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Multi-tiered Approaches to Trauma-Informed Care in Schools: A Systematic Review

Abstract

Childhood trauma can adversely impact academic performance, classroom behaviour, and student relationships. Research has gradually explored integrated approaches to care for traumatised students in schools. Increasingly, research has pointed to implementation of multi-tiered programs to trauma-informed care for traumatised students in schools. However, evaluations of these programs are limited and no systematic review of the existing evidence has been conducted. The aim of this research was to be the first systematic review to explore evidence on multi-tiered, trauma-informed approaches to address trauma in schools. Results of this systematic review yielded 13 published and unpublished studies. Findings indicated that further research, guided by empirical evidence of the effectiveness of multi-tiered and trauma-sensitive approaches in schools, is required. Recommendations for research in the area of trauma-sensitive, multi-tiered care in schools are provided.

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References

References marked with an asterisks indicate studies included in the systematic review

  1. Alisic, E. (2012). Teachers’ perspectives on providing support to children after trauma: A qualitative study. School Psychology Quarterly,27(1), 51–59. https://doi.org/10.1037/a0028590.

    Article  Google Scholar 

  2. Alisic, E., Bus, M., Dulack, W., Pennings, L., & Splinter, J. (2012). Teachers’ experiences supporting children after traumatic exposure. Journal of Traumatic Stress,25, 98–101. https://doi.org/10.1002/jts.20709.

    Article  Google Scholar 

  3. Berger, E., Carroll, M., Mayberry, D., & Harrison, D. (2018). Disaster impacts on students and staff from a specialist, trauma-informed Australian school. Journal of Child and Adolescent Trauma,11(4), 521–530. https://doi.org/10.1007/s40653-018-0228-6.

    Article  Google Scholar 

  4. Berger, R., Abu-Raiya, H., & Benatov, J. (2016). Reducing primary and secondary traumatic stress symptoms among educators by training them to deliver a resiliency program (ERASE-Stress) following the Christchurch earthquake in New Zealand. The American Journal of Orthopsychiatry,86(2), 236–251. https://doi.org/10.1037/ort0000153.

    Article  PubMed  Google Scholar 

  5. Berger, R., & Gelkopf, M. (2009). School-based intervention for the treatment of tsunami-related distress in children: A quasi-randomised controlled trial. Psychotherapy and Psychosomatics,78, 364–371. https://doi.org/10.1159/000235976.

    Article  PubMed  Google Scholar 

  6. Bride, B. E. (2007). Prevalence of secondary traumatic stress among social workers. Social Work,52(1), 63–70. https://doi.org/10.1093/sw/52.1.63.

    Article  PubMed  Google Scholar 

  7. Chafouleas, S. M., Johnson, A. H., Overstreet, S., & Santos, N. M. (2016). Towards a blueprint for trauma-informed service delivery in schools. School Mental Health,8, 144–162. https://doi.org/10.1007/s12310-015-9166-8.

    Article  Google Scholar 

  8. Chafouleas, S. M., Koriakin, T. A., Roundfield, K. D., & Overstreet, S. (2019). Addressing childhood trauma in school settings: A framework for evidence-based practice. School Mental Health,11, 40–53. https://doi.org/10.1007/s12310-018-9256-5.

    Article  Google Scholar 

  9. *Cicchetti, C. (2017). A school-community collaboration model to promote access to trauma-informed behavioural health supports. Journal of the American Academy of Child and Adolescent Psychiatry,56(10S), S30. https://doi.org/10.1016/j.jaac.2017.07.118.

    Article  Google Scholar 

  10. Cohen, J. A., Jaycox, L. H., Walker, D. W., Mannarino, A. P., Langley, A. K., & DuClos, J. L. (2009). Treating traumatised children after hurricane Katrina: Project Fleur-de Lis™. Clinical Child and Family Psychology Review,12(1), 55–64. https://doi.org/10.1007/s10567-009-0039-2.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Day, A. G., Somers, C. L., Baroni, B. A., West, S. D., Sanders, L., & Peterson, C. D. (2015). Evaluation of a trauma-informed school intervention with girls in a residential facility school: Student perceptions of school environment. Journal of Aggression, Maltreatment & Trauma,24(10), 1086–1105. https://doi.org/10.1080/10926771.2015.1079279.

