. 2020 Sep 25;14(3):381–397. doi: 10.1007/s40653-020-00321-1

Table 2.

Components of models mapped to SAMSHA domains

Model	Description	Training Component	Organisation Level Change	Practice Level Changes	Strengths/ Drivers of Change
HTL (Day et al. 2015)	The Heart of Teaching and Learning: Compassion, Resiliency and Academic Success (HTL; Wolpow et al. 2009) is grounded in ecological and attachment theories. The model is applied as a manualized curriculum using psychoeducational, cognitive-behavioural and relational approaches emphasising attachment focused interventions and a trauma-informed organisational culture cognizant of the impact of trauma on the individual at the micro-system level through levels of proximity up to broad societal impacts at the higher mesosystem level. The model includes ‘Theraplay’ (Jernberg and Booth 1999) an approach to working with children and adolescents building attachment, self-esteem, trust in others, and positive engagement, and an emphasis on positive staff and student relationships.	Two half-day staff trainings and 2-hour booster trainings occurring monthly over 8 months. Training included six modules covering trauma, survival responses and compassion, self-care, strategies, collaborative problem solving, trusting others, diversity related issues, use of role plays, games, and case vignettes. Initial training sessions, followed by small group, role play and practice sessions. Additional tools and resources for classroom use where provided, including examples and idea lists. Inclusion of Theraplay training and issues of diversity such as gender and racial identity.	Alternative school discipline policies and practices to support student regulation and problem-solving. Implemented preventative behaviour intervention polices. Development of specific spaces and supports for proactive student de-escalation – the Monarch Room (MR) – used for 10-15 minutes of calming and the Dream Catcher Room (DC) for longer withdrawal periods.	1. use of psychoeducational, cognitive-behavioural, and relational approaches to improve student self-management 2. increased teacher attention to sensory needs of students, provision of fidget toys, sensory items, access to music 3. assess to snacks and hydration. 4. supporting student use of the MR and DC rooms for self-management.	1.Teacher coaching and classroom observations to ensure fidelity of program delivery. 2. Significant focus on positive teacher-student relationships. 3. Focus on student voice. 4. Explicit attention to sensory needs and practices. 5. built student autonomy 6. As a residential charter school, had consistency across school and residence.
HEARTS (Dorado et al. 2016)	UCFS Healthy Environments and Response to Trauma in Schools (HEARTS) Model is a continuum of response model that includes universal approaches at Tier 1 and increasing levels of support and individualized intervention in Tiers 2 and 3. Core principles include promoting an understanding of trauma and stress, providing safety and predictability, fostering compassionate and trusting relationships, building resilience and social emotional learning, practicing cultural humility and responsiveness and facilitating empowerment and collaboration. The model draws significantly on the research and theory of the Attachment, Self-Regulation and Competency (ARC) framework (Blaustein and Kinnniburg, 2010). The models' 4 specific aims: (1) increase student wellness, engagement and success in school, (2) build staff and school system capacities to support trauma-impacted students through increasing knowledge and practice of trauma sensitive classroom and school-wide strategies, (3) promote staff wellbeing through addressing burnout and secondary trauma (4) integrate a cultural and equity lens. This model emphasizes a whole of system approach guided by a flexible framework based on TLPI (Cole, et al., 2013)	Initial and follow-up training, with on-site consultation and capacity building for staff, embedding understanding of survival-based behaviors, student triggers and the student’s safety needs. Staff training presented the neuro-biology and physiology of trauma using educator’ language and everyday metaphors e.g the ‘learning brain’ and the ‘survival brain’, discussion on behaviorally based consequences serving to inadvertently escalate unwanted behaviors and how to focus on the safety needs of the student to reduce escalation. Supplemental training provided additional depth in trauma awareness including the impact of secondary stress for staff and need for self-care.	Mapped the trauma-informed approach into MTSS used at the school, discipline policy changes from punitive to a focus on meeting safety needs and supporting student emotional regulation. Use of Logic model and clear statement of the model’s core guiding principles, rationale and practices.	1. use of trauma-sensitive practices (unspecified). 2. trauma-informed behaviour management plans. 3. trauma-impacted students received culturally congruent trauma-specific psychotherapy aimed at building emotion regulation and relationship skills, and other positive coping skills. 4. intergenerational and community impacts of trauma recognised. 5. clinicians working with the caregivers of students in therapy groups to strengthen parenting capacity.	1.pre-intervention analysis of the readiness and motivation of the school. 2. particular attention to school infrastructure, e.g. a reasonably well functioning Coordinated Care Team with key staff and administrators, and leadership by-in. 3. pre-intervention dove-tailing program principles with school district’s existing values, goals and initiatives. 4. onsite consultation supporting staff to put theory into practice, in-class, in-the-moment modelling of behaviour support strategies. 5. engaging with and supporting families 6. Staff self-care training
