Posted: March 11th, 2023
Complete a Trauma-Informed Education Presentation for Educators
Consider the topics for educators and staff in regard trauma in the school system.
Think about and summarize trauma in educational settings,
populations that may experience trauma,
elevated trauma risk,
the impact of trauma,
identify practices that exacerbate and mitigate the effects of trauma in the classroom and the roles of support personnel in educational settings and,
include at least two steps that educators and administrators can take to minimize vicarious or secondary trauma in your presentation.
A Systematic Review on the Impact of Trauma-Informed Education
Programs on Academic and Academic-Related Functioning for Students
Who Have Experienced Childhood Adversity
Sally Roseby1 and Michael Gascoigne1, 2
1 School of Psychological Science, Australian College of Applied Psychology
2 School of Psychology, The University of Sydney
The purpose of this study was to conduct a systematic review of the existing literature regarding
trauma-informed education programs and their impact on academic and academic-related outcomes. The
articles included for review (n � 15) contained data on trauma-informed education programs imple-
mented in preschool, primary/elementary, and high school settings. Academic and academic-related
outcomes reported included attendance, disciplinary referrals, suspension, and academic achievement, as
well as student resilience, school attachment, and emotional presentation. Findings from this systematic
review highlight that trauma-informed education programs can improve students’ academic and
academic-related outcomes; however, results were not consistent across the studies. Moving forward,
recommendations include the need for additional trauma-informed school-based research to be conducted
and dissemination of this research to ensure school systems are upskilled and responding appropriately
to their traumatized students.
Keywords: systemic intervention, adverse childhood experiences, school systems
Adverse childhood experiences (ACEs) are associated with a
range of deleterious individual outcomes, such as compromised
neurodevelopment (Bick & Nelson, 2016; Chugani et al., 2001;
Perry et al., 1995); social, emotional, and behavioral difficulties
(Burke et al., 2011; Davis & Petretic-Jackson, 2000; Hanson et al.,
2015; van der Kolk, 2005); and reduced cognitive and academic
functioning (Australian Childhood Foundation, 2018; Blodgett &
Lanigan, 2018; Downey, 2007; Perfect et al., 2016). The impor-
tance of mitigating the impact of ACEs is further underscored by
their association with several adverse social outcomes, such as
lower rates of educational accomplishment (Blue Knot Founda-
tion, 2015), lower levels of employment (Hardcastle et al., 2018;
Liu et al., 2013), and reduced income and lifetime productivity
(Covey et al., 2013; Currie & Widom, 2010; Zielinski, 2009).
Therefore, determining whether a school-based intervention may
improve academic functioning for those who have experienced
childhood adversity is of clinical and social significance. In par-
ticular, understanding the impact trauma-informed intervention
can have on increasing education participation and academic func-
tioning in students with a history of ACEs is important. Further-
more, with no systematic reviews and/or meta-analyses located in
the peer reviewed literature addressing the impact of trauma-
informed education programs on academic or academic-related
outcomes, this research seeks to address a gap in the empirical
literature. Additionally, it will help inform future clinical work,
including school-based work.
The Prevalence of Childhood Adversity
ACEs are prolonged or cumulative traumatic events that have
both an immediate and lifelong impact (Felitti et al., 1998; van der
Kolk, 2005). They can occur at an individual or familial level and
include child abuse or neglect (i.e., sexual, physical, or verbal
abuse; emotional or physical neglect), family dysfunction, or stress
(i.e., incarcerated household member, domestic violence, divorce
or separation, death of a parent, household substance abuse, and
household member with a mental or physical illness; Felitti et al.,
1998). Moreover, the National Child Traumatic Stress Network
reports that childhood trauma occurs when children experience a
traumatic event (i.e., neglect or abuse), which can be either acute
or chronic, that can overwhelm a child’s ability to cope with the
trauma they have experienced (Iachini et al., 2016).
The prevalence of childhood trauma has been widely re-
searched, with an estimated five million Australian adults im-
pacted (Blue Knot Foundation, 2015). Furthermore, Australian
child protection statistics highlight that approximately 225,000
children were harmed or suspected of being at risk of harm from
abuse and/or neglect during 2015–2016 (Australian Institute of
Family Studies, 2017). With childhood adversity identified as a
common occurrence and child protection figures reportedly in-
creasing (Australian Institute of Family Studies, 2017) our concern
then shifts to considering the impact of intervention on individuals
with a history of ACEs.
Sally Roseby X https://orcid.org/0000-0002-5960-2407
Michael Gascoigne X https://orcid.org/0000-0002-2786-7355
Correspondence concerning this article should be addressed to Michael
Gascoigne, School of Psychological Science, Australian College of Ap-
plied Psychology, Level 11, 255 Elizabeth Street, Sydney, New South
Wales 2000, Australia. Email: michael.gascoigne@acap.edu.au
T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
Ps
yc
ho
lo
gi
ca
l
A
ss
oc
ia
tio
n
or
on
e
of
its
al
lie
d
pu
bl
is
he
rs
.
T
hi
s
ar
tic
le
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.
Traumatology
© 2021 American Psychological Association
1085-9373/21/$12.00 https://doi.org/10.1037/trm0000276
149
2021, Vol. 27, No. 2, 149-167
This article was published Online First January 18, 2021.
https://orcid.org/0000-0002-5960-2407
https://orcid.org/0000-0002-2786-7355
mailto:michael.gascoigne@acap.edu.au
https://doi.org/10.1037/trm0000276
Intervention and Its Impact on Outcomes
Our understanding of intervention as a moderator between
childhood adversity and various outcomes is still developing
(Perfect et al., 2016). To demonstrate, Skowron and Reinemann
(2005) and Weiner et al. (2011) both completed meta-analyses
on the effectiveness of psychological interventions for child
maltreatment. Although both meta-analyses recognized that in-
tervention enhanced functioning, intricacies were noted. Sur-
prisingly, neither meta-analysis included academic functioning
as an outcome variable. Nevertheless, it has been suggested that
mental health treatment can have a positive impact on students’
educational outcomes (Baskin et al., 2010; Becker et al., 2014).
Moreover, when discussing intervention, it is vital to emphasize
the need for unified systems of care and systemic level inter-
vention, that is, trauma-informed school settings (Chafouleas et
al., 2016).
School-Based Intervention
Education offers a significant intervention opportunity for stu-
dents who have experienced childhood adversity (Brunzell et al.,
2016), with schools uniquely situated to support their traumatized
students (Soleimanpour et al., 2017). Additionally, recovery from
trauma is no longer viewed as taking place solely within counsel-
ing settings, with educators supporting this and recognizing they
too can help traumatized children, by providing a nurturing and
safe school environment (Berardi & Morton, 2017). With the
positive impact of school-based trauma-specific interventions on
students’ traumatic stress symptoms already accepted (Rolfsnes &
Idsoe, 2011), the advantages of trauma-informed approaches in
schools is also increasing in acceptance (see Overstreet & Cha-
fouleas, 2016).
Being trauma informed means understanding the impact of
trauma on neurobiology, neurodevelopment, and attachment (Kin-
niburgh et al., 2005). This understanding allows educators to
integrate this knowledge into the fabric of the school community
and provides a perspective to the complex challenges faced daily
by their traumatized students (Morton & Berardi, 2018). Substance
Abuse and Mental Health Services Administration (SAMHSA)
state that,
A program, organization or system that is trauma-informed realizes
the widespread impact of trauma and understands potential paths for
recovery; recognizes the signs and symptoms of trauma in clients,
families, staff, and others involved with the system; and responds by
fully integrating knowledge about trauma into policies, procedures,
and practices, and seeks to actively resist retraumatization. (SAM-
HSA, 2014, p. 9)
Therefore, trauma-informed schools respond to the needs of their
students by integrating effective practices, programs, and proce-
dures into all aspects of the school culture (Overstreet & Chafou-
leas, 2016). These practices, programs, and procedures may in-
clude trauma-informed school leadership, trauma-informed
policies and procedures, professional development for school staff,
adequate financing, and a safe school environment (Kataoka et al.,
2018).
The Current Study
The aim of this systematic review is to summarize the existing
literature regarding the impact of trauma-informed education pro-
grams on academic and academic-related functioning for students
with a history of ACEs. By updating the literature across academic
and academic-related functioning more broadly within a single
systematic review, this will allow for a broad range of directions
for future research to be provided. Furthermore, this research is of
clinical and social importance to understanding the impact of
trauma-informed intervention on academic functioning.
Method
Literature Search
This systematic review process was guided by the Preferred
Reporting Items for Systematic Reviews and Meta-Analysis
(PRISMA; Moher et al., 2009). PRISMA contains an evidence-
based guide for the identification and categorizing of published
articles throughout the literature review process. Consistent with
these guidelines, this systematic review was prospectively regis-
tered on the National Institute for Health Research PROSPERO
International Prospective Register of Systematic Reviews website
(registration number: CRD42018117662). The following research
databases were systematically searched during February and
March, 2019: PubMed, Web of Science, PsycINFO, Education
Resources Information Centre (ERIC), as well as 11 journals that
contain the word “school” (i.e., Journal of School Psychology,
School Psychology Quarterly, School Mental Health, School Psy-
chology Review, Psychology in the Schools, School Psychology
International, Intervention in School and Clinic, Advances in
School Mental Health Promotion, Journal of Applied School Psy-
chology, Canadian Journal of School Psychology, Preventing
School Failure). The databases and journals selected cover a
varied range of education, psychological, medical, and sociologi-
cal research topics. To review some of the gray literature, a search
of dissertations was included within the search of the PsycINFO
database.
The following keywords were used in the search: adverse child-
hood experiences; negative life events; trauma; childhood adver-
sities; posttraumatic stress. Choosing to use broad terminology as
opposed to more narrow definitions (i.e., child sexual abuse,
neglect) guarded against the limitation of not capturing all the
relevant studies as a result of using too narrow definitions of
trauma. Additionally, this allowed for the broader definition as
outlined by the National Child Traumatic Stress Network to be
adopted, that is, childhood trauma occurs when children experi-
ence a traumatic event (e.g., abuse, neglect, or victimization),
which can be either short term (i.e., acute) or long term (i.e.,
chronic), that can overwhelm a child’s ability to cope with a
traumatic experience (Iachini et al., 2016). The following key-
words were then added: intervention; treatment; therapy; counsel-
ing; group; program�; trauma-informed; alternate setting. Finally,
we added keywords regarding the following outcomes: educat�;
achievement; academic; grades; discipline; attendance. The pres-
ence of an asterisk in the keywords indicates that all applicable
terms beginning with that root were used. Due to the large number
of studies being returned and the focus being on school environ-
T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
Ps
yc
ho
lo
gi
ca
l
A
ss
oc
ia
tio
n
or
on
e
of
its
al
lie
d
pu
bl
is
he
rs
.
T
hi
s
ar
tic
le
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.
ROSEBY AND GASCOIGNE150
ments, limiters were put in place. See Table 1 for the relevant
search strategies and limiters used in each database.
Inclusion Criteria
Studies were included in the systematic review if they met the
following inclusion criteria: (a) involved a trauma-informed edu-
cation program being implemented at a whole school level (even if
results were only reported for one segment of the whole school
intervention); (b) targeted participants who have been exposed to
childhood adversity whether directly or indirectly; (c) measured an
academic, that is, grades, attendance, academic achievement, stan-
dardized achievement, discipline (as outlined in Perfect et al.,
2016), or academic-related outcome, that is, resilience, behavior,
school attachment, or student–teacher relationship (as outlined in
Baskin et al., 2010); (d) must be in English. Studies were excluded
from the systematic review if they (a) did not report evidence of
increasing trauma-informed knowledge in school teachers or other
education staff (as outlined in Kataoka et al., 2018) or (b) de-
scribed a multitier system of support that was not explicitly re-
ported as trauma-informed (see Chafouleas et al., 2016, for more
information on trauma-informed multitiered systems of support).
Articles chosen for inclusion or exclusion to this systematic
review are documented according to the PRISMA Statement
(Moher et al., 2009). Figure 1 illustrates the literature search
conducted in the four identified databases, subsequent identi-
fied journals and articles, and the application of the inclusion
and exclusion criteria.
As shown in Figure 1, five articles were unable to be sourced,
despite them appearing in the results of our literature search.
These articles could not be located, despite attempting to locate
or directly approaching the corresponding authors of these
articles.
Data Coding
Studies that met the inclusion criteria for the systematic
review were individually coded by Sally Roseby to assist in
evaluating the research design and fields of interest contained in
each article. Based on the inclusion criteria and rationale of the
current review, each study was coded along the following
methodological and treatment variables and characteristics: (a)
authors; (b) journal; (c) sample size/school size; (d) basic study
type/design; (e) study setting (i.e., mainstream or alternate
school setting); (f) method/s used to gather data (i.e., self-
report, assessment, parent report, teacher report, etc.); (g)
length of time trauma-informed education program was imple-
mented at setting (if applicable); (h) theoretical underpinning of
intervention (i.e., was the trauma-informed education program
based on one particular approach); (i) outcome areas examined
(i.e., academic or academic-related outcome); and (j) overall
findings. We also included specific variables of the participants
(where applicable) and their experienced childhood adversities,
including (a) sex of participants; (b) age mean or age range; (c)
types of trauma experienced (i.e., abuse, neglect, various, acute
Table 1
Search Strategy Used (Including Limiters) for Each Database Search Completed
Database Search string Limiters applied
Pub Med (“adverse childhood experiences” OR “negative life events” OR
trauma OR “childhood adversities” OR “post-traumatic
stress”) AND (intervention OR treatment OR therapy OR
counselling OR counseling OR group OR program OR
programme OR “trauma-informed” or “alternate setting”)
AND (education OR achievement OR academic OR grades
OR discipline OR attendance) AND psychology
And psychology added to search string
Limited to child-birth–18 years
Web of Science (“adverse childhood experiences” OR “negative life events” OR
trauma OR “childhood adversities” OR “post-traumatic
stress”) AND (intervention OR treatment OR therapy OR
counselling OR counseling OR group OR program OR
programme OR “trauma-informed” or “alternate setting”)
AND (educat� OR achievement OR academic OR grades OR
discipline OR attendance) AND (infant OR child OR
adolesce� OR minors OR pediatric OR pediatric)
PsycINFO (included dissertations
search)
(“adverse childhood experiences” OR “negative life events” OR
trauma OR “childhood adversities” OR “post-traumatic
stress”) AND (intervention OR treatment OR therapy OR
counselling OR counseling OR group OR program OR
programme OR “trauma-informed” or “alternate setting”)
AND (educat� OR achievement OR academic OR grades OR
discipline OR attendance)
Narrowed by subject age, including
preschool age (2–5 years), school
age (6–12 years), adolescence (13–
17 years), and childhood (birth–12
years)
ERIC (“adverse childhood experiences” OR “negative life events” OR
trauma OR “childhood adversities” OR “post-traumatic
stress”) AND (intervention OR treatment OR therapy OR
counselling OR counseling OR group OR program OR
programme OR “trauma-informed” or “alternate setting”)
AND (educat� OR achievement OR academic OR grades OR
discipline OR attendance)
No limiters applied
Note. ERIC � Education Resources Information Centre.
T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
Ps
yc
ho
lo
gi
ca
l
A
ss
oc
ia
tio
n
or
on
e
of
its
al
lie
d
pu
bl
is
he
rs
.
T
hi
s
ar
tic
le
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.
CHILDHOOD ADVERSITY AND ACADEMIC FUNCTIONING 151
or chronic). Lastly, specific consequences associated with the
experienced trauma were also included, that is, depression or
traumatic stress symptoms (if applicable).
Results
A total of 15 articles were identified that examined trauma-
informed education programs and their impact on academic or
academic-related outcomes. These articles were conducted in a
variety of educational settings including preschools, primary/
elementary schools, and high schools. They included a diverse
range of trauma-informed education programs as well as vari-
ous academic or academic-related outcomes. These are dis-
cussed below, with the trauma-informed theories and models
discussed and the articles organized into intervention settings,
that is, preschool, primary/elementary, or high school.
Interventions Used Across the Studies
Among the 15 articles reviewed, there were several trauma-
informed theories and models employed to support with up-
skilling educators and implementing trauma-informed systems.
See Table 2 for a summary of the trauma-informed theories and
models employed across the 15 articles reviewed. To highlight
the diversity, eight different trauma-informed theories and mod-
els were identified in this systematic review; however, there
was some overlap, with several studies drawing from the same
model of implementation. To illustrate, four studies (Dorado et
al., 2016; Holmes et al., 2015; Mitchell, 2016; Pfenninger Saint
Giles, 2016) used the attachment, self-regulation and compe-
tency model (Blaustein & Kinniburgh, 2010) to inform their
trauma-informed approach, with four additional studies (Baroni
et al., 2016; Crosby et al., 2017, 2018; Day et al., 2015) using
Figure 1
Flowchart of the Literature Search and Documentation of the Screening, Inclu-
sion, and Exclusion Processes
3282 ar�cles
iden�fied in the Pub
Med database
2648 ar�cles
iden�fied in the Web
of Science database
2503 ar�cles
iden�fied in the
PsycINFO database
339 ar�cles
iden�fied in the ERIC
database
7921 ar�cles, a�er 851 duplicates iden�fied
7921 �tles and abstracts screened
135 full text ar�cles were reviewed
10 papers were selected for the
systema�c review
15 papers were selected for the
systema�c review
0 addi�onal papers were
included a�er searching
specific journals with the
word ‘school’
4 addi�onal papers were
included a�er screening
reference lists of
iden�fied ar�cles and
other relevant ar�cles
120 were excluded on the
basis of the inclusion and
exclusion criteria, with 5
unable to be located
1 addi�onal paper
included due to authors
knowledge
T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
Ps
yc
ho
lo
gi
ca
l
A
ss
oc
ia
tio
n
or
on
e
of
its
al
lie
d
pu
bl
is
he
rs
.
T
hi
s
ar
tic
le
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.
ROSEBY AND GASCOIGNE152
Table 2
Description of Trauma-Informed Theories and Models
Intervention Description of intervention Articles that used intervention
Attachment, self-regulation and
competency (ARC) model
(Blaustein & Kinniburgh,
2010)
The ARC model is a guideline for working with traumatized
children in the community
Dorado et al., 2016; Holmes et al., 2015;
Mitchell, 2016; Pfenninger Saint
Giles, 2016The ARC model addresses trauma in three main areas: (a)
attachment (e.g., building adult affect management and
attunement skills as well as building routines and rituals),
(b) self-regulation (e.g., developing appropriate emotion
identification, modulation, and expression skills in
individuals impacted by trauma), (c) competency (e.g.,
developing executive functioning skills as well as self-
development and identity in individuals impacted by
trauma).
Berry St education model
(BSEM; Brunzell et al.,
2016)
BSEM draws on neuro-scientific findings and outlines
domains and themes for teachers to work through
sequentially with their students.
Stokes & Turnbull, 2016
The BSEM comprises five domains: body, stamina,
engagement and character, all anchored by relationships.
Within each of these domains there are themes and
specific teaching strategies and recommendations
provided, e.g., the domain of body includes themes,
specific teaching strategies, and recommendations for “de-
escalation,” “present, centered, grounded,” “mindfulness,”
and “self-regulation.”
Multitiered system of supports Multitiered systems of support offer three tiers of services to
students, staff and the wider system; these include
universal strategies, targeted strategies and intensive
strategies. These supports are further scaffolded with
work-force development trainings.
Dorado et al., 2016; Hatchett et al.,
2017; Judge, 2018; Shamblin et al.,
2016
Intervention components for trauma-informed multitiered
systems of support can include universal consultations
with teachers on a weekly basis, universal classroom
training for students on coping with stress, targeted
resiliency and trauma curriculum (i.e. REACH program),
intensive crisis support for trauma-impacted school staff.
Work-force development trainings for trauma-informed
multitiered systems of support can include the child
trauma academy’s neuro-sequential model of therapeutics
(Perry & Hambrick, 2008) and trauma-focused cognitive
behavior therapy (Cohen et al., 2006) or more
individualized training packages that focus on the
neurobiological and physiological impact of complex
trauma on students.
PACE Centre for Girls PACE Centre for Girls is a nonprofit organization that
serves girls of middle and high school age. They use a
“gender-responsive” framework for its academic services.
“Gender-responsive” treatment approaches are designed
for girls, specifically those involved with or at risk of
involvement with the juvenile justice system. PACE’s
program model promotes safety and positive relationships
and uses strengths-based and trauma-informed approaches.
PACE also rolled out in-person staff training on its key
pillars as a gender-responsive, strengths-based, and
trauma-informed program.
Millenky et al., 2019
Risking connection (Saakvitne
et al., 2000)
Risking connection is a staff training curriculum for working
specifically with survivors of childhood abuse, with an
emphasis on “collaboration” with the client as opposed to
“control” of the client’s dangerous behaviors. The main
components of the Risking Connection curriculum are (a)
an understanding of trauma, (b) importance of the
relationship between client and “treater,” (c) safety,
including maintaining physical and emotional safety while
establishing healthy boundaries, (d) transforming vicarious
trauma experienced by the treater.
Gonshak, 2011
(table continues)
T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
Ps
yc
ho
lo
gi
ca
l
A
ss
oc
ia
tio
n
or
on
e
of
its
al
lie
d
pu
bl
is
he
rs
.
T
hi
s
ar
tic
le
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.
CHILDHOOD ADVERSITY AND ACADEMIC FUNCTIONING 153
a modified version of the heart of teaching and learning: com-
passion, resiliency and academic success program (Wolpow et
al., 2009) as well as the monarch and dream catcher rooms.
Preschool
Three articles were identified that examined trauma-informed
education programs and their impact on academic-related out-
comes in preschool settings, with these summarized in Table 3.
Preschool environments promote emotional regulation and assist
children to control their behavioral impulses, essential skills that
help promote (or conversely interfere) with later learning (Sham-
blin et al., 2016). As a result, a greater emphasis is placed on
academic-related outcomes in the literature regarding preschool
settings, as opposed to other direct academic outcomes, such as
attendance or grades. All identified articles reported significant
impacts on some (not all) academic-related outcomes based on
exposure to the trauma-informed education program (Holmes et
al., 2015; Pfenninger Sant Giles, 2016; Shamblin et al., 2016).
Improvements were noted in all studies, despite differences in
implementation, domains assessed, and study design. Shamblin et
Table 2 (continued)
Intervention Description of intervention Articles that used intervention
School-based collaboration School-based collaboration provides evidence based, trauma-
informed models of interventions that support children,
teachers, and the school community.
Mitchell, 2016
The school-based collaboration on-site teams provide
individual and group therapy services for students,
consultation, and staff support regarding critical-incident
response, as well as services to the wider school
community. On-site staff also provide ongoing
psychoeducation and parent–teacher consultation as well
as facilitating positive discipline practices and trauma-
informed school and classroom procedures.
The heart of teaching and
learning: compassion,
resiliency and academic
success program (Wolpow et
al., 2009) as well as the
monarch and dream catcher
rooms
The heart of teaching and learning: compassion, resiliency
and academic success is an integrated, manualized
curriculum based on attachment and ecological theories
applied using psychoeducational, cognitive–behavioral and
relational approaches (Day et al., 2015). Six modules
were presented, including (a) background and definitions
of trauma, (b) compassionate schools and survival, (c)
self-care, (d) curriculum domains and specific strategies,
(e) collaborative problem solving, (f) role plays, games,
and case vignettes (Day et al., 2015). A modified version
was used that also presented diversity-related issues
including gender and racial identity, therapy training, and
additional emphasis on developing healthy relationships
between students and school staff (Day et al., 2015).
Baroni et al., 2016; Crosby et al., 2017,
2018; Day et al., 2015
The monarch room is an alternative to traditional school
exclusionary policies. When students become
dysregulated, they can self-refer or be referred by school
staff to the monarch room. The monarch room is
managed by staff trained in counseling, trauma, and
sensory-integration interventions. Once in the monarch
room, students are provided with coregulation and
strategies to assist them in de-escalating and regulating
their emotions, to ultimately return back to the classroom.
monarch room use is usually restricted to 10 minutes. If
students need more than 10 minutes, they are referred to
the dream catcher room.
The dream catcher room is an expansion of the monarch
room and provides students with additional time and
assistance to de-escalate and regulate their emotions.
Students can remain in the dream catcher room for the
whole school day if necessary (Day et al., 2015).
Individualized model Perry and Daniels (2016) developed an individualized model
and framework for the delivery of their trauma-informed
education program. Staff training used a combination of
online trauma-specific websites and published articles
(e.g., NCTSN.org; Australian Childhood Foundation,
2018), with classroom workshops on the impact of stress
on behavior informed by student feedback. Cognitive
behavioral intervention for trauma in the schools program
(Jaycox et al., 2018), a manualized 10-week small group
intervention, was also used.
Perry & Daniels, 2016
T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
Ps
yc
ho
lo
gi
ca
l
A
ss
oc
ia
tio
n
or
on
e
of
its
al
lie
d
pu
bl
is
he
rs
.
T
hi
s
ar
tic
le
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.
ROSEBY AND GASCOIGNE154
T
ab
le
3
T
ra
um
a-
In
fo
rm
ed
E
du
ca
ti
on
P
ro
gr
am
s
D
el
iv
er
ed
W
it
hi
n
P
re
sc
ho
ol
Se
tt
in
gs
C
ita
tio
n
Se
tti
ng
Pa
rt
ic
ip
an
ts
(n
)
M
et
ho
ds
us
ed
to
ga
th
er
in
fo
rm
at
io
n
L
en
gt
h
of
in
te
rv
en
tio
n
In
te
rv
en
tio
ns
us
ed
D
om
ai
ns
as
se
ss
ed
(o
ut
co
m
es
)
Su
m
m
ar
y
of
re
su
lts
Sh
am
bl
in
et
al
.
(2
01
6)
Pr
es
ch
oo
l
(s
pl
it
in
to
w
ho
lly
fu
nd
ed
an
d
co
ns
ul
ta
tio
n
by
re
qu
es
t
pr
es
ch
oo
ls
)
Fu
nd
ed
pr
es
ch
oo
ls
n
�
21
7
(o
ve
r
11
cl
as
sr
oo
m
s)
C
on
su
lta
tio
n
by
re
qu
es
t
pr
es
ch
oo
ls
Sa
m
pl
e
n
�
55
0
(o
ve
r
28
cl
as
sr
oo
m
s)
Q
ua
nt
ita
tiv
e
te
ac
he
r
re
po
rt
s
on
co
nf
id
en
ce
an
d
co
m
pe
te
nc
e,
pa
rt
ic
ip
at
in
g
ch
ild
re
n’
s
so
ci
al
,
em
ot
io
na
l
an
d
be
ha
vi
or
al
fu
nc
tio
ni
ng
(u
si
ng
th
e
D
ev
er
eu
x
E
ar
ly
C
hi
ld
ho
od
A
ss
es
sm
en
t)
,
sa
tis
fa
ct
io
n
su
rv
ey
re
ga
rd
in
g
co
ns
ul
ta
tio
n
se
rv
ic
es
,
cl
in
ic
ia
n
re
po
rt
s
on
qu
al
ity
of
th
e
pr
es
ch
oo
l
en
vi
ro
nm
en
t
12
m
on
th
s
(a
ll
sc
ho
ol
s
w
or
ke
d
th
ro
ug
h
a
st
ar
t-
up
ye
ar
,
i.e
.,
so
m
e
ha
d
th
e
pr
og
ra
m
fo
r
2
ye
ar
s
w
hi
le
ot
he
rs
ha
d
it
fo
r
1
ye
ar
pr
io
r
to
da
ta
co
lle
ct
io
n)
T
ra
um
a-
in
fo
rm
ed
tr
ai
ni
ng
fo
r
st
af
f
(f
un
de
d
sc
ho
ol
s
on
ly
),
tr
au
m
a-
in
fo
rm
ed
m
ul
tit
ie
re
d
sy
st
em
s
of
su
pp
or
ts
in
cl
ud
in
g
un
iv
er
sa
l,
ta
rg
et
ed
an
d
in
te
ns
iv
e
se
rv
ic
es
fo
r
ch
ild
re
n
an
d
fa
m
ili
es
(f
un
de
d
sc
ho
ol
s
on
ly
)
Fu
nc
tio
na
l
as
se
ss
m
en
t
of
ch
ild
re
n
(s
oc
ia
l,
em
ot
io
na
l,
an
d
be
ha
vi
or
al
fu
nc
tio
ni
ng
to
in
di
ca
te
re
si
lie
nc
e)
,
as
w
el
l
as
te
ac
he
r
co
nf
id
en
ce
an
d
co
m
pe
te
nc
e
to
su
pp
or
t
so
ci
al
–
em
ot
io
na
l
de
ve
lo
pm
en
t,
qu
al
ity
of
th
e
pr
es
ch
oo
l
en
vi
ro
nm
en
t
an
d
te
ac
he
r
sa
tis
fa
ct
io
n
w
ith
co
ns
ul
ta
nt
D
at
a
co
lle
ct
ed
de
m
on
st
ra
te
d
a
po
si
tiv
e
im
pa
ct
on
ch
ild
re
si
lie
nc
e.
Po
si
tiv
e
im
pa
ct
s
w
er
e
al
so
re
po
rt
ed
on
te
ac
he
r
co
m
pe
te
nc
e
an
d
co
nf
id
en
ce
,
te
ac
he
r
ap
pr
ec
ia
tio
n
of
se
rv
ic
es
pr
ov
id
ed
,
te
ac
he
r
sk
ill
s
an
d
st
re
ss
re
du
ct
io
n
in
th
e
cl
as
sr
oo
m
.
Fu
nd
ed
pr
es
ch
oo
ls
ou
tp
er
fo
rm
ed
co
ns
ul
ta
tio
n
by
re
qu
es
t
se
rv
ic
es
,
w
ith
le
ng
th
of
in
te
rv
en
tio
n
al
so
im
pa
ct
in
g
re
su
lts
,
i.e
.,
fu
nd
ed
pr
es
ch
oo
ls
w
ith
lo
ng
er
im
pl
em
en
ta
tio
n
pe
ri
od
s
re
po
rt
ed
be
tte
r
re
su
lts
.
H
ol
m
es
et
al
.