    Article  Google Scholar 

  12. *Dorado, J. S., Martinez, M., McArthur, L. E., & Leibovitz, T. (2016). Healthy Environments in Response to Trauma in Schools (HEARTS): A whole-school, multi-level, prevention and intervention program for creating trauma-informed, safe and supportive schools. School Mental Health,8(1), 163–176. https://doi.org/10.1007/s12310-016-9177-0.

    Article  Google Scholar 

  13. Dyregrov, K. (2009). The important role of the school following suicide in Norway. What support do young people think that school could provide? Omega (Westerport),59(2), 147–161. https://doi.org/10.2190/OM.59.2.d.

    Article  Google Scholar 

  14. Dyregrov, A., Bie Wikander, A. M., & Vigerust, S. (1999). Sudden death of a classmate and friend: Adolescents’ perception of support from their school. School Psychology International,20(20), 191–208. https://doi.org/10.1177/0143034399202003.

    Article  Google Scholar 

  15. *Ellis, B. H., Miller, A. B., Abdi, S., Barrett, C., Blood, E. A., & Betancourt, T. S. (2013). Multi-tier mental health program for refugee youth. Journal of Consulting and Clinical Psychology,81(1), 129–140. https://doi.org/10.1037/a0029844.

    Article  PubMed  Google Scholar 

  16. Fu, C., & Underwood, C. (2015). A meta-review of school-based disaster interventions for child and adolescent survivors. Journal of Child and Adolescent Mental Health,27(3), 161–171. https://doi.org/10.2989/17280583.2015.1117978.

    Article  PubMed  Google Scholar 

  17. *Garfin, D. R., Silver, R. C., Gil-Rivas, V., Guzmán, J., Murphy, J. M., Cova, F., et al. (2014). Children’s reactions to the 2010 Chilean Earthquake: The role of trauma exposure, family context, and school-based mental health programming. Psychological Trauma: Theory, Research, Practice, and Policy,6(5), 563–573. https://doi.org/10.1037/a0036584.

    Article  Google Scholar 

  18. Gonzalez, A., Monzon, N., Solis, D., Jaycox, L., & Langley, A. K. (2015). Trauma exposure in elementary school children: Description of screening procedures, level of exposure, and posttraumatic stress symptoms. School Mental Health,8(1), 77–88. https://doi.org/10.1007/s12310-015-9167-7.

    Article  PubMed  PubMed Central  Google Scholar 

  19. *Hansel, T. C., Osofsky, H., Osofsky, J. D., Costa, R. N., Kronenberg, M. E., & Selby, M. L. (2010). Attention to process and clinical outcomes of implementing a rural trauma treatment program. Journal of Traumatic Stress,23(6), 708–715. https://doi.org/10.1002/jts.20595.

    Article  PubMed  Google Scholar 

  20. *Holmes, C., Levy, M., Smith, A., Pinne, S., & Neese, P. (2015). A model for creating a supportive trauma-informed culture for children in preschool settings. Journal of Child and Family Studies,24(6), 1650–1659. https://doi.org/10.1007/s10826-014-9968-6.

    Article  PubMed  Google Scholar 

  21. *Hurley, J. J., Saini, S., Warren, R. A., & Carberry, A. J. (2013). Use of the pyramid model for supporting preschool refugees. Early Child Development and Care,183(1), 75–91. https://doi.org/10.1080/03004430.2012.655242.

    Article  Google Scholar 

  22. Individuals with Disabilities Education Improvement Act of 2004 (IDEA). (2004). Public law 108-446, 118, Stat. 2647.

  23. Jaycox, L. H., Langley, A. K., Stein, B. D., Wong, M., Sharma, P., Scott, M., et al. (2009). Support for students exposed to trauma: A pilot study. School Mental Health,1(2), 49–60. https://doi.org/10.1007/s12310-009-9007-8.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kenny, M. C. (2001). Child abuse reporting: Teachers’ perceived deterrents. Child Abuse and Neglect,25, 81–92.