TBRI (Parris et al. 2015)	The Trust-Based Relational Intervention (TBRI) model is grounded in authoritative discipline theory with 3 essential principles: empowering, connecting and correcting. The principal of empowering seeks to provide a safe, predictable and nurturing environment for students - includes provision of hydration, snacks and sensory tools. The connecting principles focus on relational practices and 4 specific areas of a) seeking care, b) giving care, c) negotiating, and d) feeling comfortable with an autonomous self. The correcting principles centre on preventing challenging behaviour, teaching appropriate behaviours, self-regulation and social skills. Nurture Groups are a core component, providing opportunities to build relationships, regulation and communication skills.	2-day all staff training on complex trauma and effects on youth, how to recognise trauma-based behaviours, how to help students regulate and creating environments where students feel safe, creating a balance between structure and nurture in student approaches and training on discipline that is nurturing and involved while fair and consistent. At the beginning of year-2 of implementation, leadership and 1 behaviour specialist received 5-day training in TBRI model.	Predetermined disciplinary procedures were adapted to allow an individualised response to students’ behaviours while continuing to enforce rules and expectations. Allowing students to have water-bottles at their desks, snacks and fidget toys. Allowing use of headphones for music at lunch time. Removal of punitive discipline procedures	1. staff act to build positive relationships with student & connect with student needs prior to any office referrals. 2. use healthy touch, listening to student emotional needs and providing frequent affirmations. 3. enhancing student self-management and social skills: using words for emotions, being kind, accepting consequences. 4. Building help-seeking, help-giving and negotiation skills in students. 5. Pro -active prevention of disruptive behaviour e.g. teaching appropriate behaviour, using ‘re-do’s or behavioural rehearsals. 6. create calm positive atmosphere, predictability 7. Preventative meetings to consider underlying drivers of student behaviour.	1. model develops a shared ‘TBRI’ language across staff and students e.g. ‘compromise and re-do’. 2.comprehensive action plan. 3. had consistency across residential and school approaches.
NHTC (Perry & Daniels 2016)	The New Haven Trauma Coalition Program (NHTC), is a collaboration between the New Haven Public Schools, The Mayor’s Office of the City of New Haven, United Way of Greater New Haven/ BOOST!, and the Clifford Beers Clinic. The care-coordination component of the program, based on the Milwaukee Wrap-Around model, focuses on enhancing interactions between school, student and family. All students participated in a three-day workshop series tailored to meet needs expressed by the students i.e.: how to relax and worry less. Cognitive Behavioural Intervention for Trauma in Schools (CBITS) was provided in small, gender-specific groups assessed as significantly trauma-impacted, over the course of 10 weeks.	2-day all staff training. PD explicitly aimed at creating expertise within the school to respond to students in a trauma-informed manner and creating a culture shift. Balance of trauma 101 /102 knowledge building, including presentations on impact of ACES, Developing Trust in Interpersonal Relationships and Motivational Interviewing. Workshops supported strengths-based interventions and trauma-informed practice change using new knowledge, de-escalation and self-care.	Assessment of the needs and existing structures in the school. Comprehensive action plan to respond to chronic stress responses in school. Logic model to focus short, medium and long-term outcome expectations. Included systems to collaborate with the NHT Coalition. Alignment of discipline policy with trauma-informed approach.	1.changed teacher-thinking about drivers of behaviour 2. ongoing dialogue between teachers, student and family 3. collaboration between providers-school-home-student 4. use of teacher self-care strategies. 5. stress-reduction techniques used with students 6. use of trauma-informed behavioural strategies (non-specified)	1. pre-intervention assessment of school readiness 2.pre-intervention co-design of trauma-training with school leaders and discussions around student needs. 3. school focus on collaboration with students, family, agency. 4. development of comprehensive action plans linked to desired outcomes 5. Assessed both staff and student outcomes.

