these drills.

3. Dickson, M. J., & Vargo, K. K. (2017). Training kindergarten students lockdown drill procedures using behavioral health skills training. Journal of Applied of Behavioral Analysis, 50, 407-412. https://doi.org/10.1002/jaba.369

The purpose of this study was to evaluate the effectiveness of behavioral skills training (BST) to teach kindergarten students how to comply with lockdown safety drill procedures. The study sample included 32 typically developing kindergarten students, aged 5-6 years, in a Texas elementary school located in a low socioeconomic neighborhood.

A concurrent multiple baselines across participant groups design conducted across three randomly assigned groups was used to evaluate the effectiveness of BST in achieving compliance with lockdown procedures. Such procedures entailed students stopping activities, moving to the bathroom within 30 seconds of lockdown announcement, refraining from making noise, sitting crisscross in the bathroom, and remaining still and seated for five minutes.

In the baseline phase of the study (occurring across 4 sessions for Group 1, 10 sessions for Group 2, and 13 sessions for Group 3) the experimenter announced that lockdown had begun without providing any instructions. During the BST phase (occurring across 6, 5, and 7 sessions for Groups 1, 2, and 3, respectively), each group of students received training, where the experimenter provided spoken instructions, developed in collaboration with the local police department and school administration, with pictures depicting each step, which the experimenter also modeled. Students rehearsed the procedure, receiving feedback and praise, until mastery was achieved, defined as all students completing at least 86% of steps correctly while emitting noises during a percentage of time intervals that was at least 85% below the mean baseline level. Three to four days after the BST phase, when testing retention of the behavior across 3 sessions, the experimenter announced lockdown without providing instructions. Each phase was video recorded, and experimenters took notes with paper and pencil.

Among study limitations was that the students provided instruction and feedback to one another while testing for retention of skills, limiting capacity to conclude that all students understood the BST. Further, the calm, controlled condition in which students were only required to be quiet and sit still for 5 minutes is not representative of a real lockdown scenario. Further, noise production was separated from other steps of the procedure and rated independently, as none of the groups were able to complete the procedure without producing noise. As a result, the definition of mastery was changed to completion of 86% of other steps correctly and keeping the percentage of intervals with noises to at least 85% below baseline levels.

Raters, including 3 teachers and 3 administrators, when given a 0-3 Likert scale survey, rated the lockdown drills as important (M=3.0), appropriate (M=3.0), slightly time consuming (M=1.4, range=1 to 2), and not likely to produce undesirable side effects (M=0.0). They indicated that the procedure would affect future lockdowns (M=3.0), they were willing to continue lockdown trainings in the future (M=2.8, range= 2 to 3), and that the training was effective (M=3.0). During baseline, “all groups engaged in low percentages of correct steps and high percentage of intervals with noises.” No quantification of these percentages was provided. All students achieved mastery within 7 BST sessions and maintained mastery across 3 sessions after BST was provided. As such, BST may increase compliance with lockdown safety procedures among young children in a manner that is perceived as acceptable and without negative effects by school staff.

4. Division for Emotional and Behavioral Health-CEC (2024). School Shootings: Current Status and Recommendations for Research and Practice. Behavioral Disorders, 49(2), 116-127. https://doi.org/10.1177/01987429231214801

In this theoretical paper, the Division for Emotional and Behavioral Health (DEBH) reviews evidence about school shootings, including incidence data, shooter profiles, and responses to shootings, providing recommendations for research and practice. The DEBH contrasts rising trends in school-related gun violence with decreasing rates of school-based violent acts and juvenile crime and highlights that gun violence is more prevalent outside schools than within.

The paper outlines factors commonly associated with school shooters, including experiences with bullying and other adverse childhood experiences, previous criminal activity, narcissism, violent social media posts, and mental health needs. It also weighs the risks and benefits of measures commonly taken to prevent school shootings. Exclusionary disciplinary measures were associated with dropout and future delinquency. Further, the little data available on zero-tolerance policies contradicted their effectiveness. While the presence of school resource officers (SROs) was negatively associated with some instances of delinquency, it was associated with increases in some crimes, and it was not found to prevent school shootings or gun-related incidences. SRO presence was linked to an increase in punitive and exclusionary disciplinary procedures. It is not possible to directly link school shootings to gun-free school zones. However, research has suggested that shooters do not specifically target gun-free school zones.

While research on efficacy is not outlined, commonalities across models of threat assessment were examined, including identifying persons or situations of concern, determining the level of threat, intervening, and developing a management strategy to prevent attack if threat is substantive. The DEBH describes the connection between lockdown-only procedures and increased shooting fatalities, given that students who run away can be more likely to survive than those who hide within their classrooms. Research on the impact of drills on student wellbeing is mixed, as some studies indicate student feelings of fear or even secondary trauma from drills, whereas other studies have shown that drills have neutral or even positive effects on anxiety. However, there is no evidence that overt sensory elements in drills, such as realistic simulations of a true emergency or surprise drills, improve safety, and experts identify them as unnecessary.

Community action, such as the Chicago-CeaseFire violence interruption intervention, are shown to decrease violence and homicide rates. Multi-tiered systems of support (MTSS) are associated with increased feelings of safety. Universal mental health screening procedures embedded within MTSS are highlighted as essential practice for identifying and addressing mental health needs that are associated with violence risk. Further, the DEBH highlights recommendations from professional organizations and the U.S. Secret Service to establish multidisciplinary teams and implement formal threat assessments to identify students in need of targeted support. Finally, the DEBH highlights the need for research on the incongruence between current and best practice in school shooting prevention as well as school shootings and gun violence more generally.

5. Donovan, D. J. (2024). Active shooter drills in schools: Are we helping or hurting our kids? Clinical Pediatrics, 63(4): 441-443. https://doi.org/10.1177/00099228231180707

This commentary by Denis J. Donovan describes policy options in light of existing evidence surrounding the efficacy of active shooter drills in improving safety as well as their possible negative effects. Donovan highlights the importance of psychological safety and points to a lack of evidence and scientific consensus determining whether such drills better prepare children for the event of an active shooter or improve their safety.

Illustrating the commentary’s points, a study by El Sherief et al. (2021), which analyzed social media posts 90 days before and after drills across 33 states, demonstrated a 42% increase in posts expressing anxiety and stress, 39% increase in posts displaying depression, 23% increase in concerns regarding overall health, and 22% increase in concerns regarding death following drills. Another illustration is provided by a study conducted by Moore-Petinak et al. (2020), in which 60% of adolescent text message survey respondents reported they felt “unsafe, scared, helpless or sad” due to active shooter drills. However, 20.3% of respondents felt more prepared or safe.

