Abstract
Interest in trauma-informed approaches in schools is high throughout the US, UK, Australia, Canada and other countries, but the empirical evidence on whole-school responses to trauma is limited. This conceptual and theoretical review explores relevant literature; outlines existing conceptual models for trauma-informed organisations, including schools; reviews current evidence for individual components of conceptual models relevant to schools; and considers implications for future research, practice and policy. Four common components were identified in the literature: (a) understanding trauma and making a universal commitment to address it; (b) emphasising physical, emotional and psychological safety for all school members; (c) taking a strengths-based, whole-person approach toward staff, students and families; and (d) creating and sustaining trusting, collaborative and empowering relationships among all school constituents. Most of these components have been studied as part of other literature and are not specific to trauma-informed schools. Practitioners would benefit from shifting to an organisational model for trauma rather than the historical emphasis on interpersonal approaches, toward ensuring that all staff members are trauma-aware and -responsive, and emphasising the creation of healthy, healing schools for all communities.
Keywords: conceptualisation, context, organisation, school safety, trauma-informed schools
INTRODUCTION
As society increasingly recognises the prevalence and impact of childhood trauma, there has been a growing and corresponding interest in adopting setting-level responses to trauma (Maynard et al., 2019; Substance Abuse and Mental Health Services Administration [SAMHSA], 2014). Studies have documented widespread depression and other mental health problems reported by children in response to COVID-19, school shootings and systemic inequalities that disproportionately impact low-income students (Benner et al., 2018; Cimolai et al., 2021; Jones et al., 2021). In addition, students report feelings of isolation due to personal and collective trauma (Jones et al., 2021). These outcomes of trauma affect children's social relationships, academic functioning and long-term economic outcomes (Mock & Arai, 2011; Perfect et al., 2016).
Why trauma-informed schools and settings? A response to the growing number of traumatised students that schools must serve
The estimated prevalence of traumatic experiences among children around the world is quite high (Carlson et al., 2020). One assessment of a nationally representative sample in the United States prior to the COVID-19 pandemic found that 80% of children reported at least one exposure to violence and victimisation in their lifetime (Turner et al., 2010). The pandemic has only worsened the mental health of children and families, prompting several professional associations to declare a national state of emergency regarding U.S. children's and adolescents' mental health (American Academy of Paediatrics, 2021). Although children's possible reactions and symptomatology following trauma vary significantly, the underlying neurobiological pathways are similar (Cloitre et al., 2009; Marans et al., 2012; van der Kolk, 1987). Based on a systematic review of trauma-related effects on school performance, youth with long-term or multiple trauma exposures were more likely to show cognitive effects, including lower IQ scores, memory impairments, lower language ability and attention deficits; lower academic achievement and higher rates of discipline referrals, grade retention and absences; and higher rates of teacher-reported internalising symptoms (e.g. anxiety, depression, withdrawal and lower self-esteem) and externalising behaviours (e.g. aggression, defiance and class disruption; Perfect et al., 2016).
Trauma-related effects can be ameliorated through appropriate responses. Some children receive support through clinical services. Because of barriers to access in mental health services, however—namely, inaccessibility and the reluctance of some groups to participate—trauma responses rooted in settings with which young people already engage are believed to reach more survivors than traditional clinical approaches (Jaycox et al., 2009; Wu et al., 2017). The U.S. K-12 public education system is considered by many mental health experts to be a particularly impactful setting for trauma treatments because it touches more than 90% of children in the United States (National Centre for Education Statistics, 2022).
The U.S. public education system has responded to the widespread trauma and psychosocial emotional outcomes of students. Early trauma responses in schools focused on individual clinical interventions and, more recently, peer support and psychoeducation models—that is, relaying information about the effects of stress on physical and mental wellbeing—have been implemented (e.g. Cognitive Behavioural Intervention for Trauma in Schools). A sizable empirical literature describes effective clinical interventions for childhood trauma (see Mavranezouli et al., 2020; Wilson, 2019). This clinically focused literature has been growing and evolving for decades. Most trauma-focused clinical interventions are designed for one-on-one situations or small groups led by a trained mental health professional. Clinical interventions for children with traumatic stress symptoms commonly include several elements: ensuring a child's safety; educating about trauma and its effects; teaching coping, self-regulation, or behaviour management strategies; and working with caregivers to develop and sustain positive relationships (Keeshin & Strawn, 2014). School-based clinical trauma interventions have very similar components to therapy in mental health clinics, yet they occur in school settings.
The latest iteration of trauma response promotes healing through environments that address the safety needs of trauma survivors and seek to avoid retraumatisation (SAMHSA, 2014b). Trauma-informed schools are based on a conceptual framework for a trauma-informed environment, or the idea that nonclinical settings can adapt their service provision to better support individuals who have experienced traumatic events (Harris & Fallot, 2001; Marans et al., 2012; Maynard et al., 2019). Early tools, including therapeutic interventions and psychoeducation, continue to be utilised in schools alongside setting-based approaches to trauma. Each clinical element common in early tools (e.g. an emphasis on safety, psychoeducation and relationship building) connects to one or more proposed components for a schoolwide trauma-informed approach. One of the biggest differences between clinical trauma treatments and trauma-informed settings is that in the latter, the entire organisation and all organisational members become part of the trauma-informed response. The setting and all of its practices, interactions, transactions and relationships must become trauma-informed and thus, healing is not relegated to a therapy session, specific technique, or circumscribed programme or curriculum—as is common in the therapeutic literature. A trauma-informed approach is more than an extension of individual support strategies; it is an organisation-wide shift to better address and prevent trauma.
U.S. schools have enthusiastically embraced the concept of being trauma-informed. Almost all states now have a plan for trauma-informed schools (Simon et al., 2020). This growth of interest in making all schools trauma-informed has been fairly rapid and recent. In 2017, 29 plans submitted to the U.S. Department of Education by state education authorities included provisions for the adoption of trauma-informed approaches in schools (U.S. Department of Education, 2018) and by 2019, 45 state education websites featured information about trauma and developing trauma-informed schools (Simon et al., 2020). The Every Student Succeeds Act 2015, which mandated school-based mental health services and professional development be rooted in evidence-based, trauma-informed practice, enhanced interest in trauma-informed schools, and the SUPPORT for Patients and Communities Act (2018) provided funding to state education authorities for implementation.
In contrast to the robust evidence for clinical trauma treatments, the empirical study of trauma-informed approaches as a schoolwide, organisational approach began only in the past decade (Simon et al., 2020). As such, the empirical evidence on schoolwide trauma-informed approaches is very limited (Avery et al., 2021). In fact, compared to detailed trauma-specific therapies and curricula, there is little conceptual consensus on what a whole-school, trauma-informed approach entails, how a trauma-informed strategy is implemented effectively, or what outcomes should be expected if a school effectively responds to the trauma of students, parents and the school staff (Bargeman et al., 2021; Chafouleas et al., 2016; Maynard et al., 2019; Thomas et al., 2019). Hence, this conceptual and theoretical review (Kennedy, 2007) explores disparate academic literature related to trauma-informed organisational approaches; outlines and combines existing conceptual models for trauma-informed organisations into one school-focused model; reviews current evidence for each component of trauma-informed schools; and considers implications for future research, practice and policy.
A recent systematic review of whole-school, trauma-informed approaches found only four relevant studies. All identified studies utilised qualitative or mixed methods; no studies utilised comparable quantitative methods that could be included in a quantitative synthesis or meta analysis (Avery et al., 2021). Consequently, this critical review assesses evidence for separate conceptual components of trauma-informed schools (Grant & Booth, 2009; Snyder, 2019). These distinct conceptual components are part of developing trauma-informed schools models, and prior studies have examined their effectiveness in schools and other organisations. By examining components separately, researchers can distinguish between components with promising outcomes and components that lack evidence or still need further research.
COMMON TRAUMA-INFORMED SCHOOLS' COMPONENTS FROM CURRENT CONCEPTUAL MODELS
There are eight published models for trauma-informed organisations, including school-specific models (e.g. Cole et al., 2013; National Child Traumatic Stress Network [NCTSN], 2016; Venet, 2021) and those geared more broadly to human services organisations (e.g. Harris & Fallot, 2001; SAMHSA, 2014a). Table 1 presents these models by their date of origin and includes each model's definition of a trauma-informed school or organisation, their key principles or values and strategies for change. Some models overlap or were inspired by others. For example, the SAMHSA model inspired the NCTSN, 2016, 2017 and Milwaukee Public Schools' (2020) models; Craig (2016) presented an amalgam of school-based models, including Cole et al.' (2005, 2013) and Wolpow et al.' (2016) models; and the Hopper et al.' (2010) model for trauma-informed homelessness organisations synthesised five models, including Harris and Fallot's (2001). Developers also used different descriptors for their models, from trauma-informed and trauma-sensitive to positive or compassionate schools. In this paper, the preferred terms of each model will be used. All terms are considered synonymous with a trauma-informed approach because each model stated that it originated from a desire to acknowledge and support individuals who have experienced trauma. For this review and paper, the models have been combined conceptually and this combined model will be used to explore empirical evidence for each common component of trauma-informed schools.
TABLE 1.