(2
01
5)
H
ea
d
St
ar
t
pr
og
ra
m
s
(p
re
sc
ho
ol
ch
ild
re
n
ag
ed
3–
5)
.
n
�
15
0
(r
ec
ip
ie
nt
s
of
in
te
ns
iv
e
se
rv
ic
es
);
1,
10
0
to
ta
l
en
ro
lle
d
in
sc
ho
ol
s
(a
cr
os
s
m
ul
tip
le
si
te
s)
Q
ua
nt
ita
tiv
e
(p
ar
en
t/c
ar
eg
iv
er
re
po
rt
on
tr
au
m
at
ic
hi
st
or
y
of
ch
ild
,
pa
re
nt
/c
ar
eg
iv
er
re
po
rt
on
ch
ild
be
ha
vi
or
vi
a
C
hi
ld
B
eh
av
io
r
C
he
ck
lis
t,
te
ac
he
r
re
po
rt
on
ch
ild
be
ha
vi
or
vi
a
T
ea
ch
er
R
ep
or
t
Fo
rm
an
d
cl
in
ic
ia
n
re
po
rt
s
on
qu
al
ity
of
re
la
tio
ns
hi
ps
in
th
e
pr
es
ch
oo
l
en
vi
ro
nm
en
t
vi
a
th
e
C
la
ss
ro
om
A
ss
es
sm
en
t
Sc
or
in
g
Sy
st
em
)
20
11
–2
01
2
ac
ad
em
ic
sc
ho
ol
ye
ar
H
ea
d
St
ar
t
T
ra
um
a
Sm
ar
t
tr
ai
ni
ng
(b
as
ed
on
th
e
at
ta
ch
m
en
t,
se
lf
–
re
gu
la
tio
n
an
d
co
m
pe
te
nc
y
m
od
el
),
as
w
el
l
as
co
ns
ul
ta
tio
n
an
d
ps
yc
ho
ed
uc
at
io
na
l
su
pp
or
t
fo
r
st
af
f
an
d
in
te
ns
iv
e
in
di
vi
du
al
tr
au
m
a-
fo
cu
se
d
in
te
rv
en
tio
n
fo
r
st
ud
en
ts
C
hi
ld
be
ha
vi
or
an
d
qu
al
ity
of
re
la
tio
ns
hi
ps
in
th
e
cl
as
sr
oo
m
en
vi
ro
nm
en
t
D
at
a
co
lle
ct
ed
de
m
on
st
ra
te
d
po
si
tiv
e
ch
an
ge
s
in
at
te
nt
io
n,
ex
te
rn
al
iz
in
g
pr
ob
le
m
s,
at
te
nt
io
n
de
fi
ci
t/
hy
pe
ra
ct
iv
ity
pr
ob
le
m
s,
op
po
si
tio
na
l
de
fi
an
t
pr
ob
le
m
s
an
d
in
te
rn
al
iz
in
g
pr
ob
le
m
s
fo
r
ch
ild
re
n
w
ho
re
ce
iv
ed
in
te
ns
iv
e
se
rv
ic
es
.
W
hi
le
tu
rn
ov
er
is
su
es
w
er
e
re
po
rt
ed
,
th
e
ov
er
al
l
tr
en
d
re
ga
rd
in
g
th
e
qu
al
ity
of
re
la
tio
ns
hi
ps
in
th
e
cl
as
sr
oo
m
w
as
“m
ov
in
g
in
th
e
de
si
re
d
di
re
ct
io
n”
(H
ol
m
es
et
al
.,
p.
8)
.
(t
ab
le
co
nt
in
ue
s)
T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
Ps
yc
ho
lo
gi
ca
l
A
ss
oc
ia
tio
n
or
on
e
of
its
al
lie
d
pu
bl
is
he
rs
.
T
hi
s
ar
tic
le
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.
CHILDHOOD ADVERSITY AND ACADEMIC FUNCTIONING 155
T
ab
le
3
(c
on
ti
nu
ed
)
C
ita
tio
n
Se
tti
ng
Pa
rt
ic
ip
an
ts
(n
)
M
et
ho
ds
us
ed
to
ga
th
er
in
fo
rm
at
io
n
L
en
gt
h
of
in
te
rv
en
tio
n
In
te
rv
en
tio
ns
us
ed
D
om
ai
ns
as
se
ss
ed
(o
ut
co
m
es
)
Su
m
m
ar
y
of
re
su
lts
Pf
en
ni
n-
ge
r
Sa
in
t
G
ile
s
(2
01
6)
H
ea
d
St
ar
t
pr
es
ch
oo
l
(c
hi
ld
re
n
ag
es
3–
4)
n
�
10
6
(S
pl
it
in
to
a
tr
au
m
a
an
d
no
tr
au
m
a
co
nd
iti
on
ba
se
d
on
A
C
E
sc
or
es
)
Q
ua
lit
at
iv
e
(m
en
ta
l
he
al
th
an
d
ad
m
in
is
tr
at
iv
e
st
af
f
se
lf
-r
ep
or
t
on
T
ra
um
a-
In
fo
rm
ed
A
ge
nc
y
A
ss
es
sm
en
t,
di
re
ct
ob
se
rv
at
io
ns
of
te
ac
he
r
pr
ac
tic
es
,
te
ac
he
r
se
lf
–
re
po
rt
on
sa
tis
fa
ct
io
n
w
ith
im
pl
em
en
ta
tio
n
of
pr
og
ra
m
)
Q
ua
nt
ita
tiv
e
(q
ua
lit
y
of
re
la
tio
ns
hi
ps
in
th
e
pr
es
ch
oo
l
en
vi
ro
nm
en
t,
te
ac
he
r
an
d
ca
re
gi
ve
r
ra
tin
gs
of
ch
ild
be
ha
vi
or
an
d
tr
au
m
a
ex
po
su
re
,
te
ac
he
r
se
lf
-r
ep
or
t
of
se
co
nd
ar
y
tr
au
m
a)
4
m
on
th
s
pr
et
es
t
to
po
st
te
st
(2
01
4
sc
ho
ol
ye
ar
)
T
ea
ch
er
an
d
te
ac
he
r
as
si
st
an
ts
pa
rt
ic
ip
at
ed
in
tw
o,
ha
lf
-d
ay
tr
ai
ni
ng
s
ov
er
th
e
pe
ri
od
of
6
w
ee
ks
re
ga
rd
in
g
tr
au
m
a-
in
fo
rm
ed
pr
ac
tic
e
(b
as
ed
on
th
e
at
ta
ch
m
en
t,
se
lf
–
re
gu
la
tio
n
an
d
co
m
pe
te
nc
y
m
od
el
).
T
hi
s
w
as
co
m
pa
re
d
w
ith
an
in
te
rv
en
tio
n
as
us
ua
l
pr
og
ra
m
(A
l’
s
Pa
ls
).
So
ci
al
an
d
em
ot
io
na
l
ou
tc
om
es
fo
r
H
ea
d
St
ar
t
st
ud
en
ts
w
ho
ex
pe
ri
en
ce
d
tr
au
m
a
an
d
th
ei
r
pe
er
s
w
ho
ha
ve
no
t.
H
ea
d
St
ar
t
ag
en
cy
at
tit
ud
es
,
te
ac
he
r
pr
ac
tic
es
,
an
d
cl
as
sr
oo
m
cl
im
at
e
w
er
e
al
so
in
ve
st
ig
at
ed
.
In
fo
rm
at
io
n
an
d
da
ta
co
lle
ct
ed
di
d
no
t
de
m
on
st
ra
te
si
gn
if
ic
an
t
di
ff
er
en
ce
s
in
ex
te
rn
al
iz
in
g,
at
te
nt
io
n
de
fi
ci
t
hy
pe
ra
ct
iv
ity
di
so
rd
er
,
an
d
pr
ot
ec
tiv
e
fa
ct
or
s
be
tw
ee
n
th
e
tw
o
gr
ou
ps
;
ho
w
ev
er
,
si
gn
if
ic
an
t
di
ff
er
en
ce
s
be
tw
ee
n
ch
ild
re
n
in
th
e
tw
o
gr
ou
ps
on
th
e
co
m
bi
na
tio
n
of
st
ud
en
t’
s
pr
ot
ec
tiv
e
fa
ct
or
s,
be
ha
vi
or
al
co
nc
er
ns
,
an
d
in
te
rn
al
iz
in
g
an
d
ex
te
rn
al
iz
in
g
be
ha
vi
or
s
w
er
e
fo
un
d.
T
he
se
ef
fe
ct
s
w
er
e
ev
id
en
t
fo
r
al
l
ch
ild
re
n,
ir
re
sp
ec
tiv
e
of
tr
au
m
a
hi
st
or
y.
Im
po
rt
an
tly
,
ch
ild
re
n
w
ith
tr
au
m
a
hi
st
or
ie
s
an
d
in
th
e
in
te
rv
en
tio
n
gr
ou
p
sh
ow
ed
fe
w
er
co
nc
er
ns
re
ga
rd
in
g
in
te
rn
al
iz
in
g
be
ha
vi
or
s
po
st
in
te
rv
en
tio
n.
N
ot
e.
A
C
E
�
ad
ve
rs
e
ch
ild
ho
od
ex
pe
ri
en
ce
.A
l’
s
Pa
ls
is
a
cl
as
sr
oo
m
cu
rr
ic
ul
um
an
d
te
ac
he
r
tr
ai
ni
ng
pr
og
ra
m
th
at
te
ac
he
s
so
ci
al
em
ot
io
na
ls
ki
lls
in
ch
ild
re
n
ag
ed
3–
8
ye
ar
s.
H
ea
d
St
ar
tT
ra
um
a
Sm
ar
t
tr
ai
ni
ng
is
a
tr
ai
ni
ng
pr
og
ra
m
de
ve
lo
pe
d
fo
r
H
ea
d
St
ar
te
ar
ly
le
ar
ni
ng
ce
nt
er
s,
us
in
g
ex
is
tin
g
ev
id
en
ce
-i
nf
or
m
ed
m
od
al
iti
es
an
d
m
ak
in
g
m
od
if
ic
at
io
ns
as
ne
ed
ed
to
cr
ea
te
a
un
iq
ue
ap
pr
oa
ch
to
w
or
ki
ng
w
ith
ch
ild
re
n
ag
ed
3–
5
an
d
th
ei
r
fa
m
ili
es
.
T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
Ps
yc
ho
lo
gi
ca
l
A
ss
oc
ia
tio
n
or
on
e
of
its
al
lie
d
pu
bl
is
he
rs
.
T
hi
s
ar
tic
le
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.
ROSEBY AND GASCOIGNE156
al. (2016) found that embedded trauma-informed education pro-
grams were more effective than consultation by request services
for improving relational resilience and classroom behavior of
students. Interestingly, teachers working within these embedded
programs also reported increased competence and confidence in
managing classroom behaviors and also demonstrated a reduction
in the use of negative behavior management strategies (Shamblin
et al., 2016). Holmes et al. (2015) reviewed the impact of Head
Start Trauma Smart training and intensive services on child out-
comes for children referred to the program whom may have also
experienced chronic trauma, with improvements in attention, ex-
ternalizing, and internalizing problems reported. Lastly, for chil-
dren with a trauma history who received a trauma intervention
(i.e., their teachers had undergone trauma training), improvements
regarding internalizing behaviors post intervention were reported;
however, no differences were found regarding attention, external-
izing behavior, or protective factors (Pfenninger Saint Giles,
2016).
Primary/Elementary School
Five articles were identified that examined trauma-informed
education programs and their impact on academic or academic-
related outcomes in a primary/elementary school setting. Where
articles included participants across settings, that is, from Kinder-
garten to Year 8, articles were categorized based on the majority of
participants included. Three articles reviewed the impact of em-
bedded trauma-informed education interventions (Dorado et al.,
2016; Perry & Daniels, 2016; Stokes & Turnbull, 2016), with an
additional two articles reviewing the impact of targeted support,
that is, use of targeted funding for students identified as home-
less (Hatchett et al., 2017) and targeted psychotherapeutic ser-
vices within a wider trauma-informed education setting (Mitch-
ell, 2016). Four out of the five identified articles reported
improvements on some (but not all) academic or academic-
related outcomes. Details related to all five articles are summa-
rized in Table 4.
Positive results were reported for student well-being, achieve-
ment, behavior, and engagement as a result of a trauma-informed
positive education program, with positive changes on the devel-
opment of relationships and self-awareness also reported (Stokes
& Turnbull, 2016). Although findings were not consistent across
settings (possibly due to implementation differences), positive
impacts were reported on student’s literacy and numeracy achieve-
ment, with decreases in suspension rates also reported (Stokes &
Turnbull, 2016). For students who received targeted intervention
within a wider trauma-informed program, positive changes were
reported regarding their school attendance, their ability to learn,
their time spent in the classroom, their time on task in the class-
room, and reduced disciplinary incidents (e.g., physical aggression
and school suspensions; Dorado et al., 2016).
Perry and Daniels (2016) reviewed the impact of trauma-
informed practices (universal and targeted) on students’ acquisi-
tion of coping skills and posttraumatic stress disorder (PTSD)
symptomology (as a result of the established link between healthy
socioemotional development and academic success; SAMHSA,
2014, as cited in Perry & Daniels, 2016). Students who attended
universal classroom workshops reported having a better under-
standing of how to relax, trust others, and worry less (Perry &
Daniels, 2016). Furthermore, students who received targeted in-
tervention experienced a reduction in meeting criteria for PTSD;
however, many students still met symptom criteria for at least one
of the reaction indices (i.e., reexperiencing, avoidance, or in-
creased arousal; Perry & Daniels, 2016).
Hatchett et al. (2017) reviewed the impact of targeted funding,
including trauma-informed services implemented as a result of this
funding, on the academic outcomes of homeless students in a
school district. Despite the additional targeted funding and trauma-
informed support for students identified as homeless, no positive
impact was found on attendance, achievement, or behavior be-
tween students identified as homeless and controls (Hatchett et al.,
2017). Regarding student social and emotional needs, it was hy-
pothesized that existing universal supports may have already been
effective in meeting the needs of students identified as homeless
(Hatchett et al., 2017). Lastly, Mitchell (2016) reviewed the impact
of targeted psychotherapeutic services (offered within a wider
trauma-informed education program) on the academic and school
needs, emotional and behavioral needs, cultural factors, and health
and basic needs of students. Although therapeutic services were
shown to not positively impact student’s academic, cultural fac-
tors, health, or basic needs, improvements were noted for students
social and emotional needs (Mitchell, 2016).
High School
Seven studies were identified that examined trauma-informed
education programs and their impact on academic or academic-
related outcomes in a high school setting (see Table 5). Four of
these studies appear to have been conducted in the same educa-
tional setting, with one of these studies (Baroni et al., 2016)
conducted during the same academic years as the three other
studies (Crosby et al., 2017, 2018; Day et al., 2015). Six articles
reviewed the impact of embedded trauma-informed education in-
terventions (Baroni et al., 2016; Crosby et al., 2017, 2018; Day et
al., 2015; Gonshak, 2011; Millenky et al., 2019), with an addi-
tional article reviewing the impact of a targeted tier of a trauma-
informed multitier system of supports (Judge, 2018). One located
article did not find positive impacts on either academic or
academic-related outcomes as a result of the trauma-informed
education program (Gonshak, 2011). Nonetheless, a majority of
identified articles reported positive impacts on some (not all)
academic or academic-related outcomes based on exposure to the
trauma-informed education program.
Crosby et al. (2018) found that students (and teachers) used a
trauma-informed disciplinary alternative (the monarch room) to
effectively manage student emotion dysregulation, with most users
of the monarch room successfully returning to class after their
visit, instead of escalating to the point of suspension. Furthermore,
Baroni et al. (2016) found an association between the implemen-
tation of the monarch room (combined with an upskilling of
education staff via a trauma-informed training program) and a
reduction in the use of suspension as a method of school discipline.
Day et al. (2015) also reported positive impacts as a result of the
implementation of the monarch room (combined with an upskill-
ing of education staff via a trauma-informed training program)
with a decrease in student PTSD symptoms reported. However, no
difference in student needs, self-esteem, and perceptions of the
T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
Ps
yc
ho
lo
gi
ca
l
A
ss
oc
ia
tio
n
or
on
e
of
its
al
lie
d
pu
bl
is
he
rs
.
T
hi
s
ar
tic
le
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.
CHILDHOOD ADVERSITY AND ACADEMIC FUNCTIONING 157
T
ab
le
4
T
ra
um
a-
In
fo
rm
ed
E
du
ca
ti
on
P
ro
gr
am
s
D
el
iv
er
ed
W
it
hi
n
P
ri
m
ar
y/
E
le
m
en
ta
ry
Sc
ho
ol
Se
tt
in
gs
C
ita
tio
n
Se
tti
ng
Pa
rt
ic
ip
an
ts
(n
)
M
et
ho
ds
us
ed
to
ga
th
er
in
fo
rm
at
io
n
L
en
gt
h
of
in
te
rv
en
tio
n
In
te
rv
en
tio
ns
us
ed
D
om
ai
ns
as
se
ss
ed
(o
ut
co
m
es
)
Su
m
m
ar
y
of
re
su
lts
St
ok
es
an
d
T
ur
nb
ul
l
(2
01
6)
Pr
ep
(P
)–
Y
r
6
P–
Y
r
12
(Y
r
5–
8
an
d
fl
ex
ib
le
le
ar
ni
ng
su
pp
or
t
st
ud
en
ts
in
cl
ud
ed
in
sa
m
pl
e)
M
t
E
xc
el
n
�
15
0
(e
nt
ir
e
sc
ho
ol
po
pu
la
tio
n)
L
at
im
er
V
al
le
y
n
�
13
5;
1,
90
0
st
ud
en
ts
en
ro
lle
d
ac
ro
ss
th
e
sc
ho
ol
Q
ua
lit
at
iv
e
(s
tu
de
nt
s,
te
ac
he
rs
an
d
sc
ho
ol
le
ad
er
sh
ip
fo
cu
s
gr
ou
ps
)
Q
ua
nt
ita
tiv
e
(s
tu
de
nt
w
el
lb
ei
ng
da
ta
dr
aw
n
fr
om
a
m
od
if
ie
d
ve
rs
io
n
of
th
e
St
ud
en
t
A
tti
tu
de
to
Sc
ho
ol
Su
rv
ey
,
A
us
V
E
L
S
da
ta
[D
ec
em
be
r
20
14
an
d
D
ec
em
be
r
20
15
]
an
d
sc
ho
ol
su
sp
en
si
on
da
ta
[2
01
4–
20
15
])
12
-m
on
th
tr
ia
l
at
bo
th
ed
uc
at
io
na
l
se
tti
ng
s
(d
ur
in
g
20
15
)
T
he
be
rr
y
St
ed
uc
at
io
n
m
od
el
(a
tr
au
m
a-
in
fo
rm
ed
po
si
tiv
e
ed
uc
at
io
n
pr
og
ra
m
)
w
as
pr
es
en
te
d
to
st
af
f
th
ro
ug
h
w
or
ks
ho
ps
,
se
m
in
ar
s,
an
d
tr
ai
ni
ng
se
ss
io
ns
.
St
ud
en
t
ac
hi
ev
em
en
t
(i
nc
lu
di
ng
A
us
V
E
L
S
re
ad
in
g,
w
ri
tin
g
an
d
nu
m
be
r
da
ta
),
st
ud
en
t
en
ga
ge
m
en
t
(i
nc
lu
di
ng
st
ud
en
t
be
ha
vi
or
),
an
d
te
ac
he
r–
st
ud
en
t
re
la
tio
ns
hi
ps
(i
nc
lu
di
ng
te
ac
he
r
em
pa
th
y)
In
fo
rm
at
io
n
an
d
da
ta
fr
om
bo
th
sc
ho
ol
s
af
fi
rm
ed
th
e
po
si
tiv
e
im
pa
ct
of
B
er
ry
St
E
du
ca
tio
n
M
od
el
on
st
ud
en
t
w
el
l-
be
in
g,
ac
hi
ev
em
en
t,
be
ha
vi
or
,
an
d
en
ga
ge
m
en
t.
H
ow
ev
er
,
di
ff
er
en
ce
s
in
th
e
de
gr
ee
of
po
si
tiv
e
im
pa
ct
w
er
e
no
te
d,
w
ith
th
is
pr
im
ar
ily
re
la
te
d
to
th
e
m
od
e
of
de
liv
er
y
at
ea
ch
se
tti
ng
.
D
or
ad
o
et
al
.
(2
01
6)
K
in
de
r-
ga
rt
en
(K
)–
fi
ft
h
gr
ad
e
K
–f
if
th
gr
ad
e
K
–e
ig
ht
h
gr
ad
e
K
–f
if
th
gr
ad
e
Sc
ho
ol
A
n
�
29
1
Sc
ho
ol
B
n
�
25
3
Sc
ho
ol
C
n
�
41
7
Sc
ho
ol
D
n
�
28
2
Q
ua
nt
ita
tiv
e
(s
ta
ff
re
po
rt
of
pr
og
ra
m
ev
al
ua
tio
n,
di
sc
ip
lin
ar
y
re
fe
rr
al
an
d
su
sp
en
si
on
da
ta
[f
or
sc
ho
ol
A
on
ly
],
cl
in
ic
ia
n
re
po
rt
ut
ili
zi
ng
C
hi
ld
an
d
A
do
le
sc
en
t
N
ee
ds
an
d
St
re
ng
th
s
sc
al
e)
Sc
ho
ol
A
�
5
ye
ar
s
Sc
ho
ol
B
�
4
ye
ar
s
(w
ith
a
on
e-
ye
ar
ga
p
be
tw
ee
n
th
ir
d
an
d
fo
ur
th
ye
ar
)
Sc
ho
ol
C
�
2
ye
ar
s
Sc
ho
ol
D
�
1.
5
ye
ar
s
H
ea
lth
y
en
vi
ro
nm
en
ts
an
d
re
sp
on
se
to
tr
au
m
a
in
sc
ho
ol
s
pr
og
ra
m
,
a
tr
au
m
a-
in
fo
rm
ed
m
ul
tit
ie
re
d
sy
st
em
of
su
pp
or
t
in
cl
ud
in
g
un
iv
er
sa
l,
se
le
ct
ed
an
d
ta
rg
et
ed
su
pp
or
ts
fo
r
st
ud
en
ts
,
st
af
f/
ca
re
gi
ve
rs
an
d
th
e
“s
ys
te
m
”
in
ge
ne
ra
l
(b
as
ed
on
th
e
at
ta
ch
m
en
t,
se
lf
-r
eg
ul
at
io
n
an
d
co
m
pe
te
nc
y
m
od
el
)
St
ud
en
ts
sc
ho
ol
en
ga
ge
m
en
t,
be
ha
vi
or
al
pr
ob
le
m
s,
tr
au
m
a-
re
la
te
d
sy
m
pt
om
s
(i
n
st
ud
en
ts
w
ho
re
ce
iv
e
ta
rg
et
ed
th
er
ap
y)
.
Sc
ho
ol
pe
rs
on
ne
l’
s
kn
ow
le
dg
e
ab
ou
t
ad
dr
es
si
ng
tr
au
m
a
an
d
th
ei
r
us
e
of
tr
au
m
a-
in
fo
rm
ed
pr
ac
tic
es
w
as
al
so
as
se
ss
ed
.
D
at
a
co
lle
ct
ed
pr
ov
id
ed
su
pp
or
t
fo
r
th
e
ef
fe
ct
iv
en
es
s
of
th
e
H
ea
lth
y
E
nv
ir
on
m
en
ts
an
d
R
es
po
ns
e
to
T
ra
um
a
in
Sc
ho
ol
s
pr
og
ra
m
in
:
in
cr
ea
si
ng
sc
ho
ol
pe
rs
on
ne
l’
s
kn
ow
le
dg
e
an
d
us
e
of
tr
au
m
a-
in
fo
rm
ed
pr
ac
tic
es
;
in
cr
ea
si
ng
st
ud
en
t’
s
tim
e
on
ta
sk
an
d
at
te
nd
an
ce
;
de
cr
ea
si
ng
di
sc
ip
lin
ar
y
re
fe
rr
al
s
an
d
in
ci
de
nt
s
of
ph
ys
ic
al
ag
gr
es
si
on
an
d
ou
t-
of
-s
ch
oo
l
su
sp
en
si
on
;
de
cr
ea
si
ng
tr
au
m
a-
re
la
te
d
sy
m
pt
om
s
(f
or
st
ud
en
ts
w
ho
re
ce
iv
ed
ps
yc
ho
th
er
ap
y)
.
(t
ab
le
co
nt
in
ue
s)
T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
Ps
yc
ho
lo
gi
ca
l
A
ss
oc
ia
tio
n
or
on
e
of
its
al
lie
d
pu
bl
is
he
rs
.
T
hi
s
ar
tic
le
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.
158 ROSEBY AND GASCOIGNE
T
ab
le
4
(c
on
ti
nu
ed
)
C
ita
tio
n
Se
tti
ng
Pa
rt
ic
ip
an
ts
(n
)
M
et
ho
ds
us
ed
to
ga
th
er
in
fo
rm
at
io
n
L
en
gt
h
of
in
te
rv
en
tio
n
In
te
rv
en
tio
ns
us
ed
D
om
ai
ns
as
se
ss
ed
(o
ut
co
m
es
)
Su
m
m
ar
y
of
re
su
lts
Pe
rr
y
an
d
D
an
ie
ls
(2
01
6)
Pr
e-
K
–Y
r
8
n
�
41
0
(a
ll
st
ud
en
ts
re
ce
iv
ed
un
iv
er
sa
l
su
pp
or
t
fr
om
up
sk
ill
ed
te
ac
he
rs
,
96
re
ce
iv
ed
ad
di
tio
na
l
cl
in
ic
al
in
te
rv
en
tio
n)
Q
ua
lit
at
iv
e
(p
ro
fe
ss
io
na
l
de
ve
lo
pm
en
t
pa
rt
ic
ip
an
t
re
sp
on
se
s
re
ga
rd
in
g
sa
tis
fa
ct
io
n,
te
ac
he
r
at
te
nd
an
ce
at
cl
as
sr
oo
m
w
or
ks
ho
ps
)
Q
ua
nt
ita
tiv
e
(s
tu
de
nt
pa
rt
ic
ip
an
t
re
sp
on
se
s
on
w
or
ks
ho
p
su
rv
ey
,
st
ud
en
t
se
lf
-r
ep
or
t
on
tr
au
m
a
ex
po
su
re
an
d
sy
m
pt
om
s
vi
a
th
e
U
C
L
A
PT
SD
In
de
x
fo
r
D
SM
–I
V
)
Pi
lo
t
ye
ar
–1
2-
m
on
th
im
pl
em
en
t-
at
io
n
T
ra
um
a-
in
fo
rm
ed
pr
of
es
si
on
al
de
ve
lo
pm
en
t
to
sc
ho
ol
st
af
f,
ca
re
co
-o
rd
in
at
io
n
an
d
cl
in
ic
al
se
rv
ic
es
(i
.e
.,
cl
as
sr
oo
m
w
or
ks
ho
ps
an
d
co
gn
iti
ve
be
ha
vi
or
in
te
rv
en
tio
n
fo
r
tr
au
m
a
in
th
e
sc
ho
ol
’s
gr
ou
ps
)
St
ud
en
t
PT
SD
sy
m
pt
om
s
an
d
ac
qu
is
iti
on
of
co
pi
ng
sk
ill
s,
as
w
el
l
as
sc
ho
ol
st
af
f
an
d/
or
co
m
m
un
ity
m
em
be
rs
’
kn
ow
le
dg
e
of
tr
au
m
a-
in
fo
rm
ed
pr
ac
tic
es
,
id
en
tif
ic
at
io
n
of
st
ud
en
ts
re
qu
ir
in
g
tr
au
m
a-
in
fo
rm
ed
su
pp
or
t,
an
d
sy
st
em
ic
im
pl
em
en
ta
tio
n
of
tr
au
m
a-
in
fo
rm
ed
se
rv
ic
es
to
st
ud
en
ts
In
fo
rm
at
io
n
an
d
da
ta
co
lle
ct
ed
de
m
on
st
ra
te
d
th
at
sc
ho
ol
st
af
f
an
d/
or
co
m
m
un
ity
m
em
be
rs
ac
qu
ir
ed
kn
ow
le
dg
e
on
tr
au
m
a-
in
fo
rm
ed
pr
ac
tic
es
,
st
ud
en
ts
re
qu
ir
in
g
ad
di
tio
na
l
tr
au
m
a-
in
fo
rm
ed
su
pp
or
t
at
te
nd
ed
co
gn
iti
ve
be
ha
vi
or
in
te
rv
en
tio
n
fo
r
tr
au
m
a
in
th
e
sc
ho
ol
gr
ou
ps
(w
ith
a
de
cr
ea
se
in
PT
SD
sy
m
pt
om
ol
og
y
re
po
rt
ed
),
sy
st
em
ic
tr
au
m
a-
in
fo
rm
ed
ch
an
ge
w
as
re
po
rt
ed
,
an
d
a
m
aj
or
ity
of
st
ud
en
ts
re
po
rt
ed
un
de
rs
ta
nd
in
g
ho
w
to
re
la
x,
w
or
ry
le
ss
,
an
d
tr
us
t
ot
he
rs
.
H
at
ch
et
t
et
al
.
(2
01
7)
U
rb
an
sc
ho
ol
di
st
ri
ct
(c
om
po
se
d
of
12
pu
bl
ic
sc
ho
ol
s)
se
rv
in
g
K
–Y
r
6
n
�
52
0
(1
30
ra
nd
om
ly
se
le
ct
ed
st
ud
en
ts
w
ho
w
er
e
el
ig
ib
le
as
ho
m
el
es
s
an
d
39
0
“v
ir
tu
al
tw
in
s”
co
m
pr
is
in
g
ra
nd
om
ly
se
le
ct
ed
no
nh
om
el
es
s
st
ud
en
ts
)
Q
ua
lit
at
iv
e
(e
du
ca
tio
n
st
af
f
se
lf
-r
ep
or
t
on
ba
rr
ie
rs
ob
se
rv
ed
,
pa
re
nt
/c
ar
eg
iv
er
se
lf
–
re
po
rt
on
pe
rc
ep
tio
n
of
se
rv
ic
es
)
Q
ua
nt
ita
tiv
e
(t
ea
ch
er
re
po
rt
on
St
ud
en
t
R
is
k
Sc
re
en
in
g
sc
al
e
fo
r
in
te
rn
al
iz
in
g
an
d
ex
te
rn
al
iz
in
g
be
ha
vi
or
s,
A
IM
Sw
eb
un
iv
er
sa
l
sc
re
en
er
fo
r
st
ud
en
t
re
ad
in
g
an
d
m
at
h,
m
ea
su
re
s
of
ac
ad
em
ic
pr
og
re
ss
)
3
ye
ar
s
(2
01
4–
20
15
,
20
15
–2
01
6,
an
d
20
16
–2
01
7
sc
ho
ol
ye
ar
s)
M
cK
in
ne
y-
V
en
to
A
ct
fu
nd
in
g
w
hi
ch
in
cl
ud
ed
se
rv
ic
es
an
d
re
so
ur
ce
s
su
ch
as
m
ul
tit
ie
re
d
sy
st
em
s
of
su
pp
or
ts
an
d
tr
au
m
a-
se
ns
iti
ve
sc
ho
ol
pr
ac
tic
es
.
A
ca
de
m
ic
da
ta
fo
r
re
ad
in
g
an
d
m
at
h,
ac
ad
em
ic
pr
og
re
ss
io
n,
st
ud
en
t
at
te
nd
an
ce
,
an
d
in
te
rn
al
iz
in
g
an
d
ex
te
rn
al
iz
in
g
be
ha
vi
or
s.