The commentary recommends training school staff on lockdown and active shooter protocols, training students on school safety and lockdown procedures without drills, announcing drills in advance, conducting drills that are not overly realistic, and providing school mental health support. Donovan highlights a statement by the American Academy of Pediatrics recommending the elimination of high-intensity, surprise, or overly realistic drills and the provision of developmentally appropriate procedures with active consent and monitoring for signs of distress. It also underscores that the American Federation of Teachers and the National Education Association do not recommend active shooter training for students. These unions state that if such drills do occur, they should be age-appropriate, announced ahead of time, and not overly realistic. The National Association of School Psychologists and National Association of School Resource Officers issued guidance stressing the importance of lockdown procedures, advising simulations to train adults rather than students. In summary, school shooter drills should be carried out with utmost caution and account for the psychological needs of participating students.

6. El Sherief, M., Saha, K., Gupta, P., Mishra, S., Seybolt, J., Xie, J., ... & De Choudhury, M. (2021). Impacts of school shooter drills on the psychological well-being of American K-12 school communities: A social media study. Humanities and Social Sciences Communications, 8(1), 1-14. https://doi.org/10.1057/s41599-021-00993-6

This study examined the impact of school shooter drills. The population of focus was broadly outlined as school communities. Data included 27.8M social media posts, including Twitter posts by followers of schools identified as having a drill, Twitter posts by users with self-reported geo-location within relevant school districts, and Reddit posts shared within communities linked to relevant schools, between January 2018 and March 2020. A random sample of 27M Twitter posts from outside relevant school districts served as a control. Symptomatic expressions of stress, anxiety, and depression were quantified using validated machine-learning classifiers.

Interrupted time series analyses demonstrated that anxiety/stress significantly (p<10^-15) increased by 42.1% from 90 days pre- to post-drill, and depression significantly (p<10^-15) increased by 38.7%. Indicators of prosocial civic engagement increased. Expressions of interpersonal focus (p<10^-15) increased significantly by 47.79%, and use of first-person plural and second person pronouns increased significantly (p<.01) by 10.21%. References to friends significantly (p<10^-4) increased by 33.7% and references to work significantly (p<10^-15) increased by 106.18%.

Four robustness checks were conducted. In the first, data temporally or spatially overlapping with actual shooting events were excluded to isolate the effect of drills. Excluding data that temporally overlapped with real events, interrupted time series analyses demonstrated a significant (p<.0001) increase in stress/anxiety of 43.12% and a significant (p<.0001) increase in depression of 39.58%. Excluding data that spatially overlapped with real events, an interrupted time series analysis demonstrated a significant (p<.0001) increase in anxiety of 30% and a significant (p<.0001) increase in depression of 29.6%. Through the second, a model for forecasting time series was used to predict the intervention sample without a drill. The actual time series and predicted time series data were “significantly distinct, indicating that the interventions… likely caused a notable change...” The third involved generating 1000 synthetic time series following similar distributions as the intervention time series data, comparing change in each outcome around a placebo drill at the data midpoint. Analyses revealed that the probability that the placebo drill led to greater change in symptomatic expressions than the actual drill was low, ranging from 0-3.5%. The fourth entailed comparing trends in the intervention sample with those of “suitably chosen” time series in the control sample. Interrupted time series analyses revealed that the control time series showed a change of only 0.375-2.5% across all outcomes from the pre to post period. This change was significantly lower than the change of the intervention time series. All changes in the control were statistically insignificant, with one notable exception of stress/anxiety, demonstrating a significant (p<.05) increase of .3%.

Interviews with 21 parents, 11 teachers, and 2 students were held across six focus groups. A grounded theory approach was used to develop a codebook from focus group transcripts, and coders discussed and resolved discrepancies. Interviews revealed that many students were worried they were “going to die,” and some experienced panic attacks. Teachers also experienced negative reactions. Several participants described that shootings had become normalized.

The study offered empirical evidence that school shooter drills negatively impact psychological wellbeing. Among study limitations were self-selection bias of social media posters, the short (90 day) pre/post period, inclusion of posts from those who weren’t closely connected to schools, the type of drill was not noted, and clinical inferences cannot be made of symptomatic expressions.

*7. Everytown for Gun Safety Support Fund. (2022). How To Stop Shootings and Gun Violence in Schools: A Plan to Keep Students Safe. Retrieved from https://everytownresearch.org/report/how-to-stop-shootings-and-gun-violence-in-schools/

In this report, the American Federation of Teachers (AFT) and National Education Association (NEA) and Everytown for Gun Safety Action Fund outline and justify recommendations for active shooter trainings in schools. Active shooter trainings are not recommended for students, but for adult staff and faculty only. At a minimum, schools are encouraged to create developmentally- and age-appropriate drill content in collaboration with school-based mental health professionals and other school personnel, coupling trainings with trauma-informed approaches, providing advance notice of drills, not including simulations that mimic real events, and evaluating training efficacy.

8. Howard, C. C., Kelchner, V. P., Hilaire, B., Campbell, L. O., & Laguardia, E. D. (2022). Districts implementation of active shooter drill policies. Criminal Justice Policy Review, 33(7), 667-687. https://doi.org/10.1177/08874034211068448

This mixed-methods study investigates how school districts in Florida have implemented active shooter drills following legislation passed after the Marjory Stoneman Douglas High School shooting in Parkland, Florida. It analyzes school safety specialists’ perceptions and reports of drill procedures and their alignment with best practices. The majority of the districts surveyed aligned with Best Practices established by the National Association of School Psychologists and National Association of School Resource Officers. Implications for future research and considerations for the implementation of active shooter drills are discussed.

An explanatory sequential mixed-methods design was conducted to explore school safety specialist perceptions of active school shooter drills. The first phase of the study (descriptive) included a survey canvassing school safety specialists to identify variables related to active shooter drills (e.g., frequency, stakeholder factors, and general practices). In the second phase of the study (qualitative), school safety officers were individually interviewed to further elaborate on practices related to active shooter drills. Two data sources were considered: the School Safety Specialist Survey and one-to-one interviews. Interviews consisted of 14 to 16 questions each and were developed after analyzing survey data to identify themes of further interest.

Findings indicated that areas of misalignment include pre-drill procedures, modifications for developmental appropriateness, explicit attention to mental health considerations, and post drill processing. All school safety specialists interviewed spoke positively about the benefits of active shooter drills, though most emphasized the role of drills as only one component of a broader effort to support school violence threats. Interviewees described drills as ways to increase situational awareness, with benefits beyond school safety, and saw drills as supplemental to school-based threat assessment measures. All interviewees emphasized that drills should be designed to reduce, not increase, fear, and references to potentially negative consequences of hyper-realistic drills were common among all participants. A common challenge described by school safety specialists concerned developing a standard approach to active shooter drills for diverse schools and students with varying needs across the district. The number one challenge referenced by all specialists was drill fatigue, which stems from an update to the Marjory Stoneman Douglas Act requiring at least as many active shooter drills as fire drills, which is once monthly.