Definitions and key principles of trauma-informed organisational approaches applicable to schools by origin date.
| Model and source | Definition | Key principles and values | Key actions and focus areas |
|---|---|---|---|
| The Sanctuary Model (Bloom, 1995, 1997, 2010; Bloom & Yanosy Sreedhar, 2008; Sanctuary Institute, 2022) | ‘Being trauma-informed means being sensitive to the reality of traumatic experiences in the lives of most people… It means being sensitive to the ways in which trauma has affected individuals, families and entire groups (i.e. Native Americans, African-Americans and LGBT individuals). And it means becoming sensitive to the ways in which trauma impacts organisations and entire systems.’ (Bloom & Yanosy Sreedhar, 2008, p. 51) |
|
S.E.L.F. Implementation Tool as a common language:
|
| Trauma-Informed Service Systems (Harris & Fallot, 2001) | ‘To be trauma-informed means to understand the role violence and victimisation play in the lives of consumers … and to use that understanding to design service systems that accommodate the vulnerabilities of trauma survivors and allow services to be delivered in a way that will facilitate consumer participation in treatment.’ (p. 4) |
|
|
| Trauma-Sensitive Schools (Cole et al., 2005, 2013) | ‘A trauma-sensitive school is one in which all students feel safe, welcomed and supported and where addressing trauma's impact on learning on a schoolwide basis is at the center of its educational mission. It is a place where an ongoing, inquiry-based process allows for the necessary teamwork, coordination, creativity and sharing of responsibility for all students, and where continuous learning is for educators as well as students.’ (Cole et al., 2013, p. 11) |
|
Flexible Framework for school culture change (2013)
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| Compassionate Schools (Wolpow et al., 2016) |
|
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Seek to extend compassion to organisational structure of the school, district, community and state. Compassionate curriculum:
|
| Trauma-Informed Programmes, Organisations, or Systems (SAMHSA, 2014a) | ‘A programme, organisation, or system that is trauma-informed realises the widespread impact of trauma and understands potential paths for recovery; recognises the signs and symptoms of trauma in clients, families, staff and others involved with the system; responds by fully integrating knowledge about trauma into policies, procedures, practices; and seek to actively resist re-traumatisation.’ (p. 9) |
|
Implementation domains:
|
| Trauma-Informed Service Systems (NCTSN, 2016, 2017) | ‘A trauma-informed child and family service system is one in which all parties involved recognise and respond to the impact of traumatic stress on those who have contact with the system including children, caregivers and service providers. Programmes and agencies within such a system infuse and sustain trauma awareness, knowledge and skills into their organisational cultures, practices and policies. They act in collaboration with all those who are involved with the child, using the best available science, to maximise physical and psychological safety, facilitate the recovery of the child and family and support their ability to thrive.’ (NCTSN, 2016) | N/A | Trauma-informed schools (NCTSN, 2017):
|
| Positive Schools (University of Maryland, n.d.) | Positive schools ‘are environments where students, adults and community members feel safe and can flourish. School teams have the expertise and training to build strong, dynamic relationships and sustain high student and staff attendance, continually decrease suspension rates and office referrals and boost academic achievement.’ |
|
N/A |
| Equity-Centred Trauma-Informed Education (Venet, 2021) | ‘Trauma-informed educational practices respond to the impacts of trauma on the entire school community and prevent future trauma from occurring. Equity and social justice are key concerns of trauma-informed educators as we make changes in our individual practice, in classrooms, in schools and in district-wide and statewide systems’ (p. 10) |
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Four necessary shifts:
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A streamlined synthesis of common components of trauma-informed approaches
The eight unique models presented in Table 1 suggest several common components essential to a whole-school, trauma-informed approach. Several of these models are very prescriptive in how a trauma-informed approach should be implemented and include many variations of high-level components (e.g. emphasising democratic principles for leadership and/or referencing different forms of interpersonal communications). This article seeks to streamline the models into an easily digestible, condensed model that school leadership can adapt to their unique circumstances.
First, each model emphasises the importance of understanding and recognising trauma among all members of the school community and making a commitment to trauma-related policy and practice adaptations. This includes acknowledging the prevalence of trauma in society and being able to recognise trauma symptoms in individuals affiliated with an organisation, then making schoolwide changes to meet the needs of all members of the school community. Professional development focusing on trauma is typically considered an important step of this first component. The component's emphasis on policy and procedural changes also illustrates that schools cannot be trauma-informed solely through individual action; administrators, staff members, students and the broader community must collaborate to create an environment that promotes caring, healing and schoolwide wellbeing (Cole et al., 2013; Harris & Fallot, 2001; NCTSN, 2016; SAMHSA, 2014a; Venet, 2021; Wolpow et al., 2016).
Second, current conceptual models emphasise safety, which pertains to the final component of SAMHSA's (2014a) definition of a trauma-informed organisation: resisting retraumatisation. Safety goes beyond interpersonal interactions, however, to include creating an environment that anyone who engages with the school, including staff members, students, family and community members, can feel safe in (Harris & Fallot, 2001; NCTSN, 2016; SAMHSA, 2014a; Venet, 2021).
The third common component of trauma-informed schools is rooted in Harris and Fallot's (2001) promotion of a strengths-based, whole-person approach, which is also partially reflected in SAMHSA's (2014a) cultural, historical and gender principle and Venet's (2021) asset-based focus. A strengths-based, whole-person approach considers community members as unique, whole individuals in the context of their broader ecology and seeks to recognise abilities, competencies and possibilities at all system levels instead of focusing on symptoms or deficits (Saleebey, 1996). More recent models for trauma-informed schools specifically also include a focus on antiracism and equity (University of Maryland, n.d.; Venet, 2021). In schools, a strengths-based, whole-person approach should be applied toward anyone who engages with the school: staff members, students and their families, and the broader community.
Fourth, the importance of relationships is mentioned in various contexts across almost all models for trauma-informed schools or trauma-informed organisations. Harris and Fallot (2001) emphasised warm, collaborative provider–patient relationships, an idea furthered by SAMHSA (2014a) and the NCTSN (2016). SAMHSA (2014a) also called for trustworthiness and transparency, peer support and mutuality, whereas Cole et al. (2013) suggested an environment that welcomes and supports students and involves teamwork, coordination and sharing of responsibility among staff members. Harris and Fallot (2001) and SAMHSA (2014a) also mentioned empowerment and the promotion of client autonomy and control. Traumatic experiences can lead to feelings of lost power or self-efficacy, which must be rebuilt so that survivors can make meaning of their experience and move forward (Herman, 1992). Staff members in a trauma-informed organisation are encouraged to engage constituents in decision-making about their options and preferences and support them in voicing their thoughts and opinions (Levenson, 2017). For this discussion, empowerment is reviewed under the guise of supportive relationships because it is an interpersonal process.
In summary, the following common components can serve as a condensed and actionable model for implementing and sustaining trauma-informed approaches in schools: (a) an understanding of and commitment to trauma across the organisation; (b) ensuring physical, emotional and psychological safety for all school members; (c) adopting a strengths-based, whole-person approach toward staff members, students and families; and (d) developing and sustaining trust-based, collaborative and empowering relationships among administrators and staff members, and with students, their families and the broader community. Some conceptual components of a trauma-informed approach overlap with other school-based approaches such as positive school climate and socioemotional learning (Collaborative for Academic, Social, and Emotional Learning [CASEL], 2013; Wang & Degol, 2016). A review was conducted to identify relevant empirical evidence of trauma-informed approaches in schools since 2019. Because there has been very limited examination of whole-school trauma-informed approaches, each component will be discussed individually, including its rationale, available empirical support, and connection to other school-based approaches (Avery et al., 2021; Maynard et al., 2019).
METHOD
This review utilises a critical approach to further the literature and conceptualisation of trauma-informed schools (Grant & Booth, 2009). A critical review evaluates empirical support across multiple literature and seeks to advance the conceptualisation and future research of a topic. Because the main goal of critical reviews is synthesising extant conceptualisations and analysing existing evidence, they are more interpretive than other forms of systematic review. Therefore, we began with a narrative review of existing conceptualisations for trauma-informed schools and other organisations to inform the development of a consensus model. Then we undertook a more systematic approach to assessing the empirical support for whole-school, trauma-informed approaches. Research on whole-school approaches to trauma was very limited. Hence, we intentionally structured our review by focusing on specific common components among existing models for trauma-informed schools. This required synthesising evidence for each component across a broad range of academic literature.
Search strategy
The research team searched four databases most utilised in education, psychology and social sciences research: Web of Science, PubMed, PsycINFO and ERIC. First, search terms were developed to locate articles about trauma-informed schools. Initial search terms were: (a) trauma-informed schools AND organis* AND study, and (b) whole school OR schoolwide AND trauma-informed OR trauma OR trauma-sensitive OR trauma-aware. Second, because some conceptual models include components of trauma-informed approaches without explicit mention of trauma, additional searches were conducted to identify articles that addressed school-based relationships, school safety, strengths-based or whole-person approaches, equity and empowerment. Secondary search terms included relationships OR strengths OR equity OR empower* OR whole person.
Eligibility criteria and study selection
Criteria for inclusion in this review were: (a) The article must be in a peer-reviewed journal, (b) in English, (c) present results from an empirical study, (d) relate to improving outcomes for school staff, students and the community in a K-12 population (vs. presenting implementation findings from an intervention study), and (e) be published since 2019. Our rationale for limiting the date range was because two prior systematic reviews covered earlier work (see Avery et al., 2021; Maynard et al., 2019). Articles that related to clinical interventions were excluded because our focus was on universal, whole-school approaches. After accounting for the above criteria, the lead author reviewed titles and abstracts of 158 articles, excluding 119 for lack of relevance, then reviewed 39 full-text articles to determine the final list of 14 included works. See Figure 1 for a flow diagram of the review inclusion process. Both qualitative and quantitative studies were included.
FIGURE 1.
Flow diagram of the review inclusion process.
Data extraction
The lead author independently extracted the following data from included studies: (a) study design and focus, (b) sample characteristics, (c) trauma-informed component or subcomponent studied, and (d) main findings. Included studies are presented in Table 2.
TABLE 2.
Empirical evidence for trauma-informed approaches in schools since 2019.