Model

Description

Training Component

Organisation Level Change

Practice Level Changes

Strengths/ Drivers of Change

HTL (Day et al. 2015)

The Heart of Teaching and Learning: Compassion, Resiliency and Academic Success (HTL; Wolpow et al. 2009) is grounded in ecological and attachment theories. The model is applied as a manualized curriculum using psychoeducational, cognitive-behavioural and relational approaches emphasising attachment focused interventions and a trauma-informed organisational culture cognizant of the impact of trauma on the individual at the micro-system level through levels of proximity up to broad societal impacts at the higher mesosystem level.

The model includes ‘Theraplay’ (Jernberg and Booth 1999) an approach to working with children and adolescents building attachment, self-esteem, trust in others, and positive engagement, and an emphasis on positive staff and student relationships.

Two half-day staff trainings and 2-hour booster trainings occurring monthly over 8 months. Training included six modules covering trauma, survival responses and compassion, self-care, strategies, collaborative problem solving, trusting others, diversity related issues, use of role plays, games, and case vignettes.

Initial training sessions, followed by small group, role play and practice sessions. Additional tools and resources for classroom use where provided, including examples and idea lists. Inclusion of Theraplay training and issues of diversity such as gender and racial identity.

Alternative school discipline policies and practices to support student regulation and problem-solving. Implemented preventative behaviour intervention polices.

Development of specific spaces and supports for proactive student de-escalation – the Monarch Room (MR) – used for 10-15 minutes of calming and the Dream Catcher Room (DC) for longer withdrawal periods.

1. use of psychoeducational, cognitive-behavioural, and relational approaches to improve student self-management

2. increased teacher attention to sensory needs of students, provision of fidget toys, sensory items, access to music

3. assess to snacks and hydration.

4. supporting student use of the MR and DC rooms for self-management.

1.Teacher coaching and classroom observations to ensure fidelity of program delivery.

2. Significant focus on positive teacher-student relationships.

3. Focus on student voice.

4. Explicit attention to sensory needs and practices.

5. built student autonomy

6. As a residential charter school, had consistency across school and residence.

HEARTS (Dorado et al. 2016)

UCFS Healthy Environments and Response to Trauma in Schools (HEARTS) Model is a continuum of response model that includes universal approaches at Tier 1 and increasing levels of support and individualized intervention in Tiers 2 and 3. Core principles include promoting an understanding of trauma and stress, providing safety and predictability, fostering compassionate and trusting relationships, building resilience and social emotional learning, practicing cultural humility and responsiveness and facilitating empowerment and collaboration. The model draws significantly on the research and theory of the Attachment, Self-Regulation and Competency (ARC) framework (Blaustein and Kinnniburg, 2010). The models' 4 specific aims: (1) increase student wellness, engagement and success in school, (2) build staff and school system capacities to support trauma-impacted students through increasing knowledge and practice of trauma sensitive classroom and school-wide strategies, (3) promote staff wellbeing through addressing burnout and secondary trauma (4) integrate a cultural and equity lens. This model emphasizes a whole of system approach guided by a flexible framework based on TLPI (Cole, et al., 2013)

Initial and follow-up training, with on-site consultation and capacity building for staff, embedding understanding of survival-based behaviors, student triggers and the student’s safety needs.

Staff training presented the neuro-biology and physiology of trauma using educator’ language and everyday metaphors e.g the ‘learning brain’ and the ‘survival brain’, discussion on behaviorally based consequences serving to inadvertently escalate unwanted behaviors and how to focus on the safety needs of the student to reduce escalation.

Supplemental training provided additional depth in trauma awareness including the impact of secondary stress for staff and need for self-care.

Mapped the trauma-informed approach into MTSS used at the school, discipline policy changes from punitive to a focus on meeting safety needs and supporting student emotional regulation.

Use of Logic model and clear statement of the model’s core guiding principles, rationale and practices.

1. use of trauma-sensitive practices (unspecified).

2. trauma-informed behaviour management plans.

3. trauma-impacted students received culturally congruent trauma-specific psychotherapy aimed at building emotion regulation and relationship skills, and other positive coping skills.

4. intergenerational and community impacts of trauma recognised.

5. clinicians working with the caregivers of students in therapy groups to strengthen parenting capacity.

