School-based trauma counseling
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:
Improved mental health
Reduced post-traumatic stress
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 strong evidence that school-based trauma-specific counseling interventions improve mental health among students and reduce symptoms of childhood anxiety disorders, post-traumatic stress disorder (PTSD), and depression1, 4, 5, 6, 7, 8. School-based trauma counseling is also a suggested strategy to address unmet mental health needs, build resilient recovery, reduce grief symptoms, and support academic success9, 10. Several types of cognitive behavioral therapy (CBT), including trauma-focused CBT (TF-CBT), have been shown to reduce symptoms of psychological harm, PTSD, and depression. Additional evidence is needed to confirm effects of some treatments adapted for school settings1, 5, 7.
CBT interventions for children and adolescents reduce childhood anxiety disorders and have positive effects when delivered in both group and individual settings5, 6. Studies of the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program and Bounce Back, two school-based trauma counseling interventions, show reductions in PTSD, depression, and anxiety among participating children6, 8, 9, 11, 12. Parents of participants also report greater improvements in their children’s daily functioning than parents of non-participating children8. 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 program13.
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 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 average10. Bosnia-based studies suggest school-based trauma and grief counseling can reduce symptoms of psychological distress for participating students14.
School-based trauma counseling interventions may vary in effectiveness depending on treatment duration, the number and frequency of counseling sessions, and the length of program participation; additional evidence is needed to assess those variations5. Early trauma screening and treatment can improve student outcomes and mitigate difficulties with coping and resilient recovery later in life15. Students attending schools offering counseling and mental health services are six times more likely to receive mental health care than students relying on counseling and mental health services in community settings15, 16.
Available evidence shows that trauma counseling is part of successful and sustainable school-wide trauma-informed interventions, especially when implemented with professional development, stakeholder engagement, staff and teacher buy-in, leadership support, and comprehensive planning components17. Through school-wide, trauma-informed interventions, teachers and staff receive training that helps them recognize behaviors that may be reactions to trauma and prepares them to assist and refer students to support services, including trauma counseling18, 19, 20, 21.
Available evidence suggests that school mental health programs are cost-effective, with potential national economic savings of nearly $247 billion per year15. Experts suggest that group trauma counseling offers an efficient and cost-effective way to offer mental health services to more students when school resources to support counseling programs are limited16.
How could this strategy advance health equity? This strategy is rated potential to decrease disparities: suggested by expert opinion.
Experts suggest school-based trauma counseling has the potential to decrease disparities in mental health and academic outcomes experienced by students of color and students from families with lower incomes15, 22, 26. The overall effectiveness of school-based trauma counseling is well-established; however, more research is needed to evaluate the effects on disparities in academic achievement outcomes and anxiety, depression, and behavioral health disorders15, 26.
Survey data show school-based mental health supports and counseling services are less likely to be available in schools in lower income neighborhoods than in higher income areas26. Surveys also show racial disparities in the availability and receipt of counseling and mental health services among students, with white students more likely to receive counseling than students of color22. Experts suggest that improving equitable access to school-based trauma counseling requires resources and support for schools that do not yet have a mental health services system established22, 26. One study suggests universal screening processes may help reduce gender and racial bias in referrals for school-based trauma counseling; in this study female students and white students were more likely to receive counseling referrals than male students and students of color16.
Experiencing adverse childhood experiences (ACEs) is associated with increased mental health struggles, increased prescription opioid misuse, and increased suicide behaviors among high school students27, 28. One national report of high school students under 18 suggests students identifying as multiracial, Native, female, or LGBTQIA+ report experiencing the highest number of ACEs27. Over 60% of these students report experiencing emotional abuse and over 30% report experiencing physical abuse27. In the U.S., Black youth experience disproportionately more ACEs than all other racial or ethnic groups with some estimates suggesting 61% of Black children in the U.S. experience ACEs before the age of 18 compared to 40% of white children29.
School-based mental health and counseling services are less likely to be available in schools in rural areas and towns than in urban and suburban areas26. School-wide trauma-informed programs that include school-based trauma counseling can be beneficial for students in rural and urban areas30, 31. In rural areas, trauma-informed programs that include trauma counseling are suggested to help mitigate the effects of ACEs and reduce academic achievement gaps for students30. Data shows that 25% of children in the U.S. attend school in rural areas, and ACEs and trauma disproportionately affect rural schoolchildren30. In a rural Minnesota-based study, teacher and staff surveys and classroom observations suggest implementing the SAFE Model (Structured Approach to Formulating a trauma-informed Environment) – that includes trauma counseling – helps schools meet the needs of students who have experienced trauma. Implementing the SAFE Model is associated with improved student learning, behaviors, and relationships, which helps students who have experienced trauma improve academic achievement rather than falling behind their peers32. In many urban areas, communities have experienced disinvestment and concentrated poverty; children in these communities are frequently exposed to stress and trauma that negatively impacts academic achievement31. A study of urban school implementation of the trauma-informed Sanctuary Model, a framework that supports the use of CBT and school counseling, suggests positive improvements addressing students’ trauma31.
What is the relevant historical background?
