School-based trauma counseling

Evidence Rating  
Evidence rating: Some Evidence

Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.

Health Factors  
Decision Makers
Date last updated

School-based trauma-specific counseling interventions help students process trauma exposure and learn how to cope with feelings that result from their experiences (e.g., anger, fear, depression, grief, etc.). These interventions include trauma screening and assessment, individual or small group counseling from mental health professionals or school staff with trauma-specific training, and parent and caregiver education and engagement. Specific treatment programs vary; many use a 3-phase process of stabilization, resolution of traumatic memory, and personality (re)integration and rehabilitation1, others use a 4-phase process of skill building, trauma processing, grief processing, and return to developmental progression2. Many school-based counseling interventions are tailored to the specific needs of participating youth. Individual trauma counseling interventions are often implemented as part of broader trauma-informed school initiatives3.

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Reduced post-traumatic stress

  • Improved mental health

Potential Benefits

Our evidence rating is not based on these outcomes, but these benefits may also be possible:

  • Increased resilient recovery

  • Improved academic outcomes

What does the research say about effectiveness?

There is some evidence that school-based trauma-specific counseling interventions reduce symptoms of post-traumatic stress disorder (PTSD) and depression1, 4, 5. School-based trauma counseling is also a suggested strategy to address unmet mental health needs, build resilience, reduce grief symptoms, and support academic success6, 7. Several types of cognitive behavior therapy (CBT), including trauma-focused CBT (TF-CBT), have been shown to reduce symptoms of psychological harm, PTSD, and depression. However, additional evidence is needed to confirm effects of treatments adapted for school settings1, 4.

Studies of the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program and Bounce Back, two school-based trauma counseling interventions, suggest reductions in PTSD, depression, and anxiety among participating children5, 6, 8, 9. Parents of participants also report greater improvements in their children’s daily functioning than parents of non-participating children5. Additional research is needed to determine effects of other school-based trauma counseling interventions, such as the Support for Students Exposed to Trauma (SSET) program, an adaptation of the CBITS program10

Studies of the Trauma-Grief Component Therapy for Adolescents (TGCT-A) program, a trauma and grief counseling intervention often implemented in schools, suggest such interventions can reduce PTSD, depression, and grief. Such interventions can also promote resilient recovery and improve school behavior by teaching youth social support recruitment skills, cognitive reframing, relaxation skills, and skills to deal with trauma and loss reminders2. Reduced PTSD symptoms are significantly associated with improvements in student grade point average7. Bosnia-based studies suggest school-based trauma and grief counseling can reduce symptoms of psychological distress for participating students11.

How could this strategy impact health disparities? This strategy is rated likely to decrease disparities.
Implementation Examples

The Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program has been implemented in California, Colorado, Illinois, Louisiana, Maryland, Mississippi, Missouri, Montana, New Jersey, New Mexico, Tennessee, Washington, Wisconsin, and Washington, D.C.12. The Support for Students Exposed to Trauma (SSET) program is a recent adaptation of the CBITS program that has not yet been implemented widely13.

The Bounce Back program, an elementary school program for trauma intervention, has been implemented in California, Illinois, Connecticut, Louisiana, Nebraska, and New York14.

Implementation Resources

NCTSN-Trauma services - National Child Traumatic Stress Network (NCTSN). Trauma services in schools: NCTSN resources.

RAND-CBITS - RAND Corporation. Cognitive-Behavioral Intervention for Trauma in Schools (CBITS).

Bounce Back-Resources - Bounce Back. Bounce Back program overview and resources.

CPI-TIC resources - Crisis Prevention Institute (CPI). The top 10 recommended trauma-informed care (TIC) online resources.

PACEs-TIC toolkits - PACEs Connection. Positive & adverse childhood experiences (PACEs): Trauma-informed care (TIC) toolkits.

AHWG-Toolkit 2013 - Adolescent Health Working Group (AHWG). Adolescent provider toolkit: Trauma and resilience. 2013.

WI DPI-Resources for schools - Wisconsin Department of Public Instruction (WI DPI). Resources for schools to help students affected by trauma learn.

Addictions-CBT - Cognitive-behavioral therapy (CBT).

Center-TIS resources - Center for Resiliency, Hope, and Wellness in Schools. Promoting trauma-informed school (TIS) systems that provide prevention and early intervention strategies that create supportive and nurturing school environments: Resources.


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1 Leenarts 2013 - Leenarts LEW, Diehle J, Doreleijers TAH, Jansma EP, Lindauer RJL. Evidence-based treatments for children with trauma-related psychopathology as a result of childhood maltreatment: A systematic review. European Child & Adolescent Psychiatry. 2013;22(5):269-283.

2 CEBC-TGCT-A - California Evidence-Based Clearinghouse for Child Welfare (CEBC). Trauma-Grief Component Therapy for Adolescents (TGCT-A).

3 McInerney 2014 - McInerney M, McKlindon A. Unlocking the door to learning: Trauma-informed classrooms & transformational schools. Education Law Center. 2014.

4 Wethington 2008 - Wethington HR, Hahn RA, Fuqua-Whitley DS, et al. The effectiveness of interventions to reduce psychological harm from traumatic events among children and adolescents: A systematic review. American Journal of Preventive Medicine. 2008;35(3):287-313.

5 Blueprints - Center for the Study and Prevention of Violence (CSPV). Blueprints for healthy youth development.

6 Nadeem 2014 - Nadeem E, Jaycox LH, Langley AK, et al. Effects of trauma on students: Early intervention through the cognitive behavioral intervention for trauma in schools. In: Weist MD, Lever NA, Bradshaw CP, Owens JS, eds. Handbook of School Mental Health: Research, Training, Practice, and Policy. Boston, MA: Springer U.S.; 2014:145-157.

7 Saltzman 2001 - Saltzman WR, Layne CM, Pynoos RS, Steinberg AM, Aisenberg E. Trauma- and grief-focused intervention for adolescents exposed to community violence: Results of a school-based screening and group treatment protocol. Group Dynamics. 2001;5(4):291-303.

8 CEBC-CBITS - The California Evidence-Based Clearinghouse (CEBC). Cognitive Behavioral Intervention for Trauma in Schools (CBITS).

9 CEBC-Bounce Back - The California Evidence-Based Clearinghouse (CEBC). Bounce Back.

10 CEBC-SSET - The California Evidence-Based Clearinghouse (CEBC). Support for Students Exposed to Trauma (SSET).

11 Layne 2001 - Layne CM, Pynoos RS, Saltzman WR, et al. Trauma/grief-focused group psychotherapy: School-based postwar intervention with traumatized Bosnian adolescents. Group Dynamics: Theory, Research, and Practice. 2001;5(4):277-290.

12 CBITS - Cognitive Behavioral Intervention for Trauma in Schools (CBITS). Learn more: Where has CBITS been implemented?

13 SSET - Support for Students Exposed to Trauma (SSET). Learn more: Where has SSET been implemented?

14 Bounce Back-Learn more - Bounce Back. Learn more: Where has Bounce Back been implemented?