This study notes implications for policy and practice, including the state’s focus on quantity without an emphasis on quality leading to variations in the way drills were implemented. A more proactive approach to establishing guiding principles could help deter drill practices that fail to minimize potential for harm. Schools and districts practicing active shooter drills may need support in two key areas: (a) strengthening partnerships with mental health professionals in the design and implementation of drills and (b) building capacity to support students with diverse neurological needs. The study emphasizes that districts need to be mindful that fear and negative emotions should not be the only source driving policy change, as this can lead to unintended negative consequences. The study concludes by calling for further research into student anxiety and investigation into the policy development process.

*9. Huskey, M. G., & Connell, N. M. (2021). Preparation or provocation? Student perceptions of active shooter drills. Criminal Justice Policy Review, 32, 3–26. https://doi.org/10.1177/0887403419900316

The purpose of this retrospective cross-sectional study was to examine student perceptions of active shooter drills and a possible linkage between such drills and negative student outcomes. The study examined survey responses of 379 undergraduate students from a convenience sample regarding the association between experiencing an active shooter drill during high school and several indicators of wellbeing. Students were sampled across courses taught by nine Criminology and Criminal Justice instructors, and sample demographics largely reflected those of the university, with 12% freshman, 15% sophomores, 33% juniors, and 39% seniors, and a majority of the sample (57%) was non-White. There was slight underrepresentation of males (49%) in the sample compared to the wider student population (58%).

Outcomes examined with relation to shooter drill exposure in high school included fear, perceived risk, and perceived school safety. Other independent variables examined included awareness of security measures, such as metal detectors and security cameras, level of positive school climate, school characteristics, including public/private, rural/suburban/urban, and individual demographics.

Ordinary least squares regression models revealed a significant (p<.05) positive (β= .19) relationship between exposure to an active shooter drill in high school and student fear and a significant (p<.05) positive (β= .1) relationship between such a drill and perceived risk. Further, an ordinal logistic regression model revealed a significant (p<.001) negative (β= -.76) relationship between an active shooter drill in high school and perceived school safety. Other factors significantly associated with student fear included level of positive school climate (β=-.05, p<.05), awareness of security measures (β=-.05, p<.05), and an urban location (β=.32, p<.01). Significantly associated with perceived risk included level of positive school climate (β=-.3, p<.05) and an urban location (β=.16, p<.01). Finally, other than exposure to an active shooter drill in high school, the only factor significantly linked to perceptions of school safety was level of positive school climate (β=.68, p<.01). Among study limitations were the reliance upon a convenience sample, the retrospective nature of the survey, failure to capture the undergraduate major of each respondent, and limitations inherent to abbreviated measures of school safety perception.

10. Miotto, M. B., & Cogan, R. (2023). Empowered or traumatized? A call for evidence-informed armed-assailant drills in U.S. schools. New England Journal of Medicine, 389(1), 6-8. https://doi.org/10.1056/NEJMp2301804

This article discusses ‘Armed-assailant preparedness drills,’ an umbrella term to include all school programs designed to train the school community in safety responses to suspected armed assailants. These programs were first introduced in the late 1990s and are now prevalent nationwide. The article concludes that both the language used to discuss armed assaults in school and the preparedness training programs being implemented to mitigate harm from school shooters are highly inconsistent. According to the Department of Education (DOE), 96.2% of U.S. schools reported having used some sort of written plan to prepare for the possibility of an active shooter in 2019–2020, and 40 states currently mandate active-shooter preparedness in schools. These programs have drastically changed the school experiences of students in the 21st century, yet there is no federal standard for live crisis-drill curricula and no objective evidence that drills increase preparedness for a dangerous attack. Drills were designed by retired law-enforcement officers, counter-terrorism experts, and school safety personnel but are often implemented by individual districts with an urgency that precludes full analysis of best practices.

In 2016, the U.S. Government Accountability Office reported to Congress on the lack of coordination of school emergency-management efforts on the district and state level. State laws are interpreted and implemented by districts and individual schools in a variety of ways, most of them untested. Program heterogeneity and lack of commitment to evidence informed decision making have contributed to a data desert. The article states that with such low-frequency events, there is little opportunity for rigorous outcomes testing. There is no peer-reviewed evidence on the effects of armed-assailant drills on outcomes of actual school shootings. There is also little evidence on mastery of skills demonstrated in simulation safety drills. A study by Zhe and Nickerson (2007) reported finding heightened feelings of preparedness among a small group of mid–elementary-school-age students after lockdown drills, but their study did not include a control group.

While researchers Huskey and Connell (2021) found decreased perceptions of school safety and increased school-drill–associated anxiety among a larger group of recent high school graduates, there isn’t evidence to link increasing rates of anxiety and depression among young people to drill-associated trauma. This article recommends physicians partner with students, school staff, and psychologists to implement school safety plans; that safety programming pay specific attention to the wide variety of developmental stages and vulnerabilities at every grade level; that schools focus on teaching skills rather than simulating distressing crisis events; and that children not be routinely involved in high-intensity drills or exercises.

11. Moore, P., Diliberti, M. K., & Jackson, B. A. (2024). Teachers' Experiences with School Violence and Lockdown Drills: Findings from a 2023 American Teacher Panel Survey. Homeland Security Operational Analysis Center operated by the RAND Corporation. Retrieved from https://www.rand.org/pubs/research_reports/RRA1077-6.html.

This paper reports findings from a 2023 American Teacher Panel Survey and discusses teachers’ perceptions of violent incidents (especially gun violence) at their schools; how schools are using drills to prepare for violent incidents; and whether teachers perceive that drills increase their and their students’ sense of preparedness and safety. The survey gauged teachers’ perceptions of school safety, their main safety concerns, their experiences with incidents of gun violence, mass shootings or other threats and natural hazard emergencies, and to learn about the supports and resources that their schools have made available in the aftermath of these emergencies. It included a set of questions about active shooter, active assailant, or other drills designed to prepare the school community for a school shooting, starting with whether teachers had participated in such drills during the past school year (2022-2023). These school safety questions were administered as a module of a longer Fall 2023 American Teacher Panel survey. The Survey was administered between 10/11/2023-11/07/2023. RAND researchers used probability-based sampling to invite teachers in the panel to complete the survey. A sample of 1,020 K-12 public school teachers completed the survey.

Between January 2023 and March 2024, the Gun Violence Archive (GVA) recorded more than 8 shootings per month on average at K-12 schools. The GVA dataset captured news reports of an average of 68 incidents per month of confiscated guns at K-12 schools and an average of 8 additional incidents of gun carrying per month reported as resulting in campuswide lockdowns. These datasets rely on capturing media reports of violent and potentially violent incidents, so almost certainly represent significant undercounts of true values.

One in six K-12 teachers nationally works in a district that has been touched by gun violence since the 2019-2020 school year. Teachers in 2023-2024 reported more concern about being victims of an attack at their schools and were even more concerned for their students relative to the 2022-2023 school year. In the 2023-2024 school year, a greater share of female teachers than male teachers reported fear of being harmed or attached at school (27% vs 14%). Variability in the elements used in lockdown drills to prepare for school shootings and actions involved in drills highlights the need for more standardized implementation in this area. Teachers are split on whether participation in drills makes them feel more prepared to respond to active shooter incidents (47% report feeling more prepared themselves, and 54% report drills making students feel more prepared). Most teachers (69%) indicated that participating in active shooter drills has no impact on their perception of safety at school, and only one in five responded that drills make them feel safer.

