Introduction

A child’s ability to learn is dependent on multiple factors including the optimal development of their cognitive, physical, emotional and psychosocial skills, which influences academic outcomes and behaviours at school. Interpersonal trauma disrupts multiple developmental areas which are important for learning, such as attentional and memory capacities, as well as emotional regulation (Carrion & Wong, 2012; Panlilio et al., 2019). Indeed, research suggests greater rates of absenteeism and expulsion, lower academic performance, and greater problem behaviours within the classroom in this population compared to students with no history of trauma (Frieze, 2015; Maynard et al., 2019; Perfect et al., 2016).

Interpersonal trauma is often experienced within the home environment (Dugal et al., 2016; Folger et al., 2017; Spinazzola et al., 2018), which impacts early attachments to significant others, and disrupts socioemotional development in these children (Ainsworth, 1978; Sroufe, 2005). Examples of interpersonal trauma include experiences of domestic physical or psychological violence, neglect, or the adverse effects of poor mental health by caregivers (van der Kolk, 2005). Interpersonal trauma experienced in childhood is commonly prolonged, resulting in a toxic brain response where the child is in constant state of heightened awareness (Carrion & Wong, 2012). These results in the common behaviours seen in trauma-affected children, such as poor emotional regulation, difficulties reading and responding appropriately to social cues, (McLaughlin & Lambert, 2017), and a sense of distrust of others (Hepp et al., 2021). Within the school environment, these behaviours are not conducive to learning, and affect not only the child but their classmates and teachers (Caringi et al., 2015).

Indeed, teachers who support trauma-affected children may experience vicarious trauma and burnout (Spencer, 2019; Thomas et al., 2019). Therefore, their ability to teach and provide the support these children need is affected, and teachers often report feeling ill-equipped to deal with trauma-affected students (Alisic, 2012; Berger et al., 2021; Davies & Berger, 2019). Furthermore, since learning is a social endeavour where teacher-student relationships are key (Fraser & Price, 2011), students impacted by trauma experience significant setbacks at school.

Many schools have adopted trauma-informed models in order to support students with a history of trauma. An important premise of trauma-informed practice is to provide a safe environment by implementing policies and procedures that are protective and help recognise and respond to trauma in students (Berger, 2019). Indeed, for the student population at large, the provision of the right educational environment, where a sense of safety, connectedness and belonging is fostered, is foundational for learning (Allen & Bowles, 2012). Further, relationships within school settings can function as agents of healing for trauma-exposed students (Brunzell et al., 2015; Crosby, 2015). Students exposed to trauma describe school settings as places of respite and safety away from the trauma of home life (Townsend et al., 2020).

The importance of school for children exposed to trauma can be understood within an ecological systems perspective. A child’s development is the result of interactions between different systems. The microsystem (e.g., immediate connection between child with family and child with teachers), the mesosystem (e.g., interactions between different microsystems), the exosystem (e.g., indirect influences, such as discipline policies within the school, skills and attitudes of teachers), the macrosystem (e.g., school culture and education system legislation), and the chronosystem (e.g., changes across the previously mentioned systems across a child’s life). The microsystem is where personal connections and the opportunity of developing relationships emerges. From an ecological systems perspective (Bronfenbrenner, 1979, 1986, 1996; Harvey, 1996), the school setting is in a prime position to facilitate the development of healthy attachments and help mitigate the effects of trauma (Brown et al., 2019). Further, it is a place where the trauma-affected student can develop important socio-emotional skills such as those related to self-regulation. However, as noted by Crosby (2015), the trauma-informed strategies that can occur within the microsystem are multiple. Influencing practices within the school setting could include the students’ relationship with peers, the teacher’s awareness of and connection with the students’ needs, or intervention programs provided by mental health workers to facilitate the student’s school or relational engagement (Crosby, 2015).

Encouraging healthy relationships has been recognised as essential in establishing a healthy learning environment and trauma-sensitive classrooms (Stokes & Brunzell, 2019). To date, no review has evaluated the different strategies or the outcomes and the benefits of implementing relationship building strategies within school settings to support students who have been affected by trauma. The aim of this systematic review was to evaluate the relationship building research within the trauma-informed practices in school settings. Specifically, this systematic review sought to outline the relationship strategies and frameworks that have been implemented within educational systems as part of trauma-informed practices. Secondly, it sought to evaluate the outcomes of these strategies as well as the phenomenological experiences of students and school staff in employing them. An understanding of how relationship building can be incorporated within a trauma-informed program in the educational setting is valuable in guiding future research, as well as guiding school practice and influencing policy.