| Component: Subcomponent |
First author (year) |
Method/focus | Findings |
|---|---|---|---|
| Identified as whole-school approach | Avery et al. (2022) | Quantitative six-month evaluation of a trauma-informed schoolwide approach created in Australia, as it contributed to teachers' perceptions and attitudes to being trauma responsive. Staff in three Catholic schools completed a school culture pre-assessment, pre- and post-survey using Attitudes Toward Trauma-Informed Care (ARTIC) Scale, and participated in interviews, focus groups and class observations. | Two schools showed no change on their subscale or total ARTIC scores pre- and post-evaluation; their initial scores were high. The remaining school showed a statistically significant increase on one scale and a significant decrease on another scale. In individual interviews and focus groups, school staff reported increased knowledge and understanding of trauma, improved perceptions of and responses to student and staff behaviours, reflected on the importance of school leadership, and made suggestions for intervention implementation. |
| Identified as whole-school approach | Jones, E. L. (2023) | Case study of three non-mainstream schools in the UK implementing attachment- and trauma-training and approaches. Semi-structured interviews were conducted with three staff members and 11 students completed an in-school activity soliciting their views. | Staff reported on their current individual approaches to attachment and trauma, including a motto that ‘every day is a new day;’ praising students for positive actions; being consistent so to be construed as a trustworthy adult working in a routine, structured way; and taking a nurturing approach that reassures students, seeks to understand them and makes them feel seen. Staff also implemented interventions, including school-based counselling, a safe place outside classrooms to reset, emotion-coaching and restorative conversations. Relationships among staff and between staff and students were also highlighted. Perceived benefits of the approaches included improved student achievement, behaviour, wellbeing and communication skills. |
| Relationships | Luthar (2020) | Qualitative study. 10 former and current teachers who indicated experience in trauma-informed schools were asked about challenges they faced and possible solutions. | Identified challenges included compassion fatigue, feelings of inadequacy, threats of physical violence, standardised testing and professional evaluation standards. Proposed solutions included increased mental health capacity in schools, additional training about mental health, new policies to improve mental health (e.g. mandatory social–emotional learning). Researchers concluded that teachers would benefit from ongoing relational support. |
| Relationships | Post et al. (2020) | Qualitative findings from three-year evaluation of child–teacher relationship training on teachers' stress, perception of children, social justice attitudes, and ability to demonstrate relevant skills in the classrooms of one elementary school. Four pre-school teachers completed semi-structured interviews. | Teachers reported that training lowered their stress levels and helped them build stronger relationships with students in the high poverty school. |
| Understanding & Commitment: Training | Anderson et al. (2022) | Mixed method study of trauma-informed professional development for six teachers and one other school staff member. Participants completed Professional Quality of Life Scale before and after; submitted bi-weekly reflection journal entries; and participated in a focus group. | Participants reported a change in their teaching approach based on better understanding of children's adversity and social–emotional needs. There were significant differences pre- and post-test in reported compassion satisfaction and secondary traumatic stress on the ProQOL. |
| Understanding & Commitment: Training | Garcia et al. (2023) | Quantitative pre-post survey design. 205 responses from school staff including mental health counsellors/social workers, teachers, administrators and other personnel. Evaluation of trauma-informed practices (TIPs) learning collaborative. Assessed implementation of TIPs using the Trauma Sensitive Schools Checklist against a question about leadership engagement in the collaborative. | Senior leadership awareness of the training was central to adoption of trauma-informed practices. Schools with engaged leaders demonstrated statistically significant increases in trauma-informed practices. Schools with disengaged leaders showed no significant change. |
| Understanding & Commitment: Training | MacLochlainn et al. (2022) | Quasi-experimental, waitlist control group, pre-post test design to evaluate a trauma-informed professional development training. Compared trauma-informed attitudes and compassion fatigue of 216 school personnel (n = 98 intervention, n = 118 control group) utilising the ARTIC and Pro-QoL scales. | The intervention group showed a significant positive increase in attitudes related to trauma-informed care immediately before (Time 1) and after the two-day training (Time 2), which remained in a six-month follow-up (Time 3). The same group showed a significant decrease in burnout and secondary traumatic stress from Time 1 to Time 3, but no change in compassion satisfaction. Whereas burnout scores decreased in the intervention group, the control group experienced significant increases in burnout over the same period. The intervention group also showed significantly positive increases in ARTIC scores between Times 1 & 3 while the control group had no change. The intervention group also showed positive increases in work self-efficacy and reactions vs. no change in the control group. |
| Understanding & Commitment: Training | McIntyre et al. (2019) | Quantitative pre-post assessment design; evaluation of two-day foundational professional development intervention as relates to increases in knowledge and acceptance of trauma-informed approaches; 183 teachers sampled. | Teachers demonstrated significant increased knowledge after training. Perceptions of their school's fit to trauma-informed approaches influenced acceptability. If system fit was strong, acceptability increased and vice versa. |
| Understanding & Commitment: Training | Orapallo et al. (2021) | Quantitative valuation of 20-hour trauma training. Longitudinal pre-post design, one year. 2418 staff and teachers across 42 preschools and elementary schools. | Respondents were able to demonstrate the knowledge covered in training. Attitudes toward trauma-informed care were significantly more favourable across all seven subscales and the overall ARTIC score at post test. |
| Understanding & commitment: Training | Wojciak et al. (2022) | Qualitative evaluation of a train-the-trainer trauma programme for educators. Two non-overlapping populations participated in data collection: trainers through focus groups and participants through a survey. | Trainers (principals, school counsellors and teachers) reported feeling empowered to adopt a new approach and focus on relationship-building with students. They reported no longer taking student behaviours personally and engaging in more self-reflection. Trainers reported fewer disciplinary incidents and office referrals and a calmer environment in the school. Training recipients (other school staff) reported greater awareness of trauma and its impact on learning. Recipients then advocated for more responsive support for students. They expressed both frustration with the training and changes as well as recognition of positive benefits of a trauma-informed approach. |
| Understanding & Commitment: Training & Practice changes | Stokes (2022) | Mixed method case study of one school implementing a trauma-informed instructional model in Victoria, Australia. Model consisted of 1) whole-school participation in trauma-informed positive education training, and 2) integration of trauma-informed practices, including non-punitive behaviour management. Researchers used one student and one staff survey, and then performed 32 interviews with leadership (n = 4), teachers (n = 6), educational support staff (n = 2) and students in years 7–12 (n = 20). | Respondents reported greater understanding and empathy for students' situations. School staff reported increased collective influence in several areas between 2019 and 2021. They believed the implementation of new classroom strategies to better manage student behaviours resulted in fewer disruptions and a calmer learning environment. Schoolwide, staff reported that behaviour management changed from punitive to restorative. Students reported increases in appropriate classroom behaviour and effective teaching time and staff reported better teacher-student relationships and that their time use was more effective. Students also reported increases in their connectedness to school, confidence, self-regulation and goal-setting, expectations for success and teachers' concern. Staff agreed, reporting increases in staff trust of students and students' interpersonal relationships. |
| Understanding & commitment: Training & Screening | von der Embse et al. (2019) | Study presents initial findings of a K-8 school demonstration project to integrate mental health supports and trauma-informed approaches with MTSS at Tier 1 & Tier 2. Teachers received training about trauma, classroom management and how to use screening tools, then six teachers were given ongoing coaching in classroom management. Teachers screened students during each quarter of two school years using the Social, Academic and Emotional Behaviour Risk Screener (SAEBRS) tool. | Participating teachers reported lower office discipline referrals (ODRs) compared to their peers and over time, going from an average of 1.2 ODRs per day to 0.2/day. Students exhibited a decline in risk, based on SAEBRS screening. |
| Understanding & commitment: Training, Practice changes; Relationships | Wall (2021) | Qualitative case study of educators' perspectives of trauma-informed approaches in an elementary school. Three types of regular professional development were implemented, including training about the effects of trauma, implementation of a school-wide social emotional learning programme, and a relationship-building skills programme that included self-care and mindfulness. Data gathered over three years included classroom observation; meeting and special event attendance; interviews with teachers, parents and administrators; a parent focus group; and publicly available school data. | Staff implemented trauma-informed approaches that included restorative (‘conversation over consequence’) practices in lieu of punitive ones. Classroom adaptations included more student support and empowerment through breaks, snacks, flexible seating, sensory-soothing methods and allowing students more choice. Teachers adapted their instruction to include class routines and consistency and emphasise growth over meeting goals. The school also encouraged development of positive student–student, student-teacher-staff and teacher-teacher relationships as well as supporting and empowering parents. Since implementation of the above approaches, students' scores on standardised tests have improved and there have been fewer class disruptions, improved self-regulation and more efficient de-escalation when incidents occur. |
| Understanding & Commitment: Training, Screening; Equity focus | Somers, (2022) | Case study of K-8 charter school in a Midwestern urban area. Case study included semi-structured interviews with staff and analysis of school data, including time management of counsellors, disciplinary data, professional learning records and staff surveys. Interventions included ACEs screening; teacher professional development; increased mental health staffing; creation of a mental health services centre providing SEL and character education; an equity team that reviewed school policies, retention and discipline data, and made suggestions to enhance equity; and an advisory council. Results compared pre-intervention and after three years of intervention. | School counsellors increased time serving students to 87.3%. Students were given SEL support as an alternative to in-school suspension. Out-of-school suspensions dropped from 360/year to 85/year. Vast majority of teachers and staff reported that training made school a better place to work, increased job satisfaction, and improved their confidence in handling SEL and student behavioural issues. Discipline referrals decreased by 26%. |
RESULTS
The search retrieved 193 articles, of which 35 were duplicates. After reviewing titles and abstracts, an additional 119 articles were excluded. The remaining 39 articles were reviewed in full, resulting in another 25 articles being excluded. The 14 included articles are presented in Table 2. The majority (8) of included articles addressed only the first component of a trauma-informed approach in schools: understanding of and commitment to trauma. Two articles included one additional component beyond understanding and commitment to trauma. Two articles addressed only relationships in schools. The final two papers assessed whole-school approaches encompassing all four components. Eight articles were qualitative or mixed methods studies, three of which were case studies of one or more schools. Quantitative studies all measured the first component of trauma-informed schools and typically focused on trauma training for staff.
DISCUSSION
As noted above, our review of empirical support for trauma-informed approaches in schools resulted in the identification of 14 journal articles. Most of these articles focused solely on the first component of trauma-informed schools: understanding and making a commitment to trauma. Most studies were also qualitative or mixed-methods case studies. Given the limited evidence identified for trauma-informed schools, we incorporated empirical findings related to each component of a trauma-informed approach and extended our analytical sources beyond studies that focused solely on trauma prevention and response. These methodological adaptations strived to increase understanding of the strengths and limitations of trauma-informed approaches more broadly and to enhance their future conceptualisation, study and practice integration (see Berkowitz et al., 2017; De Pedro et al., 2011 as examples).
Empirical support for component 1: Understanding, recognising and making a commitment to trauma
To be trauma-informed, experts say that organisations must first understand and acknowledge the prevalence of trauma and be able to recognise its signs in people who engage with the organisation, from service participants to staff members to community members (Bloom & Yanosy Sreedhar, 2008; Harris & Fallot, 2001; NCTSN, 2016; SAMHSA, 2014a). Doing so enables an organisation to respond appropriately to trauma survivors and provide services that empower instead of contributing to trauma-related feelings of disempowerment (Harris & Fallot, 2001). Trauma knowledge includes understanding people, individually and in groups; how they react to stress and adversity on a physical, emotional and psychological level; and what is required for both individuals and groups to heal from such experiences (Bloom, 1995, 2000). Part of making an organisational commitment to trauma awareness involves developing a shared, positive language around trauma and recovery, which can serve to destigmatise children's reactions to traumatic experiences, loss and grief (Bloom & Yanosy Sreedhar, 2008).
A second facet of the understanding and commitment component is choosing to respond to the prevalence and impact of trauma by adapting organisational policies and procedures (Bloom, 2010; Harris & Fallot, 2001; SAMHSA,2014a; Venet, 2021). Bloom (1997), who developed the Sanctuary Model, explained that organisation-wide change requires commitments on the part of everyone in the organisation, from administrators to front-line staff. Commitments could include referencing trauma responsiveness in a school's mission or policies (Cole et al., 2005; NCTSN, 2017) or committing to such trauma-responsive values as nonviolence, democratic decision-making, open communication and shared responsibility for students (Cole et al., 2013; Sanctuary Institute, 2022).