A
dd
iti
on
al
in
fo
rm
at
io
n
co
lle
ct
ed
in
cl
ud
ed
id
en
tif
yi
ng
re
so
ur
ce
s
an
d
se
rv
ic
es
of
fe
re
d,
ba
rr
ie
rs
ob
se
rv
ed
by
ed
uc
at
io
n
st
af
f
an
d
pa
re
nt
s’
pe
rc
ep
tio
ns
of
th
ei
r
ch
ild
’s
ac
ce
ss
to
se
rv
ic
es
,
ad
ve
rs
ity
an
d
pr
ot
ec
tiv
e
fa
ct
or
s.
In
fo
rm
at
io
n
an
d
da
ta
co
lle
ct
ed
de
m
on
st
ra
te
d
th
at
ho
m
el
es
s
st
ud
en
ts
at
te
nd
an
ce
w
as
hi
gh
ly
in
co
ns
is
te
nt
,
w
ith
at
te
nd
an
ce
re
su
lts
ac
ro
ss
th
e
ye
ar
s
“m
ix
ed
,”
bo
th
ho
m
el
es
s
an
d
no
nh
om
el
es
s
st
ud
en
ts
w
er
e
m
ak
in
g
si
m
ila
r
gr
ow
th
in
m
at
h
an
d
re
ad
in
g
(h
ow
ev
er
,
no
di
ff
er
en
ce
w
as
fo
un
d
be
tw
ee
n
th
e
ho
m
el
es
s
an
d
no
nh
om
el
es
s
gr
ou
ps
as
a
re
su
lt
of
th
e
in
te
rv
en
tio
n/
s
im
pl
em
en
te
d)
an
d
te
ac
he
rs
id
en
tif
ie
d
m
or
e
in
te
rn
al
iz
in
g
be
ha
vi
or
s
th
an
ex
te
rn
al
iz
in
g
be
ha
vi
or
s
of
ho
m
el
es
s
st
ud
en
ts
(w
ith
no
di
ff
er
en
ce
fo
un
d
be
tw
ee
n
th
e
ho
m
el
es
s
an
d
no
nh
om
el
es
s
gr
ou
ps
as
a
re
su
lt
of
th
e
in
te
rv
en
tio
n/
s
im
pl
em
en
te
d)
.
(t
ab
le
co
nt
in
ue
s)
T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
Ps
yc
ho
lo
gi
ca
l
A
ss
oc
ia
tio
n
or
on
e
of
its
al
lie
d
pu
bl
is
he
rs
.
T
hi
s
ar
tic
le
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.
159CHILDHOOD ADVERSITY AND ACADEMIC FUNCTIONING
school climate were reported (Day et al., 2015). Crosby et al.
(2017) reported school attachment, that is, level of school connect-
edness, was associated with lower reported trauma symptoms, with
lower reported support from peers associated with higher trauma
symptoms. Furthermore, Millenky et al. (2019) found that engage-
ment in a trauma-informed alternate education setting designed for
girls and women decreased suspension rates and increased stu-
dents’ successful completion of attempted classes.
Judge (2018) reviewed the impact of a 9-week trauma and
resiliency curriculum delivered within a multitier system of sup-
ports (that also included teachers working from a trauma-informed
approach) on student resilience. Although they found improve-
ments on two of the resiliency measures, with another six resil-
iency measures demonstrating growth, the remaining four resil-
iency measures demonstrated decline following the intervention.
Lastly, Gonshak (2011) reviewed the impact of a trauma-informed
teacher training curriculum (for working specifically with survi-
vors of childhood abuse) on outcomes for students who attend an
on-campus school within a residential treatment center. Although
no improvements were reported regarding teacher knowledge or
practices in the classroom or on student’s trauma symptomology or
perceptions of their relationship with their teacher, it was demon-
strated that teacher beliefs about trauma-informed care and student
trauma symptomology are predictors of student–teacher relation-
ship quality (Gonshak, 2011).
Discussion
Reproducibility and transparency are considered important fea-
tures of systematic reviews. By adhering to this process, this
systematic review highlighted that trauma-informed education pro-
grams can have a positive impact on academic and academic-
related functioning for students with a history of childhood adver-
sity. Although results were not always consistent, improvements
were found regarding students internalizing behaviors (Holmes et
al., 2015; Pfenninger Saint Giles, 2016), self-regulatory abilities
(Crosby et al., 2017; Perry & Daniels, 2016), resilience (Judge,
2018; Shamblin et al., 2016), achievement (Stokes & Turnbull,
2016), attention (Holmes et al., 2015), and attendance (Dorado et
al., 2016), with a reduction in suspension rates also noted (Baroni
et al., 2016; Millenky et al., 2019). Interestingly, preschool studies
with year-long intervention lengths demonstrated positive impacts
on the outcomes assessed. This trend was also observed across
both primary/elementary and high school settings. Furthermore,
the majority of identified primary/elementary studies (particularly
those with an embedded trauma-informed education programs)
reported improvements on some (but not all) academic or
academic-related outcomes. Lastly, the majority of identified high
school studies reported positive impacts on a range of academic or
academic-related outcomes, which were associated with exposure
to the trauma-informed education program. However, this litera-
ture review highlights the dearth of studies available that review
the impact of trauma-informed education programs on academic or
academic-related functioning. Furthermore, of the 15 studies lo-
cated, four were unpublished dissertations and two were research
reports, further highlighting the limited amount of peer-reviewed
research on this topic.
Interestingly, despite the many existing trauma-informed mod-
els and theories, researchers at Berry Street (www.berrystreet.orgT
ab
le
4
(c
on
ti
nu
ed
)
C
ita
tio
n
Se
tti
ng
Pa
rt
ic
ip
an
ts
(n
)
M
et
ho
ds
us
ed
to
ga
th
er
in
fo
rm
at
io
n
L
en
gt
h
of
in
te
rv
en
tio
n
In
te
rv
en
tio
ns
us
ed
D
om
ai
ns
as
se
ss
ed
(o
ut
co
m
es
)
Su
m
m
ar
y
of
re
su
lts
M
itc
he
ll
(2
01
6)
A
ge
s
4–
22
in
th
e
Sa
n
Fr
an
ci
sc
o
B
ay
A
re
a
sc
ho
ol
s
(4
el
em
en
ta
ry
sc
ho
ol
s,
2
m
id
dl
e
sc
ho
ol
s,
an
d
1
co
nt
in
ua
tio
n
hi
gh
sc
ho
ol
).
n
�
72
0
Q
ua
nt
ita
tiv
e
(s
ch
oo
l-
ba
se
d
co
lla
bo
ra
tio
n
cl
in
ic
ia
n
co
m
pl
et
ed
in
iti
al
as
se
ss
m
en
t
an
d
cl
os
in
g
as
se
ss
m
en
t.)
5
ye
ar
s
(a
rc
hi
va
l
da
ta
fr
om
20
09
to
20
14
)
T
ar
ge
te
d
ps
yc
ho
th
er
ap
eu
tic
se
rv
ic
es
.
T
he
sc
ho
ol
-b
as
ed
co
lla
bo
ra
tio
n
al
so
pr
ov
id
ed
co
ns
ul
ta
tio
n
an
d
su
pp
or
ts
to
th
e
w
ho
le
sc
ho
ol
en
vi
ro
nm
en
t
(i
.e
.,
on
go
in
g
ps
yc
ho
ed
uc
at
io
n
ab
ou
t
po
si
tiv
e
di
sc
ip
lin
e
pr
ac
tic
es
an
d
tr
au
m
a-
in
fo
rm
ed
sc
ho
ol
an
d
cl
as
sr
oo
m
pr
oc
ed
ur
es
).
Pr
es
en
tin
g
pr
ob
le
m
fr
eq
ue
nc
y
an
d
se
ve
ri
ty
,
ac
ro
ss
fi
ve
do
m
ai
ns
:
ac
ad
em
ic
an
d
sc
ho
ol
ne
ed
s,
em
ot
io
na
l
an
d
be
ha
vi
or
al
ne
ed
s,
cu
ltu
ra
l
fa
ct
or
,
an
d
he
al
th
an
d
ba
si
c
ne
ed
s
D
at
a
co
lle
ct
ed
de
m
on
st
ra
te
d
im
pr
ov
em
en
ts
in
st
ud
en
t
so
ci
al
an
d
em
ot
io
na
l
pr
ob
le
m
s.
In
ge
ne
ra
l,
th
er
ap
eu
tic
se
rv
ic
es
w
er
e
ob
se
rv
ed
to
ha
ve
no
im
pa
ct
on
ac
ad
em
ic
,
cu
ltu
ra
l
fa
ct
or
s,
he
al
th
,
an
d
ba
si
c
ne
ed
s.
N
ot
e.
Y
R
�
ye
ar
;
U
C
L
A
�
U
ni
ve
rs
ity
of
C
al
if
or
ni
a,
L
os
A
ng
el
es
;
PT
SD
�
po
st
tr
au
m
at
ic
st
re
ss
di
so
rd
er
;
D
SM
–I
V
�
D
ia
gn
os
ti
c
an
d
St
at
is
ti
ca
l
M
an
ua
l
of
M
en
ta
l
D
is
or
de
rs
,
F
ou
rt
h
E
di
ti
on
.
A
us
V
E
L
S
w
as
th
e
Fo
un
da
tio
n
to
Y
ea
r
10
cu
rr
ic
ul
um
fo
r
V
ic
to
ri
an
go
ve
rn
m
en
ta
nd
C
at
ho
lic
sc
ho
ol
s
an
d
ha
s
be
en
re
pl
ac
ed
by
th
e
V
ic
to
ri
an
C
ur
ri
cu
lu
m
Fo
un
da
tio
n
to
Y
ea
r
10
.H
ea
lth
y
E
nv
ir
on
m
en
ts
an
d
R
es
po
ns
e
to
T
ra
um
a
in
Sc
ho
ol
s
(H
E
A
R
T
S)
is
a
sc
ho
ol
-b
as
ed
pr
og
ra
m
,w
ith
its
m
is
si
on
to
pr
om
ot
e
sc
ho
ol
su
cc
es
s
fo
r
tr
au
m
a-
im
pa
ct
ed
ch
ild
re
n
an
d
yo
ut
h
by
cr
ea
tin
g
m
or
e
tr
au
m
a-
in
fo
rm
ed
,s
af
e
an
d
su
pp
or
tiv
e
sc
ho
ol
co
m
m
un
iti
es
.
T
he
M
cK
in
ne
y-
V
en
to
H
om
el
es
s
A
ss
is
ta
nc
e
A
ct
is
a
U
.S
.
fe
de
ra
l
la
w
th
at
pr
ov
id
es
fe
de
ra
l
m
on
ey
to
as
si
st
in
di
vi
du
al
s
id
en
tif
ie
d
as
ho
m
el
es
s.
T
he
Sc
ho
ol
-B
as
ed
C
ol
la
bo
ra
tio
n
pr
ov
id
es
ev
id
en
ce
-b
as
ed
,
tr
au
m
a-
in
fo
rm
ed
m
od
el
s
of
in
te
rv
en
tio
n
th
at
su
pp
or
t
ch
ild
re
n,
te
ac
he
rs
,
an
d
th
e
sc
ho
ol
co
m
m
un
ity
.
T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
Ps
yc
ho
lo
gi
ca
l
A
ss
oc
ia
tio
n
or
on
e
of
its
al
lie
d
pu
bl
is
he
rs
.
T
hi
s
ar
tic
le
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.
160 ROSEBY AND GASCOIGNE
http://www.berrystreet.org.au
T
ab
le
5
T
ra
um
a-
In
fo
rm
ed
E
du
ca
ti
on
P
ro
gr
am
s
D
el
iv
er
ed
W
it
hi
n
H
ig
h
Sc
ho
ol
Se
tt
in
gs
C
ita
tio
n
Se
tti
ng
Pa
rt
ic
ip
an
ts
(n
)
M
et
ho
ds
us
ed
to
ga
th
er
in
fo
rm
at
io
n
L
en
gt
h
of
in
te
rv
en
tio
n
In
te
rv
en
tio
ns
us
ed
D
om
ai
ns
as
se
ss
ed
(o
ut
co
m
es
)
Su
m
m
ar
y
of
re
su
lts
C
ro
sb
y
et
al
.
(2
01
8)
Y
r
9–
Y
r
12
(s
er
vi
ng
gi
rl
s
w
ho
re
si
de
in
a
re
si
de
nt
ia
l
pr
og
ra
m
lo
ca
te
d
on
ca
m
pu
s)
n
�
94
Q
ua
lit
at
iv
e
(s
em
is
tr
uc
tu
re
d
in
te
rv
ie
w
re
ga
rd
in
g
st
ud
en
ts
’
ex
pe
ri
en
ce
s
w
ith
th
e
M
on
ar
ch
R
oo
m
an
d
th
ei
r
pe
rs
pe
ct
iv
es
on
ho
w
it
ha
s
in
fl
ue
nc
ed
th
ei
r
m
oo
d
an
d
be
ha
vi
or
).
Q
ua
nt
ita
tiv
e
(s
ec
on
da
ry
an
al
ys
is
of
sc
ho
ol
da
ta
re
ga
rd
in
g
us
e
of
th
e
M
on
ar
ch
R
oo
m
).
9
m
on
th
s
(d
ur
in
g
20
14
–2
01
5
ac
ad
em
ic
sc
ho
ol
ye
ar
)
M
on
ar
ch
R
oo
m
—
a
tr
au
m
a-
in
fo
rm
ed
al
te
rn
at
iv
e
to
sc
ho
ol
di
sc
ip
lin
e,
su
sp
en
si
on
,
an
d
ex
pu
ls
io
n
po
lic
ie
s
C
ha
ng
e
in
tim
e
sp
en
t
in
th
e
M
on
ar
ch
R
oo
m
ov
er
th
e
sc
ho
ol
ye
ar
,
th
e
im
pa
ct
of
th
e
M
on
ar
ch
R
oo
m
on
st
ud
en
t’
s
m
oo
d
an
d
fo
cu
s
in
sc
ho
ol
,
su
gg
es
tio
ns
fo
r
im
pr
ov
em
en
ts
,
as
w
el
l
as
be
ha
vi
or
(e
.g
.,
su
sp
en
si
on
ra
te
s)
D
at
a
co
lle
ct
ed
de
m
on
st
ra
te
d
th
at
M
on
ar
ch
R
oo
m
us
e
in
cr
ea
se
d,
an
d
m
os
t
M
on
ar
ch
R
oo
m
us
er
s
re
tu
rn
ed
to
cl
as
s
(a
ft
er
th
ei
r
M
on
ar
ch
R
oo
m
vi
si
t)
in
st
ea
d
of
es
ca
la
tin
g
to
th
e
po
in
t
of
su
sp
en
si
on
.
St
ud
en
ts
al
so
fo
un
d
th
e
M
on
ar
ch
R
oo
m
he
lp
ed
im
pr
ov
e
th
ei
r
m
oo
d
an
d
be
ha
vi
or
at
sc
ho
ol
.
C
ro
sb
y
et
al
.
(2
01
7)
Y
r
9–
Y
r
12
(s
er
vi
ng
gi
rl
s
w
ho
re
si
de
in
a
re
si
de
nt
ia
l
pr
og
ra
m
lo
ca
te
d
on
ca
m
pu
s)
n
�
14
1
Q
ua
nt
ita
tiv
e
(s
tu
de
nt
se
lf
–
re
po
rt
on
th
e
C
hi
ld
R
ep
or
t
of
Po
st
tr
au
m
at
ic
Sy
m
pt
om
s,
st
ud
en
t
se
lf
–
re
po
rt
on
sc
ho
ol
at
ta
ch
m
en
t/
co
nn
ec
te
dn
es
s
an
d
sc
ho
ol
in
vo
lv
em
en
t
as
w
el
l
as
st
ud
en
t
se
lf
-r
ep
or
t
on
th
e
C
hi
ld
an
d
A
do
le
sc
en
t
So
ci
al
Su
pp
or
t
Sc
al
e
[t
hr
ee
su
bs
ca
le
s
ut
ili
ze
d]
)
9
m
on
th
s
(d
ur
in
g
th
e
20
13
–2
01
4
ac
ad
em
ic
sc
ho
ol
ye
ar
)
T
ra
um
a-
in
fo
rm
ed
te
ac
hi
ng
in
te
rv
en
tio
n
(m
od
if
ie
d
ve
rs
io
n
of
T
he
H
ea
rt
of
T
ea
ch
in
g
an
d
L
ea
rn
in
g:
C
om
pa
ss
io
n,
R
es
ili
en
cy
an
d
A
ca
de
m
ic
Su
cc
es
s
[m
H
T
L
])
as
w
el
l
as
th
e
M
on
ar
ch
R
oo
m
Sc
ho
ol
at
ta
ch
m
en
t/
in
vo
lv
em
en
t
an
d
its
as
so
ci
at
io
n
w
ith
st
ud
en
ts
’
tr
au
m
a
sy
m
pt
om
at
ol
og
y
as
w
el
l
as
te
ac
he
r
so
ci
al
su
pp
or
t,
cl
as
sm
at
e
so
ci
al
su
pp
or
t,
an
d
sc
ho
ol
st
af
f
so
ci
al
su
pp
or
t
an
d
its
as
so
ci
at
io
n
w
ith
st
ud
en
t’
s
tr
au
m
a
sy
m
pt
om
ol
og
y
D
at
a
co
lle
ct
ed
de
m
on
st
ra
te
d
hi
gh
tr
au
m
a
sy
m
pt
om
ol
og
y
as
w
el
l
as
re
la
tiv
el
y
st
ro
ng
sc
ho
ol
at
ta
ch
m
en
t,
sc
ho
ol
in
vo
lv
em
en
t
an
d
su
pp
or
t
fr
om
te
ac
he
rs
,
ye
t
m
od
er
at
e
su
pp
or
t
fr
om
ot
he
r
sc
ho
ol
pe
rs
on
ne
l
an
d
lo
w
er
su
pp
or
t
fr
om
cl
as
sm
at
es
.
Sc
ho
ol
at
ta
ch
m
en
t
w
as
as
so
ci
at
ed
w
ith
lo
w
er
tr
au
m
a
sy
m
pt
om
s,
w
ith
lo
w
er
su
pp
or
t
fr
om
cl
as
sm
at
es
as
so
ci
at
ed
w
ith
hi
gh
tr
au
m
a
sy
m
pt
om
s.
D
ay
et
al
.
(2
01
5)
A
ge
s
14
–1
8
(s
er
vi
ng
gi
rl
s
w
ho
re
si
de
in
a
re
si
de
nt
ia
l
pr
og
ra
m
lo
ca
te
d
on
ca
m
pu
s)
n
�
70
(o
nl
y
th
os
e
w
ith
m
at
ch
ed
da
ta
[b
ot
h
pr
e-
an
d
po
st
te
st
da
ta
]
w
er
e
in
cl
ud
ed
in
th
is
st
ud
y)
Q
ua
nt
ita
tiv
e
(s
oc
io
de
m
og
ra
ph
ic
ch
ar
ac
te
ri
st
ic
s,
st
ud
en
t
se
lf
-r
ep
or
t
on
th
e
St
ud
en
t
N
ee
ds
Su
rv
ey
,
C
hi
ld
R
ep
or
t
of
Po
st
tr
au
m
at
ic
Sy
m
pt
om
s
an
d
R
os
en
be
rg
Se
lf
-E
st
ee
m
Sc
al
e
as
w
el
l
as
st
ud
en
t
pe
rc
ep
tio
ns
of
ch
an
ge
s
in
sc
ho
ol
cl
im
at
e)
9
m
on
th
s
(d
ur
in
g
th
e
20
12
–2
01
3
ac
ad
em
ic
sc
ho
ol
ye
ar
)—
72
%
of
th
e
sa
m
pl
e
w
er
e
ex
po
se
d
to
th
e
in
te
rv
en
tio
n
fo
r
6
m
on
th
s
or
m
or
e
m
H
T
L
(T
ra
um
a-
in
fo
rm
ed
te
ac
hi
ng
in
te
rv
en
tio
n
de
liv
er
ed
ov
er
2
ha
lf
da
ys
,
w
ith
bo
os
te
r
tr
ai
ni
ng
s
oc
cu
rr
in
g
m
on
th
ly
)
as
w
el
l
as
tr
au
m
a-
in
fo
rm
ed
sc
ho
ol
di
sc
ip
lin
ar
y
pr
ac
tic
es
(M
on
ar
ch
an
d
D
re
am
C
at
ch
er
R
oo
m
s)
Po
st
tr
au
m
at
ic
st
re
ss
sy
m
pt
om
s,
se
lf
–
es
te
em
,
an
d
st
ud
en
t
at
tit
ud
es
to
w
ar
d
te
ac
he
rs
,
le
ar
ni
ng
an
d
sc
ho
ol
cl
im
at
e
D
at
a
co
lle
ct
ed
de
m
on
st
ra
te
d
no
di
ff
er
en
ce
in
st
ud
en
t
ne
ed
s,
se
lf
-e
st
ee
m
,
an
d
pe
rc
ep
tio
ns
of
sc
ho
ol
cl
im
at
e.
St
ud
en
ts
re
po
rt
ed
th
at
a
m
aj
or
ity
of
te
ac
he
rs
re
sp
on
de
d
ap
pr
op
ri
at
el
y
to
th
ei
r
ne
ed
s
pr
ei
nt
er
ve
nt
io
n,
w
ith
no
di
ff
er
en
ce
in
th
ei
r
re
sp
on
si
ve
ne
ss
re
po
rt
ed
po
st
in
te
rv
en
tio
n.
H
ow
ev
er
,
a
de
cr
ea
se
in
po
st
tr
au
m
at
ic
st
re
ss
sy
m
pt
om
s
w
as
re
po
rt
ed
.
(t
ab
le
co
nt
in
ue
s)
T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
Ps
yc
ho
lo
gi
ca
l
A
ss
oc
ia
tio
n
or
on
e
of
its
al
lie
d
pu
bl
is
he
rs
.
T
hi
s
ar
tic
le
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.
161CHILDHOOD ADVERSITY AND ACADEMIC FUNCTIONING
T
ab
le
5
(c
on
ti
nu
ed
)
C
ita
tio
n
Se
tti
ng
Pa
rt
ic
ip
an
ts
(n
)
M
et
ho
ds
us
ed
to
ga
th
er
in
fo
rm
at
io
n
L
en
gt
h
of
in
te
rv
en
tio
n
In
te
rv
en
tio
ns
us
ed
D
om
ai
ns
as
se
ss
ed
(o
ut
co
m
es
)
Su
m
m
ar
y
of
re
su
lts
B
ar
on
i
et
al
.
(2
01
6)
Y
r
9–
Y
r
12
(s
er
vi
ng
gi
rl
s
w
ho
re
si
de
in
a
re
si
de
nt
ia
l
pr
og
ra
m
lo
ca
te
d
on
ca
m
pu
s)
n
�
62
0
Q
ua
nt
ita
tiv
e
(s
ch
oo
l
ad
m
in
is
tr
at
iv
e
da
ta
an
d
da
ily
M
on
ar
ch
R
oo
m
tr
ac
ki
ng
lo
gs
)
3
ye
ar
s
(2
01
1–
20
14
ac
ad
em
ic
sc
ho
ol
ye
ar
s)
M
on
ar
ch
R
oo
m
—
a
tr
au
m
a-
in
fo
rm
ed
al
te
rn
at
iv
e
to
sc
ho
ol
di
sc
ip
lin
e
su
sp
en
si
on
an
d
ex
pu
ls
io
n
po
lic
ie
s
H
is
to
ry
of
su
sp
en
si
on
s/
ex
pu
ls
io
ns
an
d
hi
st
or
y
of
M
on
ar
ch
R
oo
m
us
e
(s
us
pe
ns
io
n
da
ta
w
er
e
on
ly
av
ai
la
bl
e
fo
r
ye
ar
s
2
an
d
3
of
th
e
ob
se
rv
at
io
n
pe
ri
od
s.
M
on
ar
ch
R
oo
m
us
e
w
as
ca
pt
ur
ed
ov
er
al
l
3
ye
ar
s)
.
D
at
a
co
lle
ct
ed
de
m
on
st
ra
te
d
an
as
so
ci
at
io
n
be
tw
ee
n
th
e
im
pl
em
en
ta
tio
n
of
th
e
M
on
ar
ch
R
oo
m
an
d
a
re
du
ct
io
n
in
th
e
us
e
of
su
sp
en
si
on
as
a
m
et
ho
d
of
sc
ho
ol
di
sc
ip
lin
e.
Fr
eq
ue
nt
sc
ho
ol
m
ob
ili
ty
,
hi
gh
er
nu
m
be
r
of
sc
ho
ol
ab
se
nc
es
,
an
d
ra
ce
pr
ed
ic
te
d
M
on
ar
ch
R
oo
m
us
e
(i
n
lin
e
w
ith
fa
ct
or
s
th
at
ha
ve
pr
ed
ic
te
d
us
e
of
su
sp
en
si
on
in
th
e
lit
er
at
ur
e)
.
M
ill
en
ky
et
al
.
(2
01
9)
A
lte
rn
at
e
se
tti
ng
se
rv
in
g
11
–1
8-
ye
ar
-o
ld
gi
rl
s
n
�
1,
12
5
(a
cr
os
s
14
ce
nt
er
s—
67
3
in
pr
og
ra
m
gr
ou
p
an
d
45
2
in
th
e
co
nt
ro
l
gr
ou
p)
Q
ua
lit
at
iv
e
(f
ol
lo
w
-u
p
su
rv
ey
an
d
se
m
is
tr
uc
tu
re
d
ph
on
e
in
te
rv
ie
w
s
co
nd
uc
te
d
w
ith
st
ud
en
ts
an
d
pa
re
nt
s)
Q
ua
nt
ita
tiv
e
(b
as
ic
de
m
og
ra
ph
ic
da
ta
an
d
re
co
rd
s
on
pa
rt
ic
ip
at
io
n,
ad
m
in
is
tr
at
iv
e
re
co
rd
s
fr
om
th
e
Fl
or
id
a
D
ep
ar
tm
en
t
of
Ju
ve
ni
le
Ju
st
ic
e,
ad
m
in
is
tr
at
iv
e
re
co
rd
s
fr
om
th
e
Fl
or
id
a
D
ep
ar
tm
en
t
of
E
du
ca
tio
n
an
d
pr
og
ra
m
co
st
da
ta
)
2
ye
ar
s,
2
m
on
th
s
(A
ug
us
t
20
13
an
d
N
ov
em
be
r
20
15
)
A
lte
rn
at
iv
e
sc
ho
ol
se
tti
ng
(P
A
C
E
C
en
tr
e)
.
E
nr
ol
le
d
st
ud
en
ts
re
ce
iv
e
a
co
m
bi
na
tio
n
of
ac
ad
em
ic
an
d
so
ci
al
se
rv
ic
es
.
St
af
f
w
er
e
tr
ai
ne
d
on
PA
C
E
’s
ke
y
pi
lla
rs
as
a
ge
nd
er
–
re
sp
on
si
ve
,
st
re
ng
th
s-
ba
se
d,
an
d
tr
au
m
a-
in
fo
rm
ed
pr
og
ra
m
.
E
du
ca
tio
na
l
ou
tc
om
es
(i
nc
lu
di
ng
at
te
nd
an
ce
,
ac
ad
em
ic
pr
og
re
ss
,
su
sp
en
si
on
,
an
d
ex
pu
ls
io
n
ra
te
s)
,
in
te
rp
er
so
na
l
re
la
tio
ns
hi
ps
w
ith
fa
m
ily
m
em
be
rs
,
PA
C
E
st
af
f
m
em
be
rs
an
d
fr
ie
nd
s,
as
w
el
l
as
ri
sk
y
be
ha
vi
or
an
d
ju
ve
ni
le
ju
st
ic
e
in
vo
lv
em
en
t
In
fo
rm
at
io
n
an
d
da
ta
co
lle
ct
ed
de
m
on
st
ra
te
d
th
at
PA
C
E
ce
nt
er
s
in
cr
ea
se
d
ac
ad
em
ic
en
ga
ge
m
en
t,
in
cr
ea
se
d
su
cc
es
sf
ul
co
m
pl
et
io
n
of
“c
re
di
ts
”
at
te
m
pt
ed
an
d
de
cr
ea
se
d
su
sp
en
si
on
.
O
ve
ra
ll,
gi
rl
s
re
po
rt
ed
fe
el
in
g
po
si
tiv
e
ab
ou
t
th
ei
r
fu
tu
re
s.
H
ow
ev
er
,
PA
C
E
gi
rl
s
di
d
no
t
ea
rn
m
or
e
“c
re
di
ts
”
ov
er
al
l,
w
ith
pr
og
ra
m
st
ud
en
ts
us
ua
lly
ta
ki
ng
fe
w
er
cl
as
se
s
th
an
gi
rl
s
at
tr
ad
iti
on
al
sc
ho
ol
s.
Ju
dg
e
(2
01
8)
Pu
bl
ic
al
te
rn
at
iv
e
hi
gh
sc
ho
ol
n
�
53
Q
ua
nt
ita
tiv
e
(T
ea
ch
er
se
lf
–
re
po
rt
on
pr
og
ra
m
de
liv
er
y,
st
ud
en
t
se
lf
–
re
po
rt
on
re
si
lie
nc
y
in
cl
ud
in
g
B
ri
ef
R
es
ili
en
ce
Sc
al
e,
Pe
rc
ei
ve
d
St
re
ss
Sc
al
e,
G
ro
w
th
M
in
ds
et
Sc
al
e,
Fl
ou
ri
sh
in
g
Sc
al
e,
B
ri
ef
In
ve
nt
or
y
of
T
hr
iv
in
g
Sc
al
e,
Sa
tis
fa
ct
io
n
w
ith
L
if
e
sc
al
e,
St
ud
en
t
Se
lf
-R
ep
or
t
of
A
ca
de
m
ic
Se
lf
–
Su
ff
ic
ie
nc
y,
T
ra
um
a
C
og
ni
tiv
e
Sk
ill
s,
C
op
in
g
Sk
ill
s
R
at
in
g
Sc
al
e,
E
xe
rc
is
e,
Sl
ee
p
an
d
C
op
in
g
Sk
ill
s
Fr
eq
ue
nc
y
Sc
al
es
)
9
w
ee
ks
.
H
ow
ev
er
,
th
e
sc
ho
ol
ha
d
be
en
im
pl
em
en
t-
in
g
m
ul
tit
ie
re
d
tr
au
m
a-
in
fo
rm
ed
su
pp
or
ts
fo
r
se
ve
ra
l
ye
ar
s.
M
ul
tit
ie
re
d
sy
st
em
of
su
pp
or
ts
—
sp
ec
if
ic
al
ly
a
tr
au
m
a-
in
fo
rm
ed
in
te
rv
en
tio
n
(R
E
A
C
H
—
tr
au
m
a
an
d
re
si
lie
nc
y
cu
rr
ic
ul
um
)
de
liv
er
ed
to
w
ho
le
cl
as
se
s
(t
ie
r
2)
.