Method

The Preferred Reporting Items of Systematic Review and Meta-Analyses (PRISMA) (Moher et al., 2010; Page et al., 2021) guidelines was employed to inform the methodology of this review. The PRISMA guidelines contain reporting recommendations for authors conducting systematic reviews in order to ensure transparency in the way reviews are executed and reported. The guidelines include information that should be included in all areas of the report such as eligibility criteria and the screening process (For detailed guidelines see PRISMA statement, 2021). Four electronic databases (i.e., Psycinfo, A + Education, ERIC, and Proquest Education Journals) were systematically searched between July 2021 and August 2021.

Eligibility criteria and literature search

Qualitative and quantitative approaches of published an unpublished literature (i.e., dissertations) in English were included in the search criteria and no exclusions were placed on year of publication given the limited studies anticipated in this area. Studies within the education system, from preschool to high school, which included connectedness to school through relationship building as part of a trauma-informed practice protocol, were included in the searches. Specialist schools were excluded from the search criteria to focus on relationship building strategies that have been employed in mainstream schools. Specialist schools were regarded as schools that cater for students with disabilities and additional learning, social, emotional and behavioural needs. Searches included terms in the area of childhood trauma (e.g., Adverse Childhood Experiences [ACEs], developmental trauma), trauma-informed practice (e.g., educational interventions), attachment (e.g., relationships, belonging, connectedness), and educational system (e.g., school, primary/secondary school, preschool). See Table 1 for a structure of the search terms, which were combined by using AND as the Boolean operator to add searches 1 to 4.

Table 1 Search terms for the literature review
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Study quality

The quality of quantitative studies was established with the Australian National Health and Medical Research Council (NHMRC; NHMRC, 2009 ) standards. The NHMRC standards have been develop for clinical research but provided guidelines to evaluate levels of evidence for quantitative research (i.e., levels I, II, III-1, III-2, III-3, IV; systematic review of randomised studies, randomised controlled trial, pseudorandomised controlled trial, comparative study with concurrent controls, comparative study without concurrent controls, or case series, respectively). Qualitative studies were evaluated for quality with the Critical Appraisal Skills Programme (CASP; CASP, 2018) checklist. Nine questions from the CASP checklist were considered to evaluate the studies. Questions covered three areas: the study’s validity, the analyses and reporting of results, and the applicability of the findings. CASP scores ranged between 0 (i.e., no criteria met) to 9 (i.e., all criteria met). Details of NHMRC standards and CASP criteria is presented in Table 2 and discussed in the “Results” section.

Table 2 Relationship building strategies within trauma-informed educational settings: study characteristics
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Procedure

Figure 1 outlines the systematic process employed during reviewing. After duplicates were excluded (k = 114), each remaining record (k = 973) was screened by title and abstract. This resulted in 38 records which were retained for full-text review, taking into account the exclusion and inclusion criteria. The reference lists of articles retained at this stage were also searched for relevant articles. A total of six additional articles were identified through this process. Thus, 44 articles in total were subject to full-text screening and through this process 31 articles were excluded. Remaining records (k = 13) were coded using PICOS categories as a guideline (i.e., population, intervention, comparison or control, outcome) (Huang et al., 2006). The following variables were also extracted: educational setting, location of study, study’s participants, study design and measures, relevant trauma risk in the educational setting, trauma-informed framework, training and program support, relationship building strategies, and outcomes pertinent to relationship building strategies.