1.pre-intervention analysis of the readiness and motivation of the school.

2. particular attention to school infrastructure, e.g. a reasonably well functioning Coordinated Care Team with key staff and administrators, and leadership by-in.

3. pre-intervention dove-tailing program principles with school district’s existing values, goals and initiatives.

4. onsite consultation supporting staff to put theory into practice, in-class, in-the-moment modelling of behaviour support strategies.

5. engaging with and supporting families

6. Staff self-care training

TBRI (Parris et al. 2015)

The Trust-Based Relational Intervention (TBRI) model is grounded in authoritative discipline theory with 3 essential principles: empowering, connecting and correcting. The principal of empowering seeks to provide a safe, predictable and nurturing environment for students - includes provision of hydration, snacks and sensory tools.

The connecting principles focus on relational practices and 4 specific areas of a) seeking care, b) giving care, c) negotiating, and d) feeling comfortable with an autonomous self.

The correcting principles centre on preventing challenging behaviour, teaching appropriate behaviours, self-regulation and social skills. Nurture Groups are a core component, providing opportunities to build relationships, regulation and communication skills.

2-day all staff training on complex trauma and effects on youth, how to recognise trauma-based behaviours, how to help students regulate and creating environments where students feel safe, creating a balance between structure and nurture in student approaches and training on discipline that is nurturing and involved while fair and consistent.

At the beginning of year-2 of implementation, leadership and 1 behaviour specialist received 5-day training in TBRI model.

Predetermined disciplinary procedures were adapted to allow an individualised response to students’ behaviours while continuing to enforce rules and expectations. Allowing students to have water-bottles at their desks, snacks and fidget toys. Allowing use of headphones for music at lunch time. Removal of punitive discipline procedures

1. staff act to build positive relationships with student & connect with student needs prior to any office referrals. 2. use healthy touch, listening to student emotional needs and providing frequent affirmations. 3. enhancing student self-management and social skills: using words for emotions, being kind, accepting consequences. 4. Building help-seeking, help-giving and negotiation skills in students. 5. Pro -active prevention of disruptive behaviour e.g. teaching appropriate behaviour, using ‘re-do’s or behavioural rehearsals. 6. create calm positive atmosphere, predictability 7. Preventative meetings to consider underlying drivers of student behaviour.

1. model develops a shared ‘TBRI’ language across staff and students e.g. ‘compromise and re-do’.

2.comprehensive action plan.

3. had consistency across residential and school approaches.

NHTC (Perry & Daniels 2016)

The New Haven Trauma Coalition Program (NHTC), is a collaboration between the New Haven Public Schools, The Mayor’s Office of the City of New Haven, United Way of Greater New Haven/ BOOST!, and the Clifford Beers Clinic. The care-coordination component of the program, based on the Milwaukee Wrap-Around model, focuses on enhancing interactions between school, student and family. All students participated in a three-day workshop series tailored to meet needs expressed by the students i.e.: how to relax and worry less. Cognitive Behavioural Intervention for Trauma in Schools (CBITS) was provided in small, gender-specific groups assessed as significantly trauma-impacted, over the course of 10 weeks.

2-day all staff training. PD explicitly aimed at creating expertise within the school to respond to students in a trauma-informed manner and creating a culture shift. Balance of trauma 101 /102 knowledge building, including presentations on impact of ACES, Developing Trust in Interpersonal Relationships and Motivational Interviewing.

Workshops supported strengths-based interventions and trauma-informed practice change using new knowledge, de-escalation and self-care.

Assessment of the needs and existing structures in the school.

Comprehensive action plan to respond to chronic stress responses in school.

Logic model to focus short, medium and long-term outcome expectations.

Included systems to collaborate with the NHT Coalition.

Alignment of discipline policy with trauma-informed approach.

1.changed teacher-thinking about drivers of behaviour

2. ongoing dialogue between teachers, student and family 3. collaboration between providers-school-home-student

4. use of teacher self-care strategies.

5. stress-reduction techniques used with students

6. use of trauma-informed behavioural strategies (non-specified)

1. pre-intervention assessment of school readiness

2.pre-intervention co-design of trauma-training with school leaders and discussions around student needs.

3. school focus on collaboration with students, family, agency.

4. development of comprehensive action plans linked to desired outcomes

5. Assessed both staff and student outcomes.