Percentages suggest that the number of lockdowns that occurred per month is more than 100 times higher than the number captured in media reports and included in such databases as the GVA. About 4 in 10 teachers indicated in a recent national survey that their school has done only a fair or poor job of providing them with the training and resources they need to deal with a potential active shooter. Surveys of youth who have been involved in lockdown drills reported that drills make many of them feel ‘scared and hopeless.’ More work is needed to understand the impact of drills on staff and students and what schools can do to better support the well-being of students and staff who are required to participate in these activities. In fall 2023, 44% of teachers responded that their districts had experienced a bomb threat or other threat of violence during this period. Thirty-seven percent of teachers said their districts had experienced a student or staff suicide, and18% of teachers reported that their districts had experienced an extreme weather or natural disaster emergency. These data suggest that schools across the country are experiencing gun violence and threats thereof nearly as frequently as they are facing natural disaster emergencies.

12. Moore-Petinak N, Waselewski, M., Patterson, B. A., & Chang, T. (2020). Active shooter drills in the United States: A national study of youth experiences and perceptions. Journal of Adolescent Health, 67(4), 509-513. https://doi.org/10.1016/j.jadohealth.2020.06.015

Moore-Petinak and colleagues aimed to better understand youth experience and opinion about active shooter drills in this cross-sectional study of 815 youth ages 14-24. Among 1,283 active participants of the online text-based survey platform MyVoice used for data collection in this study, 815 responded to the study survey (26.5% non-response rate). The paper did not explain the recruitment strategy for the MyVoice platform, though the sample was approximately balanced in terms of geographic distribution, sex, and age. Only 35% of the respondents were between the ages of 14 and 17 (i.e. in high school).

The authors used an open-ended text message poll to administer five open-ended problems to participants: (1) This week is about guns and safety. Tell us about how gun violence affects you. (2) Does/did your school have active shooter drills? (3) What happens during an active shooter drill? (4) How do active shooter drills make you feel? (5) Do you think active shooter drills make schools safer? Why or why not? Responses were analyzed using thematic analysis.

The study found that youth experiences with drills ranged widely (e.g., hiding in silence under desks vs. simulated events). Among the sample, the study found that firearm violence (82.6%) and active shooter drills (68.5%) impacted a majority of youth, many times in negative or unintentional ways. Few respondents in this study (6.7%) reported experiencing school-based active-shooter drills that followed the Run. Hide. Fight. protocol selected by federal agencies as the national standard for civilian response to an active shooter incident. However, it is questionable if self-report was the most accurate way to discern this information. Further, while this protocol is recommended by some federal agencies, it should be noted that the best practice considerations issued by the National Association of School Psychologists state that the Run. Hide. Fight. protocol may cause harm if not implemented correctly. More than half of the youth in this study (60.2%) reported feeling unsafe, scared, helpless, or sad as a result of experiencing active shooter drills. Although more than half (56.1%) stated that drills made students more prepared for an active shooter event, there was a lack of consensus over whether they make schools safer.

Authors recommend further research to explore the important perspectives of these individuals to better understand best practices regarding active shooter drills, as automated text message-based surveys are limited in terms of colleting qualitative information about the lived experience.

13. National Association of School Psychologists and National Association of School Resource Officers. (April 2017). Best Practice Considerations for Schools in Active Shooter and Other Armed Assailant. Retrieved from http://www.nasponline.org/resources/BP-armed-assailant-drills.aspx

In this document, The National Association of School Psychologists and the National Association of School Resource Officers partnered to provide guidance on armed assailant training. Authors received input from Safe and Sound Schools: A Sandy Hook Initiative and the ALICE Training Institute. This document does not endorse a particular approach to training nor a specific training program. Its stated goals are to provide best practice information to help schools determine to what extent they need armed assailant training and to conduct trainings that make best use of resources, maximize effectiveness, and minimize physical and psychological risks.

Drill approaches include traditional lockdown versus options-based drills, which provide students and staff with a range of alternative strategies to save lives depending on the situation. This document asserts that schools must carefully consider the decision-making protocol for people to engage in a strategy other than lockdown. Students should be taught to first and foremost follow the direction of their teacher, and how to make decisions if that teacher is incapacitated. Helping students and staff understand the decision-making criteria is crucial. It is also important to consider the special needs of students with disabilities, both in terms of a drill and the expectations for their functioning in the event of real emergency. These considerations are strongly distilled in the following quote, “[s]chools should not use simulation techniques with students, and exercises should be appropriate to the participants’ developmental level and physical abilities.”

Developmental and mental health considerations should be addressed before, during, and after an armed drill or simulation. The effectiveness of armed assailant drills relies on educating and training adults carefully, responsibly, and continually. Per Safe and Sound Schools (2014), if schools opt to conduct an options-based or more advanced armed assailant training, it is critical that those planning and facilitating the training consider the cognitive and emotional development of all those involved. Individual developmental levels may vary greatly due to cultural, educational level, and personal profiles within a community or classroom. School-employed mental health professionals should be a part of all stages of armed assailant drill preparation.

The document recommends that training exercises and drills to prepare for active shooters or other armed assailants should be based on the specific needs and context of each school and community, and that schools recognize this type of drill as just one specific component of comprehensive crisis preparedness and response that includes prevention, protection, mitigation, response, and recovery. Schools should consider the most cost-effective method of preparing students and staff for an active shooter situation while balancing the physical and psychological risks associated with such drills. Regardless of the nature of the drills a school chooses, the school resource officer and school-employed mental health professionals must be integrally involved in the planning and evaluation process to ensure appropriate implementation. The document concludes with five appendices addressing the hierarchy of education and training activities; safety instructions for the use of airsoft guns; considerations for students with disabilities; developmental considerations associated with school safety procedures, activities, and drills; and questions to ask when considering armed assailant training.

In 2021 this group released an updated set of recommendations¹, citing that many states and school systems had mandated lockdown and active shooter drills in schools, but often without guidance for best practices in those mandated drills. The 2021 report reiterated the findings above, but also aims to give more guidance on what are safe and appropriate drills—to be practicing lockdown procedures, not mimicking or simulating a situation. Specifically, the guidance recommends brining these drills in line with other regularly practiced drills in the same setting, such as evacuation, fire, tornado or earthquake drills.

*14. Riggs, A., Bergmann, K. R., & Zagel, A. L. (2023). Self‐reported anxiety and perception of safety following school lockdown drills among adolescent youth. Journal of School Health, 93(12), 1129-1136. https://doi.org/10.1111/josh.13362, 93, 12, 1129-1136.