Fig. 1
figure 1

Flowchart of the literature review process and articles included and excluded at each stage. Note. This chart is adapted from the Preferred Reporting Items of Systematic Review and Meta-Analyses (PRISMA) guidelines (Moher et al., 2010)

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Results

Context of studies (geographical and educational), participant characteristics, and quality of studies

After inclusion and exclusion criteria were applied, thirteen studies were identified that included one or various components of relationship building in a trauma-informed practice model within educational settings (see Tables 2 and 3). Eight studies were from peer-reviewed journals (Brunzell et al., 2019; Dorado et al., 2016; Holmes et al., 2015; Post et al., 2020; Rishel et al., 2019; Saint Gilles & Carlson, 2020; Stokes & Brunzell, 2019; Wall, 2020), three were grey literature (Fleming, 2019; Padak, 2019; VanderWegen, 2013), and two were scholarly non-peered-reviewed articles (Stokes & Turnbull, 2016; Stokes et al., 2019). Nine of these studies were conducted in the USA (Dorado et al., 2016; Fleming, 2019; Holmes et al., 2015; Post et al., 2020; Padak, 2019; Rishel et al., 2019; Saint Gilles & Carlson, 2020; VanderWegen, 2013; Wall, 2020), and four in Australia (Brunzell et al., 2019; Stokes & Brunzell, 2019; Stokes & Turnbull, 2016; Stokes et al., 2019). Data for these studies was collected across the education system; namely preschool (Holmes et al., 2015; Post et al., 2020; Saint Gilles & Carlson, 2020), or primary (Padak, 2019; Stokes & Brunzell, 2019; VanderWegen, 2013; Wall, 2020). Some studies included both preschool and primary (Fleming, 2019; Rishel et al., 2019), or primary and secondary schools (Brunzell et al., 2019; Stokes & Turnbull, 2016; Stokes et al., 2019), as well as preschool to secondary schools (Dorado et al., 2016). All studies reported data from teachers, except one which only reported information collected from students (Stokes et al., 2019). Studies also collected data across various school personnel (e.g., teachers, principals, community liaison) (Dorado et al., 2016; Fleming, 2019; Stokes & Brunzell, 2019; Stokes & Turnbull, 2016; Stokes et al., 2019; VanderWegen, 2013; Wall, 2020). The NHMRC levels of evidence for quantitative studies was level III-2 for three studies (Padak, 2019; Rishel et al., 2019; Saint Gilles & Carlson, 2020), level III-3 for one study (Dorado et al., 2016), and level IV for four studies (Brunzell et al., 2019; Fleming, 2019; Holmes et al., 2015; Stokes & Turnbull, 2016). Five qualitative studies were included in the final review. CASP criteria met was 6 for one study (Wall, 2020) 7 for three studies (Brunzell et al., 2019; Stokes et al., 2019; VanderWegen, 2013), and 8 for one study (Post et al., 2020), suggesting that all qualitative studies met most criterion evaluated. Other study characteristics and a description of the frameworks, training, strategies, and outcomes are presented in Tables 2 and 3.

Table 3 Relationship building strategies within trauma-informed educational settings: frameworks, training, strategies, and outcomes
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Methods and frameworks of relationship building employed in educational settings

All 13 studies were evaluated and organised according to the trauma-informed practice framework employed: established (i.e., frameworks widely implemented and recognised in the trauma-literature), eclectic (i.e., frameworks that incorporated a range of trauma-informed resources), or relationship-building specific (i.e., frameworks which main focus is to establish healthy teacher-student relationships).

Established trauma informed frameworks that incorporate relationship building

Eight studies included trauma informed frameworks that incorporated relationship building as a module within the model. These models were: the Berry Street Education Model (BSEM), also referred to as Trauma Informed Positive Education (TIPE) (Stokes & Turnbull, 2016), the ARC model (Blaustein & Kinniburgh, 2018) and the Healthy Environments and Response to Trauma (HEARTS) program based on ARC (Dorado et al., 2016).

BSEM/TIPE

Four studies reported evaluating the BSEM/TIPE model (Brunzell et al., 2019; Stokes & Brunzell, 2019; Stokes & Turnbull, 2016; Stokes et al., 2019). The BSEM/TIPE model is described as a strengths-based model based in positive education and the field of trauma that seeks to promote both, healing and growth from trauma. It includes three tiers of therapeutic growth: regulatory abilities, repairing disrupted attachments, and increasing the student’s psychological resources. Included in these three tiers are five domains that enable this therapeutic growth: namely, body (e.g., physical regulation activities), stamina (e.g., building resilience), engagement (e.g., providing activities that promote interest), character (e.g., identification of strengths), and relationship (e.g., strategies that promote safe environments). The relationship domain is described as anchoring the four other domains and it consists of classroom practices and planning that focus on supporting attachment-based strategies that centre on developing a sense of belonging, comfort, safety, trust and self-worth. The three tiers are therefore interrelated. For example, although tier one relates to learning self-regulatory abilities, this regulatory process occurs by the assistance of co-regulation through stable attachments to others (Stokes et al., 2019). Therefore, the classroom is considered in this model as key place to establish relationships (Brunzell et al., 2015). Unconditional positive regard is promoted in this model and refers to putting aside difficult behaviours that the student exhibits whilst accepting and supporting the student.

