School Mental Health

, Volume 8, Issue 1, pp 163–176 | Cite as

Healthy Environments and Response to Trauma in Schools (HEARTS): A Whole-School, Multi-level, Prevention and Intervention Program for Creating Trauma-Informed, Safe and Supportive Schools

  • Joyce S. DoradoEmail author
  • Miriam Martinez
  • Laura E. McArthur
  • Talia Leibovitz
Original Paper


The University of California, San Francisco’s Healthy Environments and Response to Trauma in Schools (HEARTS) Program promotes school success for trauma-impacted students through a whole-school approach utilizing the response to intervention multi-tiered framework. Tier 1 involves school-wide universal supports to change school cultures into learning environments that are more safe, supportive and trauma-informed. Tier 2 involves capacity building with school staff to facilitate the incorporation of a trauma-informed lens into the development of supports for at-risk students, school-wide concerns and disciplinary procedures. Tier 3 involves intensive interventions for students suffering from the impact of trauma. Program evaluation questions were: (1) Was there an increase in school personnel’s knowledge about addressing trauma and in their use of trauma-sensitive practices? (2) Was there an improvement in students’ school engagement? (3) Was there a decrease in behavioral problems associated with loss of students’ instructional time due to disciplinary measures taken? (4) Was there a decrease in trauma-related symptoms in students who received HEARTS therapy? Results indicate preliminary support for the effectiveness of the HEARTS program for each of the evaluation questions examined, suggesting that a whole-school, multi-tiered approach providing support at the student, school personnel and system levels can help mitigate the effects of trauma and chronic stress. Key areas for further studies include (a) an examination of data across more HEARTS schools that includes comparison control schools and (b) disaggregating disciplinary data by race and ethnicity to determine whether disproportionality in the meting out of disciplinary actions is reduced.


Trauma Complex trauma School-based mental health School to prison pipeline Trauma-informed schools Prevention 



This study was funded by The Metta Fund, John and Lisa Pritzker Family Fund, The Tipping Point Foundation, Lieff, Cabraser, Heimann & Bernstein, LLP, SFUSD School Improvement Grant, MEDA Mission Promise Neighborhoods, SFUSD (Department of Children Youth and Their Families Mayor’s Wellness Program funds), SF Community Behavioral Health Services, The Denver Foundation, The Giving Trust, Kaiser/Colorado Education Initiative and The California Endowment. Our sincere thanks to the dedicated clinicians, researchers and staff from our UCSF and AMHC programs, especially Quyen Le, Olivia Park, Megha Tailor and Martha Shumway for their help with our program evaluation, Lynn Dolce and Martha Merchant for their contributions to the HEARTS curriculum and Nancy Milliken and the UCSF Center of Excellence in Women’s Health for their support. We are deeply grateful to our school district partners, SFUSD and APS.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Division of Infant, Child, and Adolescent Psychiatry, San Francisco–San Francisco General HospitalUniversity of CaliforniaSan FranciscoUSA
  2. 2.Icahn School of Medicine at Mount SinaiNew YorkUSA
  3. 3.Aurora Mental Health CenterAuroraUSA
  4. 4.San Francisco, Child and Adolescent ServicesUniversity of CaliforniaSan FranciscoUSA

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