T
ea
ch
er
s
al
so
w
or
k
fr
om
a
tr
au
m
a-
in
fo
rm
ed
ap
pr
oa
ch
.
St
ud
en
ts
’
pe
rc
ep
tio
ns
of
th
ei
r
le
ve
l
of
re
si
lie
nc
y
an
d
te
ac
he
r
pe
rc
ep
tio
ns
on
ac
ce
pt
ab
ili
ty
,
fe
as
ib
ili
ty
,
ap
pr
op
ri
at
en
es
s,
an
d
ef
fe
ct
iv
en
es
s
of
th
e
R
E
A
C
H
pr
og
ra
m
.
D
at
a
co
lle
ct
ed
de
m
on
st
ra
te
d
im
pr
ov
em
en
ts
in
co
pi
ng
sk
ill
s
an
d
sl
ee
p,
w
ith
an
ot
he
r
si
x
re
si
lie
nc
y
m
ea
su
re
s
de
m
on
st
ra
tin
g
gr
ow
th
fo
llo
w
in
g
tr
ea
tm
en
t.
H
ow
ev
er
,
th
e
re
m
ai
ni
ng
fo
ur
re
si
lie
nc
y
m
ea
su
re
s
de
m
on
st
ra
te
d
de
cl
in
e.
It
w
as
re
po
rt
ed
th
at
th
e
pr
og
ra
m
m
ay
ne
ed
m
or
e
re
fi
ne
d
m
ea
su
re
m
en
t
an
d
tr
ea
tm
en
t.
O
ve
ra
ll,
te
ac
he
rs
ex
pr
es
se
d
po
si
tiv
e
vi
ew
s
of
th
e
R
E
A
C
H
pr
og
ra
m
;
ho
w
ev
er
,
so
m
e
ch
al
le
ng
es
w
er
e
al
so
ou
tli
ne
d.
(t
ab
le
co
nt
in
ue
s)
T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
Ps
yc
ho
lo
gi
ca
l
A
ss
oc
ia
tio
n
or
on
e
of
its
al
lie
d
pu
bl
is
he
rs
.
T
hi
s
ar
tic
le
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.
162 ROSEBY AND GASCOIGNE
.au) developed their own trauma-informed positive education pro-
gram (Brunzell et al., 2016; Stokes & Turnbull, 2016). This model
may offer benefits over the other models reviewed due to the
implicit teaching that occurs for educators, that is, a trauma-
informed system wide change filtering down to individual inter-
actions with students, as well as the explicit teaching that occurs
universally for students through specific classroom lessons and
activities on stress and trauma, that is, curriculum integration of
trauma-informed domains and themes delivered by classroom
teachers (not external teachers/clinicians; Stokes & Turnbull,
2016).
Although most studies reported improvements in academic or
academic-related outcomes, some studies did not report improve-
ments as a result of the trauma-informed education program (Day
et al., 2015; Gonshak, 2011; Hatchett et al., 2017; Mitchell, 2016).
Day et al. (2015) highlighted a vast majority of teachers were
reported by students as responsive to their needs before the staff
training being implemented, possibly explaining their results.
However, Day et al. (2015) did report positive impacts on student
self-reported PTSD symptoms as a result of the implementation of
the Monarch Room (combined with an upskilling of education
staff via a trauma-informed training program). Furthermore,
Mitchell (2016) did not report improvements in academic need;
however, improvements in social and emotional problems were
reported. It has been established that higher levels of mental health
symptoms are associated with an increase in school functioning
difficulties (Threlfall et al., 2017), adding to our understanding of
the implication of this reduction in self-reported PTSD symptoms
and improvement in emotional functioning. Furthermore, Gonshak
(2011) highlighted that their results of no change to teacher’s
knowledge of trauma, no change to their beliefs about trauma-
informed care, or no changes in their emotionally supportive
behaviors in the classroom were explained by the low sample size
of teachers. Furthermore, they also concluded that student out-
comes may need to be tracked over “many months” to observe
“considerable changes in the student-teacher relationship” (Gon-
shak, 2011, p. 87). Lastly, when discussing their results, Hatchett
et al. (2017) also acknowledged that low sample sizes may have
impacted on the results they obtained.
Although it would not be possible for all variables to be matched
between identified studies, it is nonetheless important to acknowl-
edge the heterogeneity in the research articles reviewed and the
implications for our findings. The studies described in this article
differed with respect to a number of important parameters, includ-
ing overall sample size, length of intervention, physical setting,
and outcomes assessed, to name a few. Although our studies were
not matched on these parameters, it was still possible to assess the
general impact of trauma-informed education programs, as similar
outcomes were noted between studies conducted in similar aca-
demic environments.
SAMHSA (2014) delineated that for a system to be considered
trauma informed, individuals within the system need to “realize”
the prevalence of trauma and its profound impact, they need to
“recognize” traumatic stress symptoms in individuals, and they
need to “respond” by applying a trauma-informed approach to all
areas of operating, therefore “resisting retraumatizing” individuals
who access the system (SAMHSA, 2014). Consistent with these
statements, a systematic review was conducted to provide a syn-
thesis of the trauma-informed education literature, to ultimatelyT
ab
le
5
(c
on
ti
nu
ed
)
C
ita
tio
n
Se
tti
ng
Pa
rt
ic
ip
an
ts
(n
)
M
et
ho
ds
us
ed
to
ga
th
er
in
fo
rm
at
io
n
L
en
gt
h
of
in
te
rv
en
tio
n
In
te
rv
en
tio
ns
us
ed
D
om
ai
ns
as
se
ss
ed
(o
ut
co
m
es
)
Su
m
m
ar
y
of
re
su
lts
G
on
sh
ak
(2
01
1)
A
ge
11
–1
8-
ye
ar
-o
ld
s
re
si
di
ng
in
a
re
si
de
nt
ia
l
tr
ea
tm
en
t
ce
nt
er
fo
r
ab
us
ed
an
d
ne
gl
ec
te
d
gi
rl
s
n
�
92
Q
ua
nt
ita
tiv
e
(t
ea
ch
er
se
lf
–
re
po
rt
on
th
e
R
is
ki
ng
C
on
ne
ct
io
n
cu
rr
ic
ul
um
as
se
ss
m
en
t
an
d
th
e
T
ra
um
a-
In
fo
rm
ed
C
ar
e
B
el
ie
f
m
ea
su
re
,
st
ud
en
t
se
lf
-r
ep
or
t
on
th
e
Y
ou
r
R
el
at
io
ns
hi
p
w
ith
th
is
T
ea
ch
er
an
d
T
ra
um
a
an
d
A
tta
ch
m
en
t
B
el
ie
f
sc
al
es
as
w
el
l
as
cl
as
sr
oo
m
ob
se
rv
at
io
ns
an
d
te
ac
he
r
fi
de
lit
y
to
th
e
R
is
ki
ng
C
on
ne
ct
io
n
pr
og
ra
m
)
1
ye
ar
(2
00
9)
.
T
hi
s
st
ud
y
us
ed
th
e
ar
ch
iv
al
da
ta
fr
om
th
e
pi
lo
t
st
ud
y.
R
is
ki
ng
C
on
ne
ct
io
n
te
ac
he
r
tr
ai
ni
ng
.
R
is
ki
ng
C
on
ne
ct
io
n
is
a
tr
ai
ni
ng
cu
rr
ic
ul
um
fo
r
w
or
ki
ng
sp
ec
if
ic
al
ly
w
ith
su
rv
iv
or
s
of
ch
ild
ho
od
ab
us
e.
St
ud
en
ts
pe
rc
ep
tio
n
of
th
e
st
ud
en
t–
te
ac
he
r
re
la
tio
ns
hi
p,
st
ud
en
t’
s
tr
au
m
a
sy
m
pt
om
ol
og
y,
te
ac
he
r
kn
ow
le
dg
e
ab
ou
t
tr
au
m
a,
te
ac
he
r
be
lie
fs
ab
ou
t
tr
au
m
a-
in
fo
rm
ed
ca
re
an
d
th
e
qu
al
ity
of
te
ac
he
rs
’
cl
as
sr
oo
m
be
ha
vi
or
s
an
d
in
te
ra
ct
io
ns
w
ith
st
ud
en
ts
D
at
a
co
lle
ct
ed
de
m
on
st
ra
te
d
th
at
st
ud
en
t
tr
au
m
a
sy
m
pt
om
ol
og
y
an
d
te
ac
he
r
be
lie
fs
ab
ou
t
tr
au
m
a
in
fo
rm
ed
ca
re
ar
e
pr
ed
ic
to
rs
of
st
ud
en
t’
s
ra
tin
gs
of
th
e
st
ud
en
t–
te
ac
he
r
re
la
tio
ns
hi
p
qu
al
ity
.
N
o
ch
an
ge
s
w
er
e
re
po
rt
ed
in
te
ac
he
r
kn
ow
le
dg
e
of
tr
au
m
a,
th
ei
r
tr
au
m
a-
in
fo
rm
ed
ca
re
be
lie
fs
,
or
th
ei
r
em
ot
io
na
lly
su
pp
or
tiv
e
be
ha
vi
or
in
th
e
cl
as
sr
oo
m
.
N
o
ch
an
ge
s
in
st
ud
en
t
tr
au
m
a
sy
m
pt
om
ol
og
y
or
pe
rc
ep
tio
ns
of
th
ei
r
re
la
tio
ns
hi
p
w
ith
th
ei
r
te
ac
he
r
w
er
e
re
po
rt
ed
.
N
ot
e.
Y
R
�
ye
ar
.
R
es
ili
en
ce
,
E
du
ca
tio
n,
A
ch
ie
ve
m
en
t,
C
ho
ic
es
,
H
op
e
(R
E
A
C
H
)
is
a
sc
ho
ol
-b
as
ed
re
si
lie
nc
e
an
d
tr
au
m
a
cu
rr
ic
ul
um
th
at
w
as
de
ve
lo
pe
d
by
te
ac
he
rs
an
d
ad
m
in
is
tr
at
or
s.
T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
Ps
yc
ho
lo
gi
ca
l
A
ss
oc
ia
tio
n
or
on
e
of
its
al
lie
d
pu
bl
is
he
rs
.
T
hi
s
ar
tic
le
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.
163CHILDHOOD ADVERSITY AND ACADEMIC FUNCTIONING
assist school systems to be trauma-informed. This will allow
school systems to further realize the prevalence and impact of
trauma, further recognize its presentation in their students, and
ultimately equip them to understand the importance of being
trauma-informed in their response, thereby avoiding the retrauma-
tization that can occur through more traditional or established
school approaches (SAMHSA, 2014). The current study provided
a systematic review summarizing the impact of trauma-informed
education programs on academic and academic-related functioning
for students with a history of childhood adversity. To the authors’
knowledge, no such study had been completed to date; therefore,
this research makes a distinctive contribution to the existing
trauma and trauma-informed literature. After reviewing the liter-
ature, it appears that programs that are embedded and “system-
wide” in their implementation, provide intensive initial staff train-
ing and regular booster sessions as well as programs that are
implemented over longer periods of time have a greater prospect of
positively impacting students’ academic or academic-related out-
comes.
To move forward, recommendations will be offered regarding
future research into the impact of trauma-informed education pro-
grams on academic functioning. This will enhance knowledge
about the effect of these programs on students functioning and
underscore the importance of disseminating this knowledge to the
systems that will benefit from it the most, that is, schools. Fur-
thermore, additional focus should be placed on developing
“system-friendly” approaches that enhance the school system’s
ability to effectively respond to their students’ traumatic stress
symptoms (the “respond” element of SAMHSA’s key assumptions
in a trauma-informed approach).
Implications for Future Research
Key suggestions for future research arose from several chal-
lenges that occurred while conducting this systematic review.
Areas for development regarding this include: (a) clear and con-
sistent reporting and implementation of trauma-informed educa-
tion programs (the independent variable); (b) conducting addi-
tional trauma-informed research within school settings; (c)
establishing a greater appreciation for the dissemination of this
research and knowledge; (d) recognizing possible moderators and
mediators of the association between trauma-informed education
programs and various academic and academic-related outcomes.
To tackle these current limitations, suggestions for future research
analyzing the impact of trauma-informed education programs on
students functioning will be presented.
Trauma-Informed Education Programs
As previously discussed, SAMHSA (2014) provided guidance
for the adoption and implementation of trauma-informed ap-
proaches within existing systems of care. This guidance allows
systems to adopt trauma-informed approaches in such a way that
suits their staff and student population as well as their existing
school culture. Furthermore, although it is recognized that schools
may not traditionally attend to trauma as “an aspect of how they
conduct business, understanding trauma and a trauma-informed
approach may help them meet their goals and objectives” (SAM-
HSA, 2014 p. 12). The flexibility offered by SAMHSA’s guide-
lines ultimately means that various systems of trauma-informed
care have been developed in schools, with this need borne out of
the prevalence and impact of trauma and traumatic stress symp-
toms on their student population. To illustrate, the studies within
this systematic review used a variety of models and theories when
implementing their trauma-informed education programs within
their individual school settings. Moving forward, researchers need
to clearly report the theories and models used for their trauma-
informed education program as well as the advantages of using this
system instead of the other models available. This will lend itself
to strengthening future trauma-informed school-based research.
Trauma-Informed School-Based Research
As our understanding of trauma, its prevalence and impact has
increased, the need for school systems to become trauma-informed
has been acknowledged (SAMHSA, 2014). Likewise, the routine
and consistency characteristic of the standard school day makes
the education system well suited to providing trauma-informed
interventions (SAMHSA, 2014).
Furthermore, with school-based trauma-specific interventions
shown to reduce traumatic stress symptoms for students (Rolfsnes
& Idsoe, 2011), it is only natural for school systems to be looked
at as a place for successful intervention for traumatized students.
Yet, implementing a trauma-informed approach means generating
shifts of thought at the “system level,” which is no small task, with
this change often taking years to occur (Phifer & Hull, 2016).
Furthermore, it has been identified that systems-level change re-
quires buy in from educators and school staff to be given the best
chance of success (Zakszeski et al., 2017). Therefore, it is essential
that future researchers understand the importance of cultivating the
buy in of relevant stakeholders, including outlining how “trauma-
informed” approaches can assist schools in achieving their educa-
tional goals and objectives (SAMHSA, 2014).
To illustrate, during their study, Perry and Daniels (2016) fo-
cused on building relationships within the school system, to ensure
the foundations of successful system change were laid and their
trauma-informed change would be sustained over time. It should
be noted that a shift in educator “identity” may be required to
allow teachers to meaningfully employ trauma-informed ways of
responding to their students (Morgan et al., 2015). This investment
of time may explain the lack of research located in this systematic
review. Dorado et al. (2016) tracked outcomes over 5 years in four
school settings, outlining the significant investment required to
adequately track systems level change and its impact on students’
academic outcomes. Notwithstanding the difficulty of time and
systems-level change in general, the benefits of conducting further
research into trauma-informed education programs and their im-
pact on academic and academic-related functioning can be seen to
far outweigh the challenges. Tracking these outcomes over time
allows for a better understanding of the long-term impact of
trauma-informed education programs on academic functioning,
and possibly life course outcomes, for individuals with a history of
childhood adversity.
Disseminating Research
For educators and wider school systems to respond effectively
to their students with a history of childhood adversity, it is essen-
tial that the findings presented in this systematic review (and the
studies within it) are disseminated. To respond appropriately,
T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
Ps
yc
ho
lo
gi
ca
l
A
ss
oc
ia
tio
n
or
on
e
of
its
al
lie
d
pu
bl
is
he
rs
.
T
hi
s
ar
tic
le
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.
164 ROSEBY AND GASCOIGNE
educators and schools need to be aware of the trauma-informed
responses they can employ to resist retraumatization of their stu-
dents. Furthermore, a key feature that may be missed by educators
is the notion that “readiness to learn” is mostly a function of an
individual’s emotional, behavioral, and social skills (Bettencourt et
al., 2018). Therefore, an overly anxious and dysregulated student
will have difficulty participating effectively in the school environ-
ment, including students who have experienced childhood adver-
sity. It is anticipated that dissemination of relevant trauma-
informed information and research will assist educators in making
the theory to practice links needed to respond effectively to their
overly anxious and dysregulated traumatized students. Further-
more, an interesting point to note is the response of teachers to
their student’s presentation, with teachers’ opinions about the
nature of their student’s difficulties, that is, wilful disobedience
versus difficulties as a result of childhood adversity, determining
the behavior intervention used (Watson & Westby, 2003). Hence,
lack of knowledge can lead to inappropriate interventions, with the
need for dissemination of trauma-informed knowledge and the
impact of trauma-informed education programs clear if school
systems are to make a meaningful impact on the lives of their
students (Chafouleas et al., 2016; Downey, 2007; Watson &
Westby, 2003).
Considering Moderators and Mediators
This review focused on trauma-informed education programs
and the impact they can have on academic and academic-related
outcomes. However, there are other characteristics of the individ-
ual, educators or the wider trauma-informed environment that may
affect the impact of trauma-informed education programs on aca-
demic and academic-related outcomes. Therefore, future studies
should consider mediator and moderator variables that influence
outcomes. Moderator variables may include, age, gender, school-
setting or trauma-informed model used. In addition, a theme that is
emerging more generally is the need for additional research on
factors correlated with positive results among those with a history
of childhood adversity, that is, studies of resilience (Soleimanpour
et al., 2017).
Limitations
Before completing this literature review, the decision was made
to use general search terms, including “adverse childhood experi-
ences” and “trauma.” As a result, keywords pertaining to specific
types of trauma or adverse events were not used, such as sexual or
physical abuse. Consequently, relevant articles may not have been
located. Furthermore, a reverse search of identified articles was not
completed, which may have also resulted in relevant articles not
being located. Additionally, Sally Roseby undertook the system-
atic review and subsequent coding, with valuable advice and
direction provided by Michael Gascoigne; however, a detailed
review of this process was not undertaken by Michael Gascoigne.
Given that only 15 articles met the inclusion criteria for this
systematic review, the decision was made to include all identified
articles within a high school setting, despite several of these
articles occurring within the same high school setting. This deci-
sion may have inflated the findings identified; however, these
studies are from disparate cohorts within the same institution
which were studied at different times. Although the location may
be the same, the subjects of these studies were different, as were
the teachers implementing the program. As mentioned above, it is
acknowledged that the identified studies differed with respect to a
number of variables. This is a limitation, as stronger conclusions
could be drawn if all studies were matched on a range of critical
factors, such as setting and length of intervention. Lastly, we may
not have located articles published in journals that were not located
within the selected databases searched. Nevertheless, the used
approach is believed to have led to a data set that is reproducible.
Conclusion
Although results were not consistent across the studies re-
viewed, this review highlights the possibility for trauma-informed
education programs to positively impact students’ academic and
academic-related outcomes. This is promising, as not only are
schools well posited to support their students with a history of
childhood adversity, the responsibility for schools to support the
academic, social, emotional, and behavioral needs of their students
is greater than ever before (Hatchett et al., 2017).
References
References marked with an asterisk indicate studies included in the
systematic review.
Australian Childhood Foundation. (2018). Making space for learning—
Trauma informed practice in schools. https://www.theactgroup.com.au/
documents/makingspaceforlearning-traumainschools
Australian Institute of Family Studies. (2017). Child abuse and neglect
statistics. https://aifs.gov.au/cfca/publications/child-abuse-and-neglect-
statistics
�Baroni, B., Day, A., Somers, C., Crosby, S., & Pennefather, M. (2020).
Use of the monarch room as an alternative to suspension in addressing
school discipline issues among court-involved youth. Urban Education,
55(1). Advance online publication. https://doi.org/10.1177/
0042085916651321
Baskin, T. W., Slaten, C. D., Sorenson, C., Glover-Russell, J., & Merson,
D. N. (2010). Does youth psychotherapy improve academically related
outcomes? A meta-analysis. Journal of Counseling Psychology, 57(3),
290–296. https://doi.org/10.1037/a0019652
Becker, K. D., Brandt, N. E., Stephan, S. H., & Chorpita, B. F. (2014). A
review of educational outcomes in the children’s mental health treatment
literature. Advances in School Mental Health Promotion, 7(1), 5–23.
https://doi.org/10.1080/1754730X.2013.851980
Berardi, A., & Morton, B. M. (2017). Maximizing academic success for
foster care students: A trauma-informed approach. Journal of At-Risk
Studies, 20(1),10–16.
Bettencourt, A., Gross, D., Ho, G., & Perrin, N. (2018). The costly
consequences of not being socially and behaviourally ready by kinder-
garten in Baltimore City. Journal of Urban Health, 95(1), 36–50.
https://doi.org/10.1007/s11524-017-0214-6
Bick, J., & Nelson, C. A. (2016). Early adverse experiences and the
developing brain. Neuropsychopharmacology, 41(1), 177–196. https://
doi.org/10.1038/npp.2015.252
Blaustein, M., & Kinniburgh, K. (2010). Treating traumatic stress in
children and adolescents: How to foster resilience through attachment,
self-regulation, and competency. Guilford Press.
Blodgett, C., & Lanigan, J. D. (2018). The association between adverse
childhood experience (ACE) and school success in elementary school
children. School Psychology Quarterly, 33(1), 137–146. https://doi.org/
10.1037/spq0000256
Blue Knot Foundation. (2015). The cost of unresolved childhood trauma
and abuse in adults in Australia. https://www.blueknot.org.au/Portals/
T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
Ps
yc
ho
lo
gi
ca
l
A
ss
oc
ia
tio
n
or
on
e
of
its
al
lie
d
pu
bl
is
he
rs
.
T
hi
s
ar
tic
le
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.
165CHILDHOOD ADVERSITY AND ACADEMIC FUNCTIONING
https://www.theactgroup.com.au/documents/makingspaceforlearning-traumainschools
https://www.theactgroup.com.au/documents/makingspaceforlearning-traumainschools
https://aifs.gov.au/cfca/publications/child-abuse-and-neglect-statistics
https://aifs.gov.au/cfca/publications/child-abuse-and-neglect-statistics
https://doi.org/10.1177/0042085916651321
https://doi.org/10.1177/0042085916651321
https://doi.org/10.1037/a0019652
https://doi.org/10.1080/1754730X.2013.851980
https://doi.org/10.1007/s11524-017-0214-6
https://doi.org/10.1038/npp.2015.252
https://doi.org/10.1038/npp.2015.252
https://doi.org/10.1037/spq0000256
https://doi.org/10.1037/spq0000256
https://www.blueknot.org.au/Portals/2/Economic%20Report/The%20cost%20of%20unresolved%20trauma_budget%20report%20fnl
2/Economic%20Report/The%20cost%20of%20unresolved%20trauma_
budget%20report%20fnl
Brunzell, T., Stokes, H., & Waters, L. (2016). Trauma-informed positive
education: Using positive psychology to strengthen vulnerable students.
Contemporary School Psychology, 20(1), 63– 83. https://doi.org/10
.1007/s40688-015-0070-x
Burke, N. J., Hellman, J. L., Scott, B. G., Weems, C. F., & Carrion, V. G.
(2011). The impact of adverse childhood experiences on an urban
pediatric population. Child Abuse and Neglect, 35(6), 408–413. https://
doi.org/10.1016/j.chiabu.2011.02.006
Chafouleas, S. M., Johnson, A. H., Overstreet, S., & Santos, N. M. (2016).
Toward a blue-print for trauma-informed service delivery in schools.
School Mental Health, 8(1), 144–162. https://doi.org/10.1007/s12310-
015-9166-8
Chugani, H. T., Behen, M. E., Muzik, O., Juhasz, C., Nagy, F., & Chugani,
D. C. (2001). Local brain functional activity following early deprivation:
A study of post-institutionalized Romanian orphans. NeuroImage, 14(6),
1290–1301. https://doi.org/10.1006/nimg.2001.0917
Cohen, J. A., Mannarino, A. P., Murray, L. K., & Igelman, R. (2006).
Psychosocial interventions for maltreated and violence-exposed chil-
dren. Journal of Social Issues, 62(4), 737–766. https://doi.org/10.1111/
j.1540-4560.2006.00485.x
Covey, H. C., Menard, S., & Franzese, R. J. (2013). Effects of adolescent
physical abuse, exposure to neighbourhood violence, and witnessing
parental violence on adult socioeconomic status. Child Maltreatment,
18(2), 85–97. https://doi.org/10.1177/1077559513477914
�Crosby, S., Day, A. G., Somers, C. L., & Baroni, B. A. (2018). Avoiding
school suspension: Assessment of a trauma-informed intervention with
court-involved, female students. Preventing School Failure, 62(3), 229–
237. https://doi.org/10.1080/1045988X.2018.1431873
�Crosby, S. D., Somers, C. L., Day, A. G., Zammit, M., Shier, J. M., &
Baroni, B. A. (2017). Examining school attachment, social support, and
trauma symptomatology among court-involved, female students. Jour-
nal of Child and Family Studies, 26(9), 2539–2546. https://doi.org/10
.1007/s10826-017-0766-9
Currie, J., & Widom, C. S. (2010). Long-term consequences of child abuse
and neglect on adult economic well-being. Child Maltreatment, 15(2),
111–120. https://doi.org/10.1177/1077559509355316
Davis, J. L., & Petretic-Jackson, P. A. (2000). The impact of child sexual
abuse on adult interpersonal functioning: A review and synthesis of the
empirical literature. Aggression and Violent Behavior, 5(3), 291–328.
https://doi.org/10.1016/S1359-1789(99)00010-5
�Day, A. G., Somers, C. L., Baroni, B. A., West, S. D., Sanders, L., &
Peterson, C. D. (2015). Evaluation of a trauma-informed school inter-
ventions with girls in a residential facility school: Students perceptions
of school environment. Journal of Aggression, Maltreatment and
Trauma, 24(10), 1086 –1105. https://doi.org/10.1080/10926771.2015
.1079279
�Dorado, J. S., Martinez, M., McArthur, L. E., & Leibovitz, T. (2016).
Healthy Environments and Response to Trauma in Schools (HEARTS):
A whole-school, multi-level, prevention and intervention program for
creating trauma-informed, safe and support schools. School Mental
Health, 8(1), 163–176. https://doi.org/10.1007/s12310-016-9177-0
Downey, L. (2007). Calmer classrooms: A guide to working with trauma-
tised children. Child Safety Commissioner.
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M.,
Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of
childhood abuse and household dysfunction to many of the leading
causes of deaths in adults. The Adverse Childhood Experiences (ACE)
Study. American Journal of Preventive Medicine, 14(4), 245–258.
https://doi.org/10.1016/S0749-3797(98)00017-8
�Gonshak, A. B. (2011). Analysis of trauma symptomology, trauma-
informed care, and student-teacher relationships in a residential treat-
ment center for female adolescents (Paper No. 516) [Doctoral disserta-
tion]. Electronic Theses and Dissertations, University of Louisville.
https://doi.org/10.18297/etd/516
Hanson, J. L., Nacewicz, B. M., Sutterer, M. J., Cayo, A. A., Schaefer,
S. M., Rudolph, K. D., Shirtcliff, E. A., Pollak, S. D., & Davidson, R. J.
(2015). Behavioural problems after early life stress: Contributions of the
hippocampus and amygdala. Biological Psychiatry, 77(4), 314–323.
https://doi.org/10.1016/j.biopsych.2014.04.020
Hardcastle, K., Bellis, M. A., Ford, K., Hughes, K., Garner, J., & Ro-
driquez, G. R. (2018). Measuring the relationships between adverse
childhood experiences and educational and employment success in Eng-
land and Wales: Findings from a retrospective study. Public Health, 165,
106–116. https://doi.org/10.1016/j.puhe.2018.09.014
�Hatchett, T., Minnis, C., & Nelms, A. (2017). McKinney-Vento Act: The
effectiveness of one district’s whole child approach to meeting the needs
of a vulnerable population [Doctoral Dissertation], Lipscomb Univer-
sity. Retrieved from ERIC.
�Holmes, C., Levy, M., Smith, A., Pinne, S., & Neese, P. (2015). A model
for creating a supportive trauma-informed culture for children in pre-
school settings. Journal of Child and Family Studies, 24(6), 1650–1659.
https://doi.org/10.1007/s10826-014-9968-6
Iachini, A. L., Petiwala, A. F., & DeHart, D. D. (2016). Examining adverse
childhood experiences among students repeating the ninth grade: Impli-
cations for school dropout prevention. Children and Schools, 38(4),
218–227. https://doi.org/10.1093/cs/cdw029
Jaycox, L. H., Langley, A. K., & Hoover, S. A. (2018). Cognitive behav-
ioural intervention for trauma in schools (2nd ed.). RAND Corporation.
https://www.rand.org/pubs/tools/TL272.html#download
�Judge, D. M. (2018). Evaluating a trauma-informed resilience curriculum
in a public alternative high school: Student treatment outcomes and staff
perceptions of implementation [Doctoral dissertation], University of
Washington. https://digital.lib.washington.edu/researchworks/bit
stream/handle/1773/42103/Judge_washington_0250E_18904 ?
sequence�1&isAllowed�y
Kataoka, S. H., Vona, P., Acuna, A., Jaycox, L., Escuden, P., Rojas, C.,
Ramirez, E., Langley, A., & Stein, B. D. (2018). Applying a trauma
informed school systems approach: Examples from school community-
academic partnerships. Ethnicity and Disease, 8(2), 417–426.
Kinniburgh, K. J., Blaustein, M., Spinazzola, J., & van der Kolk, B. A.
(2005). Attachment, self-regulation, and competency: A comprehensive
intervention framework for children with complex trauma. Psychiatric
Annals, 35(5), 424 – 430. https://doi.org/10.3928/00485713-2005
0501-08
Liu, Y., Croft, J. B., Chapman, D. P., Perry, G. S., Greenland, K. J., Zhao,
G., & Edwards, V. J. (2013). Relationship between adverse childhood
experiences and unemployment among adults from five U.S. states.
Social Psychiatry and Psychiatric Epidemiology, 48(3), 357–369.
https://doi.org/10.1007/s00127-012-0554-1
Millenky, M., Treskon, L., Freedman, L., & Mage, C. (2019). Focusing on
girls’ futures: Results from the evaluation of PACE Center for girls.
MDRC.
�Mitchell, C. (2016). Effectiveness of a school-based mental health practi-
cum at the Wright Institute [Doctoral dissertation, The Wright Institute
Graduate School of Psychology].
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA
Group. (2009). Methods of systematic review and meta-analysis. Pre-
ferred reporting items for systematic reviews and meta-analysis: The
PRISMA Statement. Journal of Clinical Epidemiology, 62(10), 1006–
1012. https://doi.org/10.1016/j.jclinepi.2009.06.005
Morgan, A., Pendergast, D., Brown, R., & Heck, D. (2015). Relational
ways of being an educator: Trauma-informed practice supporting disen-
franchised young people. International Journal of Inclusive Education,
19(10), 1037–1051. https://doi.org/10.1080/13603116.2015.1035344
Morton, B., & Berardi, A. A. (2018). Trauma-informed school program-
ming: Applications for mental health professionals and educator part-
T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
Ps
yc
ho
lo
gi
ca
l
A
ss
oc
ia
tio
n
or
on
e
of
its
al
lie
d
pu
bl
is
he
rs
.