Training as a method to help school staff understand and recognise trauma
The first step in creating a trauma-informed approach in schools is generally to ensure that administrators, educators and staff members understand and can recognise trauma-related symptoms in students and each other (Cole et al., 2013; NCTSN, 2017). Training for all staff members—administrators, educators and support staffers like custodians, bus drivers and lunch providers—should explain trauma, how it can affect learning and interpersonal reactions, and the importance of a schoolwide response (Cole et al., 2013). In a survey of trauma researchers and practitioners, experts argued this component was most critical to a trauma-informed approach with children and families (Hanson & Lang, 2016).
Trauma training is the most studied aspect of trauma-informed approaches in schools and thus has the strongest empirical support. However, much of the research to date has focused on changed attitudes instead of changed behaviours and outcomes. A programme evaluation of a school-based trauma intervention called Healthy Environments and Response to Trauma in Schools found significant increases among educators' self-reported knowledge of trauma (57%), ability to help traumatised children (61%), and use of trauma-sensitive practices (49%) following training (Dorado et al., 2016). In two studies from the current review, teachers and other school staff reported more positive attitudes toward trauma-informed approaches after training (MacLochlainn et al., 2022; Orapallo et al., 2021). In one of these studies, improved attitudes lasted at least six months (MacLochlainn et al., 2022). In another study, there was no change in trauma-related attitudes for two schools and mixed results for a third school (Avery et al., 2022). In a fourth study, teachers' perceptions of the fit between trauma-informed practices and current school norms affected their views of the practices; for schools with a good system fit, favourability increased, whereas for schools with a poor system fit, favourability decreased (McIntyre et al., 2019). School staff across multiple studies reported greater empathy for students and changes to their teaching approaches (Anderson et al., 2022; Avery et al., 2022; Stokes, 2022) as well as increased compassion satisfaction and decreased burnout and secondary traumatic stress after trauma training (Anderson et al., 2022; MacLochlainn et al., 2022). In some studies, staff also reported improvements to student outcomes, including higher standardised test scores (Wall, 2021) and fewer disciplinary events and office discipline referrals (von der Embse et al., 2019; Wojciak et al., 2022).
While there is some evidence that trauma training can improve teacher–student interactions, decrease educator stress, and reduce disciplinary incidents that teachers are ill-equipped to handle, more research is needed about outcomes of trauma-related professional development beyond increased knowledge and confidence working with traumatised children. Researchers should explore how trauma-training translates into changes in practice behaviour and school climate, and how such changes can be measured and sustained. Possible areas of change may include decreased use of exclusionary discipline practices whereby children are removed from their peers or classroom environment, increased classroom order, child or parent reports of increased feelings of connection to the school, better student–teacher relationships, or fewer student absences.
Some models for trauma-informed schools also encourage educating students and their caregivers about trauma and its effects (Dorado et al., 2016; NCTSN, 2017). Such activities may include psychoeducation or teaching healthy coping strategies to bolster students' protective factors and resilience (NCTSN, 2017), which are two key elements of therapeutic responses for traumatised youth (Keeshin & Strawn, 2014). Strong evidence supports a relationship of adult and family psychoeducation with positive treatment outcomes; however, more research with children is needed despite its standard inclusion in several highly regarded therapeutic models (Lyman et al., 2014). Although one study in the current review incorporated social–emotional learning and character education (Somers, 2022), none specifically engaged in trauma psychoeducation.
Recognising trauma: A comparison of screening vs. universal inclusion
One way to recognise trauma is through screenings. Many developers of trauma-informed organisational models advocate universal screening for trauma experiences and symptoms to ensure all survivors are identified and served (Elliott et al., 2005; Harris & Fallot, 2001; NCTSN, 2016). Harris and Fallot (2001) explained that screening makes trauma a focus for everyone in an organisation, conveys concern for the wellbeing of service recipients, and enables more-informed referrals to trauma-specific treatments. Several experts also support universal screening for trauma in schools, stating it can reduce bias from teacher-initiated referrals and help detect less-obvious trauma responses such as internalising behaviours (Eklund & Dowdy, 2014; NCTSN, n.d.).
At the same time, universal screening—particularly in schools—can be controversial. Some view any form of screening as a privacy violation or government intrusion, whereas others raise objections related to labelling, stigma or retraumatisation (Berliner & Kolko, 2016; Kauffman, 1999; Weist et al., 2007). Still others express concern that screening for trauma is outside a school's purview and better managed by parents and mental health providers (Dowdy et al., 2010). Three prominent school-based trauma-informed models advocate against universal screening, positing that it is potentially harmful and can create stigma, cause confidentiality concerns, and reinforce the idea that trauma-informed approaches should be targeted, not universal (Cole et al., 2005, 2013; Venet, 2021; Wolpow et al., 2016). Very few U.S. school administrators report screening universally for emotional or behavioural needs (Bruhn et al., 2014).
To avoid this screening dilemma, another way to respond to trauma in schools could be to presume that all students and staff are trauma survivors and adopt a philosophy of universal inclusion (Cole et al., 2013; Harris & Fallot, 2001; Venet, 2021). Adopting such a mindset and training school staff members about the prevalence and impact of trauma can help the staff become more conscious of their interactions with each other and with students and lead to policy changes that benefit all members of the community (e.g. enhanced interpersonal safety and feelings of belonging while ending the use of exclusionary discipline). However, it is important that schools do not use the principle of universal inclusion to take a deficit mindset toward students, families and communities, and instead use the principle to develop a supportive school environment to benefit all constituents.
Minimal evidence suggests trauma-screening will improve outcomes for traumatised youth in schools. In one study, Miller et al. (2015) found statistically significant inconsistencies in student risk identification between five teacher-administered screening tools in a study of 1,974 students across 20 schools. Validated measurements outperformed office discipline referrals and other student nomination practices but were found to be overly inclusive. In addition to limited research about screening for trauma (Eklund & Rossen, 2016), little support exists for the efficacy of available screening tools (Eklund et al., 2018). Research to date suggests that even when utilised individually to refer clients for services, the efficacy of screening is unclear. A future step could be comparing student outcomes from a school that screens for trauma with a similar school that practices universal inclusion.
This discussion has focused on the utilisation of screening results on an individual basis, which is appropriate when the goal of screening is to refer students to mental health treatment. However, in a whole-school, trauma-informed approach, it may be more appropriate to utilise screening results in the aggregate or assume universal inclusion. An aggregated approach could rely on anonymous student surveys. Shifting the screening focus from the individual to an organisational level helps shift the intervention focus accordingly (Astor & Benbenishty, 2018). Although several programmes that monitor schoolwide indicators exist at a national level, more effort is needed to implement such programmes at local, district and statewide levels (Astor & Benbenishty, 2018). One statewide monitoring tool is the California Healthy Kids Survey, which surveys California students in fifth, seventh, ninth and 11th grades about school connectedness, safety, victimisation, violence, substance use and health. Aggregated data from the California Healthy Kids Survey are used by districts and schools to advocate for resources or provide necessary services—at the school or classroom level.
Policy and procedure changes as examples of organisational commitment to trauma
Cole et al. (2013) cautioned that adopting a programme does not make a school trauma sensitive and that any policy or procedural responses as part of a trauma-informed approach must allow for flexibility so that educators and administrators can match a school's particular needs to the solutions implemented. In fact, Venet (2021) called for standardisation and one-size-fits-all approaches to be removed from schools entirely. Superintendents and principals may target several areas to adapt policies and procedures to better support trauma survivors, including changes at the district, school, or classroom level and those related to administrative actions, the curriculum and instructional methods, or extracurricular activities. One commonly cited policy adaptation that is related to the development of trauma-informed schools is the elimination of zero tolerance—whereby a child may be expelled after one offence—and exclusionary discipline (Cole et al., 2005; NCTSN, 2017; Venet, 2021). Policy and practice adaptations could be evaluated individually or as part of a whole school strategy.
With regard to instructional practices, teachers may establish routines that enhance predictability (Cole et al., 2005; Venet, 2021), develop systems to notify children in advance of changes (e.g. a bell that chimes before activities change), or establish a safe space to which students can retreat when overstimulated (NCTSN, 2017; Wolpow et al., 2016). Secondary school teachers may also consider how curricular components could be triggering to students, such as depictions of murder and suicide in Shakespeare's Romeo and Juliet or historical reenactments of violent events, and provide space for students to process any emotional reactions. Within the United States, few trauma-informed school approaches include pedagogy. Pedagogy is likely an important element in creating trauma-informed schools, given the time students spend learning in the classroom. The conceptual absence represents a limitation in the extant U.S. literature. Future research should integrate and examine trauma-informed pedagogy and conceptual models used in other countries (e.g. Brunzell et al., 2016; Brunzell & Norrish, 2021).
Universal vs. multitiered responses to trauma: A comparison
In a school context, trauma response could entail solely universal, schoolwide reforms, or adapting existing multitiered systems of support. The latter is a public-health intervention model that consists of Tier 1, universal strategies; Tier 2, strategies for select groups; and Tier 3, targeted interventions where indicated (Chafouleas et al., 2016; Hodas, 2006). Tier 3 strategies correspond to individual clinical treatments; Tier 2 strategies reflect peer-focused and psychoeducation models (SAMHSA, 2014b); and a whole-school approach emphasises universal (Tier 1) strategies.
Several experts proposed overlaying trauma-informed approaches onto multitiered system frameworks like Response to Intervention and Positive Behavioural Intervention and Supports (PBIS; Cavanaugh, 2016; Chafouleas et al., 2016; Dorado et al., 2016; Hodas, 2006; NCTSN, 2017; Plumb et al., 2016). PBIS is the most widespread multitiered support system in the United States. Developed in the mid-1990s and present in 26,000 U.S. schools (26.8% of public schools) as of June 2018, PBIS offers a school-driven process that encourages school staff members and administrators to elucidate desired academic and behavioural outcomes; identify evidence-based practices to support such goals; and establish systems to support implementation and sustainment of new practices (Sugai & Horner, 2006, 2019). PBIS is believed to incorporate several components of a trauma-informed approach, including an emphasis on safety and focus on strengths, positive relationships and cultural responsiveness (Cavanaugh, 2016). Studies have supported the relationship of Tier 1 PBIS practices with positive behavioural and academic outcomes for youth, including decreased disciplinary referrals, bullying and peer rejection and improved reading and math scores among younger children (Bradshaw et al., 2010; Simonsen et al., 2012; Sugai & Horner, 2019). However, schools have had difficulty implementing and sustaining Tier 2 and Tier 3 supports, including identifying appropriate interventions and resources to support them (Sugai & Horner, 2019). PBIS developers estimated 65% of Tier 1 schools, 35% of Tier 2 schools, and 18% of Tier 3 schools meet implementation fidelity standards (Sugai & Horner, 2019). Although it seems positive that trauma-informed responses could be incorporated into an existing, widespread behavioural intervention, additional research is required both of PBIS alone and models that integrate PBIS with a trauma-informed approach. Plumb et al. (2016) added that because PBIS arose from and is primarily geared toward managing students' classroom behaviours, it is not intended to ameliorate root causes of problematic behaviour such as trauma or its long-term effects—and thus, further study of its ability to support lasting change is needed.