The wider aim of the studies was to evaluate the effectiveness of BSEM/TIPE across the education system from various school staff, teachers’ and students’ standpoints (Stokes & Turnbull, 2016; Stokes et al., 2019). The Stokes and Brunzell (2019) and Brunzell et al. (2019) studies included data from Stokes and Turnbull (2016) large data set but focused on different aspects of the project. The Brunzell et al. (2019) study evaluated the phenomenological experience of teachers and the changed practices in their classrooms after implementation of the BSEM/TIPE framework. The Stokes et al. (2019) study focused on young people’s experiences within an educational setting employing this framework. Data across primary (Stokes & Brunzell, 2019) or both, primary and secondary schools (Brunzell et al., 2019; Stokes & Turnbull, 2016; Stokes et al., 2019) were reported.

Using mixed measure quantitative and qualitative research approaches (see Table 3), positive outcomes related to relationship building were reported by all studies. Stokes and Turnbull (2016) noted that primary and secondary school teachers had a greater focus on establishing positive relationships as they became more aware of the central role of relationships for effectiveness in teaching. Greater ability to co-regulate was also reported by primary school teachers (Stokes & Brunzell, 2019). This was reportedly achieved by positioning themselves side-by-side and being attuned to their students’ needs whilst maintaining and attitude of unconditional positive regard (Stokes & Brunzell, 2019). Similarly, the study by Brunzell et al. (2019) across primary and secondary schools reported that healthy attachments within the classroom need to be framed through an unconditional positive regard mindset. Such strategies were particularly useful with students who resisted and rejected relational interactions by testing the unconditional commitment of their teachers. Reported strategies during the focus groups sessions included positioning themselves at eye level and shoulder-to-shoulder to facilitate interaction and encourage co-regulation; encouraging co-regulation through performing one-to-one activities that were repetitive and rhythmic, such as throwing a ball; and the use of a calm voice.

In addition, the Stokes and Brunzell (2019) study reported that the benefit of implementing the BSEM/TIPE framework across all staff, starting at the leadership level, is that the focus of the school becomes not only on academic performance but the establishment of healthy connections. The Stokes and Brunzell (2019) study reported that the school survey data completed by teachers indicated that students felt more connected, accepted and understood by teachers and classmates compared to previous years before BSEM/TIPE was implemented. Being able to employ the strategies immediately and modelling those strategies to students was also reported as an advantage by teachers in this model (Stokes & Brunzell, 2019). In the Stokes et al. (2019) study students reported benefits of the program in their social circles outside of school, including better relationships with their families.

ARC

Four studies have employed the ARC model (Dorado et al., 2016; Rishel et al., 2019; Saint Gilles & Carlson, 2020; VanderWegen, 2013). ARC is a trauma informed framework with three core domains: Attachment, Regulation, and Competency. The attachment components are the building blocks for the other pillars of this model (i.e., regulation and competency) and are design to help the systems around the child become strengthened (Blaustein & Kinniburgh, 2018). The building blocks underpinning attachment within the ARC model are attunement, the teacher and carer’s affect management, consistent responses, and having routines and rituals. These central tenets have been incorporated in the program to address factors that are important in building safe relationships within the care system of children with a history of trauma. The framework addresses regulation awareness to enhance the children’s understanding of their internal experience and how to modulate and express these internal experiences. Finally, the framework addresses the importance of building resilience through social connection in the community and engagement with the academic environment.