T
hi
s
ar
tic
le
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.
166 ROSEBY AND GASCOIGNE
https://www.blueknot.org.au/Portals/2/Economic%20Report/The%20cost%20of%20unresolved%20trauma_budget%20report%20fnl
https://doi.org/10.1007/s40688-015-0070-x
https://doi.org/10.1007/s40688-015-0070-x
https://doi.org/10.1016/j.chiabu.2011.02.006
https://doi.org/10.1016/j.chiabu.2011.02.006
https://doi.org/10.1007/s12310-015-9166-8
https://doi.org/10.1007/s12310-015-9166-8
https://doi.org/10.1006/nimg.2001.0917
https://doi.org/10.1111/j.1540-4560.2006.00485.x
https://doi.org/10.1111/j.1540-4560.2006.00485.x
https://doi.org/10.1177/1077559513477914
https://doi.org/10.1080/1045988X.2018.1431873
https://doi.org/10.1007/s10826-017-0766-9
https://doi.org/10.1007/s10826-017-0766-9
https://doi.org/10.1177/1077559509355316
https://doi.org/10.1016/S1359-1789%2899%2900010-5
https://doi.org/10.1080/10926771.2015.1079279
https://doi.org/10.1080/10926771.2015.1079279
https://doi.org/10.1007/s12310-016-9177-0
https://doi.org/10.1016/S0749-3797%2898%2900017-8
https://doi.org/10.18297/etd/516
https://doi.org/10.1016/j.biopsych.2014.04.020
https://doi.org/10.1016/j.puhe.2018.09.014
https://doi.org/10.1007/s10826-014-9968-6
https://doi.org/10.1093/cs/cdw029
https://www.rand.org/pubs/tools/TL272.html#download
https://digital.lib.washington.edu/researchworks/bitstream/handle/1773/42103/Judge_washington_0250E_18904 ?sequence=1&isAllowed=y
https://digital.lib.washington.edu/researchworks/bitstream/handle/1773/42103/Judge_washington_0250E_18904 ?sequence=1&isAllowed=y
https://digital.lib.washington.edu/researchworks/bitstream/handle/1773/42103/Judge_washington_0250E_18904 ?sequence=1&isAllowed=y
https://doi.org/10.3928/00485713-20050501-08
https://doi.org/10.3928/00485713-20050501-08
https://doi.org/10.1007/s00127-012-0554-1
https://doi.org/10.1016/j.jclinepi.2009.06.005
https://doi.org/10.1080/13603116.2015.1035344
nerships. Journal of Child and Adolescent Trauma, 11(4), 487–493.
https://doi.org/10.1007/s40653-017-0160-1
Overstreet, S., & Chafouleas, S. M. (2016). Trauma-informed schools:
Introduction to the special issue. School Mental Health, 8(1), 1–6.
https://doi.org/10.1007/s12310-016-9184-1
Perfect, M. M., Turley, M. R., Carlson, J. S., Yohanna, J., & Pfenninger
Saint Gilles, M. (2016). School-related outcomes of traumatic event
exposure and traumatic stress symptoms in students: A systematic re-
view of research from 1990 to 2015. School Mental Health, 8(1), 7–43.
https://doi.org/10.1007/s12310-016-9175-2
Perry, B. D., & Hambrick, E. P. (2008). The neurosequential model of
therapeutics. Reclaiming Children and Youth, 17(3), 38–43.
Perry, B. D., Pollard, R. A., Blakley, T. L., Baker, W. L., & Vigilante, D.
(1995). Childhood trauma, the neurobiology of adaptation, and “use-
dependent” development of the brain: How “states” become “traits”.
Infant Mental Health Journal, 16(4), 271–291. https://doi.org/10.1002/
1097-0355(199524)16:4�271::AID-IMHJ2280160404�3.0.CO;2-B
�Perry, D. L., & Daniels, M. L. (2016). Implementing trauma-informed
practices in the school setting: A pilot study. School Mental Health, 8(1),
177–188. https://doi.org/10.1007/s12310-016-9182-3
�Pfenninger Saint Gilles, M. (2016). A pilot study of the effects of a trauma
supplement intervention on agency attitudes, classroom climate, head
start teacher practices, and student trauma-related symptomology [Doc-
toral dissertation, Michigan State University].
Phifer, L. W., & Hull, R. (2016). Helping students heal: Observations of
trauma-informed practices in the schools. School Mental Health, 8(1),
201–205. https://doi.org/10.1007/s12310-016-9183-2
Rolfsnes, E. S., & Idsoe, T. (2011). School-based intervention programs for
PTSD symptoms: A review and meta-analysis. Journal of Traumatic
Stress, 24(2), 155–165. https://doi.org/10.1002/jts.20622
Saakvitne, K. W., Gamble, S., Pearlman, L. A., & Lev, B. T. (2000).
Risking connection: A training curriculum for working with survivors of
childhood abuse. The Sidran Press.
�Shamblin, S., Graham, D., & Bianco, J. A. (2016). Creating trauma-
informed schools for rural Appalachia: The partnerships program for
enhancing resiliency, confidence and workforce development in early
childhood education. School Mental Health, 8(1), 189–200. https://doi
.org/10.1007/s12310-016-9181-4
Skowron, E., & Reinemann, D. H. S. (2005). Effectiveness of psycholog-
ical interventions for child maltreatment: A meta-analysis. Psychother-
apy: Theory, Research, Practice, Training, 42(1), 52–71. https://doi.org/
10.1037/0033-3204.42.1.52
Soleimanpour, S., Geierstanger, S., & Brindis, C. D. (2017). Adverse
childhood experiences and resilience: Addressing the unique needs of
adolescents. Academic Pediatrics, 17(7), 108–114. https://doi.org/10
.1016/j.acap.2017.01.008
Stokes, H., & Turnbull, M. (2016). Evaluation of the Berry Street Educa-
tion Model: Trauma informed positive education enacted in mainstream
schools. University of Melbourne Graduate School of Education, Youth
Research Centre.
Substance Abuse and Mental Health Services Administration (SAMHSA).
(2014). SAMHSA’s concept of trauma and guidance for a trauma-
informed approach. https://store.samhsa.gov/system/files/sma14-4884
Threlfall, J. M., Auslander, W., Gerke, D., McGinnis, H., & Tlapek, S. M.
(2017). Mental health and school functioning for girls in the child
welfare system: The mediating role of future orientation and school
engagement. School Mental Health, 9(2), 194–204. https://doi.org/10
.1007/s12310-017-9207-6
van der Kolk, B. A. (2005). Developmental trauma disorder: Toward a
rational diagnosis for children with complex trauma histories. Psychiat-
ric Annals, 35(5), 401– 408. https://doi.org/10.3928/00485713-
20050501-06
Watson, S. M. R., & Westby, C. E. (2003). Prenatal drug exposure:
Implications for personnel preparation. Remedial and Special Education,
24(4), 204–214. https://doi.org/10.1177/07419325030240040401
Weiner, H., Ward, A., & Yasik, A. E. (2011, August). Examining the
effectiveness of psychological treatments and interventions for child
maltreatment: A meta-analysis [Paper presentation]. Washington DC:
American Psychological Association 2011 Convention. Retrieved from
EBSCO Host database on 28th October 2018.
Wolpow, R., Johnson, M. M., Hertel, R., & Kincaid, S. O. (2009). The
heart of learning and teaching: Compassion, resiliency, and academic
success. https://www.k12.wa.us/sites/default/files/public/compassionate
schools/pubdocs/theheartoflearningandteaching
Zakszeski, B. N., Ventresco, N. E., & Jaffe, A. R. (2017). Promoting
resilience through trauma-focused practices: A critical review of school-
based implementation. School Mental Health, 9(4), 310–321. https://doi
.org/10.1007/s12310-017-9228-1
Zielinski, D. S. (2009). Child maltreatment and adult socioeconomic well-
being. Child Abuse and Neglect, 33(10), 666–678. https://doi.org/10
.1016/j.chiabu.2009.09.001
Received October 18, 2019
Revision received April 15, 2020
Accepted May 27, 2020 �
T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
Ps
yc
ho
lo
gi
ca
l
A
ss
oc
ia
tio
n
or
on
e
of
its
al
lie
d
pu
bl
is
he
rs
.
T
hi
s
ar
tic
le
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.
167CHILDHOOD ADVERSITY AND ACADEMIC FUNCTIONING
https://doi.org/10.1007/s40653-017-0160-1
https://doi.org/10.1007/s12310-016-9184-1
https://doi.org/10.1007/s12310-016-9175-2
https://doi.org/10.1002/1097-0355%28199524%2916:4%3C271::AID-IMHJ2280160404%3E3.0.CO;2-B
https://doi.org/10.1002/1097-0355%28199524%2916:4%3C271::AID-IMHJ2280160404%3E3.0.CO;2-B
https://doi.org/10.1007/s12310-016-9182-3
https://doi.org/10.1007/s12310-016-9183-2
https://doi.org/10.1002/jts.20622
https://doi.org/10.1007/s12310-016-9181-4
https://doi.org/10.1007/s12310-016-9181-4
https://doi.org/10.1037/0033-3204.42.1.52
https://doi.org/10.1037/0033-3204.42.1.52
https://doi.org/10.1016/j.acap.2017.01.008
https://doi.org/10.1016/j.acap.2017.01.008
https://store.samhsa.gov/system/files/sma14-4884
https://store.samhsa.gov/system/files/sma14-4884
https://doi.org/10.1007/s12310-017-9207-6
https://doi.org/10.1007/s12310-017-9207-6
https://doi.org/10.3928/00485713-20050501-06
https://doi.org/10.3928/00485713-20050501-06
https://doi.org/10.1177/07419325030240040401
https://www.k12.wa.us/sites/default/files/public/compassionateschools/pubdocs/theheartoflearningandteaching
https://www.k12.wa.us/sites/default/files/public/compassionateschools/pubdocs/theheartoflearningandteaching
https://doi.org/10.1007/s12310-017-9228-1
https://doi.org/10.1007/s12310-017-9228-1
https://doi.org/10.1016/j.chiabu.2009.09.001
https://doi.org/10.1016/j.chiabu.2009.09.001
A Systematic Review on the Impact of Trauma-Informed Education Programs on Academic and Academic …
The Prevalence of Childhood Adversity
Intervention and Its Impact on Outcomes
School-Based Intervention
The Current Study
Method
Literature Search
Inclusion Criteria
Data Coding
Results
Interventions Used Across the Studies
Preschool
Primary/Elementary School
High School
Discussion
Implications for Future Research
Trauma-Informed Education Programs
Trauma-Informed School-Based Research
Disseminating Research
Considering Moderators and Mediators
Limitations
Conclusion
References
79
As reviewed in Chapter 4, several models have been proposed to
enhance school climate and schoolwide supports for students exposed
to trauma through the creation of trauma-informed schools. Although
research on the effectiveness of these models is lacking, the largest area
of growth in evidence-based trauma-informed programming for schools
has been in the area of interventions for trauma-exposed students. These
intervention models have received great interest in part because of their
ability to circumvent many of the barriers that impede children from get-
ting mental health care in specialty settings. By delivering mental health
care in schools, usually with no cost to the family, many logistical barriers
(transportation, scheduling) are removed, and the stigma associated
with mental health treatment is decreased as well. To date, the interven-
tions developed specifically for use in schools are targeted intervention
programs, designed to help students with elevated symptoms following
Targeted and Intensive
Interventions for Trauma
in Schools
7
http://dx.doi.org/10.1037/0000072-008
Creating Healing School Communities: School-Based Interventions for Students Exposed to Trauma,
by C. D. Santiago, T. Raviv, and L. H. Jaycox
Copyright © 2018 by the American Psychological Association. All rights reserved.
Co
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
CREATING HEALING SCHOOL COMMUNITIES
80
trauma. Students requiring more intensive services are still generally
referred out to specialty care, although some evidence-based treatments
have been successfully delivered on school campuses. In this chapter, we
review each of these in turn.
SCHOOL-BASED TARGETED INTERVENTIONS
Compatible with the Multi-Tiered System of Supports models presented
earlier, targeted interventions generally fit into the Tier 2 level. Several
interventions have been developed in this area, and some have been eval-
uated and have demonstrated positive outcomes for students. A compre-
hensive review of these programs can be found in other sources (Jaycox,
Morse, Tanielian, & Stein, 2006; Jaycox, Stein, & Amaya-Jackson, 2008;
Jaycox, Stein, Amaya-Jackson, & Morse, 2007; Rolfsnes & Idsoe, 2011).
In general, the majority of such interventions involve cognitive behavior
therapy (CBT; Rolfsnes & Idsoe, 2011). The core components of CBT
that addresses traumatic exposure can be summarized by the acronym
PRACTICE: Parenting skills, Psychoeducation, Relaxation skills, Affective
Modulation skills, Cognitive coping skills, Trauma narrative, In vivo mas-
tery of trauma reminders, Conjoint sessions for parents, and Enhancing
safety (see Exhibit 7.1; Cohen, Mannarino, & Deblinger, 2006). Although
Exhibit 7.1
Evidence-Based Intervention Techniques
77 Parenting skills
77 Psychoeducation
77 Relaxation skills
77 Affective modulation skills
77 Cognitive coping skills
77 Trauma narration
77 In vivo mastery of trauma reminders
77 Conjoint sessions for caregivers
77 Enhancing safety
Co
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
TARGETED AND INTENSIVE INTERVENTIONS FOR TRAUMA IN SCHOOLS
81
other techniques and theoretical orientations are also used in some pro-
grams (e.g., psychodynamic theories, crisis intervention models), they are
less common and tend to be less well-tested to date. One obvious reason
for the popularity of CBT in these interventions is its strong evidence base
among adults and in different modalities (see Foa, Keane, Friedman, &
Cohen, 2008). In addition, these techniques can easily be delivered in group
formats in the school setting. For instance, the psychoeducational compo-
nents of CBT can be delivered in a didactic manner, and the behavioral
assignment setting that is integral to CBT is similar to the concept of home-
work. Table 7.1 summarizes key interventions; we review each in turn in
this section. The Resources section of this book lists URLs you can access
for more information about these programs.
Table 7.1
Selected School-Based Interventions
Name Description Target Evidence Dissemination
Cognitive
Behavioral
Intervention
for Trauma
in Schools
CBT, 10 group
sessions,
1–3 individual
sessions,
1 teacher ses-
sion, 2 parent
sessions
5th grade
and
above
1 RCT, 1 quasi-
experimental
study, 1 field
trial
Wide dissemina-
tion through
http://www.
cbitsprogram.
org and
national
training
Support for
Students
Exposed to
Trauma
CBT, adaptation
of CBITS for
nonclinical
school person-
nel, 10 group
sessions
5th grade
and
above
1 pilot study Wide dissemina-
tion through
http://www.
ssetprogram.
org and
national
training
Bounce Back CBT, adaptation of
CBITS for early
elementary,
10 group ses-
sions, 2–3 indi-
vidual sessions
Grades K–5 2 RCTs Wide dissemina-
tion through
http://www.
bounceback
program.org
and national
training
(continues)
Co
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
CREATING HEALING SCHOOL COMMUNITIES
82
Trauma-
Focused
Coping in
Schools
CBT, 14 group and
1 individual
session
6–18 years 1 quasi-
experimental
study
Information
and training
available from
developers
Trauma Grief
Component
Therapy for
Adolescents
CBT + grief
work, 10–24
50-minute
individual or
group sessions
12–20 years 1 quasi-
experimental
study, 3 open
trials
Information
and training
available from
developers
Classroom-
Based
Intervention
CBT, 15 classroom-
based sessions
7–19 years 1 RCT Information
and training
available from
developers
Overshadowing
the Threat of
Terrorism
CBT for ongoing
terrorism
context
Grades 2–6 1 RCT Information
and training
available from
developers
Enhancing
Resilience
Among
Students
Experiencing
Stress
CBT curriculum
for teachers
related to
ongoing terror-
ism context
Grades 3–8 1 RCT, 2 quasi-
experimental
studies
Information
and training
available from
developers
Note. CBT = cognitive behavior therapy; CBITS = Cognitive Behavioral Intervention for Trauma in
Schools; RCT = randomized controlled trial.
Table 7.1
Selected School-Based Interventions (Continued)
Name Description Target Evidence Dissemination
Cognitive Behavioral Intervention for Trauma in Schools (CBITS;
Jaycox, 2003) is probably the most widely used and accessible program,
it has demonstrated improvement in child posttraumatic stress disorder
(PTSD) and depressive symptoms in several studies, and it is associated
with improved academic outcomes. It involves 10 group sessions, one
to three individual sessions, two parent meetings, and one teacher pre-
sentation and is delivered by school mental health providers. CBITS is
recommended for students in fifth grade or higher. The program was eval-
uated first in a quasi-experimental study with students who were recent
Co
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
TARGETED AND INTENSIVE INTERVENTIONS FOR TRAUMA IN SCHOOLS
83
immigrants to Los Angeles and who received the program in Spanish
(Kataoka et al., 2003). Results demonstrated a significant decrease in PTSD
and depressive symptoms in the group of students who received CBITS as
compared with those on a waiting list. A second evaluation among students
in the general school population showed similar results in a randomized
controlled trial (Stein et al., 2003), with significantly lower scores on mea-
sures of depression, PTSD, psychosocial dysfunction among those ran-
domized to receive CBITS, but no difference observed for teacher-reported
behavior problems. A subsequent analysis of changes in grades within this
study showed that those who received CBITS earlier in the school year had
improved grades compared with those who received it later in the year
(Kataoka et al., 2011). A field trial in New Orleans following Hurricane
Katrina showed comparable results in terms of reductions in PTSD and
depression scores among those randomized to CBITS as well as those who
received trauma-focused CBT (Jaycox et al., 2010). The program is being
implemented broadly within the United States (e.g., New Orleans, Chicago,
Los Angeles, San Francisco, several cities in Connecticut).
Three adaptations of CBITS are also promising. Bounce Back is a pro-
gram that has been developed for younger elementary students. This inter-
vention addresses the same core components but in a more developmentally
appropriate manner, and it involves parents to a larger degree than CBITS.
It has demonstrated improved child PTSD and anxiety symptoms in one
randomized controlled trial (Langley, Gonzalez, Sugar, Solis, & Jaycox,
2015) and improved PTSD symptoms and coping skills in a replication trial
(Santiago et al., in press). A second adaptation for CBITS, called Support for
Students Exposed to Trauma, was developed for nonclinical school person-
nel such as teachers or school counselors (Jaycox, Langley, & Dean, 2009). In
one pilot study it demonstrated improved outcomes (reductions in PTSD
symptoms and depression) and thus is considered a promising approach,
even though it led to no changes in parent- or teacher-reported behavior
problems (Jaycox, Langley, Stein, et al., 2009). The addition of a family
component showed that parent functioning can be improved alongside the
child improvements (Santiago, Lennon, Fuller, Brewer, & Kataoka, 2014).
CBITS, Support for Students Exposed to Trauma, and Bounce Back
are disseminated through the websites listed in the Resources section of
Co
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
CREATING HEALING SCHOOL COMMUNITIES
84
this book, which provide extensive implementation materials and an online
training course for each. Live trainings are usually arranged on-site for
groups of school mental health providers. Training manuals for Bounce
Back and Support for Students Exposed to Trauma are available for down-
load free of charge; the CBITS manual is available for purchase.
Two other school-based interventions have also been evaluated and
have demonstrated improved child outcomes: Trauma-Focused Coping in
Schools (formerly called Multi-Modality Trauma Treatment; Amaya-Jackson
et al., 2003; March et al., 1998), and the Trauma Grief Component Therapy
for Adolescents (formerly called the University of California, Los Angeles
Trauma/Grief Program; Goenjian et al., 2005; Saltzman, Steinberg, Layne,
Aisenberg, & Pynoos, 2001). Both draw on evidence-based practices for
trauma, largely cognitive behavior techniques, and have empirical support
for the reduction of trauma-related symptoms. Specifically, Trauma-Focused
Coping in Schools was evaluated with a staggered start date control design
and showed decreases in PTSD, depressive, and anxiety symptoms among
14 treated students (March et al., 1998). These effects were replicated in sub-
sequent studies (Amaya-Jackson et al., 2003). Trauma Grief Component
Therapy for Adolescents, targeting community violence in Southern Cali-
fornia, showed reductions in PTSD and grief symptoms and improvements
in GPA among 26 participants in an open trial, but it did not show changes
in depressive symptoms (Layne, Pynoos, & Cardenas, 2001; Saltzman,
Pynoos, Layne, Steinberg, & Aisenberg, 2001). A brief version of the pro-
gram demonstrated reductions in PTSD symptoms in two field trials fol-
lowing an earthquake in Armenia (Goenjian et al., 1997, 2005). In addition,
the program was implemented in postwar Bosnia (Layne, Pynoos, Saltzman,
et al., 2001), showing greater reductions in PTSD, depression, and maladap-
tive grief, within the full program as compared with an active comparison
condition, with both groups improving significantly (Layne et al., 2008).
Trauma-Focused Coping in Schools is implemented with groups of
students, whereas Trauma Grief Component Therapy for Adolescents is
run with individual students or in groups. Both of these interventions
require 1 to 2 days of in-person training by the program authors. Access to
implementation manuals and materials requires contacting the authors of
the intervention.
Co
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
TARGETED AND INTENSIVE INTERVENTIONS FOR TRAUMA IN SCHOOLS
85
There also have been some notable international efforts in regions
affected by disaster or ongoing terrorist threat, five of which have been
evaluated. The Classroom-Based Intervention program (Macy, Bary, &
Noam, 2003) is a 15-session, classroom-based intervention providing a
psychoeducational curriculum for children ages 7 to 19 that is used to
address critical needs of children and youth exposed to threat and terror
(Macy et al., 2003). A large randomized controlled trial of 664 children
and adolescents in Turkey following an earthquake and in the West Bank/
Gaza schools and camps for Palestinian refugees showed improvements
among children (ages 4–11) and female adolescents (ages 12–16). Improve-
ments were noted on multiple domains, including communication, social
support, negotiation skills, use of relaxation as a coping strategy and,
among younger children, decreasing emotional and behavior problems. No
improvements were noted among adolescent boys (ages 12–16), however
(Khamis, Macy, & Coignez, 2004).
An eight-session program for second through sixth graders called
Overshadowing the Threat of Terrorism has been used and evaluated in
Israel (Berger, Pat-Horenczyk, & Gelkopf, 2007), showing reduced PTSD,
somatic, and anxiety symptoms 2 months after the intervention among
children who took part. A related program, more curricular in nature, is
Enhancing Resilience Among Students Experiencing Stress (ERASE-S),
designed to mitigate the effects of ongoing terrorism. ERASE-S uses teachers
to deliver the material and has demonstrated improved outcomes in terms
of PTSD and anxiety, as well as reduced stereotypes and discriminatory
behaviors (Berger, Gelkopf, & Heineberg, 2012; Berger, Gelkopf, Heineberg,
& Zimbardo, 2016; Gelkopf & Berger, 2009). Although these programs use
many of the same cognitive behavior techniques as those developed within
the United States, none of them have been tested within the United States
to date, and their applicability to U.S. schoolchildren is unknown.
OTHER TREATMENTS USED IN SCHOOLS
The interventions described in the preceding section were all developed
specifically for use in schools. It is certainly possible to bring clinical ser-
vices onto school campuses and adapt them to fit the school context and
Co
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
CREATING HEALING SCHOOL COMMUNITIES
86
culture. These are typically considered Tier 3 services within the Multi-
Tiered System of Supports framework, and a full review of their effec-
tiveness can be found in Foa et al. (2008). Implementing these types of
interventions can be challenging as they require more intensive training
and supervision for school mental health providers, fitting the sessions
into the school day, and handling logistical issues such as space and privacy.
Despite these challenges, these interventions can be good options
for students with demonstrated clinical need. We review a few selected
interventions here (and summarize the salient points in Table 7.2). For
instance, an adaptation of Trauma-Focused Cognitive Behavior Therapy
(TF-CBT; Cohen et al., 2006) has begun to be implemented in school
settings. Although this treatment has a good deal of empirical support
from multiple studies, its effectiveness in schools has not been formally
evaluated. Other examples of efforts to bring clinical treatments into
schools include Community Outreach Program—Esperanza (De Arellano
et al., 2005), which integrates the core components of a TF-CBT pack-
age with Parent–Child Interaction Therapy and case management for
children ages 4 to 18. Life Skills, Life Stories (Cloitre, Koenen, Cohen, &
Han, 2002) is a clinical program for women that was adapted for female
high school students with histories of sexual victimization and child
abuse. A version for adolescents, called STAIR-A, was tested in schools in
a quasi-experimental study and found to reduce depressive symptoms
and improve some aspects of functioning (Gudiño, Leonard, & Cloitre,
2016). Trauma Adaptive Recovery Group Education and Therapy for
Adolescents (Ford, Mahoney, & Russo, 2001) focuses on body self-
regulation, memory, interpersonal problem solving, and stress man-
agement for youths ages 10 to 18 affected by physical or sexual abuse,
domestic or community violence, or traumatic loss. Structured Psy-
chotherapy for Adolescents Responding to Chronic Stress (DeRosa &
Pelcovitz, 2009) for teens (ages 12–19) exposed to chronic interpersonal
traumas combines CBT and dialectical behavior therapy approaches
(including mindfulness) to improve coping, affect regulation, relation-
ships, and functioning in the present. Although each of these treat-
ments has some evidence of their effectiveness, their use in schools has
not been formally tested.
Co
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
TARGETED AND INTENSIVE INTERVENTIONS FOR TRAUMA IN SCHOOLS
87
Table 7.2
Selected Clinical Treatments Used in School Settings
Name Description Target Application in schools
Trauma-Focused
Cognitive
Behavior Therapy
(Jaycox et al.,
2010)
Cognitive behavior
therapy in parent–child
dyads
Ages 3–18 Limited use in
schools, not for-
mally tested
Community
Outreach
Program—
Esperanza
(De Arellano
et al., 2005)
Trauma-Focused Cogni-
tive Behavior Therapy
components plus
Parent–Child Inter-
action Therapy
components and
case management for
parent–child dyads,
delivered in homes and
community settings
Ages 4–18 Designed for use in
schools and other
community settings
Life Skills, Life
Stories (Gudiño,
Leonard, &
Cloitre, 2016)
Group sessions to build
social emotional
competencies
Girls, ages
12–21 with
a history of
abuse
Some use in schools,
tested in one study
with good effects
Trauma Adaptive
Recovery Group
Education and
Therapy for
Adolescents
(Ford, Mahoney,
& Russo, 2001)
Group or individual cog-
nitive behavior therapy
with focus on emotion
regulation
Ages 10–18,
complex
trauma
Designed for use in
juvenile justice set-
tings (community
or residential) or
schools
Structured
Psychotherapy
for Adolescents
Responding to
Chronic Stress
(DeRosa &
Pelcovitz, 2009)
Group cognitive behavior
therapy and dialectical
behavior therapy
elements
Ages 12–19,
complex
trauma
Designed for use in
clinical settings, not
formally tested in
schools
Co
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
CREATING HEALING SCHOOL COMMUNITIES
88
CONCLUSION
This chapter summarized the most widely known and evaluated school-
based programs for trauma. However, many more programs have been
developed locally to respond to disasters, school crises such as shootings,
and the everyday occurrence of family and community violence. These
local efforts often remain untested, and so their effectiveness is unknown.
The few programs examined in randomized controlled trials show mod-
erate to large improvements in child outcomes (Jaycox, Stein, & Amaya-
Jackson, 2008). School mental health providers together with their school
administration can select programs that will best fit their school environ-
ment and student body. Programs that have been designed for and tested
within schools, with good evidence, will likely be most successful.
Co
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
Trauma-Informed Preschool Education in Public
School Classrooms: Responding to Suspension,
Expulsion, and Mental Health Issues of Young
Children
Dolores (Dee) Stegelin, Carmen Leggett, Diane Ricketts, Misty Bgant, Chanci Peterson, and Andrea Holzner
Abstract: The mpid expansion of public-school Meschool programs significantly challenges America’s school administratom, teachers, and
school professionals. The complex issues of preschool mental health needs, expulsion, and suspension are at the forefTont In the United
States, schools aTe reporting Tapidly increasing numbers of Meschool programs, Mimarily in the form of 3K, 4K, and inclusion Mograms.
This dramatic increase of young childmn in the public schools is a result of (a) TeseaTch on the long·term cognitive and social benefits of
high-quality early childhood programs, (b) fedual and state legislation supporting statefunded preschool education, and (c) the continued
need to support working parents via public-funded education for their young children. This article is a review of the TeseaTch on Meschool
mental health. and early Mauma Bom adverse childhood experiences (ACEs), the impact of suspension and expulsion on preschool children,
and the benefits of high-quality preschool programs in the public schools. Also included is a review of current policies and pmctices in ex-
emplary public-school preschool tn-ograms related to mental health services, ACEs, suspension, and expulsion. Recommendations for future
policy and practices for the pieschool population are presented. Appendix B provides resources for school administrators and professionals.