This cross-sectional, survey-based study discusses lockdown drills in educational settings in the US and their contributions to adverse mental health. It describes factors associated with post-drill anxiety and perceived effectiveness of drills. English-speaking child-caregiver dyads were recruited from two urban pediatric emergency departments (EDs) within a tertiary care pediatric health system serving a large, Midwestern metropolitan area from March-October 2021. Children were ages 12-17, visiting the ED for low acuity reasons, and accompanied by their legal guardian. Univariate analyses were conducted utilizing Pearson chi-square and Wilcoxon signed-rank tests to examine differences across categorical and continuous variables, respectively. A sample of 106 children responded to directed questioning regarding their feelings of anxiety regarding lockdown drills.

Children who reported anxiety following the drill (27%) were more likely to have an increase in both depression symptoms (such as poor or increased sleep, feelings of guilt, low energy, suicidal thoughts, etc.) and anxiety symptoms (such as fast breathing, restlessness, excessive worry, etc.) following the drill compared to those who did not report anxiety following the drill. Children who felt more anxious about lockdown drills were more likely to have a history of being bullied at school and a history of skipping school for safety. Forty-four percent of participants reported both skipping school for safety and being bullied, suggesting that bullying may not be the primary reason for skipping school among the participants in our sample. One recent survey study of over 10,000 children and adolescents showed that while students were less fearful after lockdown drills, school avoidance behaviors increased.

This study has several limitations, including limited sample size due to enrollment capabilities during the COVID-19 pandemic in the pediatric ED, and thus there was limited staffing as well as eligible children. This study began at the same time as many schools were virtual, in relation to the COVID-19 pandemic, therefore eliminating school-based lockdown drills. Participants were asked to reflect on lockdown drills which occurred within the previous two school years, which may have led to a bias in accuracy due to the long-recall time, though may point to chronic effects of these drills by some children.

The study concludes that lockdown drills can increase anxiety and depression symptoms in children. Children with a history of skipping school for safety or being a victim of bullying at school are more likely to report anxiety after a drill. Having a caregiver with a mental health history may contribute to anxiety. Caregivers may not recognize the anxiety and depression their child is experiencing following a drill. If lockdown drills remain a ubiquitous practice, schools should emphasize the safety measures being taken and should encourage open discussion with their students. Schools should put an emphasis on screening their students for poor reactions to these drills.

15. Saggers, B, Campbell, M. A., Kelly, A. B., & Killingly, C. (2021). Are schools’ lockdown drills really beneficial? —A commentary. Journal of School Health, 91(6), 451-453. https://doi.org/10.1111/josh.13020

This is a commentary by researchers in Australia, based on a literature search focusing on lockdown drills in kindergarten through 12^th grade in 2021.

The authors note that they were looking for research regarding “lockdown drills” but use “active shooter drills” throughout the commentary at times. Upon searching for literature on lockdown drills and student mental health outcomes, the authors found four papers, three of which are in the context of schools in the United States, and one in Russia. The authors concluded that more empirical evidence is needed to understand the intersection of lockdown drills and psychological effects, both harmful and protective.

16. Schildkraut, J., Greene-Colozzi, E.A., & Nickerson, A.B. (2024). Emergency preparedness drills for active and mass shootings in schools. Current Psychiatry Reports, 26, 304–311. https://doi.org/10.1007/s11920-024-01502-7

This systematic review summarizes the effectiveness of various approaches to lockdown and active shooter drills in school settings. The authors considered research with both qualitative and quantitative aims and assessed the following themes within the literature they discovered (findings were delineated as different among “lockdown drills” vs. “active shooter drills”): anxiety, perceived safety at school, emergency preparedness, fear, risk, and avoidance. The review also assessed evaluation of procedural integrity of the drills, but this was not necessarily relevant to the mental health outcomes.

The review finds that “active shooter drill” effects on participants, specifically school-aged children, are not clear, and more research is needed on the topic. Moreover, “lockdown drills” have positive results on teaching participants the skills to respond to the relevant emergency, however, there are conflicting examples of how these drills can be protective or harmful to mental health (or even neutral).

This review is limited by the cross-sectional nature of the included studies, and few were cohort-based or over longer periods of time. Additionally, due to the inclusivity of the review criteria, the discussion is not structured to report out on the findings of the review in a systematic way, but rather discuss the variety of findings in a narrative form. Lastly, the methods for the review are absent, so understanding which papers were searched and how they were ultimately included are unknown. The number of papers included in the review is unclear: The works cited includes 41 citations, of which four are marked as “Of importance” and seven as “Of major importance” (however, these delineations are not defined).

17. Schildkraut, J., Greene-Colozzi, E. A., & Nickerson, A. B. (2024). Balancing students’ perceptions of safety and emergency preparedness: A quasi-experimental test of protection motivation theory as it relates to lockdown drills. Victims & Offenders. Advance online publicationhttps://doi.org/10.1080/15564886.2024.2410999

This study draws data from a large, ongoing emergency preparedness project the authors conducted in a large, urban school system in central New York State. The focus of the study is Protection Motivation Theory (PMT) and if the participants in the preparedness project may experience PMT with their increased training. The PMT project took place throughout the school year from February 2022 in one high school (although overall the project was throughout a school district). Protection Motivation Theory explains the process for adopting safe, healthy, and protective behaviors.

The emergency preparedness project sought to assess PMT in relation to evaluating a lockdown drill, as opposed to assessing students and school staff regardless of recency or presence of drill training. The initiative sent anonymous surveys to students in the second period of their school day as a baseline (295 of 479 students responded); and 12 days later, a lockdown drill was performed at random (with the consent of school administrators). Research staff observed adherence to best practices during that time. The same survey instrument as baseline was distributed after the drill (264 responses were collected).

Researchers explored demographic and other differences between the pre and post survey responses. The survey tool assessed avoidant behaviors, proactive behaviors, and self-protective behaviors. Researchers also explored the following as potential mediators: prevention, preparedness, fear, and perceived risk of victimization.

Results suggest student perceptions of preparedness efficacy increased self-protective and proactive behaviors. At the same time, perception of school safety was associated with a significant decrease in self-protective and avoidant behaviors, but not proactive behaviors. The researchers seem to consider decreasing self-protective and avoidant behaviors are indications of positive mental health effects. Students who perceived their schools to be safer reported lower risk, less fear, and more efficacy for preparation and prevention. Students with lower perceptions of school safety reported being more likely to engage in self-protective behavior. These findings are consistent with PMT and suggest that schools should teach self-protective behavior via trainings, demonstrations, or drills to empower students who feel less safe in their school. Findings should be considered with the limitation that this was conducted as a pilot study.

18. Schildkraut, J., & Nickerson, A. B. (2022). Effects of lockdown drills on students’ fear, perceived risk, and use of avoidance behaviors: A quasi-experimental study. Criminal Justice Policy Review, 33(8), 787-813. https://doi.org/10.1177/08874034221089867

This study explored school-district-wide emergency preparedness in a large, urban school district to understand the psychological impact of lockdown drills on school-aged children.