The general aim in all four studies was to evaluate the impact of trauma-informed training for staff based on the ARC framework in educational settings. Saint Gilles and Carlson (2020) compared data between preschool classrooms where teachers and assistants were trained with the ARC framework compared to preschool classrooms where teachers and assistants were not trained with the ARC framework. Pertinent to relationship building, the study evaluated the Attachment component of the intervention by assessing the quality of relationships within the classroom environment and emotional support (e.g., teacher’s sensitivity, positive climate), classroom organisation/routines, and teacher’s feeling of self-confidence. All of which are meant to determine the quality of attachments within the classroom. By contrast, VanderWegen (2013) concentrated on qualitatively evaluating the primary school teacher’s implementation of practices that promoted relationship building and their perceived outcomes. Rishel et al.’s (2019) study aimed to evaluate the effect of a pilot program implemented for two years in elementary classrooms called Trauma-Informed Elementary Schools (TIES) based on the ARC framework. The study compared TIES classrooms and non-TIES classrooms on measures that reflect quality of classroom interactions based on ARC building blocks at two time periods (i.e., baseline and follow-up) (Rishel et al., 2019). The Dorado et al. study (2016) evaluated the impact of a trauma-informed model based on ARC principles on trained school personnel working with kindergarten through to year 8 students.

Quantitative analyses suggested significantly less internalising behaviours after program implementation in children who had experienced severe trauma in the Saint Gilles and Carlson (2020) study. No other significant differences were identified by quantitative measures in the Saint Gilles and Carlson (2020) study. However various positive outcomes were reported by all studies qualitatively. That is, Saint Gilles and Carlson (2020) found that although teachers who received the ARC intervention noted greater knowledge regarding trauma informed care, no differences were found between the classrooms implementing the ARC intervention and those that did not in relation to measures of attachment (Saint Gilles & Carlson, 2020). Teachers also reported not feeling any more equipped to deal with trauma-affected students after the training. However, results could have been impacted by the length and timing of the observations, which may not have captured the positive elements of the program. Furthermore, the participant numbers were small to perform quantitative analyses.

By contrast, through theme analyses, the VanderWegen (2013) study identified an increase in implementation of trauma-sensitive practices as reported by staff and teachers in the school. The power of relationship building, creating rituals, and safe spaces for learning were identified. For example, all teachers interviewed mentioned “morning greetings” as an important activity that enables the teachers/staff to connect with the students and make relationship a priority over academic success (VanderWegen, 2013). Similarly, Rishel et al. (2019) reported that participating classrooms had a significant increase in the level of emotional support compared to comparison classrooms. Through quantitative comparative analyses of the CANS questionnaires pre and post treatment, Dorado et al. (2016) concluded that students who received the intervention exhibited a significant improvement in symptoms related to trauma including difficulties with attachment; hence the student’s ability to relate and develop healthy relationships with others improved significantly.

Trauma informed models employing eclectic approaches of relationship building not based on a specific model

Four studies included eclectic approaches of trauma informed practice where a variety of sources were employed with flexibility to fit the particular educational needs in each context. The studies included students and staff from preschool, elementary, and middle school. The primary aims of two of the studies was to evaluate the outcomes of trauma-informed practices on teachers’ and preschool students’ behaviours (Holmes et al., 2015; Wall, 2020). The focus of the other two studies was in understanding the elementary and middle school teachers’ (Fleming, 2019) and students’ (Padak, 2019) perceptions of the trauma-informed programs.

The programs employed focused on slightly different facets of relationship building. The Head Start Trauma Smart (HSTS) program (Holmes et al., 2015) integrated three established trauma-informed programs in a preschool setting, namely ARC, Trauma-Focused Cognitive Behavioural Therapy (TF-CBT), and early childhood mental health consultation. The ARC model focuses on strengthening the relational systems around the child and therefore concentrated on building parent-child and teacher-child relationships (Holmes et al., 2015). Quantitative results in the Classroom Assessment Scoring System (CLASS), which provides a measure of relationship quality within the classrooms, noted an overall trend where scores improved over a period of 2 years.

By contrast, The Jump Start for Success program (Padak, 2019) implemented a variety of resources books, workshops and conferences from which different strategies were adopted in an elementary school. The components of the program centred around building strong rapport with students, creating safe learning environments, as well as supporting and educating families and staff. Further, it involved mentorship where staff from the core team were paired with a trauma-affected student. The student met with their respective mentor a week before school started as well as other key school personal. The student and their families were also contacted by the schoolteacher to establish collaborative connections with the family. Early in the year, rapport building activities were incorporated by the teacher in the classroom to get to know the child better. Questionnaire data from families was also collected at this point and individualised behavioural plans were created according to the child’s needs. A sense of classroom community was encouraged in daily classroom circles that lasted around 10–15 min where they did activities that would help build connections and develop a sense of community within the classroom. Outcome from interviews revealed that building strong connections and rapport with students was the most referenced component in creating trauma sensitive classrooms and was noted as the greatest priority for teachers. Relationship building was encouraged through mentoring, “getting to know you” classroom activities, being available at the door to greet the students at the start of the day and listening attentively. All these were reported by teachers to change their practices from focusing on academics to focusing on the whole person. Quantitative analysis revealed attendance rates improved across the elementary school after the program had been implemented.