Trauma experiences are exacerbated when combined with inequality, poverty, racism, or community violence33. The 1998 Adverse Childhood Experiences (ACEs) prevalence study and subsequent research found a strong association between early trauma experiences and several long-term behavioral, mental, and physical health issues34. In response in 2000, Congress established the National Child Traumatic Stress Initiative (NCTSI) and the National Child Traumatic Stress Network (NCTSN), which funded school-based trauma-informed care to increase services, including school-based trauma counseling, for children exposed to trauma and their families35, 36. The 2015 Every Student Succeeds Act (ESSA) provided more resources for schools to implement trauma-informed policies and programming and to increase comprehensive school mental health services37. In 2018, the U.S. House of Representatives approved HR 443, a resolution that acknowledges the importance of trauma-informed care, designates May as national trauma awareness month, and designates the third Wednesday of May as national trauma awareness day37.
Children in the U.S. continue to be exposed to trauma and have many mental health and well-being challenges38, 39. In the 2010s and 2020s, across the U.S. schools experienced school shootings, community unrest in response to police shootings, the COVID-19 pandemic, and more awareness of persistent systemic inequalities15, 40. After the disproportionate effects of the COVID-19 pandemic, many policymakers, researchers, and educators called for school-wide trauma-informed interventions to be combined with broader social justice and restorative justice efforts to address systemic and institutional oppression and to prevent ongoing trauma in youth populations34, 41, 42. Many schools and school districts expanded trauma-informed interventions with mental health, counseling, and social-emotional support systems38, 39, 43. Over time definitions of ACEs developed to include multiple, different types of traumatic experiences. More sensitive screening processes aim to better serve youth populations with diverse trauma experiences34.
Equity Considerations
- In your community, how available is school-based trauma counseling? Are mental health specialists, counselors, and support staff available for students and teachers? How are your schools supporting mental health services and trauma-informed care, especially for students exposed to trauma?
- How are efforts to increase mental health services and school-based trauma counseling supported in your community? What collaborations could support trauma counseling services?
- What kinds of professional development and training are available to support teachers and staff identifying and assessing trauma symptoms to refer students to trauma counseling? Are multi-tier trauma-informed schools implemented in your district? How can your community encourage implementation of trauma-informed schools, which include school-based trauma counseling?
Implementation Examples
As of 2025, 70% of public schools in the U.S. have a school or district-level licensed mental health professional on staff; however, about one-third of schools reported that they could not effectively provide mental health services to their school community, most often due to funding limitations and mental health professional staff shortages22. In the 2024-25 school year, 83% of public schools offered individual-based interventions such as counseling or therapy of some kind22.
The Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program has been implemented in California, Colorado, Connecticut, Illinois, Louisiana, Maryland, Mississippi, Missouri, Montana, New Jersey, New Mexico, Pennsylvania, Tennessee, Washington, Wisconsin, and Washington, D.C.23. The CBITS program has also been translated into Spanish and Arabic23. The Support for Students Exposed to Trauma (SSET) program is an adaptation of the CBITS program that has been implemented in many communities across the country24.
The Bounce Back program, an elementary school program for trauma intervention, has been implemented in California, Illinois, Connecticut, Louisiana, Nebraska, and New York25. Bounce Back is also available in Spanish25.
Implementation Resources
‡ Resources with a focus on equity.
NCTSN-School resources - The National Child Traumatic Stress Network (NCTSN). (n.d.). School trauma-informed systems: NCTSN resources. Accessed April 10, 2026.
RAND-CBITS - RAND Corporation. Cognitive-Behavioral Intervention for Trauma in Schools (CBITS).
NCSS-Toolkit 2021 - National Center for School Safety (NCSS). (2021). Trauma-informed, resilience-oriented schools toolkit. Accessed April 12, 2026.
CSHA-TIS - California School-Based Health Alliance (CSHA). (n.d.). Trauma-informed school interventions. Accessed April 12, 2026.
CDC-School action guide 2023 - Centers for Disease Control and Prevention (CDC). (2023). Promoting mental health and well-being in schools: An action guide for school and district leaders. Accessed April 13, 2026.
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.
NCSSLE-SCI Resources - National Center on Safe Supportive Learning Environments (NCSSLE). School climate improvement (SCI) resource package.
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 - Addictions.com. 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.
Footnotes
* Journal subscription may be required for access.
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 Avery 2024 - Avery, F., Kennedy, N., James, M., Jones, H., Amos, R., Bellis, M., Hughes, K., & Brophy, S. (2024). A systematic review of non-clinician trauma-based interventions for school-age youth. PLOS ONE, 19(9), e0293248.
5 Cochrane-James 2020 - James, A. C., Reardon, T., Soler, A., James, G., & Creswell, C. (2020). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews, (11), CD013162.
6 Fondren 2020 - Fondren, K., Lawson, M., Speidel, R., McDonnell, C. G., & Valentino, K. (2020). Buffering the effects of childhood trauma within the school setting: A systematic review of trauma-informed and trauma-responsive interventions among trauma-affected youth. Children and Youth Services Review, 109, 104691.
7 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.
8 Blueprints - Center for the Study and Prevention of Violence (CSPV). Blueprints for healthy youth development.
9 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.