Implementing and evaluating a multitiered framework is complex. Large-scale evaluations typically require significant financial and other resources (Maynard et al., 2019). When assessing multiple tiers of support, it also may be unclear which outcomes relate to each tier. Given that Tier 1 supports are those most associated with positive behavioural and academic outcomes (Sugai & Horner, 2019), it may be appropriate to begin evaluating trauma-informed responses solely at the universal level. After all, trauma-informed approaches were not intended to be an add-on to existing programmes and practices, but instead an organisational paradigm shift (Harris & Fallot, 2001; Venet, 2021). A universal approach also allows schools to become proactive in their trauma response, seeking to avoid traumatic experiences for children and staff members, instead of solely reactive to prior traumatic events (Venet, 2021). The Trauma and Learning Policy Initiative's flexible framework is an adaptive, whole-school trauma response that administrators tailor to their school's and students' needs (Cole et al., 2005). The flexible framework is designed to bolster protective factors associated with competence in children—specifically, positive relationships, cognitive abilities and self-regulation skills (Cole et al., 2005). The framework requires administrator and staff engagement in strategic planning; adaptation of teaching and extracurricular methods; and review of discipline, communication and safety policies. In contrast, Washington state's Compassionate Schools initiative suggests several principles to guide trauma-informed instruction and discipline practices and three new domains of classroom instruction (Wolpow et al., 2016). Compassionate Schools' principles are discussed in later sections. Instructional domains involve helping students feel safe, improving their emotional and behavioural regulation skills, and developing self-agency, social and academic abilities (Wolpow et al., 2016). Although both models offer flexible approaches that schools can adapt to their needs, the flexible framework provides a concrete, holistic guide to organisational change, whereas the Compassionate Schools model focuses more on principles of how and what to teach traumatised children. It is important to recognise that both models for schoolwide trauma-informed approaches implement aspects of socioemotional learning.
Empirical study combining trauma-informed approaches with MTSS is just beginning. One study in the current review involved a demonstration project implementing Tier 1 supports for trauma such as teacher training about trauma, classroom management and use of trauma screening tools, the outcomes of which were being used to inform implementation of and referrals to Tier 2 support. Results included an overall decline in student risk throughout the school year, as registered by teachers using a screening tool, and a decline in office discipline referrals among participating teachers (von der Embse et al., 2019).
Organisational assessments as a measure of schools' trauma response
Measuring schoolwide responses to trauma can take multiple forms. One recommended tool is an organisational assessment. Typically, trauma-informed organisational assessments measure staff attitudes or behaviours related to trauma policies and practices. Examples of relevant tools include the 75-item ARTIC scale, which assesses employee attitudes related to trauma-informed approaches (Baker et al., 2016) and was used in multiple included studies (e.g. MacLochlainn et al., 2022; Orapallo et al., 2021); the 35-item TICOMETER, which measures the extent to which organisations engage in trauma-informed behaviours (Bassuk et al., 2017); and the NCTSN's 89-item Trauma-Informed Organisational Assessment, which is geared to any child- and family-serving organisation (Halladay Goldman et al., 2019).
Potential limitations of organisational assessments include a tendency of organisations to treat them as one-time events that may or may not lead to practice or policy change; the expense of hiring a consultant to facilitate the assessment process; and assessments' distribution solely to administrators and the staff. Without incorporating students' and caregivers' views, key impressions of a school's trauma response may be overlooked or misunderstood. Instead, schools could undertake an ongoing monitoring strategy that solicits the reactions—both behavioural and emotional—of students, caregivers and staff members to changes in policies and practice. This method is based on the Astor et al.' (2004, 2021) mapping and monitoring approach to school safety, which empowers school constituents to develop grassroots solutions to their school's needs rooted in data. Such an approach emphasises tying school-based responses to the needs of the local community, which naturally vary over time and space, whereas standardised evidence-based practices often need considerable modification to fit different schools' needs, which then may compromise implementation fidelity and efficacy (Astor et al., 2004, 2021). Both models described above are flexible enough to be utilised with a mapping and monitoring approach.
As noted, evidence for whole-school responses to trauma—either three-tiered or universal—remains limited because the field is so nascent (Avery et al., 2021; Chafouleas et al., 2016; Maynard et al., 2019). A study of five Trauma and Learning Policy Initiative schools found staff-reported increases in trauma awareness, mindset shifts that led to practice changes and improvements in school climate and culture, including increased feelings of safety, staff cohesion and student–staff relationships (W. Jones et al., 2018). A preliminary evaluation of the Healthy Environments and Response to Trauma in Schools programme in four schools found teacher-reported improvements in children's ability to learn, time on task and school attendance coupled with a decrease in disciplinary referrals and incidents involving physical aggression (Dorado et al., 2016). Lincoln High School found that changing its approach to student discipline—from punishment for missteps to asking students what happened and giving them space to share their feelings—resulted in suspension days and disciplinary referrals decreasing by 83% and 47%, respectively, in one year (Stevens, 2012). Synthesising suggested components for trauma-informed schools, and providing suggestions for methods and measurement through this review may contribute to more empirical study of schoolwide trauma responses.
Availability of trauma-specific treatments in trauma-informed schools
Some experts have suggested that trauma-specific clinical treatments should be available as part of a trauma-informed organisational response (Bloom & Yanosy Sreedhar, 2008; Elliott et al., 2005; NCTSN, 2016). Evidence suggests that school-based trauma treatments decrease symptoms and increase treatment completion (Jaycox et al., 2010; Rolfsnes & Idsoe, 2011). However, because of the time required to implement such treatments and their individualised focus, they generally reach limited numbers of students (Jaycox et al., 2010; Langley et al., 2015). Budget constraints and a lack of on-site clinical staff may also render the provision of trauma-specific treatments challenging for schools. Cognitive Behavioural Intervention for Trauma in Schools, which is led by mental health clinicians, was adapted into the Support for Students Experiencing Trauma programme to address a need for school interventions led by nonclinical staff members (Chafouleas et al., 2019). Some evidence supports a relationship between these interventions and reduced symptoms of posttraumatic stress disorder, particularly among children with greater symptomatology (Jaycox et al., 2009). Additional research is needed to determine the factors that support or hinder the efficacy of school-based trauma treatments (Chafouleas et al., 2019). Robust community partnerships may also increase access to clinical treatments for students and staff members, as suggested by some whole-school models for trauma response (e.g. Cole et al., 2005; Wolpow et al., 2016).
Evidence for component 2: Safety and its relationship to other school models
Another key component of trauma-informed schools is safety. School safety is a separate field of academic study and a commonly cited dimension of school climate research (National School Climate Council, n.d.; Wang & Degol, 2016). Creating safe schools means ensuring that all students and staff members feel safe and welcomed, regardless of personal or cultural identity (Cole et al., 2013; NCTSN, n.d.; Wolpow et al., 2016).
Types of safety relevant to a whole-school, trauma-informed approach
Physical, psychological, emotional, social, moral and academic safety are included in various conceptualisations of a trauma-informed organisational approach (Bloom, 2010; Harris & Fallot, 2001; Venet, 2021; Wolpow et al., 2016). Physical safety relates to creating a warm, welcoming environment that allows for adequate personal space and privacy; offers sufficient lighting, security and accessibility for individuals with various abilities; and is free from physical hazards (Bloom, 2010; Elliott et al., 2005; Levenson, 2017). Psychological, social and emotional safety result from creating an environment free from potentially triggering materials and ensuring that interactions with staff members are respectful, consistent and adhere to existing privacy and confidentiality policies (Bloom, 2010; Elliott et al., 2005; Harris & Fallot, 2001; Hopper et al., 2010; Levenson, 2017). Psychological safety also entails feeling comfortable sharing ideas and concerns and making mistakes without fear of retribution (Edmondson, 2018). Such interactions must also consider inherent power dynamics between members of the organisation, avoid shaming or blaming and allow participants to have control over their experience, which points to the connections between safety and empowering relationships in an organisational model (Bloom, 2010; Elliott et al., 2005; Harris & Fallot, 2001; Levenson, 2017). Social safety may also involve staff members modelling appropriate behaviours, like emotional regulation, and helping students establish and maintain boundaries (Bloom, 2010; Elliott et al., 2005; Levenson, 2017), a concept included in conceptualisations of social and emotional learning (CASEL, 2013). Moral safety refers to a feeling that personal choices and values will be respected (Bloom, 2010), which relates to both adopting a whole-person, strengths-based approach and the importance of empowering relationships. Academic safety is the ability to feel comfortable making mistakes to learn and grow (Cole et al., 2013), which relates to psychological safety more broadly (Edmondson, 2018). School climate research often includes the use of fair, consistent discipline practices in conceptualisations of safety (Wang & Degol, 2016). As previously noted, because safety relates to all members of the organisation, understanding and seeking to minimise the potential impact on staff members of frequent engagement with trauma survivors and their stories is part of creating a safe environment (NCTSN, 2016). Several school-based models emphasise the importance of staff self-care to limit mental health disturbances such as vicarious traumatisation, secondary traumatic stress and compassion fatigue (NCTSN, n.d.; Wolpow et al., 2016).
Rationale for ensuring safety in school-based trauma-informed approaches
Many trauma experts agree a positive, safe environment is a critical component of a trauma-informed approach (Hanson & Lang, 2016). The emphasis on safety in trauma-informed approaches relates to the centrality of safety in therapeutic relationships, where trauma responses originated (Geller & Porges, 2014; Herman, 1992). In her seminal work Trauma and Recovery, Herman (1992) explained that because traumatic experiences remove an individual's feeling of power and control, re-establishing safety must occur before any other therapeutic activities. Therapists help clients feel safe through their physical presence and attunement, expressions and vocal tone, which contributes to better treatment outcomes (Geller & Porges, 2014).