The elementary and middle schools evaluated by Fleming (2019) implemented a program provided by the state of Massachusetts, which included practices across six domains. Regarding relationship building, within the staff training domain, practices focused on strengthening relationships between staff, students and their caregivers (Fleming, 2019). Within the discipline domain, the school adopted policies that promoted respectful relationships and trauma informed communication protocols that would strengthen teacher-student and teacher-family relationships. The authors reported four emerging themes which were based on data from interviews with teachers; four of which were specifically related to relationship building. The first theme related to maintaining home and school connections. The possibility of influencing the family dynamics, as well as increasing the likelihood that the student would trust the teacher, was seen as a valuable outcome of establishing teacher-family relationships. The second theme related to encouraging the development of caring relationship with adults within the school. Having at least one adult who the student could attend to for support was considered as an essential foundation for teaching. Placing relationships before academic goals was seen as changing the school’s learning environment. A third theme was verbally expressing affection to the students. Understanding the difficulties the students were experiencing at home, enabled teachers to express this affection, which in turn, was reported to motivate students to achieve.

Similarly, one of the main goals of the program evaluated by Wall (2020) in elementary schools was to establish a healthy learning community where relational connections are considered important in fostering environments that facilitate learning. The program was centred on creating relational trust, working in collaboration, and providing empowerment within school systems. Three strands were covered by the program. Firstly, education for teachers which focused on three different areas: understanding behaviour in a child after trauma in order to encourage calm and supportive relationships with students; secondly, the development of socio-emotional skills to facilitates the student’s ability to interact with others; and thirdly, addressing compassion fatigue amongst the adults who support trauma-affected children (Wall, 2020). Results suggest that, after the implementation of trauma-informed training, teachers avoided punishment or rewards to manage behaviour and instead focused on communication that help foster teacher-student relationships. Also, teacher interviews and questionnaires revealed that teacher-teacher relational networks and communication were also strengthened which provided peer support and encouragement. Teacher-parent relationships were fostered by providing a variety of outreach programs and by supporting parent-child relationships. The outcome of better parent-teacher relationships were less parental defensiveness which also impacted teacher-student relationships.

Trauma informed relationship model

One study employed a trauma-informed model which only focused on relationship building, namely, Child-Teacher Relationship Training (CTRT) (Post et al., 2020). The purpose of this study was to evaluate the effects of employing trauma-informed training that focuses on the relationship between kindergarten teachers and children in an educational community with high levels of poverty. Regarding relationship building, the study evaluated the teachers’ levels of stress, their perception of the children, and their implementation of CTRT skills. CTRT focuses on developing stronger relationships between the teacher and child by using techniques implemented in play therapy, such as returning responsibility, esteem building, and tracking or attending to the child fully.

The program was run in two phases. During phase 1, after the first four group sessions, the teachers engaged in a 30-minute play with one of their students before applying the strategies in the classroom. The intervention in phase 2 was located in the classroom where the trainers model skills. Group sessions also continued during phase 2 where the teachers reflected on their experiences. Positive outcomes were reported by the teacher and relationship building at different levels (i.e., teacher- student, teacher-researcher, and student-researcher relationships) were found to be important. Teachers reported learning more effective ways of communicating and a greater willingness to be patient, as they better understood the effects of trauma on children’s behaviour and the teacher’s influential position as sources of stability in the child’s life. The relationships were strengthened as the dynamics changed, with teachers reporting feeling less stressed, and children’s displaying calmer behaviours as a result of the teacher’s changing the language they used. Teachers also believed the changed dynamics were impactful for the whole classroom, not only the trauma-affected children. Further, teachers reported that the relationship between the teacher and the researcher provided support, modelling and reassurance as they implemented the learnt skills. Similarly, it was reported by the teacher that the children became glad when the researchers came to participate in the classroom, as they anticipated positive attention from other adults.

