Abstract
The current review sought to describe the implementation and evaluation of trauma-focused school practices as represented in the published literature. Through a systematic literature search, we identified 39 articles describing trauma-focused practices implemented in school settings with elementary populations and coded data regarding these interventions’ characteristics as well as their implementation and evaluation procedures. Reviewed interventions were most often implemented by external clinicians or researchers with select populations in response to traumatic events experienced by a community (e.g., natural disaster, political violence). Additionally, interventions were most frequently evaluated solely using rating scales assessing psychopathological symptoms and without consideration of important dimensions such as treatment integrity, fidelity, and acceptability as well as outcome generalization and maintenance. We call for coordinated practice and research agendas focused on embedding trauma-focused practices within integrated multi-tiered systems of supports; designing culturally sensitive practices and training school personnel to serve as intervention agents; and increasing the rigor and broadening the methods, informants, and foci of screening and intervention evaluation procedures in the direction of leveraging multi-method, multi-informant, strengths-based assessment.
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Notes
Herein, we will use trauma-informed approach to refer to the general framework of service delivery as described by SAMHSA (2014), and trauma-focused practices to refer to specific interventions designed to prevent trauma or address responses to trauma and promote resilience.
Note that our coding procedures do not include classification of “tier.” Although we recognize the commonality for the multi-tiered systems of support literature to describe, for example, a behavioral strategy as “tier-1” or a reading intervention as “tier-2,” we also recognize the extent to which one’s environment could affect the delivery of trauma-focused practices at varying intensities to universal, targeted, and select populations (Sugai, Horner, & Gresham, 2002); that is, we acknowledge the potential for contextual specificity of “tiers” and find it challenging to generalize school systems’ approaches to multi-tiered trauma-informed care across contexts of variable trauma prevalence. For example, a group cognitive-behavioral therapeutic intervention might be considered a tier-1 intervention in a post-crisis environment (when delivered universally) but might be considered a tier-3 intervention in a school that has not recently been affected by a community-wide crisis (when delivered to select students; e.g., those referred or identified with elevated behavior ratings). Accordingly, to more precisely characterize the reviewed trauma-focused practices, we specifically describe the breadth (i.e., method of participant identification), intensity, and timing of service delivery, which readers may use to evaluate such practices’ relevance to their school populations’ needs. In moving toward consensus on trauma-informed service delivery in schools, Chafouleas et al. (2016) have provided an exemplary multi-tiered model of trauma-informed care (see pp. 148–149) from which we have adopted our operationalizations for the three levels of service intensities. Thus, readers embracing the service delivery approach advocated by Chafouleas et al. may choose to interpret our use of “service intensity” as a proxy for tier.
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Zakszeski, B.N., Ventresco, N.E. & Jaffe, A.R. Promoting Resilience Through Trauma-Focused Practices: A Critical Review of School-Based Implementation. School Mental Health 9, 310–321 (2017). https://doi.org/10.1007/s12310-017-9228-1
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DOI: https://doi.org/10.1007/s12310-017-9228-1