Students were surveyed across three points in time: baseline, after the first lockdown drill, and after a training and second lockdown drill. The survey intended to identify the impact of fear, perceived risk, and avoidance following the lockdown drills (and associated training). The intervention was completed during Fall 2018 in a school district with 6^th-12^th grade students. The survey instrument was administered to 10,015 students. In the winter of 2019 (January to March), additional trainings were held using supplementary materials, and in March 2019 another round of lockdown drills was performed and observed by the research team. In April 2019, the final survey was administered. Over the three points of surveys, surveys were left with schools to administer anonymously, without matching survey responses from the different points of time. The average response rate was 36.4%.

The results of the surveys identified that students were less fearful and perceived lower risk after participating in lockdown drills and emergency response training, although avoidance behaviors increased. Perceived school safety predicted less fear, risk, and avoidance, while perceived emergency preparedness predicted less fear and avoidance but higher risk.

There are some limitations, including the quasi-experimental approach; there was not a comparison group to help identify if observed changes in perception would have occurred regardless of the lockdown. Additionally, the study is of one type of emergency preparedness response and does not define what students may have been fearful of in the survey. Similar conclusions can be found in the paper Schildkraut, J., Nickerson, A. B., & Ristoff, T. (2019). Locks, lights, out of sight: Assessing students’ perceptions of emergency preparedness across multiple lockdown drills. Journal of School Violence, 19(1), 93-106. https://doi.org/10.1080/15388220.2019.1703720.

19. Schildkraut, J., Nickerson, A. B., & Klingaman, K. R. (2022). Reading, writing, responding: Educators’ perceptions of safety, preparedness, and lockdown drills. Educational Policy,36(7), 1876-1900. https://doi.org/10.1177/08959048211015617

This study builds on the evidence of Schildkraut and Nickerson (2022). The study was conducted with a central New York state school system employing 3,500 staff and faculty. And assessed staff perceptions at three timepoints Surveys were administered to assess staff perceptions of impact, if any, that lockdown drills and training have on feelings and perceptions of preparedness. Staff responses were linked across time-points.

The survey aimed to answer two main questions regarding safety and preparedness:

1. What impact, if any, do lockdown drills and training have on feelings of school safety among faculty, staff, and administrators?
2. What impact, if any, do lockdown drills and training have on perceptions of emergency preparedness among school faculty, staff, and administrators?

Researchers distributed a baseline survey in September 2018, and again after a drill, which was observed for adherence by the researchers. The students, faculty and staff were trained in January to March 2019, followed by a final drill and survey from March to April 2018. Approximately 30-32% of the 3,221 staff and faculty responded to each of the three surveys.

Survey results indicated that faculty and staff did not change their perceptions of safety across the three points in time, suggesting the drills and training did not change their opinions or perceptions of safety. However, across the three timepoints there were significant differences in perceptions of preparedness, increasing after drills and training. There were racial differences, with white respondents reporting less feelings of safety than Black respondents), and age-related differences, with older respondents reporting more feelings of safety than younger respondents.

20. Schildkraut, J., Nickerson, A. B., Vogel, M., & Finnerty, A. (2023). Assessing the relationship between exposure to violence and perceptions of school safety and emergency preparedness in the context of lockdown drills. Journal of School Violence, 23(3), 319-332. https://doi.org/10.1080/15388220.2023.2291655

This study builds on Schildkraut and Nickerson (2022). This study specifically examines the potential impact of students’ exposure to violence (ETV) in their school on perceptions of safety and emergency preparedness in the context of lockdown drills via surveys.

Survey findings indicate that ETV decreased both reported perceptions of safety and preparedness. The association between perceived school safety and ETV, however, weakened over time and may be lessened by participation in drills and associated training. The survey item for ETV assessed if students indicated whether they had (1) heard of someone bringing a gun to school, (2) personally seen someone bring a gun to school, (3) seen someone bring a knife to school, (4) seen one or more physical fights, (5) been involved in one or more fights, (6) seen someone being bullied, and (7) been bullied. All questions were asked relative to the current school year and responses were dichotomous (1 = Yes, 0 = No). These questions have moderate internal consistency (Cronbach’s α = .603) and are summed together to create an index representing ETV.

The team modeled perceived school safety and emergency preparedness as a function of ETV through the ordinary least squares method and adjust the standard errors for the clustering of respondents across the 16 schools in the sample. They interpreted statistically significant differences in the slope on ETV across survey waves as evidence of moderation.

Results from this intervention and analysis indicate students who report greater ETV also express lower levels of perceived school safety. Students who reported more ETV reported more impact of ETV at baseline than after participating in the training and both lockdown drill. Understanding that students are likely experiencing exposure to school violence throughout the school year, regardless of the timing of the lockdown drills and training, data from this analysis suggests that ETV may be more consequential to perceived safety than the intervention drills. This may mean participating in ongoing preparedness efforts, such as drills and training, could serve to mitigate the harmful effects of ETV, a secondary benefit beyond the scope of the intervention.

The association between perceived preparedness and ETV had a negative effect on the pooled sample across all three time points, such that students with more exposure to violence had less feelings of preparedness. However, overall reported preparedness increased across the three timepoints of survey administration.

As with the previous articles on this intervention, this study is limited in that it is only within one school system, during one intervention on training with one lockdown method, and does not include comparison groups.

21. Schonfeld, D. J., Melzer-Lange, M., Hashikawa, A. N., Gorski, P. A., Krug, S., Baum, C., ... & Zonfrillo, M. R. (2020). Participation of children and adolescents in live crisis drills and exercises. Pediatrics, 146(3). https://doi.org/10.1542/peds.2020-015503

This policy statement from the American Academy of Pediatrics (authored by Schonfield and colleagues) outlines the current practices for active shooter drills implemented in general school settings in the United States. The authors provide recommendations to eliminate children’s involvement in high intensity drills and exercises; prohibit deception in drills and exercises; and ensure appropriate accommodations during drills and exercises based on children’s unique vulnerabilities. The authors emphasize that active shooter drills should consider the unique needs of young children (e.g., early care and education settings), children who have physical, intellectual, and neurodevelopmental disabilities, and children who have been previously exposed to traumatic events. The authors state that in practice, preparedness initiatives and approaches are rarely planned and conducted with guidance from those familiar with the unique needs and vulnerabilities of individual or groups of children. The authors point to a dearth of evidence to support best practices for age-appropriate active shooter drills for schools, and a general lack of national recommendations on whether and how to include children in active shooter exercises and other crisis drills.