Discussion

This systematic review sought to evaluate the relationship building strategies implemented within trauma-informed practices in educational settings. A literature search found quantitative randomised controlled trials are lacking, and most research involves case studies and qualitative designs. Whilst randomised trials have the advantage of providing experimental designs where better causation predictions can be ascertained, qualitative case study designs have the advantage of providing deeper insights regarding the distinct practices across educational settings and across individuals (Kelle, 2006). In addition, qualitative studies are useful when understanding complex phenomena and translating research into practice (Kalu & Bwalya, 2017). The predominantly qualitative research available on trauma-informed, relationship building activities has the advantage of revealing strengths and barriers to program delivery, which could be further explored through randomised quantitative designs (Kalu & Bwalya, 2017). The present systematic review provides further understanding across the qualitative and quantitative research in this area. Further, given that most studies have been conducted in the USA, followed by a few studies within the Australian educational system, results need to be interpreted in light of different cultural contexts and educational systems. This is one aspects of ecological systems theory which will be discussed more here in framing the results of this review.

The present review found predominantly positive outcomes relating to relationship building strategies across the three types of trauma-informed frameworks employed, namely, established, eclectic, or relationship building specific. Positive outcomes reported included improved relationships with teachers (Rishel et al., 2019; VanderWegen, 2013), better relationships with other students (Stokes et al., 2019), greater use of relationship building practices, an increased willingness of teachers to develop better relationships with their trauma-affected students (Stokes & Turnbull, 2016), and improved relationships with families (Fleming, 2019; Wall, 2020). However, the review suggests that the practices employed to encourage healthy connections with trauma-affected students varies across educational settings. This is expected given that schools adapt their specific trauma-informed practices to the needs of their students (e.g., nature of trauma, grade), the communities they service, and inherent differences between schools (Chafouleas et al., 2019). However, this also raises the important consideration of how schools continue to monitor and evaluate the outcomes of their trauma-informed practices. The review found that differences in delivery of trauma-informed practice are most evident in schools that have employed eclectic models, but the variability of implementation and training is also evident across settings that have employed the same trauma-informed framework.

The two established models that have been employed in school settings, ARC and BSEM/TIPE, acknowledge that the practices within the classroom can be implemented with flexibility to suit the needs of the school. During training, the BSEM/TIPE model, for instance, provided a list of strategies that teachers can employ to build connections with their students, but teachers are encouraged to tailor these strategies to suit their classroom needs and the needs of their students (Stokes & Turnbull, 2016). In contrast to the ARC model, the BSEM/TIPE was reported to be taught within the school curriculum with students noting improved relationships with teachers, other students, and family members. Flexibility in implementation was also reported in ARC studies. For example, in the Rishel et al. (2019) study, ARC staff observed and supported the teacher’s individual and differing strengths in their connection building strategies with students. This mirrors the student-centred approach of congruence, which describes the importance of teachers being genuine and authentic during their interactions with students (alongside the other student-centred principles of unconditional positive regard and empathy). However, as noted by Berger (2019), teachers require ongoing education and support to continue to embody these principles of student-centred, trauma-informed practice. Training and support provided to teachers can be linked back to a child’s exosystem; practices within the child’s exosystem (e.g., the teacher receiving training) are seen to benefit the student indirectly (Crosby, 2015).

More specifically, within the exosystem practices, most educational settings which adopted the ARC framework implemented support for teachers by trained facilitators who would model, support, and provide feedback to teachers regarding their practices (Dorado et al., 2016; Rishel et al., 2019; VanderWegen, 2013). In Dorado et al.’s (2016) study, guidance was also provided to the school’s care team when creating support plans for students by ensuring they use practices that protected the teacher-student relationships. Further, in Post et al.’s (2020) study, which implemented the only relationship-specific trauma-informed approach, establishing trusting relationships with the teachers and their trainers and ensuring that teachers received feedback on their practice was considered key to successful implementation of those strategies. By contrast, in an ARC study that did not implement onsite supports (Saint Gilles & Carlson, 2020), the teachers reported that their confidence in using practices that dealt with trauma-affected students did not improve after training. Further, teachers noted that little supports were in place to help them cope with the challenges of relating to trauma-affected students. The authors acknowledge that, in addition to psychoeducation, it is essential that teachers receive other modes of assistance when dealing with trauma-affected students, such as therapy to prevent vicarious trauma. Hence, the results of this review suggest that relationship building strategies implemented within the classroom are more likely to be sustainable when teachers receive ongoing support. Further, these supports would be helpful in the prevention of vicarious trauma, though none of the reviewed studies directly measured this aspect of teacher wellbeing.