    Article  Google Scholar 

  25. Kenny, M. C. (2004). Teachers’ attitudes toward and knowledge of child maltreatment. Child Abuse and Neglect,28, 1311–1319.

    Article  Google Scholar 

  26. *Layne, C. M., Saltzman, W. R., Poppleton, L., Burlingame, G. M., Pasalić, A., Duraković, E., et al. (2008). Effectiveness of a school-based group psychotherapy program for war-exposed adolescents: A randomised controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry,47(9), 1048–1062. https://doi.org/10.1097/CHI.0b013e31817eecae.

    Article  PubMed  Google Scholar 

  27. *McConnico, N., Boynton-Jarrett, R., Bailey, C., & Nandi, M. (2016). A framework for trauma-sensitive schools: Infusing trauma-informed practices into early childhood education systems. Zero to Three,36(5), 36–44.

    Google Scholar 

  28. McDermott, B. M., & Cobham, V. E. (2014). A stepped-care model of post-disaster child and adolescent mental health service provision. European Journal of Psychotraumatology. https://doi.org/10.3402/3jpt.v5.24294.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Mendelson, T., Tandon, S. D., O’Brennan, L., Leaf, P. J., & Ialongo, N. S. (2015). Brief report: Moving prevention into schools: The impact of a trauma-informed school-based intervention. Journal of Adolescence,43, 142–147. https://doi.org/10.1016/j.adolescence.2015.05.017.

    Article  PubMed  Google Scholar 

  30. Mrazek, P. J., & Haggerty, R. J. (1994). Reducing risks for mental disorders: Frontiers for preventive intervention research. Washington, DC: National Academy Press.

    Google Scholar 

  31. Nadeem, E., & Ringle, V. A. (2016). De-adoption of an evidence-based trauma intervention in schools: A retrospective report from an urban school district. School Mental Health,8, 132–143. https://doi.org/10.1007/s12310-016-9179-y.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Papadatou, D., Metallinou, O., Hatzichristou, C., & Pavlidi, L. (2002). Supporting the bereaved child: Teacher’s perceptions and experiences in Greece. Mortality,7(3), 324–339. https://doi.org/10.1080/1357627021000025478.

    Article  Google Scholar 

  33. Perfect, M. M., Turley, M. R., Carlson, J. S., Yohanna, J., & Saint Gilles, M. P. (2016). School-related outcomes of traumatic event exposure and traumatic stress symptoms in students: A systematic review of research from 1990 to 2015. School Mental Health,8, 7–43. https://doi.org/10.1007/s12310-016-9175-2.

    Article  Google Scholar 

  34. *Perry, D., & Daniels, M. (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.

    Article  Google Scholar 

  35. Phifer, L. W., & Hull, R. (2016). Helping students heal: Observations of trauma-informed practices in the schools. School Mental Health,8, 201–205. https://doi.org/10.1007/s12310-016-9183-2.

    Article  Google Scholar 

  36. Plumb, J. L., Bush, K. A., & Kersevich, S. E. (2016). Trauma-sensitive schools: An evidence-based approach. School Social Work Journal,40(2), 37–60.

    Google Scholar 

  37. Powell, T. M., & Bui, T. (2016). Supporting social and emotional skills after a disaster: Findings from a mixed method study. School Mental Health,8, 106–119. https://doi.org/10.1007/s12310-016-9180-5.

    Article  Google Scholar 

  38. Price, O. A., Ellis, H. B., Escudero, P. V., Huffman-Gottschling, K., Sander, M. A., & Birman, D. (2012). Implementing trauma interventions in schools: Addressing the immigrant and refugee experience. Advances in Education in Diverse Communities: Research, Policy and Praxis,9, 95–119.

    Google Scholar 

  39. Reinbergs, E. J., & Fefer, S. A. (2018). Addressing trauma in schools: Multitiered service delivery options for practitioners. Psychology in the Schools,55(3), 250–263. https://doi.org/10.1002/pits.22105.

    Article  Google Scholar 

  40. 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.