22. Simonetti, J. A. (2020). Active shooter safety drills and us students—should we take a step back?JAMA Pediatrics, 174(11), 1021–1022. https://doi.org/10.1001/jamapediatrics.2020.2592

This viewpoint article by Joseph Simonetti discusses active shooter training practices in US school settings, in the context of compelling preliminary evidence (Schildkraut, 2019) that lockdown or active shooter drills may be associated with substantial emotional and psychological harms to children in kindergarten through 12^th grade. The author cites recommendations for best practices issued by the National Association of School Psychologists and National Association of School Resource Officers and emphasizes that drills are not evidence based with respect to injury outcomes and are meant to mitigate injuries from rare incidents. Simonetti calls for dialogue at the school and district levels to ensure that lockdown and active shooter drills are being implemented in a way that is consistent with family and community values and are based on transparent discussions with respect to potential benefits and harms.

23. Stevens, T., Barnard-Brak, L., Roberts, B., Acosta, R., & Wilburn, S. (2020). Aggression toward teachers, interaction with school shooting media, and secondary trauma: Lockdown drills as moderator. Psychology in the Schools, 57(4), 583-605. https://doi.org/10.1002/pits.22329

Teachers who are not exposed to direct, violent experiences in their classrooms and related trauma can still experience secondary trauma. Teachers are often the target of classroom aggression and interact with school shooting media in a unique way, given their role in directing active shooter drills in schools.

This was a cross-sectional observational study which investigated 1) whether teacher‐reported classroom aggression and teachers’ interaction with school shooting media are associated with teachers’ secondary trauma related to school shootings and 2) the role that participation in lockdown drills may moderate these relationships.

The authors administered an online survey to a convenience sample of 296 adults currently or formerly employed as teachers in public and private schools across all grade levels, up to high school. Former teachers were included in the sampling strategy because the authors hypothesized that secondary trauma related to school shootings and classroom aggression could be associated with teachers leaving the profession. Recruitment was done through Facebook. The study did not specify if specific geographic area of the United States were targeted (e.g., cities, regions, etc.). Less than a quarter of the sample taught in urban areas (14.5%), compared to suburban (44.6%) and rural areas (34.5%). The majority of the sample were teachers in public schools (65.9%), and 18.2% of the sample were not in a teaching role but were currently employed in schools.

The survey used an author‐created 24‐item instrument to measure aggression toward teachers, and a 20-item instrument to measure interaction with media related to school shootings. To evaluate lockdown drills experienced by teachers in schools, participants were asked to describe their schools’ lockdown procedures. Thematic analysis and frequency count was used to identify different types of lockdown drill activities within three themes (sheltering in place, defending against an attacker, and simulation). Structural equation modeling was used to assess the relationship between teacher‐reported classroom, teachers’ interaction with school shooting media, and the role of lockdown drills in experiencing secondary trauma.

Both teacher‐reported classroom aggression and teachers’ interaction with school shooting media were associated with higher levels of secondary trauma related to school shootings. Teachers’ interaction with this media leads to higher levels of secondary trauma just as experiencing aggression in their classroom does. Lockdown drills did not appear to have a role in these relationships in this study. The authors concluded that considering teachers’ well-being and how it might influence their ability to effectively carry out their professional duties is important and requires further research. The authors recommended the involvement of school psychologists in lockdown drill planning and implementation.

24. Zhe, E. J., & Nickerson, A. B. (2007). Effects of an intruder crisis drill on children's knowledge, anxiety, and perceptions of school safety. School Psychology Review, 36(3), 501-508. https://doi.org/10.1080/02796015.2007.12087936

This cross-sectional observational study examined the effects of children’s crisis drill participation on knowledge, skills, anxiety, and perceptions of school safety. Seventy-four children in the fourth, fifth and sixth grades participated in an intervention or control condition and competed measures about knowledge of drill procedures, anxiety, and perceptions of safety. The study was conducted in an elementary school in a suburban school district in upstate New York. Participants ranged from 8 to 11 years of age, and nearly 70% were white.

The intervention for this study was an intruder drill, rather than a lockdown drill which was already a part of the school’s crisis plan. The control group participated in an origami class. Both the intervention and control activities lasted 30 minutes and were followed by a 45-minute survey and debriefing. Thirty-eight percent (N=15) of the 39 students in the intervention group indicated that they had previously participated in an intruder drill, compared to 23% in the placebo group of 35 students. Observation forms were used by the researchers to capture information about student performance (i.e., how many students moved their desks to a safe area of their classroom within 2 minutes), and descriptors of student’s behaviors during the interventions. The State-Trait Anxiety Inventory for Children was used to capture self-reported measures of anxiety, and post measure questions were administered to the children to capture knowledge acquisition of the drill procedures and perception of school safety. The control group conditions were methodologically questionable, as an origami class is not comparable to a crisis drill.

The intervention group attained higher post-test schools of knowledge. However, there were no group differences in anxiety or perception of school safety. The authors conclude there was not great concern that children will experience adverse emotional reactions to participating in developmentally appropriate crisis drills which follow best practices. The findings of this study may have limited generalizability due to two key factors. First, the intervention was implemented nearly two decades ago and may have limited relevance to current contexts or practices. Second, the study had a small sample size—approximately 40 children in both the intervention and control group, which may not provide a sufficiently diverse or representative population to draw broad conclusions.

Appendix A: Papers excluded from the original bibliography and methods for exclusion

Methods: The list of relevant citations from the subject matter experts including some papers which the team concluded would not help meet the needs of the literature review. Therefore, they were excluded if they met any of the following criteria:

1. Were not accessible in any form.
2. Were not explicitly discussing lockdown drills or active shooter drills.
3. Discussed outdated practices or technology as a major component of the publication.
4. Did not assess a mental health or stress related outcome.
5. Duplication of an intervention and its findings already in the bibliography.

Excluded citations listed below with reasons for exclusion as cited above:

Baer, R. D., Zarger, R. K., Ruiz, E., Noble, C., & Weller, S. C. (2014). Lockdown: Applied anthropology and the study of campus emergencies. Human Organization, 73(4), 326-339. https://doi.org/10.17730/humo.73.4.a4j559nm2h17p177. Reason for exclusion: #3 and #2: This is an anthropologic case study of a 2009 lockdown following a bomb threat incident; it is not about active shooter drills, and the feedback from students on their perceptions of the university administration’s response refers to many technologies and practices that are not current.

Perrodin, D. P. (2019). Backtalk: Why no safety drills for students with disabilities? Phi Delta Kappan, 101(2), 72. https://doi.org/10.1177/0031721719879164. Reason for exclusion: #1, is not available anywhere online for those working on this product.

Schildkraut, J., Greene-Colozzi, E., Nickerson, A. B., & Florczykowski, A. (2023). Can school lockdowns save lives? An assessment of drills and use in real-world events. Journal of School Violence, 22(2), 167–182. https://doi.org/10.1080/15388220.2022.2162533 Reason for exclusion: 4. This study is about the effectiveness of active shooter and lockdown drills but not about mental health outcomes among participants or potential participants.