Other practices within the child’s exosystem that were evident in this review included the provision of space for teachers to establish connections with their colleagues. For example, The BSEM/TIPE model encouraged within session peer-collaboration where teachers shared their strategies for working with trauma-exposed students with other teachers (Stokes & Turnbull, 2016). After each session, teachers were encouraged by trainers to implement new strategies and shared them with the rest of the group the following training session. Similarly, Wall’s (2020) study, which employed an eclectic trauma-informed approach, provided ongoing peer support meetings and self-reflective groups with the purpose of preventing vicarious trauma, though the latter was not explicitly measured. During these sessions, colleagues also had the opportunity to share strengths and difficulties in the relationship building methods employed. Encouraging teacher-to-teacher connections would be beneficial in schools that cannot implement ongoing support from outside trainers. Further, results from the review suggest that both of these exosystem strategies, that is, trainer driven supports or teacher-to-teacher driven supports, facilitates translating training into practice. This is consistent with other trauma-based research showing the effectiveness of ongoing training and support for teachers when responding to the needs of traumatised students (Berger, 2019).

Some studies in this review included practices within the child’s mesosystem and the child’s exosystem which included parental involvement. For example, the ARC framework emphasises the engagement of the whole students care system and, as such, encouraged the involvement of parents. These included practices within the child’s mesosystem such as teacher’s connecting with parents to encourage parental involvement in the classroom (Fleming, 2019; VanderWegen, 2013), and practices within the child’s exosystem, such as psychoeducation and support for parents regarding relationship building with their children (Holmes et al., 2015; Rishel et al., 2019; Saint Gilles & Carlson, 2020; VanderWegen, 2013). Parental involvement was also found in eclectic trauma-informed frameworks. As part of establishing school-family connections, Padak’s study (2019) reported that meetings with parents at the start of the school year were essential to establish the best mode of communication with them for the year. Also, parents with children who received individual therapy in the Holmes's (2015) study, were encouraged to attend therapy which included parent-child relationship training through parental skills sessions within a trauma-informed approach. Parental involvement did not form a large part of the relationship building strategies in the other studies, some of which employed BSEM/TIPE, eclectic, or the relationship-specific frameworks. The lack of parental involvement is concerning, especially for marginalised cultural and racial groups for whom connection between family and school is particularly important when establishing trust, communication, and school trauma-informed practices (Miller & Berger, 2023). Given the influence of microsystem relationships in a child’s development, particularly in trauma-affected children (Crosby, 2015), parental involvement should be considered and evaluated in future research.

Limitations

A limitation of this review was not being able to ascertain the direct impact of relationship building practices on outcomes and wellbeing of trauma-affected students. In addition, as discussed earlier, educational settings adapt their strategies to the needs of the particular educational setting. Future research could consider randomised control trials comparing various relationship building strategies within the same educational setting and schools using the same trauma-informed framework. In addition, a phenomenological approach that further explores parents and students views regarding relationship building practices would add further insights in this area. This is particularly important given that teachers often misinterpret the experiences of their students (Mitra, 2018). Finally, meta-analysis techniques would be useful in future reviews using a more stringent criteria for study selection. This could be based on study design, population, or educational setting type. The present review could inform the criteria selected in future review studies.

Conclusion

In conclusion, trauma-informed practices have addressed relationship building among trauma-affected students differently and implementation across schools is difficult to compare with the existent research method designs. However, results from this systematic review suggest that relationship building strategies within the school system need to be considered and implemented within a systems framework where teacher-child and teacher-family relationships are supported and encouraged. Results from this review suggest that, from an ecological systems perspective, relationship building strategies implemented at the microsystem level are fluid and should be tailored by the teacher according to strengths and the needs within the classroom. However, these relationships within the microsystem (teacher-student and teacher-parent) need to also be supported by exosystem strategies, such as supports by trainers or teacher-to teacher-supports. Thus, part of effective implementation of relationship building practices is the ongoing training and support of teachers who are susceptible to vicarious trauma.