The issues of preschool mental health, suspension, Furthermore, teachers are reporting higher levels of
and expulsion are timely ones as significant societal stress and inadequate support to meet the needs of these
forces are converging to bring these important issues children (Carolan & Connors-Tadros, 2015). Some profes-
to the forefront (Carolan & Connors-Tadros, 2015). Public sionals describe this phenomenon as a secondary traumatic
schools across the nation are reporting rapidly expanding stress reaction; teachers are absorbing and responding to
preschool programs, primarily in the form of 3K, 4K, and the primary trauma ofyoung children with whom they are
inclusion programs (Bouffard, 2018). The growth in num- working (Carolan & Connors-Tadros, 2015). Compassion
bers of young children in the public schools is a result of fatigue, or secondary traumatic stress disorder, is a natural
a) recognition ofthe research-based and long-term benefits but disruptive by-product of working with traumatized
of high- quality early childhood programs, b) federal and individuals (Lawson et al., 2019). It is a set of observable
state legislation supporting public-funded preschool edu- reactions to working with people who have been trauma-
cation, and c) the continued need for support of working tized and mirrors the symptoms of posttraumatic stress
parents via public-funded preschool education (Heckman, disorder (PTSD; Osofsky et al., 2008). In short, school
2017; Schweinhart et al., 2011). See Appendix A for appli- administrators, many with limited education regarding and
cable definitions. experience with the preschool population, must confront
In the United States, childcare for most families is complex decisions on how best to address developmental,
among the largest of their household expenses; thus, par- behavioral, and emotional needs of 3- and 4-year-old chil-
ents are supportive of public-funded preschool programs dren as well as preschool teachers’ fatigue and secondary
for their 3- to 5-year-olds (Whitehurst, 2018). In addition to trauma (Hancock & Carter, 2016; Stegelin, 2018).
the sheer growth of preschool programs in school settings First, there is a critical need for increased awareness
from coast to coast (Bouffard, 2018), schools are reporting that young children have mental health issues and that the
an increased incidence of behavioral and developmental problems that they encounter will require comprehensive
challenges in the preschool population (Hancock & solutions (Giannakopoulos et al., 2014). Children are
Carter, 2016). This is documented in the relatively high developmentally less able to express their feelings and
rate of preschool suspension and/or expulsion and is verbalize their needs (Choi & Graham-Bermann, 2018).
a practice that is often a last resort for the teacher and The tendency is to believe that mental health issues devel-
school administrator (Gilliam, 2005; Gilliam et al., 2016). op over time and arise later, thus not directly impacting
The practice of suspension and expulsion reflects how young children (Choi & Graham-Bermann, 2018). The
difficult it is for teachers and administrators to sufficiently important study of adverse childhood experiences (ACEs)
address challenging, complex, and sometimes disruptive provides information on how major trauma very early in
child behaviors (Gilliam et al., 2016; Stegelin, 2018). The a person’s life can have a lasting and profound impact
result is that many preschool children are unable to cope on long-term mental and physical well-being (Centers for
with or negotiate the demands of public-school preschool’s Disease Control and Prevention, 2019; Giannakopoulos
daily routines, structured environments, and academic et al., 2014). ACEs research clearly offers evidence that
expectations (Statman-Weil, 2015) children with higher levels of trauma in the early years
THE JOURNAL OF AT-RISK ISSUES 9
are associated with poorer physical and mental health child development (Knopf, 2016). All young children are
outcomes as adults (Centers for Disease Control and vulnerable to mental health issues, and those children with
Prevention, 2019). Those working with children need to early trauma are more at risk (Liming & Grube, 2018). The
increase their awareness and understanding that young research on adverse childhood experiences (ACEs) height-
children-birth to age 5-do in fact experience feelings of ens awareness of the impact of early trauma on children’s
anxiety, depression, and other mental health conditions, overall development and the apparent relationship between
many of which are related to early traumatic experiences early trauma and associated adult health conditions, both
(Knopf, 2016; Liming & Grube, 2018). physical and mental (Liming & Grube, 2018). This research
Second, there is a need to educate professionals, is important to consider within the context of preschool
parents, and the public about the need for trauma- children in public schools (Whitted, 2011). According to
informed education in our school systems (Nicholson et Carolan and Connors-Tadros (2015), the criteria for enroll-
al., 2019). To meet the needs of individual young children ment in public-school preschool programs are frequently
in our public-school classrooms, a multidisciplinary team based on factors such as being low-income, having single
approach with teachers, social workers, nurses, school parent status, parental distress, developmental delays,
counselors, psychologists, parents, pediatricians, adminis- immigrant status, and other family stressors. Thus, the ,
trators, and others is recommended (O’Reilly et al., 2018; children who are accepted into state-funded preschool
Statman-Weil, 2015). Trauma-informed early education programs in the schools are more likely to have experienced
is aligned with the concept of individualized education early trauma that is associated with their developmental
plans (IEPs) for older students with special needs. Teachers.~ and social demographics (Carolan & Connors-Tadros,
administrators, and professional staff (school psycholo- 2015). In addition, children and families who meet these
gists, counselors, social workers, nurses, special education criteria are more likely to be represented by minority pop-
coordinators, and preschool program directors) need to
provide ongoing systemic and individualized assessment ulations, especially African American and Latinx families
and support for children demonstrating the developmental (Gilliam et al., 2016).
Not only are preschool children more likely to ex-
and behavioral impacts of early trauma and mental health perience early trauma and subsequent changes in brainconditions (Nicholson et al., 2019).
Third, there is a need to implement trauma-informed development, but they are also more likely to present men-
early education in schools (Fazel et al., 2014). Based on tal health issues when compared to the general preschool
guidance from Fazel et al. (2014) and Nicholson et al. population (Nicholson et al., 2019). They are also more
(2019), trauma-informed early education requires all pro- likely to experience associated health-related conditions
fessionals to (a) understand the impact of trauma on early later, such as cardiovascular diseases, respiratory diseas-
brain development, (b) construct school and classroom en- es, obesity, cancer, and other chronic health conditions
vironments that support trauma-impacted young children’s (Liming & Grube, 2018). Finding a solution to the mental
emotional and developmental needs and those with mental health needs of preschool children requires understand-
health issues, (c) implement instructional and assessment ing the phenomenon of early trauma, its impact on brain
strategies that are developmentally appropriate and attuned development, and its impact on later development and
to the social-emotional needs of these children, (d) follow quality of life in adolescence and adulthood (Carolan &
up intervention as a team and with written documenta- Connors-Tadros, 2015). The research on ACEs provides a
tion of progress, and (e) engage and educate parents and useful framework for professionals who work with young
families about trauma and the team effort to intervene children impacted by trauma and mental health issues
and maintain consistency in expectations between the (Centers for Disease Control and Prevention (CDC), 2019;
home and classroom. Liming & Grube, 2018). The impact of children’s early
In summary, the convergence of several major forces traumatic experiences can be lessened and remediated
creates a complex and challenging situation for America’s (CDC, 2019). Children are inherently resilient; thus, they
public schools. In addition, public-funded preschool pro- are responsive to teachers, caregivers, and parents who are
grams, such as state-funded 4K and federally funded Head nurturing, responsive, and in tune with the child’s needs
Start, typically have enrollment criteria that are aligned (Pianta et al., 2009). This offers hope for these young
with such factors as lower family income and parental children and motivates researchers and practitioners to
educational levels, developmental delay, special education garner the necessary resources to meet their needs while
needs, and other family/social/health indicators (Carolan the children are still in the formative preschool years (U.S.
& Connors-Tadros, 2015). This translates into a preschool Department of Education, 2016).
population in public-school classrooms that is more in need
of social, emotional, economic, and academic support and Expulsion and Suspension of Preschool Children
early intervention than the general preschool population Each year, thousands of preschool children are sus-
(Carolan & Connors-Tadros, 2015; Knopf, 2016). pended or expelled from their early childhood care and
education programs (Hancock & Carter, 2016; Zeng et al.,
Review of Research Literature 2019). As an example, over 8,700 children 3- and 4-years-
Eady Mental Health and Tmuma Impacts old are expelled from state-funded preschool or prekinder-
The growing emphasis on preschool mental health garten classroorns (Hancock and Carter 2016; Stegelin,
is related to understanding the impact of early trauma on 2018). Hancock and Carter (2016) found that preschool
10 VOLUME 23 NUMBER 2
children are expelled at three times the rate of children the form of 4-year-old kindergarten (4K) designed to meet
in kindergarten through 12th grade. Importantly, marry of the needs of the state’s young children who have demon-
these preschool children suspended are identified as Afri- strated developmental delays or disabilities (Best & Cohen,
can American boys (Gilliam et al., 2016). These racial and 2013; U.S. Department of Education, 2018). According
gender disparities are evident as early as preschool, where to the U.S. Department of Education (2018), hundreds of
Black students are 3.6 times more likely to receive an out- thousands of preschool children across the country have
of-school suspension as their White classmates (Hancock access to high-quality early learning programs. In 2013,
& Carter, 2016; Stegelin, 2018). In addition, while boys President Obama put forth the Preschool for All proposal
represent 54% of preschool enrollment, they constitute to establish a federal-state partnership that would provide
79% of all suspended preschool children (Stegelin, 2018). high quality preschool for all 4-year-olds from low and
More than 10 years after foundational research by Gilliam moderate income families (U.S. Department of Education,
(2005), federal data reflect a disproportionate number of 2016), These evidence-based programs document the long-
male students representing minority populations. African term benefits of high-quality early childhood programs,
American and Latinx children are expelled along with especially young children from economically challenged
English Language Learners and students with disabili- households (Heckman, 2017; Schweinhart et al., 2011).
ties, all of whom would benefit from daily attendance in After President Obama’s call for expanded programs
high-quality preschool programs (Horowitz, 2015). for 4-year-olds, many states took action, and nearly all states
Early suspension or expulsion from their preschool now offer preschool programs in the public schools for
programs creates another form of trauma for these young young children (U.S. Department of Education, 2016). In
children (Morrison, 2015). According to the joint policy the 2015-16 budget year, for example, states increased their
statement on suspension and expulsion policies in early investments in preschool programs by nearly $767 million
childhood settings, the beginning years of any child’s life or 12% over the 2014-15 fiscal year (U.S. Departmentare critical for building the early foundation of learning
health and wellness needed for school and in adulthood of Education, 2016). From 2009 to 2015, states enrolled
(U.S. Health and Human Resources and Education, 2014). 48,000 more 4-year-olds in state-run preschool programs
Bronfenbrenner’s ecological systems theory explains the (U.S. Department of Education, 2016). The Obama
dynamics of preschool suspension and expulsion within Administration increased investments by over $6 billion
the context and dynamics of the child’s microsystem (Mor- in early childhood programs from FY 2009 to FY 2016,
rison, 2015; Psychology Notes Headquarters, 2019). During including high-quality preschool, Head Start, childcare
these early years, children’s brains are developing rapidly, subsidies, evidence-based home visiting, and programs for
influenced by the experiences that they share within their infants and toddlers with disabilities (U.S. Department
microsystems: their families, caregivers, teachers, peers, of Education, 2018). Former U. S. Secretary of Education
and communities. Both positive and negative experiences John B. King Jr., said:
play major roles (Morrison, 2015; Stegelin, 2018).
The practice of preschool suspension and expulsion A high-quality early education provides the foun-
should direct focus even more on the mental health of dation that every child needs to start kindergarten
preschool children and the likelihood that these children prepared for success. Because of historic invest-
are more vulnerable to mental health issues (Knopf, 2016). ments from the Obama Administration, states and
Preschool suspension and expulsion impact the young cities, more children, particularly those who have
child, the family, and society in general (Stegelin, 2018). been historically underserved, now have access to
The effect of suspension and expulsion on the child is high-quality early learning. But we can’t stop there.
immediate and can have long-term implications for the We must continue our collective work to ensure
child’s overall emotional and social development as well that all children regardless of socioeconomic status,
as the likelihood of permanent school dropout in the later race, background, language spoken at home, dis-
years (Horowitz, 2015). In the long run, the negative effects ability or zip code have access to the opportunities
of early suspension and expulsion may play out in middle that prepare them to thrive in school and beyond.
and secondary education settings, future employment, (U.S. Department of Education, 2016)
and, in some cases, the criminal justice system (Stegelin,
2018). Young students who are suspended or expelled State-funded preschool programs continue to expand
are as much as 10 times more likely to drop out of high across the United States, with some states also adding 3K
school, experience academic failure and grade retention, and inclusion programs to the more typical 4K programs
hold negative school attitudes, and face incarceration than (Stegelin, 2018). These programs are diverse and com-
those preschoolers who do not experience suspension or munity driven in terms of admission criteria, selected
expulsion (U.S. Department of Health and Human Ser- curriculum, and program locations, and some state-fund-
vices and Education, 2014; U.S. Department of Education ed 4K programs are situated in childcare or Head Start
Office for Civil Rights, 2014). programs, reflecting new partnerships in the delivery of
high-quality preschool programs (Stegelin, 2018). Even
Rapid Growth of Public-School Preschool Programs though this new early education initiative is state direct-
Across the United States there has been a rapid ex- ed, there are common goals regarding the establishment
pansion of classrooms for preschool children, especially in and implementation of public-school preschool programs
THE JOURNAL OF AT-RISK ISSUES 11
(Stegelin, 2018). Common goals across the states imple- Preschool Mental Health Initiatives and the
menting preschool programs funded at the state level are Public Schools
premised on the belief that high-quality early childhood As preschool programs expand in the public schools,
programs lead to more robust and successful academic and some school districts are developing innovative approaches
employment futures for these children (Heckman, 2017; to meet the mental health needs of these young children
Schweinhart er al., 2011). The program goals include en- (Statman-Weil, 2015). These school settings provide a
hanced overall child development; cognitive development fertile ground for both research and program innovation
and attainment of basic concepts related to mathematics related to preschool mental health issues (Fenwick-Smith
and science; social-emotional development and the skills et al., 2018). Children spend more time in public schools
to work with others, negotiate group settings, and develop than in any other formal institutional structure (Fazel et
a strong sense of self and positive self-esteem; language al., 2014).Thus, the public schools play a key part in chil-
development and the ability to recognize letters and the dren’s development, ranging from peer relationships and
rudimentary elements of reading and writing; physical social interactions to academic attainment and cognitive
development and the ability to make good nutrition de- progress (U.S. Department of Education, 2016). All these
cisions and understand the need for physical movement developmental areas affect and are reciprocally affected
and activity; and character development and the ability to by mental health in a dynamic and interactive manner
demonstrate empathy, respect for the needs of others, and (Hancock & Carter, 2016). An increase in recognition of
tolerance for diversity and differences (Morrison, 2015; the effects of mental health problems on academic attain-
Nicholson et al., 2019). ment, alongwith the unique platform that schools can offer
Along with the rapid and expansive growth of pre. in access to and support for children with psychological
school programs in the public schools has come a range of difficulties, has led to an expansion of school-based mental
adaptations and challenges for school administrators (Bouf- health interventions, particularly in high-income countries
fard, 2018). The adaptations and challenges include but are (Fazel et al., 2014). According to research, the prevalence of
not limited to expansion of physical space in elementary psychiatric disorders varies among children from preschool
schools to accommodate younger students ; assessment through secondary age levels (Carolan & Connors-Tadros ,
and curriculum development for preschool learners; hip 2015; O’Reilly et al., 2018). The most common difficulties
ing of certified early childhood educators (ECE) teachers in school-age children are disruptive behaviors and anx-
and assistant teachers; enhanced parent education and iety disorders (Fazel et al., 2014). Separation anxiety and
engagement; developmentally appropriate instructional oppositional defiant disorder are seen mainly in primary
strategies and behavior management; and diverse school school children (age 4-10 years), whereas generalized anx-
professionals to meet the unique social-emotional, men- iety, conduct disorder, and depression are more common
tal health, and special needs of such a large and diverse in secondary school (age 11-18 years) students (Fazel et al.,
student population (Bouffard, 2018). School dibit kib have 2014). Attention deficiL liypeiditivily Jioorder (ADHD) and
been challenged with the rapid explosion of preschool pro- autism spectrum disorders pose particular difficulties for
grams and are still working to secure adequate resources, children in the school environment, and the incidence of
personnel, and funds to meet the complex needs of these eating disorders and psychosis starts to increase rapidly
young children (Bouffard, 2018). from mid-adolescence onwards (Fazel et al., 2014).
In summary, preschool childieit in the public-school Schools ate complex environments, varying by size,
sector have increased dramatically over the past decade racial makeup, socio-economic levels, language, gender,
in the United States (Carolan & Connors-Tadros, 2015; and cultural variations (Bouffard, 2018). As the school
U.S. Department of Education, 2016), presenting great population increases in diversity, the dynamics between
challenges to school systems, administrators, and school students, teachers and students, and parents and school
personnel (Bouffard, 2018). Many of these young children personnel also become more complex (Fenwick-Smith et
demonstrate trauma-impacted behaviors and mental health al., 2018). Within the school context, some school-specific
needs, reflected in teachers reporting increased incidences factors are related to mental health during childhood
of difficult, challenging, aggressive, and disruptive child (Whitted, 2011). For example, bullying often takes place
behaviors (Choi & Graham-Bermann, 2018; Zeng et al., within the school context; a study in the United King-
2019). School personnel are challenged to meet the assess- dom showed that 46% of school-aged children had been
ment, intervention, and follow-up needs of these children bullied (Department for Children, Schools, and Families,
(Hancock & Carter, 2016). In some cases, schools resort 2015). The odds ofsuicidal ideation and suicidal attempts
to suspension or expulsion of the most challenging chil- are more than doubled in young people who report peer
dren (Carolan & Connors-Tadros, 2015). Paradoxically, victimization (Meltzer et al., 2011). Bullying can affect
these are the children who are most at risk for healthy children into adulthood, with increases in the prevalence
development and are in greatest need of psychological and of anxiety, depression, and self-harm (Meltzer et al., 2011).
developmental assessment and individualized intervention
(Knopf, 2016). In addition, teachers in these preschool Mental Health Strategy: Needs Assessment
classrooms are frequently stressed and are experiencing Among the several school-based strategies addressing
fatigue, burnout, and, in many cases, secondary traumatic mental health needs of the preschool population is that of
stress disorder (Osofsky et al., 2008). assessment (Fazel et al., 2014). Many professionals working
12 VOLUME 23 NUMBER 2
with children advocate the use of a multiple-gated screening systems; this varies across countries (Bouffard, 2018). In
system to determine mental health need in schools (Fazel the United States, staff employed at schools are limited
etal., 2014). If one considers the school environment from by school policies that restrict the type of direct services
the Bronfenbrenner systems approach (Morrison, 2015), that they can provide (Dowdy et al., 2015). For example,
there are opportunities to observe, assess, and document because of funding and special education mandates, school
the mental health needs of young students at several differ- psychologists in the United States spend much of their time
ent levels. For example, a school might complete a school conducting routine psychological testing and eligibility
climate scale (measures students’ or teachers’ perceptions assessments rather than applying their broader consultative
of how the environment of classrooms and schools as a and direct intervention skills (Eklund et al., 2018). In many
whole affects education) to review and select a universal other countries, school-employed personnel work mainly
intervention of school-wide character development, or they with students who have educational difficulties that result
might use a screening program to identify children at risk from emotional and behavioral issues and provide direct
of suicide (Fazel et al., 2014; Morrison, 2015). This type mental health services and interventions (Giannakopoulos
of assessment focuses on the larger learning environment et al., 2014). Thus, in the United States, school personnel
(macro) of the school which is the environment for students are frequently restricted from providing therapeutic ser-
and teachers and how the environment affects education, vices for mental health needs (Fazel et al., 2014).
relationship building, and other important dynamics of Community mental health professionals in schools
the school environment (Fazel et al., 2014). work in a range of disciplines, including counselling, social
On an individual student level, schools utilize various work, occupational therapy, psychology, and psychiatry
methods to identify students who could benefit from inter- (Nicholson etal., 2019). Three broad models of integration
ventions (Doll et al., 2017; Lenares-Solomon et al., 2019). are com mon:
These methods include functional behavioral assessments, 1. Individuals from an outside agency are contracted
teacher or student recommendations, and systematic to work within a school.
universal screening (Doll et al., 2017). Screening can pose 2. The school includes a mental health clinic staffed
a risk of over-identification of children or failure to recog- by professionals who deliver mental health services.
nize a condition (Doll et al., 2017). Provided these risks 3. The school has a health center with mental health
are managed, and if screening is done with standardized as a subspecialty (Allen-Meares et al., 2013).
methods and by qualified staff with appropriate informed
consent, this technique can provide a useful avenue for Counselors and social workers are more likely to
schools to identify and support students with mental health provide direct school-based mental health services than
disorders (Doll et al., 2017; Dowdy et al., 2015; Lenares-Sol- psychologists or psychiatrists (O’Dea et al., 2017). In some
omon et al., 2019). This type of individualized student countries, schools collaborate with psychologists and
assessment is costly, both in terms of time and manpower psychiatrists to provide consultation and intervention for
(Lenares-Solomon et al., 2019). In addition, specialized specific students with complex challenges. Still, this model
school personnel are essential. Specialized personnel is unlikely to be scalable given the global scarcity of child
include school psychologists, school counselors, social and adolescent psychiatrists and the financial resources
workers, and other professionals with formal training in required for this model (Fazel et al., 2014). Technology
individual preschool child assessment (Dowdy et al., 2015; is rapidly opening new avenues for intervention (Ramsey
Statman-Weil, 2015). For very large school systems, this et al., 2016). For example, telemedicine can increase the
approach can be very expensive (Doll et al., 2017). However, capacity of mental health services in schools, although sue-
at the preschool level, some forward-thinking schools are cessful models have additional on-site school mental health
requiring comprehensive developmental, mental health, providers to support engagement and continuous psycho-
and academic screening of all enrolled preschool children social intervention (Ramsey et al., 2016). Some schools
(Best & Cohen, 2013). With these assessment data in hand, have recruited advanced nurse practitioners to manage the
school districts are more able to advocate for additional nee ds of students (Bohnemkamp et al., 2019). However,
funding to provide smaller classes, higher teacher-to-child most schools rely on internal resources for mental health
ratios, and the hiring of mental health specialists (Doll intervention, such as school nurses, school social workers,
et al., 2017). Thus, screening and assessment seem to school counselors, or special education personnel with
be fundamental strategies for giving equal attention to specialized training in mental health (Sanchez et al., 2018).
all students regarding mental health needs (Doll et al., It is clear that providing mental health services in
2017; Lenares-Soloman et al., 2019). With experience and the school environment varies widely and is related to the
focused effort, these screening mechanisms can become size of the school, geographical location (urban vs. rural),
more efficient and effective in identifying young students general funding of the school, and leadership priority for
with mental health indicators (Dowdy et al., 2015). addressing mental health issues (Moon et al., 2017). More
evidence-based models with these varied configurations to
Mental Health Stmtegy: Specialists in the Schools provide to school districts who are determining their own
Globally, mental health services in schools are pro- mental health policies and practices are needed. Preschool
vided by a variety of professional staff whose training or children who are screened, identified, and served earlier in
employment might be within education or healthcare their lives are more likely to have positive developmental,
THE JOURNAL OF AT-RISK ISSUES 13
social, and academic outcomes than young children who behaviors, social inclusion, effective problem solving, and
are not identified at the preschool level (Abo El Elella et good citizenry (Fenwick-Smith et al., 2018). Examples in
al., 2017). From this review of school based mental health the 4K curriculum include strategies to recognize one’s
strategies, the need for more school professionals trained own emotions, verbalize feelings, listen to peers as they
in mental health intervention is indicated. There is a need talk about their emotions, and then respond appropriately
for more school-based counselors, social workers, nurses, to be socially supportive.
and psychologists, as well as for partnerships between the In whole-school and classroom-based interventions,
schools and community-based mental health agencies, to universal mental health promotion programs are often
meet the mental health needs of these preschool children delivered by the school’s own staff and are done in both
(Bradshaw et al., 2012). primary and secondary schools (Fazel et al., 2014). Mental
health promotion should begin at the earliest levels in the
Mental Health Strategy: A Tiered Approach to Mental school, including preschool (O’Reilly et at., 2018). One
Health Services example is a program known as MindMatters, developed
An empirically driven approach to school strategies in the late 1990s. This approach is the leading national
has been used in parts of the United States (Safari et al., initiative for promotion of mental health in schools in
2020). Known as a tiered approach, this includes univer- Australia, with substantial national investment to equip
sal strategies for all students, followed by interventions schools and educators with skills to promote student
to assist selected students who face particular risks, and wellbeing (O’Reilly et al., 2018). Specific strategies to help
finally a tier with specific treatment interventions for those students include social and emotional learning programs,
with the greatest needs (Safari et al., 2020). An advantage increasing student connection to school, building student
of this public health and tiered approach is that schools skills in understanding and management of emotions,
and teachers can support students with varying needs effective communication, and stress management (Taylor
and create classroom and whole-school environments that et al., 2017). Teachers participate in various professional
support the learning of all children (O’Reilly et al., 2018). development opportunities to support their learning in
Additionally, this tiered approach utilizes resources most these curricular domains (Zin et al., 2019). These programs
effectively, with some resources provided to screen and are included in many schools in the United Kingdom,
deliver services for all students, followed by more selective and United States schools could include this strategy
and focused interventions for fewer students with greater with limited additional expense. School buy-in is import-
needs (Bradshaw et al., 2012). ant to create a school environment that is nurtured and
This approach is also most useful for very large supported by all participants, including administrators,
school districts that are serving many children of diverse teachers, school professionals, cafeteria staff, and janitorial
backgrounds (Bradshaw et al., 2012). Regarding person- personnel (Yoon, 2016).
nel, the tiered approach aligns resources in a graduated
way so that more highly specialized school personnel are Examples of Early Childhood Mental Health
available to serve the needs of more high-need students, (ECMH) School-Based Models
and universal screening and mental health specialists and The Florida Center for Early Childhood
teachers who have received professional development can An example of a highlysuccessful school-based mental
provide daily interventions and formal training related to 1 tealth model for the early childhood student population is
general mental health assessment (Bradshaw et al., 2012). in Sarasota, Florida. In partnership with the school district
The authors note mental health specialists and teachers ofSarasota County and the community foundation of Sara-
who have more training can provide observation and sota County, the Florida Center provides mental health
identification of students who may need more in-depth counseling services to students in 15 Sarasota County
assessment and services as well as daily positive support elementary schools (Florida Center, 2019). The purpose of
strategies with students. the program is to help students succeed in school despite
outside influences that may hinder that success. Integrated
Mental Health Stmtegy: Promotion of Mental Health elementary school therapists at each elementary school
Mental health promotion is a positive strategy that conducted one-on-one counseling with students who had
enhances awareness of mental health, encourages prac- a variety of issues (Florida Center, 2019). ACEs research
tices to support good health, and serves as a preventive informs us that many young children in the United States
measure (0’Reilly et al., 2018). Interestingly, principles of are exposed to violence and trauma at an alarming rate
school mental health promotion have been espoused since (Liming & Grube, 2018). By age 16, two-thirds of children
Plato’s Republic, in which he identified the importance of in the United States have already experienced a potentially
the school environment to children’s social development traumatic event such as physical or sexual abuse; natural
(Fenwick-Smith et al., 2018). Plato also noted that by disaster or terrorism; sudden or violent loss ofa loved one;
maintaining a sound system of education and upbringing, refugee and war experiences; serious accident or life-threat-
schools then produce citizens of good character. Universal ening illness; or military family-related stress, according
promotion of mental health programs often focuses on to the National Child Traumatic Stress Network (Bartlett
constructs such as social and emotional skills, positive & Steber, 2019). With support, many children can heal
14 VOLUME 23 NUMBER 2
and overcome such traumatic experiences through mental and private early childhood programs to help identify
health therapy (Sanchez et al., 2018; Zin et al., 2019). As and provide intervention for young children’s mental
schools maintain their critical focus on education and health needs and to support their families (Ohio Depart-
achievement, elementary students have access to trained, ment of Mental Health and Addiction Services, 2019).
school-based mental health counselors who nurture their This initiative assumes a community-based approach
mental health and wellness, two components that are and focuses on each child’s surrounding environments,
integrally connected to students’ success in the classroom including the home, childcare or other early learning
and to a thriving school environment (Bartlett & Steber, setting, neighborhood, and community contexts (Ohio
2019; Sanchez et al., 2018; WestED, 2019). Department of Mental Health and Addiction Services,
The comprehensive partnership in Florida is truly 2019). Aligned with Bronfenbrenner system’s theory of
a successful early childhood mental health model that child development (Morrison, 2015), this approach views
provides mental health services to infants, toddlers, pre- the child within several meaningful daily contexts. For
schoolers, and young children through age eight (Florida example, early childhood mental health specialists provide
Center, 2019). School-based mental health specialists are consultation and intervention within the child’s home,
trained in social work, mental health counseling, and school, childcare, preschool, and community-based set-
child development (Doll et al., 2017). Each elementary tings (Ohio Department of Mental Health and Addiction
school in this school district has its own mental health Services, 2019). In this way, mental health specialists are
specialist, and the learning environment and curriculum able to meet the needs of individual children within the
provide an understanding of self, well-being, and mental setting that is best suited for the child and their family.
health (Florida Center, 2019). One of the school-based
partnership goals is to reduce the stigma associated with Chicago Public Schools Initiative
mental health issues and to make accessible to all families The Chicago Public School (CPS) system provides an
the support they need to negotiate difficult and challenging extensive network of preschool programs for young chil-
life situations (Florida Center, 2019). dren, and these programs are recognized for their quality
and inclusive practices (Chicago Public Schools, 2019). As
Ohio’s Early Childhood Mental Health (ECMH) part of an effort to maintain quality and reduce preschool
Initiatig,e: Schools and Communities Partnership suspension and expulsion incidents, the CPS system un-
Ohio provides an excellent model of school and dertook a sel f-study of its practices related to managing the
community partnerships through the Early Childhood behavioral challenges among their preschool population
Mental Health (ECMH) Initiative via Ohio’s Schools (Chicago Public Schools, 2019). This study was conducted
and Communities program (Ohio Department of Mental on preschool programs from academic years 2011-2015 in
Health and Addiction Services, 2019). In this partnership, all pre-k through second grade classrooms (Chicago Public
the Ohio Department of Mental Health and Addiction Ser- Schools, 2019). The primary goal of the self-study was to
vices provides leadership for this school program situated gain insight into CPS practices with preschool children
in Ohio communities and their respective public schools with a focus on those children who demonstrated be-
(Ohio Department of Mental Health and Addiction Ser- havioral challenges to teachers and school staff (Chicago
vices, 2019). This initiative defines early childhood mental Public Schools, 2019). The study was conducted within the
health as the social, emotional, and behavioral well-being context of rapidly expanding preschool programs for the
of children birth through six years old and their families preschool child population in Chicago and a rising number
(Ohio Department of Mental Health and Addiction Ser- of classroom management issues that were reflected in an
vices, 2019). The goals of this ECMH program are to build increase of reported incidences of challenging or disruptive
capacity to experience, regulate and express emotion, form child behaviors (Chicago Public Schools, 2019). School
close, secure relationships, and explore the environment officials were also concerned with the relatively high rate
and learn. of preschool suspension and expulsion (Chicago Public
1n this state-wide initiative, early childhood mental Schools, 2019). The CPS wanted to better understand
health is believed to be influenced and shaped by the how they were addressing the needs of young children
following factors: with special needs and health-related issues, including
mental health (Chicago Public Schools, 2019). Officials
(a) physical characteristics of the young child wanted to determine if their practices with these children
(b) quality of the adult relationships in the child’s life were more restorative than more punitive or disciplinary
(c) the child’s caregiving environments (i.e., out-of-class suspensions or expulsions; Stegelin, 2018).