Although researchers suggest that a safe school environment is a prerequisite for student learning, empirical evidence rarely connects safety with academic outcomes (Berkowitz et al., 2017; Cornell & Mayer, 2010; Wang & Degol, 2016). Benbenishty et al. (2016) found that improvements in academic outcomes can instead be a causal factor for decreased violence and improved school climate, including greater school safety. In a study of theoretically atypical schools—that is, schools in high violence neighbourhoods with low in-school violence—Astor et al. (2009) found that principals can be instrumental in creating a safe environment by role modelling positive behaviours and promoting warm, supportive staff–student relationships, collective responsibility and inclusivity. Côté-Lussier and Fitzpatrick (2016) found that teachers identified youth who reported feeling safer at school as being more engaged in the classroom. This work bolsters our understanding of the connection between two components of trauma-informed schools: safety and positive relationships. None of the included studies addressed safety as a component of trauma-informed approaches in schools.
Challenges for the empirical study of safety in schools
Studying school safety empirically can be challenging. First, conceptions of safety shift contextually and temporally. Different school constituents—teaching vs. nonteaching staff members, administrators or students—may have differing views about the safety of a school and varied suggestions for improving the environment (Astor et al., 2010; Loukas, 2007). Also, constituent views may shift over time based on events both inside and outside the school, including major news events (Astor et al., 2010; Astor & Benbenishty, 2019). Second, safety can be evaluated in multiple ways, both as behaviours and as a subjective feeling. Behaviours used to evaluate school safety may include incidents of physical or sexual violence, verbal attacks, or weapon-carrying, whereas subjective assessments reflect individuals' perceptions of the safety of the school overall or their personal safety in the school environment (Astor et al., 2010). Third, different aspects of safety may have different causal or mediating relationships. Benbenishty and Astor (2005) found that in secondary schools, the main factor contributing to students' assessment of a school's safety was the school climate, whereas their decision to skip school out of fear for personal safety was associated with severe victimisation or sexual harassment. At the same time, students' assessment of violence as a school problem most closely related to such risky peer behaviours as bringing weapons to school and engaging in substance use or violence. Findings have indicated that because aspects of school safety and climate (e.g. experiences of violence and victimisation, missing school and fears of violence and victimisation) are conceptually similar and often conflated in research, school safety and climate must be assessed across multiple dimensions (Astor et al., 2010; Benbenishty & Astor, 2005). Thus, the varied understanding of safety in a trauma-informed school requires multidimensional consideration.
Evidence for component 3: A strengths-based, whole-person approach and its connection to other school-based models
Another key component of a trauma-informed school is viewing participants through a strengths-based, whole-person approach. Features fundamental to this approach include empowerment and encouragement of a sense of belonging (Saleebey, 1996). Such an approach involves acknowledging trauma symptoms as coping mechanisms and helping participants bolster their protective factors (Elliott et al., 2005; NCTSN, 2016). Considering the whole person means recognising each individual as more than the sum of their traits or experiences, and their resulting responses and beliefs (Singer, 2005). Fully understanding the entirety of an individual student and the interconnections between students and their external environments may be beyond the ability of any teacher or administrator; as such, taking a whole-person approach encourages school staff members to ask students and their families about their needs, responses and beliefs (Wolpow et al., 2016) and seek to understand students' and families' cultural context directly and through class assignments and school practices (Elliott et al., 2005). Acknowledging strengths and supporting the whole person, including their cultural heritage, traditions and identities, helps promote an individual's self-esteem and lays a foundation for skills development that can lead to new, improved coping strategies (Elliott et al., 2005). Thapa et al. (2013) included respect for diversity in their conceptualisation of positive relationships, a component of school climate—a decision indicative of how intermingled topics can become in school-based approaches to trauma, safety, or climate.
A whole-person approach also includes recognising the intersection of trauma and culture—particularly for communities affected by structural inequalities and historical marginalisation, including LGBTQ individuals, Native Americans and African Americans—and honouring how cultural beliefs and connections can promote healing (Bloom & Yanosy Sreedhar, 2008; NCTSN, 2016; SAMHSA, 2014a). Two recent school-based trauma models go beyond seeking to understand students' culture in order to emphasise antiracism, equity and social justice being part of a whole-person, trauma-informed approach or approach (University of Maryland, n.d.; Venet, 2021). Prior research has also highlighted a need for measurable, anti-racist action to be included in trauma-informed approaches (Watson et al., 2022).
Trauma-informed school models generally emphasise taking a strengths-based, whole-person approach. Cole et al. (2013) explained that schools need to look at the whole child and try to understand their behaviours in the context of needs, whether for belonging, safety, or other support. Milwaukee Public Schools (2020) asked staff members to consider student behaviours in context and as a way to get their needs met. To focus on strengths, Wolpow et al. (2016) encouraged adopting a sense of curiosity about students, asking children about their behaviours and noting any personal assumptions or biases. Scholars have that argued a strengths-based, whole-person approach improves student–staff relationships and promotes a positive classroom environment (Shankland & Rosset, 2017).
How unique is a strengths-based approach to a trauma-informed approach?
Hanson and Lang (2016) found that trauma researchers and practitioners believe a strengths-based approach is an essential, though not unique, element of trauma-informed organisational approaches. In school environments, strengths-based research is often limited to the assessment and promotion of individual character strengths (Shankland & Rosset, 2017; White & Waters, 2015). For example, Wagner and Ruch (2015) found positive correlations between the academic achievement and character strengths of love of learning, perseverance, zest, gratitude, hope and perspective. A character focus is insufficient to a whole-school, trauma-informed approach, however, because it limits strengths to personal characteristics and overlooks key familial, cultural and environmental strengths.
Broader strengths-based approaches have been found to benefit youth in non-school contexts (Catalano et al., 2014). Because strengths-based approaches are diverse, empirical support is available across programmes and interventions. Strengths-based psychological assessment has been linked to significantly better clinical outcomes among children relative to traditional assessment (Cox, 2006). The positive youth development perspective, seen in such programmes as Big Brothers/Big Sisters and 4-H, is a strengths-based approach that has been repeatedly validated for use with domestic and international populations (Catalano et al., 2014; Lerner et al., 2019). Positive outcomes of these programmes include increased emotional, social, cognitive and behavioural competence; improved parental bonding; and lower substance use, delinquency, aggression and risky sexual behaviours. School-related outcomes of positive youth development include greater achievement, increased school attachment and attendance, improved high school graduation rates and higher postsecondary and college attendance coupled with lower truancy and school suspensions (Catalano et al., 2014).
In the current review, only one study addressed elements of this component, specifically a commitment to equity. In a case study of a K-8 charter school in the Midwest, Somers and Wheeler (2022) reported that, as part of the commitment to creating a trauma-informed school, staff created an equity team that reviewed school policies and student retention and discipline data to make equity-enhancing recommendations. As a result of their suggestions, the school implemented socioemotional learning support as an alternative to in-school suspension and reduced out-of-school suspensions from 360 per year to 85 per year over three years (Somers & Wheeler, 2022).
Component 4: Relationships that promote trust, collaboration and empowerment as an underpinning of trauma-informed approaches
Teaching and learning are interpersonal processes that depend on relationship quality (Aspen Institute, 2018; Thapa et al., 2013). Although factors of trust, collaboration and empowerment are discussed individually in the trauma-informed settings literature (e.g. SAMHSA, 2014a), they are better conceptualised as characteristics of interpersonal relationships in a school system. Relationship characteristics are discussed individually here as a nod to the trauma literature, but with an eye toward synthesis in the final proposed model for trauma-informed schools.
Along with school safety, the teaching and learning experience and the institutional environment, relationship quality is consistently cited as a dimension of school climate (Thapa et al., 2013; Wang & Degol, 2016). Positive connections between teacher–student relationship quality and student engagement, behaviours and achievement have been well documented (Klem & Connell, 2004; Quin, 2017; Roorda et al., 2011). Evidence also exists that teacher–administrator trust affects school climate and impressions of principal leadership (Tschannen-Moran & Gareis, 2015); however, staff relational experiences are rarely included in school climate research (Capp et al., 2020, 2022).
School relationship quality is also conceptually linked to socioemotional learning. Socioemotional competencies—self-awareness, self-management, social awareness, relationship skills and responsible decision making—contribute to the development and sustainment of positive relationships (CASEL, 2013). School-based socioemotional learning programmes have consistently been found to improve students' social and emotional skills, behaviour and academic performance (Durlak et al., 2011). Of course, such programmes can only be effective when the staff charged with teaching them also has high relational competence (Schonert-Reichl, 2017).
Teachers' relationships with students stem from their feelings toward those students. Positive relationships can lead to an environment that students perceive as safer (Kutsyuruba et al., 2015; Loukas, 2007). Two school models encourage staff members to adopt an attitude of unconditional positive regard for students and model positive relationships to build trust and promote healing (Venet, 2021; Wolpow et al., 2016). Unconditional positive regard is an element of Carl Rogers' (1959) person-centred theory of therapy.
Three studies in the current review addressed school-based relationships as they relate to trauma-informed approaches. One qualitative study reported teachers' challenges and recommendations for trauma-informed schools. Among teachers' recommendations were to increase capacity for mental health services, to provide teachers with additional training related to mental health and to implement related policies (e.g. mandatory socioemotional learning programmes). Based on their responses, the authors concluded that teachers would also benefit from ongoing interpersonal/relational support (Luthar & Mendes, 2020). Another study found that teachers reported lower stress and higher-quality relationships with students following child–teacher relationship training (Post et al., 2020). In a third study, trauma-training and related practice changes were found to improve student–teacher relationships from the perspective of both teachers and students (Stokes, 2022).
Trust as a prerequisite for trauma-informed relationships
Developmental psychologist Erik Erikson (1993) posited that developing trust with our earliest caregivers is a requirement for future developmental tasks like autonomy, initiative and intimacy—and ultimately, healthy human development. Many experts now believe that safe, stable and nurturing relationships and environments can be created beyond the family context, including in schools (Robinson et al., 2016). Trauma survivors often experience a breakdown in trust, whether toward an individual or larger social systems; as such, healing occurs through the reestablishment of that lost trust (Elliott et al., 2005; Harris & Fallot, 2001; Herman, 1992).
Trust is closely related to the trauma-informed principle of safety (Harris & Fallot, 2001). Positive relationships require trust (Kutsyuruba et al., 2015). At the same time, emotional and psychological safety promotes open communication that is essential to trusting relationships (Edmondson, 2018; Wang & Degol, 2016). Trust is rooted in interpersonal interactions built on consistency, clearly outlined expectations and transparency (Bloom, 2010; Hummer et al., 2010; SAMHSA, 2014a). To encourage a sense of trust and safety among students, teachers may collaborate with them to establish clear expectations for teacher and student behaviour and discuss how such behaviours contribute to a positive classroom environment; identify appropriate responses to lapses in behaviour; and consistently enforce mutually acceptable standards. Enforcement may require teacher willingness to be corrected by students and vice versa. Similar strategies for setting and maintaining expectations could exist at the staff and administrator level. Trust must be cultivated between administrators and staff members, staff members across functions and levels, and staff members, students and their families. A lack of trust in an organisation can create significant impediments to delivering trauma-informed care (Bloom, 2010).