    Article  PubMed  Google Scholar 

  41. Runge, T. J., Knoster, T. P., Moerer, D., Breinich, T., & Palmiero, J. (2017). A practical protocol for situating evidence-based mental health programs and practices within school-wide positive behavioural interventions and supports. Advances in School Mental Health Promotion,10(2), 101–112. https://doi.org/10.1080/1754730X.2017.1285708.

    Article  Google Scholar 

  42. *Saint Gilles, M. P. (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. Doctor of Philosophy thesis, Michigan, USA: Michigan State University.

  43. Saltzman, W. R., Layne, C. M., Steinberg, A. M., Arslanagic, B., & Pynoos, R. S. (2003). Developing a culturally and ecologically sound intervention program for youth exposed to war and terrorism. Child and Adolescent Psychiatric Clinics of North America,12, 319–342. https://doi.org/10.1016/S1056-4993(02)00099-8.

    Article  PubMed  Google Scholar 

  44. *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.

    Article  Google Scholar 

  45. Simonsen, B., MacSuga-Gage, A. S., Briere, D. E., Freeman, J., Myers, D., Scott, T. M., et al. (2014). Multitiered support framework for teachers’ classroom-management practices: Overview and case study of building the triangle for teachers. Journal of Positive Behaviour Interventions,16(3), 179–190.

    Article  Google Scholar 

  46. Smith Hatcher, S., Bride, B. E., Oh, H., Moultrie King, D., & Catrett, J. F. (2011). An assessment of secondary traumatic stress in juvenile justice education workers. Journal of Correctional Health Care,17(3), 208–217. https://doi.org/10.1177/1078345811401509.

    Article  PubMed  Google Scholar 

  47. *Stokes, H., & Turnbull, M. (2016). Evaluation of the Berry Street Education Model: Trauma informed positive education enacted in mainstream schools. Melbourne, Victoria: University of Melbourne Graduate School of Education, Youth Research Centre.

    Google Scholar 

  48. Sugai, G., & Horner, R. R. (2006). A promising approach for expanding and sustaining school-wide positive behaviour support. School Psychology Review,35(2), 245–259.

    Google Scholar 

  49. Weems, C. F., Scott, B. G., Taylor, L. K., Cannon, M. F., Romano, D. M., & Perry, A. M. (2013). A theoretical model for continuity in anxiety and links to academic achievement in disaster-exposed school children. Development and Psychopathology,25(3), 729–737. https://doi.org/10.1017/S0954579413000138.

    Article  PubMed  Google Scholar 

  50. Weist, M. D., Eber, L., Horner, R., Speltt, J., Putman, R., Barrett, S., et al. (2018). Improving multitiered systems of support for students with “Internalising” emotional/behavioural problems. Journal of Positive Behavior Interventions, 20(3), 172–184.

    Article  Google Scholar 

  51. Wolmer, L., Hamiel, D., Barchas, J. D., Slone, M., & Laor, N. (2011a). Teacher-delivered resilience-focused intervention in schools with traumatised children following the second Lebanon War. Journal of Traumatic Stress,24(3), 309–316. https://doi.org/10.1002/jts.20638.

    Article  PubMed  Google Scholar 

  52. Wolmer, L., Hamiel, D., & Laor, N. (2011b). Preventing children’s posttraumatic stress after disaster with teacher-based intervention: A controlled study. Journal of the American Academy of Child and Adolescent Psychiatry,50(4), 340–348. https://doi.org/10.1016/j.jaac.2011.01.002.

    Article  PubMed  Google Scholar 

  53. Woodbridge, M. W., Sumi, W. C., Thornton, S. P., Fabikant, N., Rouspil, K. M., Langley, A. K., et al. (2015). Screening for trauma in early adolescence: Findings from a diverse school district. School Mental Health,8(1), 89–105. https://doi.org/10.1007/s12310-015-9169-5.

    Article  Google Scholar 

  54. 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.

    Article  Google Scholar 

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Correspondence to Emily Berger.

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Berger, E. Multi-tiered Approaches to Trauma-Informed Care in Schools: A Systematic Review. School Mental Health 11, 650–664 (2019). https://doi.org/10.1007/s12310-019-09326-0

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Keywords

  • Trauma
  • Post-traumatic stress disorder
  • Multi-tiered
  • Trauma-informed
  • School