(d) community context in which the child and family Preschoolers are not suspended and expelled on an equal
lives. basis; Black and Latinx preschoolers are expelled and
Ohio’s initiative includes ECMH consultation and suspended at higher rates than White preschoolers (CT
treatment and partnerships between schools and state- Mirror Viewpoints, 2019).
level, health-related agencies within each community (Ohio Data from the assessment study of Chicago Public
Department of Mental Health and Addiction Services, Schools (2019) reflected a shift in practices beginning in
2019). Early childhood mental health specialists work the 2013-14 academic year, compared with those during
with childcare providers, Head Start, and school-based 2011-12 and 2012-13 academic years. Duringthe 2013-14
THE JOURNAL OF AT-RISK ISSUES 15
academic year, the data reflected a change to more restor- a collaborative, cooperative, comprehensive, and inclusive
ative responses-practices that help children respond to way (Office of Early Education and Development; 2016);
and work through challenges rather than disciplining Stegelin, 2018). In 2011 a plan was developed to address
them for acting out-that outnumbered the out of school the social and emotional needs of a growing number of pre-
suspensions (Chicago Public Schools, 2019). In 2014-15, school children who were enrolling in their school-based
there were 2,273 restorative responses compared to only 77 programs (Office of Early Education and Development;
out-of-school suspensions (Chicago Public Schools, 2019). 2016). 1 his plan included a series of efforts to educate
This shift in practice denotes a significant change in how and prepare teachers, administrators, and all school staff
the school district chose to address preschool behavioral about the reasons and intervention options for challeng-
challenges and reflects a commitment to enhancing the ing behaviors among preschool children (Office of Early
qUality preschool classroom experience (Chicago Public Education and Development, 2016). After several years
Schools, 2019). of making policy and practice changes, the 2014-2015
This Chicago Public Schools (2019) self-study was academic year reflected a significant shift from higher
informative, and the data guided decision-making that re- levels of preschool suspension and expulsion to substantial
sulted in substantial changes in the preschool classrooms. restorative responses to behavioral challenges (Office of
One of these changes was to establish an Office of Social Early Education and Development, 2016).
and Emotional Learning with a network of stakeholders School districts across the country are beginning to
to engage in self-study and policy development (Chicago address preschool children’s social and emotional needs in
Public Schools, 2019). The Office of Social and Emotional their school-based programs (Office of Early Education and
Learning within the CPS system provided leadership for Development, 2016; Chicago Public Schools, 2019; U.S.
changes in practice and policy related to preschool suspen- Department of Health and Human Services and Educa-
sion and expulsion (Chicago Public Schools, 2019). One tion, 2014). These school districts are to be commended for
of their strategies was to build a Stakeholders Engagement their efforts to address the developmentally inappropriate
group that included the following: practice of preschool suspension and expulsion (Chicago
• District-wide committee known as the Social and Public Schools, 2019). The CPS initiative brings together
Emotional Learning, Early Childhood Education, stakeholders and constituents to plan and implement
Safety & Security, Office of Diverse Learner P olicy changes sensitive to at-risk young children’s needs
for learning (Chicago Public Schools, 2019). Viewing theirSupports & Services, Law and Labor Relations.
• School staff focus groups (including deans, developmental needs as a necessity for responsive inter-
principals, teachers, counselors, social workers, vention rather than out of class suspension or expulsion
is the first step in addressing these issues (Chicago Publicand others).
• Chicago Teachers Union (CTU) and the Chi- Schools, 2019).
cago Principals and Administrators Association
(CPAA). Recommendations for Future Policy and Research
According to the American Psychological Association,• Network chiefs and deputies
• Citywide collaborative approximately half the children in this country experience
trauma during their childhood (Nicholson et al., 2019).• Community forums
• Student focus groups (Chicago Public Schools, 2019). Schools are increasingly leveraged as intervention points
to address childhood trauma due to the established links
In short, the CPS initiated a self-study of their between childhood trauma exposure and poor child
practices regarding dealing with preschool children who well-being outcomes (Loomis, 2018). Several organizations
demonstrated behavioral challenges (Stegelin, 2018). This provide leadership to make changes in policies related to
study was undertaken within the context of a large school serving the needs of young children who have experienced
district’s rapidly expanding preschool education programs trauma (Statman-Weil, 2015; WestED, 2019; Zero to Three,
across the entire system (Chicago Public Schools, 2019; 2010). The following are recommendations for policy
Stegelin, 2018). During the 2013 academic year, the CPS development to support trauma-informed early education
launched the district-wide Suspensions & Expulsions in the United States (Giannakopoulos et al., 2014; Moon
Reduction Project aimed at policy change, accountability et al., 2017). They represent a compilation and synthesis
systems, resource development, professional development, of best practices related to early trauma intervention
and collaboration (Chicago Public Schools, 2019). In the (Statman-Weil, 2015).
2014 academic year, a new Student Code of Conduct was
implemented that placed strict limits on suspension and Workforce Recommendationsexpulsion for Pre-K through Grade 2 classrooms (van With the rapid expansion of preschool programs in
Ausdal, 2015; U.S. Department of Health and Human the public-school sector, many professionals provide care
Services and Education, 2014). and education for children (Giannakopoulos et al., 2014).
The findings were significant and demonstrated the Most of these professionals are in need of professional
positive impact of the self-study (Vanassche & Kelchtermans, development related to caring for young children impact-
2016). This resulted in initiatives developed to address the ed by trauma since most teacher education programs in
preschool children’s social and emotional learning needs in the United States do not include the knowledge and skill
16 VOLUME 23 NUMBER 2
development necessary to assess, provide intervention, and We know that children who have experienced trauma in
evaluate young children with these special needs (Gianna- their early development are also more likely to demonstrate
kopoulos et al., 2014; Moon et al., 2017). Along with an challenging behaviors and are more likely to be perceived
increased focus on preschool education academics, there in negatively by preschool teachers (Statman-Weil, 2015).
is also a need to increase teacher awareness and under- Trauma-impacted children are also more at risk for mental
standing of social and emotional development of young health issues. These children need assessment, responsive
children and to recognize when children have experienced care, and education to work through their social and emo-
trauma (Moon et al., 2017). Based on a synthesis of reo tional problems (Carolan & Connors-Tadros, 2015; Eklund
ommendations, early childhood teachers, administrators, et al., 2018; Whitted, 2011). Finally, trauma-impacted
and other school professionals according to Statman-Weil children respond more positively to restorative strategies
(2015) should be: than exclusionary and punitive strategies (Chicago Public
• Informed about trauma and its effects on chil- Schools, 2019).
With this important research in mind, the followingdren’s development and learning
• Sensitive to those effects of trauma when interact- research questions are posed (Chicago Public Schools,
ing and making decisions about interventions for 2019):
these children 1. Which strategies are most aligned with which kinds
• Equipped with skills and knowledge that promote of trauma and child’s gender, race, and ethnicity?
responsive and caring programs for children 2. What kinds of professional development are most
affected by all kinds of trauma (Nicholson et al., appropriate for early childhood care and education
2019) teachers and paraprofessionals to prepare them for
• Capable of planning and implementing strategies working with young children with trauma and/
that are sensitive to children with trauma and that or mental health issues? What content is most
support the overall health, healing, and well-being important to include in trauma-informed profes-
of these children sional development? What are the most effective
• Knowledgeable of an assets-based approach when professional development strategies to use with
working with all young trauma-impacted children teac hers and other school personnel?
and helping them build resilience 3. In what ways are parents engaged most successfully
• Eager to seek professional development to strength- in interventions for trauma-informed children?
en their capacity to observe, Llnderstand, assess, What roles can parents play in the interventions
and provide interventions for young children with process? What are home-school intervention
trauma backgrounds strategies that both teachers and parents can
• Able to provide leadership for their organizations employ?
and embrace policies and practices that support 4. Which child populations are most at-risk for
children and families experiencing trauma trauma in their early lives? Are we including in
our research immigrant children, children with
Research Recommendations diverse economic backgrounds, children with
More research is needed on preschool mental health, special needs, and possible gender- and race-based
trauma, and publioschool suspension and expulsion. factors?
Foundational research by Gilliam (2005) and Gilliam et 5. What are the perceptions of public-school ad-
al. (2016) has contributed to our understanding of the ministrators, program coordinators, and other
complexity of teacher-child interactions and preschool decision-makers ofyoung children with challenging
suspension and expulsion. The research by Gilliam (2005) behaviors? To what extent are future school admin-
uncovered the alarming rate of preschool suspension and istrators prepared to meet the needs of very young
expulsion that occurs in the United States. In addition, learners (e.g.,3- and 4-year-old children), especially
Gilliam et al. (2016) focused on implicit teacher bias and those who have experienced trauma in their early
how a teacher’s perceptions of a child may be related to lives?
their suspension and expulsion rates. Gilliam’s study found 6. What are the relationships between childhood
that suspension and expulsion were related to a preschool trauma, preschool suspension and expulsion, and
child’s gender, size, ethnicity, and other demographics. Im- the incidence of mental health issues?
portantly, they found that male Latino and African Amer- 7. What research strategies-quantitative, qualitative,
ican children were more likely to experience suspension mixed methods-are most effective in capturing
or expulsion than children with different demographics the authentic voices of trauma-impacted children
(Gilliam et al., 2016). or those with mental health needs?
Other areas of research needing further exploration 8. How can the community most effectively provide
include explaining the relationships between trauma, resources for trauma-impacted preschool children
social-emotional development, teacher perceptions of and their families? How can partnerships between
children’s behavior, and mental health issues (Centers for these community resources and schools be devel-
Disease Control and Prevention, 2019; Zeng et al, 2019). oped and maintained?
THE JOURNAL OF AT-RISK ISSUES 17
Policy Recommendations With these recommendations for research, policy,
While progress is being made to address the needs of and practice, school districts will be better able to serve
young children with mental health issues and those with the preschool student population with mental health and
early traumatic experiences, as well as the harmful practice trauma-related needs. Creating innovative partnerships
of preschool suspension and expulsion, many changes in between education and health providers is a good start to-
school policies are indicated (Liming & Grube, 2018). ward building a trauma-informed and restorative approach
The federal government has taken the leadership role in to early education. Punitive practices, such as suspension
addressing these complex issues, supporting state-level and expulsion, should decline and become unnecessary.
efforts to reduce preschool expulsion and suspension,
and reinforcing the understanding of the federal Individ-
uals with Disabilities Education Act (IDEA) to protect
the rights of children with special needs or disabilities References
without discrimination (Office of Early Education and
Development, 2016; U.S. Department of Education, 2014; Abo El Elella, S., Tawfik, M. A. M., Abo El Fotoh W.
U.S. Department of Health and Human Services and M. M., & Barseem, N. R (2017). Screening for
Education, 2014). developmental delay in preschool-aged children using
Based on a review of the policy literature, the follow- parent-completed ages and stages questionnaires:
ing recommendations are made for policy development at Additional insights into child development.
the state and local levels: Postgraduate Medical JouTnal, 93(1104), 597-602.
https://doi.org/10.1136/postgradmedj-2016-134694
• Establish developmentally appropriate expulsion Allen-Meares, R, Montgomery, K. L., & Kim, J. S. (2013).
and suspension policies for preschool programs in School-based social work interventions: A cross-
the schools, implement them without bias, and set national systematic review. Social Work, 58(3), 253-262.
a goal of eliminating this practice. https://doi.org/10.1093/sw/swt022
• Invest in and support an informed and skilled Bartlett, J. D., & Steber, K. (2019, May 9). How to implement
workforce that includes professional development trauma-informed care to build resilience to childhood
for preschool teachers and school staff related to trauma. Child Trends. https://www.childtrends.org/’
trauma-impacts on child development, responsive publications/how-to-implement-trauma-informed-
strategies to address the child’s social and emo- care-to-build-resilience-to-childhood-trauma
tional needs, and the needs of teachers related to Best, J., & Cohen, C., (2013). EaTly care and education: Policy
secondary trauma and stress as well as individual considerations fo~ ensu·ing high-quality pre-K programs
teacher’s implicit biases toward children. (ED544246). ERIC. https://eric.ed.gov/?id=ED544246
• Address mental health issues of preschool children Bohnemkamp, J. H. Hoover, S. A., Conners, E. H.,
from a health perspective rather than a disci- Wissow, L., Bobo, N., & Mazyck, D. (2019).
plinary perspective. Identify and provide resources The mental health training intervention for
in the school to meet the unique mental health school nurses and other health providers in
needs of very young children, including hiring of schools. Journal of School Nursing, 35(6), 422-433.
early childhood mental health specialists, leduced https//rloi.org/10.1177/1059840518785437
class sizes, and lower child to teacher ratios. Seek Bouffard, S. (2018, February 13). Principals aren’t ready
additional funding for health purposes. for public pre-K. Education Week. https:#www.edweek.
• Engage parents of trauma-impacted children and org/teaching-learning/opinion-principals-arent-ready-
for-public-pre-k/2018/02
collaborate with the family to develop both home-
and school-based strategies to support and provide Bradshaw, C., Pas, E., Bloom, J., Barrett, S., Hershfeldt,
P., Alexander, A., McKenna, M., Chafin, A., &
consistency for the child. Leaf, R (2012). A state-wide partnership to promote
• Provide comprehensive developmental and behav- safe and supportive schools: The PBIS Maryland
ioral screening for all preschool children as part Initiative. Administration 8 Policy in Mental Health
of the induction process into the school setting. 8 Mental Health Se~vices Resea~ch, 39(4), 225-237.
• Set goals and track data on all preschool children https://doi.org/10.1007/s10488-011-0384-6
so that interventions are data driven. Carolan, M. E., & Connors-Tadros, L. (2015). Approaches
• Provide individualized education/intervention to state Me-k eligibility policy: Considerations for policy
plans for each child identified as trauma-impacted makeTs in revising policy to increase access foT high needs
or needing mental health services. children (CEELO Policy Report). Center on Enhancing
• Engage the school administrators, teachers, and Early Learning Outcomes. http://ceelo.org/wp-
all professional staff in professional development content/uploads/2015/05/ceelo_policy_report_prek_
and training on federal legislation and guidelines eligibility_approaches
for preschool children with special needs (IDEA) Centers for Disease Control and Prevention. (2019).
and how schools can build a sense of a caring Preventing adverse childhood experiences: Leveraging the
community for all students and families. best available evidence. National Center for Injury
18 VOLUME 23 NUMBER 2
Prevention and Control. https://www.cdc.gov/ Gilliam, W. S. (2005). Prekindergartners left behind: ffxpulsion
violenceprevention/pdf/preventingACES rates in state prekindergartneT systems. Foundation for
Chicago Public Schools. (2019). Chicago public schools Child Development. https://medicine.yale.edu/
preschool programs. http//www.eps.edu/Schools/ childstudy/zigler/publications/National%20
EarlyChildhood/Pages/Preschoolprogramtypes.aspx Prek%20Study_expulsion%20brief_34775_5379_
Choi, K. R., & Graham-Bermann, S. A. (2018). vl
Developmental considerations for assessment of Gilliam, W. S., Maupin, A. N., Reyes, C. R., Accavitti,
trauma symptoms in preschoolers: A review of M., & Shic, F. (2016, September 28). Do eady
measures and diagnoses. Journal of Child and Family educators’ implicit biases regarding sex and race relate
Studies, 27, 3427-3439. https://doi.org/10.1007/ to behavioT expectations and recommendations of
s10826-018-1177-2 pTeschool expulsions and suspensions? (A Research
CT Mirror-Viewpoints. (2019, August 22). We need Brief). Yale University Child Study Center. https:/7
trauma-informed preschool practices: Laws medicine.yale.edu/childstudy/zigler/publications/
banning or limiting suspension and expulsion for Preschool%20Implicit%20Bias%20Policy%20
preschoolers are not enough, Connecticut MiTTor. Brief_final_9_26_276766_5379_vl
https://ctmirror.org/category/ct-viewpoints/ Hancock, C., & Carter, D. (2016). Building environments
we-need-trauma-informed-preschool-practices/ that encourage positive behavior: The preschoolDepartment for Children, Schools, and Families. (2015). behavior support self-assessment. Young Children,Working together tosafeguard children: Aguide to intepagency 71(1). https://www.naeyc.org/resources/pubs/yc/working to safeguard and pmmote the welfare of children.
mar2016/building-environments-encourage-positive-Department for Children, Schools, and Families,
behavior-preschoolHM Government, Nottingham, United Kingdom.
Heckman,J.J. (2017). Heckman on quality early childhoodhttps://www.gov.uk/government/publications/
working-together-to-safeguard-children-2 education: There is no “Fadeout, only lastingbenefits.
Doll, B., Nastasi, B. K., Cornell, L., & Song, S. Y. (2017). The Washington Post. https://www.ffyf.org/beckman-
School-based mental health services: Defirtitions and quality-early.childhood-education-no-fadeout-lasting-
models of effective practice. Journal of Applied School benefits/
Psychology, 33(3), 179-194. https://doi.org/10.1080/ Horowitz, M. (2015, August). Early childhood suspension
15377903.2017.1317143 and expulsion. Center on Enhancing Early
Dowdy, E., Furlong, M., Raines, T. C., Bovery, B., Learning Outcomes. http://ceelo.org/wpcontent/
Kauffman, B., Kamphaus, R. W., Dever, B. V., uploads/2015/08/ceelo_annotated_bib_
Price, M., & Murdock, J. (2015). Enhancing school- expulsion_2015_08_final_web e
based mental health services with a preventive Knopf, A. (2016). Officials discourage preschool
and promotive approach to universal screening suspensions, encourage mental health consultations.
for complete mental health. Journal of Educational Brown Uniumity Child 8 Adolescent Behavior Lettg
8 Psychological Consultation, 25(2/3), 178-197. 32(10), 1-2. https://doi.org/10.1002/cbl.30161
https://doi.org./10.1080/10474412.2014.929951 Lenares-Solomon, D., Brown, M. H., & Czerepak, R.
Eklund, K., Rossen, E., Koriakin, T., Chafouleas, S. (2019). The necessity for school-based mental health
M., & Resnick, C. (2018). A systematic review services. Journal of Professional Counseling: Practice,
of trauma screening measures for children and Theory 8 Research, 46(1/2), 3-13. https://doi.org/
adolescents. School Psychology Quarterly, 33(1), 30-43. 10.1080/15566382.2019.1674074
https://doi.org/10.1037/spq0000244 Lawson, H. A., Caringi, J. C., Gottfried, R., Bride, B. E., &
Fazel,M.,Patel,V., Thomas, S.,&Tol, W.(2014). Mentalhealth Hydon, S. R (2019). Educators’ secondary traumatic
interventions in schools in low-income and middle- stress, children’s trauma, and the need for trauma
income countries. Lancet Psychiatry, 1(5), 388-398. literacy. Haward Educational Review, 89(3), 421-448.
https://doi.org/10.1016/s2215-0366 (14)70357-8 https://doi.org/10.17763/1943-5045-89.3.421
Fenwick-Smith, A., Dahlberg, E. E., & Thompson, S. C.
(2018). Systematic review of resilience-enhancing, Liming, K. W., & Grube, W. A. (2018). Wellbeing
outcomes for children exposed to multiple adverse
universal, primary school-based mental health experiences in early childhood: A systematic review.
promotion programs. BMC Psychology, 6(1), 1-17. Child 8 Adolescent Social Work Journal, 35(4), 317-335.https://doi.org/10.1186/s40359-018-0242-3 https://doi.org/10.1007/s10560-018-0532-xFlorida Center for Early Childhood. (2019). haps://www Loomis, A. (2018). The role of preschool as a pointthefloridacenter.org/
of intervention and prevention for trauma-Giannakopoulos, G., Agapidaki, E., Dimitrakaki, C.,
Oikonomidou, D., Petanidou, D., Tsermidou, L., exposed children: Recommendations for practice,
Kolaitis, G., Tountas, Y., & Papadopoulou, K. policy, and research. Topics in Early Childhood
(2014). Early childhood educators’ perceptions of Special Education, 38(3), 134-145. https://doi.org/
preschoolers’ mental health problems: A qualitative 10.1177/0271121418789254
analysis. Annals of General Psychiatry, 13(1), 1-12. Morrison, G. (2015). Eady childhood education today (13th
https://doi.org/10.1186/1744-859X-13-1 ed.). Pearson Publishers.
THE JOURNAL OF AT-RISK ISSUES 19
Meltzer, H., Vostanis, R, Ford, T, Bebbington, P., & Identifying key barriers to use of technology-based
Dennis, M. S. (2011). Victims of bullyingin childhood therapeutic tools for behavioral health care. The
and suicide attempts in adulthood. European Journal of Behavioral Health Services 8 Research, 43(1),
Psychiatry, 26(8), 498-503. https://doi.org/10.1016/ 54-70. https://doi.org/10.1007/s11414-9436-5
j.eurpsy.2010.11.006 Safari, S., Abedi, A., & Faramarzi, S. (2020). Implementing
Moon, I., Williford, A., & Mendenhall, A. (2017). an RTI approach: A qualitative study of prerequisites
Educators’ perceptions of youth mental health: and obstacles. Educational Research for Policy and
Implications for training and the promotion of Pmctice, 19, 261-279. https://doi.org/10.1007/s10671-
mental health services in schools. ChildTen and Youth 020-09258-6
Services Review, 73, 384-391. https://doi.org/10.1016/ Sanchez, A. L., Cornacchio, D., Poznanski, B., Golik, A.
j.rhildyotith.2017.01.006 M., Chou, T., & Comer, J. S. (2018). The effectiveness
National Center for Pyramid Model Innovations. of school-based mental health services for elementary-
(2020). Suspension and expulsion in early childhood. aged children: A meta-analysis. Journal of the American
https://challengingbehavior.cbcs.usf.edu/Pyramid/ Academy of Child SAdolescent Psychiatyy, 57(3), 153-165.
suspension.html https://doi.org/10.1016/j.jaac.2017.11.022
Nicholson, J., Perez, L., & Kurtz, J. (2019). Trauma-informed Schweinhart, L. J., Montie, J., Xiang, Z., Barnette, W. S.,
practices for early childhood educators: Relationship based Bolfieldm, C. R., & Nores, M. (2011). The High/Scope
approaches that support healing and build Tesilience in young Perry Preschool Study through age 40: Summary, conclusions,
children. Routledge Publishers. and frequently asked questions. High/Scope Press.
O’Dea, B., King, C., Subotic-Kerry, M., O’Moore, K., Statman-Wei K. (2015). Creating trauma-sensitive
& Christensen, H. (2017). School counselors’ classrooms. YC: Young Children, 70(2), 72-79. https://
perspectives ofaweb-based stepped care mental health www.naeyc.org/system/files/YC0515_Trauma-
service for schools: Cross-sectional online survey. Sensitive_Classrooms_Statman-Weil
JMIR Mental Health, 4(4). https://doi.org/10.2196/ Stegelin, D. (2018). Preschool suspension and expulsion:
mental.8369 Defining the issues [Policy brief]. Institute for Child
Office of Early Education and Development. (2016). Success. https://www.instituteforchildsuccess.org/
Reducing suspension and expulsion practices in early publication/preschool-suspension-and-expulsion-
childhood: Expulsion Wei)inar 2. Department of Health defining-the-issues/
and Human Services. https://www. acf.hhs.gov/ecd/ Taylor, R. D., Oberle, E., Durlak, J. A., & Weissberg, R.
child-health-development/reducing-suspension-and- P. (2017). Promoting positive youth development
expulsion-practices through school-based social and emotional
Ohio Department of Mental Health and Addiction learning interventions: A meta-analysis of follow-
Services. (2019, October 19). Early childhood mental up effects. Child Development, 88(4), 1156-1171.
health (ECMH) initiative. https://mha.ohio.gov/ https://doi.org/10.1111/cdev.12864
Portals/0/assets/SchoolsAndCommunities/ U.S. Department of Education. (2014). Data snapshot: Emb
Funding%20Opportunities/2020/2020_ECMH_ childhood education highlights (Issue Brief No. 2). Office
EI_RFP_10.23.19_HH.GK.LH_approved_final_VA6. for Civil Rights. https://www2.ed.gov/about/offices/
pdf?vcr=2019·10-23-122842-733 list/ocr/docs/crdc early-learning-snapshot,pdf
O’Reilly, M., Svirydzenka, N., Adams, S., & Dogra, U.S. Department of Education. (2016, September 15).
N. (2018). Review of mental health promotion Obama administrative investments in ea~ly learning have
interventions in schools. Social Psychiatry and led to more children enTolled in high,quality preschool [Press
Psychiatric Epidemiology, 53(7), 647-662. https://doi. release]. https://www.ed.gov/news/press-releases/
org/10.1007/s00127-018-1530-1 obama-administration-investments-early-learning-
Osofsky, J. D., Putnam, R W., & Lederman, C. (2008). have-led-thousands-more-children-enrolled-high-
How to maintain emotional health when working with quality-preschool
trauma. Juvenile and Family Court Journal, 59(4), 91-102. U.S. Department of Education. (2018). Early learning. https:/7
https://doi.org/10.1111/j.1755-6988.2008.00023.x www2.ed.gov/about/inits/ed/earlylearning/index.html
Pianta, R. C., Barnett, W. S., Burchinal, M., & Thornburg, U.S. Department of Health and Human Services and
K. R. (2009). The effects of preschool education: Education. (2014). Policy statement on suspension
What we know. How public policy is or is not aligned and expulsion policies in early childhood settings. https://
with the evidence base, and what we need to know. www2.ed.gov/policy/gen/guid/school-discipline/
Psychological Science in the Public Interest, 10(2), 49-88. policy-statement-ece-expulsions-suspensions
https:#doi.org/10.1177/1529100610381908 Vanassche, E., & Kelchtermans, G. (2016). Facilitating
Psychology Notes Headquarters. (2019). What is self-study of teacher education practices: Toward
Bronfenbrenner’s ecological systems theoTy. littps://www. a pedagogy of teacher educator professional
psychologynoteshq.com/bronfenbrenner-ecological- development. Professional Development in
theory/ Education, 42(1), 100-122. https://doi.org/10.1080/
Ramsey, A., Lord, S., Torrey, J., Marsch, L., & Lardiete, M. 19415257.2014.986813(2016). Paving the way to successful implementation:
20 VOLUME 23 NUMBER 2
Van Ausdal, K. (2015). Suspensions and expulsions reduction
project (SERP Update). Chicago Public Schools.
https://www.cpsboe.org/content/documents/
cps_serp_03252015
WestED. (2019). Trauma-informed practices in early childhood
education. https://www.wested.org/service/trauma-
informed-practices-in-early-education/
Whitehurst, G. J. (2018, April 19). What is the market price
of daycare and preschool? Brookings Institute-Evidence
Speaks Reports, 2(48). https://www.brookings.edu/
research/what-is-the-market-price-of-daycare-and-
preschool/
Whitted, K. (2011). Understanding how social and
emotional skill deficits contribute to school
failure. Preventing School Failun, 55(1), 10-16.
https://doi.org/10.1080/10459880903286755
Yoon, S. Y. (2016). Principals’ data-driven practice and its
influences on teacher buy-in and student achievement
in comprehensive school reform models. Leadership
and Policy in Schools, 15(4), 500-523. https://doi.org/
10.1080/15700763.2016.1181187
Zeng, S., Corn C. P., O’Grady, C., & Guan, Y. (2019).
Adverse childhood experiences and preschool
suspension expulsion: A population study. Child
Abuse 8 Neglect, 97. https://doi.org/10.1016/
j.chiabu.2019.104149
Zero to Three. (2019). Trauma and stress in early childhood.
https://www.zerotothree.org/espanol/trauma-and-
stress
Zin, D. M. M., Mohamed, S., Kashim, M. I. A. M.,
Jamsari, E. A., Kamaruzaman, A. F., & Rahman,
Z. A. (2019). Teachers’ knowledge and practice in
implementing the therapeutic approach in pre-school.
International Journal of Civil Engineering and Technology,
10(1), 1870-1881. https://oarep.usim.edu.my/jspui/
handle/123456789/1449
THE JOURNAL OF AT-RISK ISSUES 21
Appendix A
Defining Suspension and Expulsion
St,spension Expulsion
• In School/Program Suspension: The child is Expulsion/Dismissal: Permanent dismissal of the child
temporarily removed from classroom and/or class from the program in response to problem behavior.
peers. Child is sent to some other part of the school/ Does not include transition to another program,
program (e.g., other classroom, director’s office) service, or classroom (e.g., special education,
for part of the day or multiple days in response to liansitional classroom, or therapeutir preschool
problem behavior. This includes when the child is program) deemed more appropriate for the child
removed from the classroom to spend extended time if done in collaboration with the family and the
with administrator, counselor, behavior therapist or receiving classroom, program or service.
another adult.
• Short Term Out-of-School/Program Suspension: Source: National Center for Pyramid Model Innovations
Child is sent home for some part of the school/ (NCMPI) https://challengingbehavior.cbcs.us£
program day in response to problem behavior. edu/Pyramid/suspension.html)
• Out-of-School/Program Suspension: Child is not
allowed to return to school/program for one or more
days in response to problem behavior.
• For children with disabilities served under IDEA (with
an IEP or IFSP): Out-of-school/program suspension
is an instance in which a child is temporarily removed
from his/her regular school/program to another
setting (e.g., home, behavior center) for at least half a
day in response to problem behavior. Out-of-school/
program suspensions include both removals in
which no individualized family service plan (IFSP) or
individualized education program (1EP) services are
provided because the removal is 10 days or less as well
as removals in which the child continues to receive
services according to his/her IFSP or IER
22 VOLUME 23 NUMBER 2
Appendix B
Resources for School Professionals
Professional Organizations Online Articles
• National Association for the Education of Young • 50,000 Meschoolers aTe suspended each yeaT. Can mental..
Children (NAEYC) http//www.nbcnews.com/news/us-news/50-000-
Creating Trauma-Sensitive Classrooms preschoolers-are-suspended-each-year.can-mental-
http//www.naeyc.org/resources/pubs/yc/may2015/ health-n962691 an 26, 2019. Mental health consultants
trauma-sensitive-classrooms aim to equip early childhood teachers with the tools
they need.• Centers for Disease Control and Prevention (CDC)
Preventing Adverse Childhood Experiences: Leveraging the • Should Childhood Trauma Be Treated as A PublicBest Available Evidence
Health Crisis? http//www.npr.org/sections/health-CDC: Childhood trauma is a public health issue
shots/2018/11/09/666143092/shorild<hildhood-http//www.npr.org/sections/health-shots/2019/
11/05/776550377/cdc-childhood-trauma-i trauma…
• Administration for Children and Families (ACF). Researchers followed a group of kids from childhood
Expulsion and suspension prevention webinar series. into adulthood to track the link between trauma in
WebinaT 2. Reducing Suspension and ffxpulsion Practices early life and adult mental health.
in Eady Childhood. Department of Health and Human
Services, Washington, DC 20037. • Childhood Trauma Tied to Greater Social Dysfunction
https://www.acf.hhs.gov/ecd/child-health- in…
development/reducing -suspension-and-expulsion- psychcentral.com/news/2018/09/14/childhood-
practices trauma-tied-to-greater-social…
• United States Department of Health and Human Childhood trauma is tied to impaired social cognition
Services and Education in adults diagnosed with major psychiatric disorders,
Joint policy statement on suspension and expulsion policies according to a new Irish study published in the journal
in early childhood settings. European Psychiatry.
https://www2.ed.gov/policy/gen/guid/school-
discipline/policy-statement-ece-expulsions- • Childhood Trauma and Chronic Illness in Adulthood:
suspensions Mental
http//www.nebi.nlm.nih.gov/pmc/articles/
• United States Department of Education, Office for PMC3153850
Civil Rights Mental health and socioeconomic status are also tested
Data Snapshot: Early Childhood Education Highlights. as buffers against the typically adverse consequences
Issues Brief #2. Washington, DC. http://ocrdata.ed.gov of childhood trauma. The results suggest mental
• Zero to Three: Infant and Early Childhood Mental health and socioeconomic status partially explain the
Health association of childhood trauma with chronic illness
‘Infant mental health” refers to how well a child in adulthood, with mental health showing a stronger
develops socially and emotionally from birth to three. effect.