Empirical evidence suggests that trusting relationships contribute to positive school and student outcomes. At the staff level, Goddard et al. (2009) found that faculty members' trust in their colleagues and students improved fourth-grade reading and mathematics achievement in a stratified random sample of public elementary schools in Michigan. Trusting relationships also mediated the effect of socioeconomic disadvantage on school achievement. A subsequent study supported these findings, reporting that a significant portion of variability in faculty trust exists among schools, even those in the same district, indicating a need for policies and practices that enhance trust (Adams & Forsyth, 2013). In a nationally representative sample of public high school students, Romero (2015) found that students who expressed greater trust in teachers had fewer behavioural challenges and in turn, better academic outcomes. This finding is noteworthy because studies have shown the quality of teacher–student relationships tends to decline from elementary school to high school (Eccles & Roeser, 2009; Ellerbrock & Kiefer, 2010). Teachers who strive to establish trusting relationships with traumatised students can contribute to better behavioural and academic outcomes for such students.
Collaboration as a key relational activity in trauma-informed approaches in schools
Another accepted aspect of a trauma-informed relational approach is collaboration and mutuality (Harris & Fallot, 2001; SAMHSA, 2014a). Although generally discussed independently, trust and collaboration can be viewed as mutually reinforcing characteristics of positive relationships; that is, collaboration breeds trust and trust breeds future collaboration. Collaboration conveys the importance of working in partnership throughout an organisation, between administrators and front-line staff members; providers, clients and families; and inside and outside the organisation (NCTSN, 2016). Working together to break down power differentials helps develop the trust and safety necessary for healing from trauma (Elliott et al., 2005; SAMHSA, 2014a). Collaborating with external partners can enhance access to services beyond the school, better supporting students and their families (NCTSN, 2016; Wolpow et al., 2016).
Schools seeking to become trauma-informed are encouraged to leverage constituent input when designing and evaluating services. Students and parents could serve on advisory boards or participate in programme evaluations, provided their participation is truly meaningful and not tokenised. Although Elliott et al. (2005) explained that collaboration and mutuality is the least recognised principle in the trauma literature, they asserted that both are imperative to truly integrate constituents and bring about many other aspects of a trauma-informed approach.
In the context of schools, it is evident that collaboration and mutuality necessitate actively seeking to develop positive relationships among staff members of all levels and with all students, including those who exhibit emotional or behavioural challenges (Cole et al., 2013; NCTSN, n.d.). When staff members effectively work together and share responsibility for all students, they create an environment in which they model appropriate interpersonal interactions and relationship competencies (Cole et al., 2013; Wolpow et al., 2016). One systematic review found many benefits of teacher collaboration at the student, teacher and organisational levels: (a) students improved their learning and showed higher reading and mathematics achievement; (b) the school environment benefited from increased innovation, equity and sharing of power; and (c) teachers benefited the most, reporting improvements in morale, skills, absenteeism, goal attainment, collegiality, efficiency and efficacy (Vangrieken et al., 2015).
As previously noted, effective collaboration also involves working with the external community. In a survey of trauma experts, Hanson and Lang (2016) found that service coordination inside and outside the organisation was believed to be an essential ingredient of a trauma-informed approach. Some studies have shown a positive relationship between parent–school partnerships and student achievement (Hill & Taylor, 2004; Sheldon, 2003). School–community partnerships have also been found to promote behavioural and academic achievements through community provision of intensive services; and service coordination resulted in improved attendance, immunisations and student behaviour (Sanders, 2003). Meaningful outcomes from such partnerships depend on meaningful family and community participation in selecting and developing linkages (Sanders, 2003).
Voice and choice as requirements for the empowerment of trauma survivors
A trauma-informed approach supports constituents in reasserting a sense of personal sovereignty and control (Elliott et al., 2005; Harris & Fallot, 2001; SAMHSA, 2014a). As previously noted, traumatic experiences often result in feeling a loss of power and self-efficacy, both of which need to be rebuilt for survivors to make meaning of their experience and move forward (Herman, 1992). In a trauma-informed organisation, staff members are encouraged to engage constituents in discussions about their options and preferences and support their decision-making processes (Levenson, 2017). Democratised decision-making helps minimise power imbalances and promotes a trauma survivor's return to self-mastery (Sanctuary Institute, 2022). This is done in a context of safe interpersonal communication, which avoids shaming or blaming, and instead takes a strengths-based approach, acknowledging that trauma symptoms are often positive adaptations to untenable past circumstances (Levenson, 2017; Venet, 2021). As such, empowerment is strongly tied to two other components of a trauma-informed approach: safety and taking a strengths-based, whole-person approach. Empowerment also contributes to trust throughout the organisation. When principals empower their staff, relationships between staff members and supervisors improve (Moye et al., 2005) and empowered staff members feel more comfortable empowering students (Mitra & Gross, 2009).
Although the need for teacher and staff empowerment is prevalent in existing trauma-informed school models, fewer models address the need for student empowerment, voice and choice. Washington state's Compassionate Schools initiative offers two applicable principles. The first asks staff members to ‘always empower, never disempower’ students (Wolpow et al., 2016, p. 71). Children with trauma histories may compete with teachers for authority, and attempts by the teacher to exert control may exacerbate negative behaviours. Instead, giving children choices from a constrained set of possibilities and being consistent in their interactions with students can aid a child's healing. A second principle advises teachers to provide opportunities for children to contribute meaningfully to the school environment and classroom. Helping others can support a sense of belonging and highlight how all people experience challenges and setbacks, enhancing resilience awareness and skills (Wolpow et al., 2016). Milwaukee Public Schools (2020) supports students in developing self-regulation skills, which can relate to empowerment and self-mastery, by teaching calming strategies. Self-regulation or self-management is also one of five socioemotional learning competencies (CASEL, 2013).
Research has shown that empowering students has benefits for both students and teachers. Youth who are encouraged to participate in school decision-making and who feel empowered are more likely to remain engaged and take greater responsibility for their education (Cook-Sather, 2002; Muncey & McQuillan, 1996). Empowered students are less likely to skip class, get in trouble, or receive suspensions, and are more likely to participate in school activities, receive higher grades, and report higher educational aspirations than disempowered students (Kirk et al., 2016). In a qualitative, grounded theory study, Mitra (2004) found that youth participating in school programmes to amplify ‘student voice’ reported an increased sense of agency, belonging and competence through skill-building.
Relationships in trauma-informed and other school-focused approaches
As previously noted, the quality of relationships in a school is a commonly studied dimension of school climate (Thapa et al., 2013; Wang & Degol, 2016). What is known about the contribution of relationships to school climate and student outcomes can inform future study of relationships in trauma-informed schools. Research has found that teachers' interpersonal relationships with co-workers and supervisors, and feelings of inclusion and respect, can mediate the relationship between whole-school character interventions and school climate change (Guo, 2012). Student–teacher interactions have been shown to relate to students' classroom engagement behaviourally and emotionally (Skinner & Belmont, 1993). Further, students who experience negative teacher relationships in preschool are more likely to later demonstrate behavioural and academic challenges (Hamre & Pianta, 2001). When teachers and administrators consciously cultivate positive relationships with each other and with students, the children's academic, behavioural and emotional outcomes may improve.
Future directions
In summary, based on a comparison of eight models for trauma-informed organisations, a consensus model for a trauma-informed school can be conceptualised as having four key components: (a) understanding trauma and making a commitment to address it by all members of the school community; (b) an emphasis on physical, emotional and psychological safety for all school members; (c) taking a strengths-based, whole-person approach toward the staff, students and families; and (d) trusting, collaborative and empowering relationships among administrators, staff members, students, families and the broader community. Although empirical support for whole-school, trauma-informed approaches remains limited (Avery et al., 2021; see Table 2), when components are considered individually, many of them have been studied in the trauma-informed and other literature.
One important consideration regarding the popularity of trauma-informed approaches in schools is whether every U.S. school needs to be identified as trauma-informed. Some scholars have argued that focusing on trauma emphasises children's negative experiences and is thus a deficit approach. They recommended a positive frame instead, such as healing-centred engagement or compassionate, caring schools (Ginwright, 2018; Thomas et al., 2019). Given that a trauma-informed approach has been tied to deficit thinking, it is perhaps antithetical that applying a strengths-based approach toward all school constituents is an essential component of trauma-informed schools. We must ask whether trauma-informed schools could and should be reconceptualised in a more positive light, based on extant understandings of safe, supportive and caring schools. The trauma-informed school components of safety; a strengths-based, whole-person and equitable focus; and positive relationships directly relate to the ideal of safe, supportive and caring schools.
Interdependence and multidimensionality of trauma-informed school components
Many components of trauma-informed schools overlap and are mutually dependent. For example, collaboration promotes trust and safety and trust reinforces collaboration (Elliott et al., 2005; SAMHSA, 2014a). Warm, supportive student–teacher relationships contribute to students' feelings of safety (Astor et al., 2009). Adopting a strengths-based, whole-person approach helps to empower people (Saleebey, 1996) and create feelings of safety (Bloom, 2010). Although the interplay of various components adds complexity to the model and challenges for empirical study, this should be expected from a multidimensional, whole-school construct. Some researchers have concluded that the multidimensionality of a model enriches understanding of its underlying concept and provides greater opportunity for action (Wang & Degol, 2016).
Multidimensional organisational models require multifaceted assessment; however, this is rarely done. Almost half of empirical studies of school climate have been descriptive or correlational and more than one quarter have been qualitative (Wang & Degol, 2016). Self-report surveys accounted for nine in 10 studies of school climate, and half of those focused solely on student reports (Wang & Degol, 2016). Fewer studies have surveyed school staff members or utilised focus group, interview, or observational data, but such triangulation is useful for developing a more complete picture of school climate (Capp et al., 2020; Wang & Degol, 2016). The same will be true for the study of trauma-informed schools. Although surveys can be used to gather data across all components of a trauma-informed model, it may be necessary to use follow-up interviews, focus groups and observations to understand the full experience and the mechanisms driving and sustaining change. Multiple stakeholders should also be included in the assessments.