Schildkraut, J., & Nickerson, A., B. (2020). Ready to Respond: Effects of lockdown drills and training on school emergency preparedness. Victims & Offenders, 15(5), 619-638. https://doi.org/10.1080/15564886.2020.1749199. Reason for exclusion: 4. This study is about the effectiveness of active shooter and lockdown drills but not about mental health outcomes among participants or potential participants.

Schildkraut, J., Nickerson, A. B., & Ristoff, T. (2019). Locks, lights, out of sight: assessing students’ perceptions of emergency preparedness across multiple lockdown drills. Journal of School Violence, 19(1), 93—106. https://doi.org/10.1080/15388220.2019.1703720. Reason for exclusion: 5, this intervention and its similar results are already described in the paper Schildkraut, J., & Nickerson, A. B. (2022). Effects of lockdown drills on students’ fear, perceived risk, and use of avoidance behaviors: A quasi-experimental study. Criminal Justice Policy Review, 33(8), 787-813. https://doi.org/10.1177/08874034221089867.

Appendix B: Federal Firearms-related violence prevention resources

Reducing the burden of firearms-related violence in school settings is a priority across federal agencies, including the U.S. Department of Health and Human Services. Preventing firearm violence in school settings requires a broader approach that extends beyond the school environment to include comprehensive violence prevention strategies within the community. Below is an overview of violence prevention resources available from HHS and its agencies which can be used to guide school leaders, parents, community leaders, and children to prevent violence:

Department of Health and Human Services

The Department of Health and Human Services co-leads an interagency effort with the Departments of Education, Homeland Security, and Justice called SchoolSafety.gov. This resource is a public website of the Federal School Safety Clearinghouse (Federal Clearinghouse on School Safety Evidence-Based Practices) created to provide schools and districts with actionable recommendations to create safe and supportive learning environments for students and educators. Schools can prevent and mitigate targeted violence threats by taking proactive measures to improve the physical security of school grounds, buildings, and classrooms. The K-12 School Security Guide Product Suite provides tools and information to support school physical security planning, assess vulnerabilities across campuses, and better protect against physical and crime-related threats.

Substance Abuse and Mental Health Services Administration

The National Child Traumatic Stress Network (NCTSN), a collaboration of academic and community-based service centers focused on improving and increasing access to services for traumatized children and their families, was established by Congress in 2000 and is funded by Substance Abuse and Mental Health Services Administration (SAMHSA). NCTSN’s website hosts a site directing readers to school shooting resources, which includes a fact page providing information to schools about how to create a trauma-informed active shooter/intruder drill and a resource to help parents, educators, and the broader community address children's concerns about school safety before, during and after violence events.

SAMHSA also has a range of resources addressing lethal means safety and suicide prevention, including a webpage providing background information which refers readers to broader federal resources to support on lethal means safety and suicide prevention.

SMAHSA’s Tribal Training and Technical Assistance Center also hosts a hub of resources focused on violence prevention interventions and tools, including Native-specific resources.

Centers for Disease Control

The Centers for Disease Control’s Injury Center has developed Prevention Resources for Action, a series of resources for action to help states and communities make decisions about violence prevention activities. This includes resources focused on preventing adverse childhood experiences, child abuse and neglect, community and youth violence, intimate partner violence, sexual violence, and suicide. Each resource for action describes a select group of strategies, including strategies for schools and communities, based on the best available evidence to help focus on prevention activities with the greatest potential to prevent violence and its consequences.

The CDC’s Cardiff Violence Prevention Model helps communities—including hospitals, law enforcement agencies, public health agencies, community groups, and others interested in violence prevention—map violence by combining and mapping both hospital and police data on violence. The tool can be leveraged to develop collaborative violence prevention strategies.

Crime Prevention Through Environmental Design (CPTED) is an approach that focuses on improving the design of the built environment to help reduce opportunities for disputes and violence and promote positive behavior. The CPTED School Assessment (CSA) tool can be used to assess the use of CPTED principles in three areas of schools: grounds, buildings, and interiors.

VetoViolence is CDC’s public-facing online resource for violence prevention education and training. It provides online trainings, step by step guides, resources, and information. It is designed for diverse audiences, including education professionals. With over twenty different trainings, tools and resources, the topics covered range from prevention fundamentals to information on how to address risks shared across different forms of violence, and tools for effectively building partnerships to prevent violence. Tools of interest to schools include Violence Prevention in Practice, an Overview of Adverse Childhood Experiences for Educators, and the Connecting the Dots tool which users explore the relationship between multiple types of violence—including youth violence—and the risk and protective factors they share at each level of the social-ecological model (SEM).

The CDC’s Division of Adolescent and School Health (DASH) has developed resources to support mental health in school settings. The Promoting Mental Health and Well-Being in Schools Action Guide for School and District Leaders which describes six in-school strategies that are proven to promote and support mental health and well-being. The action plan is accompanied by an implementation guide that helps schools to reflect on what their school or district is already doing to promote mental health and well-being, prioritize strategies and approaches from the Action Guide to fill gaps and strengthen what is already in place, make actionable plans to implement the strategies and approaches.

DASH has also developed the Health Education Curriculum Analysis Tool (HECAT), an assessment tool which provides guidance and tools for schools to improve health curriculum selection and development. The Tool includes a violence prevention module and mental and emotional health module. Each module is accompanied by a webinar which provide an overview of data on the impact of violence and mental and emotional health on youth, and walk through the module while explaining recent updates to tools, resources, and student knowledge and skill content found in grades PreK-2 through 12 health education curricula.

Finally, DASH has produced What Works in Schools Program, a school-based program that prevents adolescent health risks by promoting a safe and supportive school environment. The program addresses improving health education, connecting young people to the health services they need, and making school environments safer and more supportive. Program implementation has been associated with reductions in student absenteeism due to safety concerns.²

The National Institutes of Health/ Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

The NICHD funded the University of Michigan Firearm Safety Among Children and Teens (FACTS) Consortium https://reporter.nih.gov/project-details/10002246

The expected outcomes of this funded project is to create six research resources: 1) consensus documents detailing the state of the science and key research questions for pediatric firearm injury prevention; 2) pilot data to support five large-scale research proposals; 3) a web-based data archive and searchable research repository on childhood firearm injury; 4) enhanced data collection opportunities on childhood firearm injuries through existing national networks, a cadre of new researchers (postdoctoral students) focused in this research area; and 6) a webinar series to inform researchers nationally in this topic area.

Current research resources stemming from this funded project can be found here:

• University of Michigan firearm injury prevention open online course
• Institute for Firearm Injury Prevention Data Repository

(*) Indicates literature added from citations of the original bibliography.

Endnotes

¹ https://www.nasponline.org/resources-and-publications/resources-and-podcasts/school-safety-and-crisis/systems-level-prevention/best-practice-considerations-for-armed-assailant-drills-in-schools

² Robin L, Timpe Z, Suarez NA, Li J, Barrios L, Ethier KA. Local education agency impact on school environments to reduce health risk behaviors and experiences among high school students. Journal of Adolescent Health. 2022 Feb 1;70(2):313-21.