Understanding infant mental health is the key to
preventing and treating the mental health problems
of very young children and their families.
http//www. zerotothree.org/espanol/infant-and-early-
childhood-mental-health
Books
Nicholson, J., Perez, L., & Kurtz, J. (2019). Trauma-Informed
Practices for Early Childhood Educators – Relationship
Based Approaches that Support Healing and Build
Resilience in Young Children, First Edition, Routledge
Publishers.
Souers, K. & Hall, R (2018). Creating a Tmuma-Sensitive
Classroom. ASCD Publishers.
Souers, K. & Hall, R (2016). Fostering Resilient Learners:
Strategies foy Creating a Trauma-Sensitive Classroom.
ASCD Publishers.
THE JOURNAL OF AT-RISK ISSUES 23
Andrea Holzner, MPH, is pursuing a doctorate in
Authors Gerontology at Walden University. She is a doctoral
mentor and National Society of Leadership and Success
Dolores (Dee) Stegelin, PhD, is a professor emeritus at member. Her career has been spent in advocacy for aging
Clemson University where she serves on the advisory board
of the Emeritus College and the steering committee of the and disability policy, ethical standards, and human rights.
US Play Coalition, headquartered at Clemson University. She maintains a clinical practice for comprehensive aging
She was a professor in the College of Education with treatment planning. While she is finishing her qualitative
an area of expertise in early childhood education. Her research, she focuses on rural aging sustainability in the
research interests are public policy, public school preschool United States and globally with Aging Nepal. Additionally,
programs, and professional development for professionals she volunteers for orEanizations focusing on aging rights
serving students with traumatic experiences and mental and age-related issues.
health needs. Dr. Stegelin is a Research Fellow for the
National Dropout Prevention Center and Successful
Practices Network. She is the author of numerous journal
articles and several books.
Carmen Leggett, PhD, is a recent graduate of Walden
University where she earned her doctorate. in Human
Services. She has spent years cultivating social change by
advocating for military families, promoting violence-free
environments, and increased educational opportunities
to enhance quality of life. Dr. Leggett’s research interests
include adoption and education. She is retired from the
United States Army and currently serving as the Family
Advocacy Program Manager, USAG Italy, and as a mentor
for PhD candidates at Walden University.
Diane Ricketts, PhD, is an adjunct instructor and a
Director for a structural engineering company. She was
appointed by the Cayman Islands Government as a
Guardian Ad Litem, effective May 2020. Dr. Ricketts
represents infants’ interests, the unborn, children, or
incompetent persons involved in various legal actions
before the courts in the Cayman Islands. She has
volunteered on multiple committees that mentor young
people, advancing yniith’s lives globally. She currently
works for a non-profit organization.
Misty Bryant, PhD, has been a Program Director for
a nonprofit organization since 2015 and an Education
Consultant since 2017. Dr. Bryant is a recent graduate
of Walden University with a PhD in Human Services.
She spent 17 years providing school-based preparatory
one-to-one mentoring and group mentoring for students
who require academic, social, and developmental support.
Dr. Bryant is a mentor for Walden University doctoral
candidates and the lead mentor trainer for undergraduate
students seeking mentor opportunities for local nonprofit
organizations.
Chanci Peterson, MSHS, is pursuing a doctorate in Human
and Social Services at Walden University. Her research
interests are parenting, adolescent behavior, relationship
studies, and familial research. She is a member of the
National Society of Leadership and Success as well as the
Tau Upsilon Alpha Honor Society.
24 VOLUME 23 NUMBER 2
Copyright of Journal of At-Risk Issues is the property of National Dropout Prevention Center
and its content may not be copied or emailed to multiple sites or posted to a listserv without
the copyright holder’s express written permission. However, users may print, download, or
email articles for individual use.
63
Yvonne RB-Banks & Joseph MeyerThe Journal of Educational Foundations, 2017
Yvonne RB-Banks is a professor in the School of Urban Education at Metropolitan State University, Saint
Paul, Minnesota. Joseph Meyer is a teaching member of the International Society of Sandplay Therapy and a
member of the Sandplay Therapists of America. Their e-mail addresses are: yvonne.rb-banks@metrostate.edu
& Rcc4unow@gmail.com
Keywords:
Trauma, Urban Classrooms, Sandplay, Resiliency
Abstract
Childhood trauma leaves its marks on the brain (Sandi, 2013) with
unseen scars as evident in brain research. Addressing childhood trauma
in today’s urban classrooms is no small feat. According to the 2011—12
National Survey of Children’s Health, nearly 35 million children in the
United States are living with emotional and psychological trauma. Pro-
viding today’s educators with Trauma Informed Practices is essential.
Trauma Informed Practices (TIPs) are specific interventions that fortify
one’s ability to learn strategies for living with trauma. Schools as learn-
ing environments should be on the frontline as advocates for the use of
TIPs. This writing highlights insights from teacher candidates, seeking
licenses with a pedagogy grounded in urban education, in classroom ses-
sions with an experienced therapist grounded in trauma interventions
through the lens of sandplay. They learned first-hand about the impact
of TIPs on the educational experiences of urban students. Discussions
centered on the benefits to urban students when teachers and therapists
collaborated and used TIPs as a critical first step.
Childhood Trauma
in Today’s Urban
Classroom
Moving Beyond
the Therapist’s Office
Yvonne RB-Banks
& Joseph Meyer
The Journal of Educational Foundations
2017, Vol. 30. No. 1-4, pp. 63-
75
Copyright 2017 by Caddo Gap Press
64
Childhood Trauma in Today’s Urban Classroom
Introduction
What is the role between therapists working with school age children
in urban settings and classroom teachers? What do professional devel-
opment activities need to ensure they know in order to use strategies
related to Trauma Informed Practices (TIPs)? How can schools collaborate
with mental health professionals in ways that bring needed services to
students facing trauma? These questions and their underlying impact
are a direct outgrowth of discussions in a college classroom between
teacher-candidates and a certified sandplay therapist with experience
in urban schools working with students exposed to trauma. The intent
of the engagement was to offer teacher candidates an opportunity to
have an in-depth connection with a practitioner specifically trained in
trauma, while being engaged in urban field placements. This article
uses responses gathered from the teacher candidates after several en-
gagements with the therapist. Teacher candidates had a unique chance
to share their current experiences while in field placements and learn
about strategies and opportunities that could benefit students, as well
as hear and share about the relevance on what a collaborative relation-
ship between a therapist and a teacher could mean in the lives of urban
students experiencing trauma. These rich and informed discussions grew
out of encounters between the therapist and teacher candidates over
the course of several semesters.
Initially, when asked about what trauma may look like in the school
setting, especially classrooms, many teacher candidates were perplexed
about the term, as well as how to see what may be behind “behaviors”
they saw as bad in students. Teacher candidates acquired a clear defini-
tion of the essential components of Trauma Informed Practices. They
learned such practices to be strategies that involved interconnections
that allowed practitioners to infuse trauma awareness, knowledge, and
skills into their work with children and families. They work collabora-
tively, using the best available science, to screen and treat children and
help them develop resiliency (SCAN, 2013).
The conversations around questions guided by research on Adverse
Childhood Experiences (ACE) proved to be an informed foundation for
starting to increase awareness in teacher candidates about childhood
trauma and signs of such that may appear in educational settings. The
work done with the guest therapist coming to the college classroom re-
vealed a keen interest from many teacher candidates, as several were
already working in urban schools. Their interests indicated that they
wanted more information about trauma informed practices. The oppor-
tunity to have a therapist in the learning experiences allowed teacher
65
Yvonne RB-Banks & Joseph Meyer
candidates to express their concerns about working in environments with
urban students facing trauma. In the follow-up feedback about the benefits
of having a therapist come to the college classroom to discuss the impact
of trauma in urban schools, several teacher candidates expressed that
they felt free to ask questions without fear of judgment (e.g., appearing
racist or biased regarding poverty or parents struggling with addiction).
Such comments related to how some felt or even had fears about having
students with such intense needs as part of their future classrooms, and
even working with the parents of the students.
The Tension of Opposites:
Learning with a Therapist as Discovery
Teachers are on the frontline when it comes to seeing the impact of
trauma and the needs of children in a variety of arena. Children enter
school with a range of needs, such as educational, health, physical, and
social/emotional. With this in mind, it appeared only appropriate to in-
vite a trained specialist from the field of mental health into the college
setting for teacher candidates to learn first-hand about TIPs. The initial
decision to bring in a therapist started around the question of “who else
would be better informed in the area of trauma than a licensed social
worker trained as a Jungian sandplay clinician, and who has been the
bridge between home, school and the therapist’s office in the advocacy
of students facing trauma for over 30 years?”
The initial encounter with the therapist, who is also a licensed social
worker coming into the college setting revealed discoveries about how
some teaching professionals may feel about therapists in general. This
discovery revealed a tension of opposites (Winter, 2002), meaning that
some teachers might see a limited relationship between the work that
occurs in the classroom and the work that occurs in a therapist’s office.
Yet, as conversations deepened, many could acknowledge the value of
mental health services integrated with school relationships. The teacher
candidates’ comments revealed that this tension stemmed from their
own views or experiences with therapists. Often teachers do not have
the opportunity to know or even have a conversation with a therapist
working with a student in need. It was expressed that some teachers
felt excluded due to rules of confidentiality or fear regarding their lack
of knowledge on the subject of trauma. During classroom discussions
with the therapist teacher candidates addressed their perceptions and
learned about what avenues were available to change actual relation-
ships between the school, the teacher, and the therapist, in order to
more effectively help students facing trauma. The connecting factor in
these conversations centered on the importance for both professionals,
66
Childhood Trauma in Today’s Urban Classroom
meaning teacher and therapists, as well as to collaborate. In discussions
with the visiting therapist, teacher candidates learned how a founda-
tion of collaboration could build a common bridge for at best seeing and
moving beyond the therapist office regarding TIPs. Teacher candidates
started to see why a practice where teachers collaborated could build
stronger relationships between two professionals with insights that
brought needed interventions directly on behalf of students in urban
setting experiencing trauma. This observation has been seen in other
fields that work on behalf of students facing trauma, such as the court
system (McInerney & McKlindon, 2015).
By the end of the college classroom engagements on trauma, teacher
candidates started to indicate new insight into seeing the benefits that
could come to students exposed to trauma when their therapist and teacher
worked collaboratively using TIPs to support their needs. Initially, some
teacher candidates expressed that they perceived the two professional
groups to be in separate categories with very different skillsets. By the
end of the semester they were able to see how teachers working with
therapists, built resiliency in urban students over a longer period of time.
Teacher candidates also started to see how TIPs could help move students
beyond the therapist’s office and into the day-to-day of school life.
Relevance, Resiliency and the New Face of Trauma
The new face of trauma is often invisible in today’s classroom
because traditionally childhood trauma is often seen as a domain for
social workers or clinical psychologists. At best, general education has
relegated students in need due to traumatic life experiences to the Emo-
tional Behavioral Disorder (EBD) realm of education. Therefore, general
education schoolteachers and staff members are often unaware of best
practices for dealing with students impacted by childhood trauma.
This article seeks to reveal the impact teachers can have by using
TIPs and many of the conceptual roots of sandplay to build meaning-
ful relationships with children often unable to access such support in
a timely manner. The authors believe, and the research confirms, that
teachers can learn the needed strategies that build resiliency in urban
students when the work is intentional (Sagor, 1996). The relevance of
TIPs in the classroom to build resiliency in students facing trauma is
essential in the design of an effective educational platform. In the fight
to reduce the impact of trauma on the life of school-aged children early
exposure in the training of teachers and future teachers, as well as, other
professionals in the Trauma Informed Practices (TIPs) model lays the
groundwork for addressing what some see as the new face of trauma as
it relates to urban settings (Gotham, Blum, & Campanella, 2014).
67
Yvonne RB-Banks & Joseph Meyer
Exposure Matters:
Early Interventions with Teachers and Trauma Informed Practices
The role of a school social worker with experience with urban stu-
dents living with trauma, who has skills in specific TIPs, is an essential
resource for teachers in addressing the effects of modern day trauma.
Exposing teachers to what the new face of trauma may look like in the
life of urban students and how it can manifest in school settings can-
not be understated in its importance in changing the lens by which an
untrained eye learns to see what is important. Exposure to TIPs is key
to the learning platform of urban schools if outcomes are to change.
Bringing a sandplay therapist into the college learning environment
allowed teacher candidates to learn how to consult on best practices for
successful classroom management of traumatized students. Discussing
and modeling strategies that teachers can use could carry over into how
best to work with urban students and families who cannot access the
needed referral process outside the school. Teacher candidates learned
the methodology of engagement in order to ask the right questions, how
to advocate, which agencies could help and how to avoid adversely rein-
forcing the negative impact of trauma on students in the classroom by
just seeing the child as “bad.” Learning these insight laid the foundation
for how future teachers could prepare to improve their day-to-day rela-
tionships with students functioning in complex life situations. Specific
questions proved to be worthwhile, when the questions related to “How
can we continue to have a positive impact in the success of school stu-
dents once they are no longer in our classroom?” were a part of various
touchpoints with the therapist. This engagement helped future teachers
to see the importance of how working with a therapist, who may have a
longer-term relationship with a student [read: client] could effectively tap
into powerful resources that could continue as TIPs in helping students
cope with traumatic life experiences as they moved through various
schools and other locations over the course of their academic career.
Research indicates that urban/inner city school age children can fall
into the category of what is termed “highly mobile” (Walls, 2003). Guid-
ing and connecting urban students in ways that support them learning
how to navigate school systems in the face of trauma is one key to their
long-term academic success.
One outcome from the work done with the more than sixty teacher
candidates is the support around knowing that the more exposure teach-
ers and teacher candidates have to TIPs and trained professionals using
the practice the more effective they will become in using and seeking
out such partnerships on behalf of students. Research is clear that TIPs
68
Childhood Trauma in Today’s Urban Classroom
as an intervention strategy, helps teachers work more effectively with
all students, not just those coming to school with a greater capacity to
be successful (Oehlberg, 2017).
Research Supports the Benefits of Trauma Informed Practices
The National Child Traumatic Stress Network 2010 report outlined
one study that indicated more than half (52.5%) of children aged 2-5
had experienced severe stressors in their lifetimes. According to the
National Survey of Children’s Health, nearly 35 million children in the
United States are living with emotional and psychological trauma. We
understand that 20% to 25% of people have suffered some form of trauma
(in the general population). Such data reveals that we can expect that
some portion of the teaching profession have individuals entering with
exposure to trauma prior to starting their career. This data is especially
important as teachers need to be aware of their own feelings, reactions,
triggers and the possibility of developing “compassion fatigue” or second-
ary traumatic stress as they prepare to support students with trauma
in the classroom (Simpson & Starkey, 2006).
As teachers grow in their awareness about trauma, not only in the
lives of their students, but possibly in their own lives systemic changes
should occur in the learning environment. The hope here is to reduce
having teachers respond through their socialized trauma, as clearly
revealed by the research that a percent of teachers start their careers
with latent responses to their own triggers tied to possible childhood
trauma. Such information should inform teachers’ interactions with
urban students in ways that are positive. Meaning, informed prac-
tices should have a positive impact on referral of students to programs
identified as EBD, hence, reducing the over-representation of African
American males referred to such program (Zorigian & Job, 2014). One
teacher candidate captured the benefit of such work in a statement to
the visiting therapist, “This is my life—this explains so much!” Lynne
Ehlers, (2015) supports this type of exhortation from professionals as
it is clear that when they heal their own trauma they are able to “heal
and return,” and this personal awareness benefits those they work with
who are living with trauma.
The above outlined presents us with further urgency to engage in
ways that support curriculum in teacher preparation program that will
infuse TIPs into the college training experience. This appears especially
relevant in benefiting those entering the vocation of teaching seeking
a specific niche to prepare as urban teachers. One clue would be the
frequency in which teacher candidates selecting college education pro-
grams with an urban focus indicate they did so “because I can identify
69
Yvonne RB-Banks & Joseph Meyer
with these students.” This may be an area for future research as their
motivation appears interconnected due to similar life experiences. The
better that teachers are prepared in how best to understand the powerful
impact of trauma—the more successful educational outcomes will be in
the learning environment.
A Touch of Sandplay in Urban Classrooms:
Sharing What We Learned
Modeling for teacher candidates during their preparation program
how the use of various expressions gives children the opportunity to
demonstrate what they are possibly wanting, thinking, feeling or need-
ing to share. This could help reduce the over-referral of students of
color to special education. In appropriately designed TIPs classrooms
providing students with opportunities to touch, select, and build objects,
students are given multiple means to demonstrate their learning and
feelings (UDL). We know that Carl Jung “played himself back to health”
after the break from Freud. He said. “Often the hands know how to
solve a riddle with which the intellect has wrestled in vain.” Jung, C.G.
(1969/1985). One might conclude from Jung’s work that appropriate
play would also be helpful in the classroom for all children, especially
those exposed to trauma.
A combined review of data outlined by Levine (2010) and Sandi
(2013) informs us that “much of early childhood trauma never reaches
the prefrontal cortex of the brain, the portion of the brain used in speech,”
meaning there is a correlation between “trauma in childhood and early
life stressors, with implications and lasting impact.” Levine’s (2010)
work tells us that not only does one not wish to talk about a traumatic
experience, but also often it is not possible to talk about such early experi-
ences. The benefits of TIPs combined with the work of Levine and Sandi
provide good indicators for teachers learning about and collaborating
with therapists in order to help students facing trauma.
What does this mean for the classroom experience of young students
facing trauma? It means that teachers cannot rely on the children’s
verbal abilities to self-express. If early trauma is to be successfully ad-
dressed it must be processed through more physicals means, such as
movement, drawing/forms of art work, dramatic play and other such
choices for expression; hence sandplay. Trauma can impair an individual
on many levels. A review of what happens in reactions to trauma (e.g.,
one may freeze, the body becomes still, the breath slows, the heart rate
slows appears to be in a trance state, fear occurs or even explode into
action) could help teachers express more specifically what a child does
in the classroom setting when they are working collaboratively with
70
Childhood Trauma in Today’s Urban Classroom
therapists. One possible outcome from such a collaboration might be
that the child’s interactions with the therapist help develop strategic
outcomes designed around classroom experiences (Levine, 2010).
What difference can teachers make in the life of urban children
today by providing a space that helps to build positive relationships?
Essentially, when non-verbal strategies are encouraged to relieve stress
in the academic setting students exposed to trauma are more likely to
exhibit less explosive behaviors as a response to stress (Levine, 2010).
Such options can help reduce referrals to EBD school placements for
urban school age children responding to traumatic life experiences.
The following are reoccurring themes from teacher candidates
engaging for the first time with the concept of “Sandplay and Urban
Trauma.”
Relevance and the need for a Application to the Classroom:
relationship between teacher/therapist:
“I see myself in this work…I think “Be open minded and
I have experienced trauma…” watch for signs [of] trauma”
We need to know about trauma and “…decrease black boys being put
what to do!” into those special ed. Programs”
“Why do poor kids have to be left out “…could close the achievement
[therapy]…the school could help” gap for urban youth…”
Reflecting on specific reactions during the class experience and gathering
feedback at the end of each session it was noted that the experiences
with the therapist were positive and many of the teacher candidates
wanted to know more about Trauma Informed Practices (TIPs).
By combining the training of TIPs with the introduction of the work
done in urban settings under the heading of Adverse Childhood Experi-
ence (ACE) the learning process for teachers will improve. Again, most
of the teacher candidates indicated wanting to learn about “trauma
informed practices” for working with urban students. Many were sur-
prised to know that much of trauma, especially repeated trauma is
stored in the body and that the body must be engaged to help process
the event. Meaning, as future teachers this is an area of self-reflection
that needs to happen, especially if teachers are working in educational
settings with disproportionate exposure to trauma. The work done with
teacher candidates during the semester led to the comments based on
self-reflection about stress and the impact of trauma management,
71
Yvonne RB-Banks & Joseph Meyer
What would be the purpose Recommendations from the
of this work? learning you gained?
“…it can be useful for both early “Giving students sustainability—
and elementary [students]” different perspectives.”
“Help parents get help for their children.” What resources did you add to your
teaching toolkit [from this
experience]?
Best learning experience as a tool in the “…using the rocks…always ask,
urban classroom: give shake off (movement]
breaks…”
“Work together as a team…” “Join a gym program—
“… unseen/unknown trauma could be the fee would be worth it.”
the root of [student’s] problem…”
The above comments are good guides for how future teachers and
current teachers could start to think about play/movement/manipulation
and other methods of engagement in the classroom as an outgrowth of
understanding some key concepts found in sandplay therapy. This ap-
pears an appropriate foundation as again, teachers incorporate learning
from other fields of study that work with students in different ways to
help them cope with processing the impact of trauma. Movement helps
process tension, tightness, fear, and anger that get stored from trauma
or the memory of a traumatic event in the past.
It is reasonable to expect that in a classroom setting students should
be able to even do something as simple as standing up, moving around,
walking or running in place, or even shaking parts of the body to help
release the pressure built up, in lieu of labeling and referring them out as
being unable to contribute in a positive manner to the learning environ-
ment. Simply put “movement helps in the face of trauma experiences.”
Teacher candidates in their feedback, agreed with the research that
such activities if done in a timely manner should help reduce the explosive
stage of acting out. Many were hopeful and expressed that teachers needed
to be sensitive to recognizing triggers to trauma in the classroom with
early interventions strategies; meaning they did not express that it was
someone else’s job, but theirs to help urban students facing trauma.
The Hope
Working with the teacher candidates and the sandplay therapist
over a period proved to be worthwhile and informative for what steps
teacher preparation programs could do to add TIPs awareness to the
curriculum prior to graduation. The feedback rested solidly that the
72
Childhood Trauma in Today’s Urban Classroom
teacher candidates gained and benefited from the in class work with the
experienced sandplay therapist and learned direct intervention strategies
for supporting students who had suffered from trauma. Therapists can
be allies in the work to train urban teachers about the nature of early
childhood trauma. Starting with the development of strategies in teacher
preparation programs is a good first step towards collaboration with a
therapist. We can help teach future teachers to better understand how to
work more effectively with trauma situations and how to recognize those
situations through collaboration. We believe that this work will lead to
the reduction of specific populations of student being over-referred to
special education program such as EBD. In addition to working directly
in schools we believe that we increase reaching many future teachers by
working directly in their college classrooms to give them a head start on
how best to use strategies designed for traumatized students; and as in-
dicated in some cases, help them better understand their own traumatic
experiences. Essential questions can help guide the way, for example: “How
might we effectively mobilize the resources of the sandplay community?”
Will other sandplay therapists step up to help train teachers and teacher
candidates to maximize their ability to reach all students effectively? If,
using feedback from teacher candidates in an urban teacher preparation
program is any indication of the impact from such training, educational
outcomes should improve for urban students when their teacher works
with their therapist.
If we rely on the unexpected and unsolicited, as well as, the solicited
feedback gained from the teacher candidates in this classroom experience
and use the comments directly, it should be interpreted that promoting such
training for teacher candidates (as well as teachers in general) is positive
in the right direction. Noting, as well, that such TIPs training for future
teachers reduces some underlying fears about working in urban settings
with possible students coming from homes that have experienced trauma,
such as (returning veterans as parents, child abuse, school conferences, etc.).
The basic recommendation here from this work is drawn from a simple
teacher candidate’s feedback and it was simply stated well: “We need to
know about trauma and what to do!” If sandplay therapists find ways to
work in urban education programs the impact could be significant on the
lives of urban students. As stated previously in this writing the collabora-
tion between teachers and therapists could move TIPs beyond the office
of clinicians and into the classrooms of teachers. Such partnerships could
help teacher candidates understand some of the triggers of trauma and
some of the behaviors likely to relate to those trauma triggers. Teacher
candidates could learn early ways to understand and reduce the negative
impact of trauma induced behavior in the classroom, thereby, increasing
students’ academic success. As a practice, resources that support such
73
Yvonne RB-Banks & Joseph Meyer
collaboration benefit both the profession of teachers and therapists as
the interventions reach far beyond either’s threshold.
Conclusion
The essential work ahead is to take steps that will make building
relationships between classroom teachers and therapists a common
practice. One way to possibly start this relationship is to provide a com-
mon language and understanding about what trauma informed practices
represent and strategies for engagement. The work and resources offered
by the National Child Trauma Stress Network (NCTSN) outlines a good
starting place with core concepts for effectively working children facing
trauma. NCTSN offers:
• 12 Core Concepts for Understanding Traumatic Stress Responses in Children
and Families
• The Core Curriculum on Childhood Trauma (CCCT), a tool developed by the
National Child Traumatic Stress Network to promote a trauma-informed mental
health workforce.
• The 12 Core Concepts for Understanding Traumatic Stress Responses in Children
and Families form the theoretical foundation and act as guiding principles for the
CCCT. The main objective for these concepts is to provide practitioners with a
shared vocabulary for conceptualizing and talking about traumatic events. This
course contains interactive online lessons that lead you through each of the 12
Core Concepts.
Starting with similar resources as those outlined above would give
both teacher and therapist a common starting place for collaborating and
working to support urban students living with the impact of trauma. The
outcomes before each practitioner have overlapping themes related to
increasing urban students’ success through collaborative efforts. We know
from the work of many scholars that student success is tied to multiple
arenas; social, emotional, health, as well as academic developmental skills
(Weissberg, 2011), and success in all arenas is the combination that fosters
resiliency in students’ experiences in and out of the classroom.
As outlined at the onset, the intent of this writing was to bring forth
the voices of more than sixty teacher candidates who shared their ex-
periences with a trained Jungian therapist regarding learning TIPS to
prepare well to work with urban learners. The therapist’s thirty years of
advocacy in public schools on behalf of urban school age children facing
trauma, aligned with what research says about trauma informed prac-
tices and collaboration between professionals being a possible solution
for improving students’ success, and the teacher candidates agreed.
74
Childhood Trauma in Today’s Urban Classroom
Such outcomes point to the benefits that can be gained successfully
though collaborative efforts that bring support to schools where students
facing trauma come daily. Schools and mental health professionals can
help students facing trauma by crossing beyond the doors of not only
the therapist’s office, but also beyond the classroom teacher’s door.
References
Adverse Childhood Experiences: ACE Response. (n.d.). What is ACE? Retrieved from
http://www.aceresponse.org/
ACES too high. (n.d.). Retrieved from https://acestoohigh.com/2013/05/13/nearly-35-million-
u-s-children-have-experienced-one-or-more-types-of-childhood-trauma/
Baylor, B. (1985). Every one needs a rock. Aladdin Books. http://simonandschusterpublishing.
com/aladdin/index.html
Blue, L. (2013). Childhood trauma leaves legacy of brain changes. Retrieved from http://
healthland.time.com/2013/01/16/childhood-trauma-leaves-legacy-of-brain-changes/
Burke-Harris, N, (2012). How childhood trauma effects health. TEDTALK. Retrieved from
https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_
health_across_a_lifetime
Child Welfare Gateway. (n.d.). Trauma-informed practices. Washington, DC: U.S. Department
of Health. Retrieved from https://www.childwelfare.gov/topics/responding/trauma/
Dahl, G., & Lochner, L. (2012). Research regarding academic impact of growing up with
parents who work changeable hours. American Economic Review, 102(5). Retrieved
from http://econweb.ucsd.edu/~gdahl/papers/children-and-EITC and http://dx.doi.
org/10.1257/aer.102.5.1927.
Egger, H,, & Angold, A. (2004). Stressful life events and PTSD in preschool children. Paper
presented at the annual meeting of the American Academy of Child & Adolescent
Psychiatry, Washington, DC.
Ehlers, L. (2015). Written in the sand: Trauma, healing and return. Journal of SandPlay
Therapy, 24(1), 101-113.
Gotham, K. F., Blum, M., & Campanella, R. (2014). Toward a new normal: Trauma, diversity,
and the New Orleans urban long-term research area exploratory (ULTRA-Ex) project.
Cities and the Environment (CATE), 7(1), Article 4. http://digitalcommons.lmu.edu/
cate/vol7/iss1/4
Jung, C. G. (1969/1958). The structure and dynamics of the psyche. Collected Works, 8.
Princeton, NJ: Princeton University Press.
Jung, C. G. (1965/1961). Memories, dreams, reflections. New York, NY: Vintage books, a
Division of Random House.
Levine, P. (2010). In an unspoken voice: How the body releases trauma and restores goodness.
Berkeley, CA: North Atlantic Books.
McInerney, M., & McKlindon, A. (2015). Unlocking the door to learning: Trauma-informed
classrooms & transformational schools. Retrieved from http://www.elc-pa.org/
wp-content/uploads/2015/06/Trauma-Informed-in-Schools-Classrooms-FINAL-
December2014-2
The National Child Traumatic Stress Network of the Center for Mental Health. Retrieved
from http://www.nctsn.org/ and https://learn.nctsn.org/
Oehlberg, B. (n.d.).Trauma informed classrooms. Retrieved from http://www.
75
Yvonne RB-Banks & Joseph Meyer
reachingdifficultkids.org/Trauma_Informed_Classrooms .
Sagor, R. (1996). Building resiliency in students: Creating a climate for learning. Educational
Leadership, 54(1), 38-43.
Sandi, C. (2013). Childhood trauma leaves its mark on the brain. Ecole Polytechnique Fédérale
de Lausanne. Retrieved from (http://healthland.time.com/2013/01/16/childhood) and
https://www.sciencedaily.com/releases/2013/01/130115090215.htm.
Services/Substance Abuse and Mental Health Services Administration. (n.d.).Retrieved from
https://www.samhsa.gov/
Simpson, L. R., & Starkey, D. S. (2006). Secondary traumatic stress, compassion fatigue,
and counselor spirituality: Implications for counselors working with trauma. Retrieved
from http://www.counselingoutfitters.com/Simpson.htm
National Survey of Children’s Health. (2011-2012). Adverse childhood experiences (pp. 116-
119). Retrieved from http://www.childhealthdata.org/docs/nsch-docs/sas-codebook_-
2011-2012-nsch-v1_05-10-13
Walls, C. A. (2003). Providing highly mobile students with an effective education. ERIC
Identifier: ED482918.
Weissberg, R. P. (2011, March 11). Strategies to support social, emotional, and behavioral
needs of students. University of Illinois at Chicago. Paper presented at Collaborative
for Academic, Social, and Emotional Learning School Climate Technical Assistance
Symposium, New Orleans, LA.
Winter, R. (2002). September 11, the day and the experience. Sandplay Therapist of America
Journal, 11(1).
Trauma Informed Practices. (2013). SCAN. Retrieved from scanofnova.wordpress.
com/2013/06/21/what-is-trauma-informed-practice.
Zorigian, K., & Job, J. (2014). Minority representation in special education classrooms.
Retrieved from http://www.learnnc.org/lp/pages/6799.
Copyright of Educational Foundations is the property of Caddo Gap Press and its content may
not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s
express written permission. However, users may print, download, or email articles for
individual use.
Expert paper writers are just a few clicks away
Place an order in 3 easy steps. Takes less than 5 mins.