As has been discussed, several components of a trauma-informed school have been studied as part of other literature. School safety has a separate literature and is also studied as part of the school climate literature and in conjunction with bullying, violence and victimisation literature. Dyadic relationships (e.g. teacher–student, student–student, etc.) are studied in the developmental science and pedagogic literature while interpersonal relationships are more generally examined in the school safety, school climate and organisational behaviour literature. A strengths-based, whole-person approach; relationship quality; and safety are also encompassed in the overall trauma literature as elements of clinical interventions. Each of these literature can inform the future study of trauma-informed schools.
Differentiation between trauma-informed schools and other school-based approaches
Many researchers have noted that the distinctions between trauma-informed and other school-based approaches are not always clear (e.g. Hanson & Lang, 2016). Some asserted that components of a trauma-informed approach—namely, its strengths-based, whole-person focus; emphasis on safety; and promotion of high-quality relationships—could be considered standard good practice (Berliner & Kolko, 2016; Goodman et al., 2016). What a trauma-informed approach most clearly adds is an emphasis on trauma awareness and response. In fact, Hanson and Lang (2016) found that trauma researchers and practitioners reported trauma-training to be the most critical element of a trauma-informed approach. Although the concepts of trauma awareness and response seem simple and potentially reductive compared to a whole-school initiative, much more is encompassed in these components than may initially appear. By becoming aware of the emotional, behavioural and learning needs of children who have experienced trauma, educators and administrators can adapt the school experience to create a more nurturing and supportive school environment that will not only help traumatised children heal, but also improve school-related outcomes for all students, families and staff members. Such efforts would be in line with strengths-based, equity-focused and positive education approaches suggested by educational equity and trauma-informed pedagogy researchers (Brunzell & Norrish, 2021; Ginwright, 2018; Thomas et al., 2019; Venet, 2021).
Conceptual and empirical gaps for trauma-informed schools
Trauma-informed approaches still have numerous conceptual and empirical gaps. Among them are concise, accepted definitions for each component; practice and policy implications of a trauma-informed approach; intended outcomes and how to measure them; and organisational characteristics that make implementation of a trauma-informed approach possible and sustainable (Berliner & Kolko, 2016; Branson et al., 2017; DeCandia & Guarino, 2015; Hopper et al., 2010; Marans et al., 2012). A recent Campbell Collaboration review determined that, despite the popularity of trauma-informed approaches in schools, there was little to no evidence supporting them and the associated cost–benefit trade-offs were impossible to quantify. Review authors recommended that trauma-informed approaches in schools be systematically inventoried and described, and they called for qualitative research on what is being implemented in the name of a trauma-informed approach (Maynard et al., 2019).
A need for increased awareness of the expected outcomes for trauma-informed schools
It is essential to determine what outcomes should be expected from a trauma-informed approach. Bloom and Yanosy Sreedhar (2008) suggested that trauma-informed approaches should lead to less organisational violence, better staff morale and lower turnover, and improved participant outcomes. In terms of schools, research should assess the extent to which trauma-informed approaches contribute to improved emotional, behavioural, or academic outcomes for students—particularly given that trauma experiences have been related to impairment in these areas. Understanding the empirical support for individual components of trauma-informed schools can help point to expected outcomes for a whole-school approach. For example, trusting relationships among school staff members have been shown to improve students' academic outcomes and mediate socioeconomic disadvantages (Goddard et al., 2009).
We expect that different constituencies may value different outcomes. School administrators and educators would likely prioritise students' academic outcomes, e.g. does a trauma-informed approach improve material retention and standardised test performance? School staff overall would likely prioritise a positive work environment where they can meet expectations and take pride in their contributions. School mental health professionals and counsellors, as well as students and families, would likely value an increased sense of belonging and connection to the school, less punitive disciplinary approaches and more equity among student experiences to ensure that each child has ample opportunity for success.
Shifting analysis to the organisational level
Ultimately, the goal of future study should be to understand how making a commitment to a trauma-informed approach is reflected holistically, in everything a school does, and how such change contributes to the experiences of everyone in the school. As such, a shift in the unit of analysis is necessary. Whereas assessing outcomes at the individual level is undoubtedly important in clinical and small-group trauma interventions, when evaluating an organisation-wide trauma-informed approach, the unit of analysis needs to be the setting. Outcomes should be considered in aggregate, but with attention paid to differences in experiences across constituent groups, particularly historically marginalised groups. Relevant areas of consideration may include improved teacher appraisals of classroom order and decreased use of exclusionary discipline or child and caregiver reports of enhanced school connectedness, improved student–teacher relationships and fewer absences.
Broadening trauma understanding for all school staff members
Regarding understanding and recognising trauma, researchers should evaluate expected outcomes of trauma-training for school staff members beyond increased knowledge and confidence working with traumatised children. It is important to understand how trauma-training translates into changed practice and policy. As noted earlier, trauma-training or psychoeducation has not been well documented with young people; as a result, more study is needed to understand its relationship to youth wellbeing and other outcomes.
For the screening dimension, researchers are encouraged to compare student outcomes in a school that screens for trauma with those in a similar school that practices universal inclusion and structures its trauma response accordingly. Such study could use school-level administrative data to determine the extent of differences in attendance, achievement, or reports of problematic behaviours, including weapon possession, substance use, or violence. Students, teachers and parents could also be surveyed about their perceived wellbeing, including mental health and feelings toward the school as a result of its screening or universal inclusion practices.
Measurement of trauma-informed schools' practice and policy changes
The trauma response component could be evaluated as individual practice and policy changes, or as a universal or multitiered system. Significant funding and time is required for large-scale studies. Trauma response could be measured quantitatively by surveying constituents about their subjective appraisals of the school's response or by comparing various outcome measures before and after practice and policy changes. Findings from different policies and practices could then be compared across schools or districts. Qualitative research, including interviews and observation, would provide additional detail, allowing an understanding of how practice and policy changes occurred and what characteristics of the school supported or hindered such changes.
Multidimensionality of safety in schools
In trauma-informed school research, safety should continue to be studied in various ways, as is typical of school climate and safety research. It will be important to connect safety to expected inputs and outputs of a trauma-informed approach. For example, to what extent do students or staff members report enhanced feelings of safety when staff members receive trauma training? How do reports of weapon possession or violent incidents trend over time after trauma-informed policies are implemented? As with other elements, surveys could gather student and staff reports of subjective experience, and administrative data could be reviewed before and after such changes.
Importance of using aggregated data to understand strengths-based and relationship components
Typically, studies of strengths-based interventions and relationships have focused on individual or interpersonal factors. As with other trauma-informed schools components, a shift in the unit of analysis is necessary. To evaluate a whole-school trauma-informed approach, data must be collected and reviewed in the aggregate. School constituents could be surveyed about their subjective experiences of trauma-informed schools components and aggregated results could be assessed by group membership (staff member, student, etc.), grade level and demographics. By reviewing aggregated responses, patterns of wellbeing among marginalised populations (e.g. LGBTQ, homeless, undocumented, or foster youth) or between schools may become more apparent. Qualitative studies could enhance findings by uncovering the nuances in associations between school policies and practices, and staff and student experiences.
CONCLUSION
As previously noted, many challenges exist in the conceptualisation and study of multidimensional school-based models. These challenges should be expected with the study of trauma-informed approaches in schools. At the same time, the benefits of such study may be considerable, offering an opportunity to validate a new whole-school model rooted in therapeutic interventions for trauma and organisational behaviour, and possibly improving emotional, behavioural and cognitive outcomes for the next generation of U.S. children, families and school staff members.
Empirical takeaways
Several empirical takeaways result from this work. The most studied component of whole-school, trauma-informed approaches is training for staff. However, the focus to date has been on changes in attitudes toward trauma-informed care. There is now a need to move beyond this focus to explore and assess changed behaviours across all school functions, including teaching and discipline, as well as related outcomes for staff, students and their families. Multidimensional constructs like whole-school, trauma-informed approaches, school climate and school safety need to be studied in multiple ways to understand their many dimensions. Multiple stakeholders must be consulted (e.g. students and all types of staff) to understand all components of these constructs. Significant additional research is necessary, including qualitative case studies and interviews as well as analysis of outcomes related to incorporating whole-school, trauma-informed approaches. It is our hope that greater conceptual, empirical and practice integration for trauma-informed schools will enable future research that explores the concept more consistently and can provide more clarity on whether and how such approaches might benefit staff, students and families. Additional and/ or dedicated financial resources are necessary to enable the above takeaways.
Practice takeaways
There are implications for school-based practitioners as well. All school staff, from administrators and educators to custodial and office personnel, should be educated about the prevalence of trauma and its effects on student behaviours and educational outcomes. Given that trauma screening can be controversial, and the efficacy of related tools is unclear, school staff and administrators should consider approaching trauma from an approach of universal inclusion, i.e. the assumption that all students may have experienced trauma and thus all should benefit from a physically and psychologically safe school environment that focuses on their strengths and whole beings and that prioritises supportive, empowering relationships. Whole-school, trauma-informed approaches should be flexible to allow administrators and staff to customise their approach based on the unique needs of students and families in their community. School-based models can establish high-level goals and strategies but allow flexibility in implementation tactics. Positive connections between teacher–student relationship quality and student engagement, behaviours and achievement are well documented; thus, school administrators and staff should seek to improve and sustain positive relationships between staff and students as well as among staff, given that staff are essential to create a positive and healthy school climate. Finally, because many components of a whole-school, trauma-informed approach are not unique to having a trauma approach and could be considered standard student-focused educational practice, school staff should consider whether a continued focus on trauma is necessary per se and whether a more positive focus such as on caring, supportive or healing schools is more appropriate.
Context and implications.
Rationale for this study: Interest in trauma-informed approaches is high but evidence remains limited. This review outlines and combines existing conceptual models into one school-focused, trauma-informed model and evaluates current evidence for each component individually.
Why the new findings matter: These findings provide the latest evidence for trauma-informed approaches in schools and highlight areas for additional research.
Implications for educational researchers and policy makers: Implications for researchers include suggestions for studying whole-school approaches to trauma and how these models relate to and complement other school-based models. School-based practitioners will benefit from guidance on what a trauma-informed school looks like in practice and how to implement related approaches. The review provides policymakers with the latest empirical support for trauma-informed schools, which are increasingly called for in state and national legislation and thus require a deeper understanding of what is known and remains unclear. Without clear, accepted understanding of what trauma-informed schools consist of, progress toward their creation is likely to be inconsistent.
FUNDING INFORMATION
The authors did not receive support from any organisation for the submitted work.
Footnotes
CONFLICT OF INTEREST STATEMENT
The authors have no relevant financial or non-financial interests to disclose.
DATA AVAILABILITY STATEMENT
Research data are not shared.
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