10 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.
11 CEBC-CBITS - The California Evidence-Based Clearinghouse (CEBC). Cognitive Behavioral Intervention for Trauma in Schools (CBITS).
12 CEBC-Bounce Back - The California Evidence-Based Clearinghouse (CEBC). Bounce Back.
13 CEBC-SSET - The California Evidence-Based Clearinghouse (CEBC). Support for Students Exposed to Trauma (SSET).
14 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.
15 NCSL-Children mental health 2021 - National Conference of State Legislatures (NCSL). (2021). Report: Enhancing school capacity to support children’s mental health.
16 Bekele 2025 - Bekele, Y., Scardamalia, K., Hoover, S. A., & Schaeffer, C. M. (2025). Who gets referred to school‐based trauma treatment? A descriptive analysis of Bounce Back and Support for Students Exposed to Trauma. Psychology in the Schools, 62(10), 4195–4206.
17 Wassink-de Stigter 2022 - Wassink-de Stigter, R., Kooijmans, R., Asselman, M. W., Offerman, E. C. P., Nelen, W., & Helmond, P. (2022). Facilitators and barriers in the implementation of trauma-informed approaches in schools: A scoping review. School Mental Health, 14(3), 470–484.
18 Badger 2026 - Badger, S., Wilkinson, D., & Chopra, I. (2026). A systematic review of the existing evidence on early year interventions for trauma and violence prevention. Trauma, Violence, & Abuse, 27(1), 203–214.
19 Sun 2024 - Sun, Y., Blewitt, C., Minson, V., Bajayo, R., Cameron, L., & Skouteris, H. (2024). Trauma-informed interventions in early childhood education and care settings: A scoping review. Trauma, Violence, & Abuse, 25(1), 648–662.
20 Cohen 2021c - Cohen, C. E., & Barron, I. G. (2021). Trauma-informed high schools: A systematic narrative review of the literature. School Mental Health, 13(2), 225–234.
21 Wiest-Stevenson 2016 - Wiest-Stevenson C, Lee C. Trauma-informed schools. Journal of Evidence-Informed Social Work. 2016;13(5):498-503.
22 KFF-Panchal 2025 - Panchal, N., Cox, C., & Rudowitz, R. (2025). The landscape of school-based mental health services. KFF.
23 CBITS - Cognitive Behavioral Intervention for Trauma in Schools (CBITS). Learn more: Where has CBITS been implemented?
24 SSET - Support for Students Exposed to Trauma (SSET). SSET program: School archive.
25 CSRSW-Bounce Back - Center for Safe & Resilient Schools and Workplaces (CSRSW). (n.d.). Bounce Back: Learn more about Bounce Back.
26 Moore 2024 - Moore, S., Timpe, Z., Rasberry, C. N., Hertz, M., Verlenden, J., Spencer, P., Murray, C., Lee, S., Barrios, L. C., Tripathi, T., McConnell, L., Iachan, R., & Pampati, S. (2024). Disparities in the implementation of school-based mental health supports among K–12 public schools. Psychiatric Services, 75(1), 17–24.
27 CDC MMWR-Swedo 2024 - Swedo, E. A., Pampati, S., Anderson, K. N., Thorne, E., McKinnon, I. I., Brener, N. D., Stinson, J., Mpofu, J. J., & Niolon, P. H. (2024). Adverse childhood experiences and health conditions and risk behaviors among high school students—Youth Risk Behavior Survey, United States, 2023. Morbidity and Mortality Weekly Report, MMWR Supplements, 73(4), 39–50.
28 Anderson 2022 - Anderson, K. N., Swedo, E. A., Trinh, E., Ray, C. M., Krause, K. H., Verlenden, J. V., Clayton, H. B., Villaveces, A., Massetti, G. M., & Holditch Niolon, P. (2022). Adverse childhood experiences during the COVID-19 pandemic and associations with poor mental health and suicidal behaviors among high school students—Adolescent Behaviors and Experiences Survey, United States, January–June 2021. MMWR. Morbidity and Mortality Weekly Report, 71(41), 1301–1305.
29 Danforth 2024 - Danforth, L., McElwee, T., Miller, J., & Burse, J. (2024). Mitigating rACEsm in K-12 classrooms: The consideration of culturally-informed adverse childhood experiences and utilization of culturally relevant education and systemically trauma-informed practice. Journal of Black Studies, 55(8), 684–708.
30 Frankland 2021 - Frankland, M. (2021). Meeting students where they are: Trauma-informed approaches in rural schools. The Rural Educator, 42(2), 51–71.
31 Blitz 2020 - Blitz, L. V., Yull, D., & Clauhs, M. (2020). Bringing sanctuary to school: Assessing school climate as a foundation for culturally responsive trauma-informed approaches for urban schools. Urban Education, 55(1), 95–124.
32 Erickson 2023 - Erickson, M., & Harvey, T. (2023). A framework for a structured approach for formulating a trauma-informed environment. Journal of Education, 203(3), 666–677.
33 O’Toole 2022 - O’Toole, C. (2022). When trauma comes to school: Toward a socially just trauma-informed praxis. International Journal of School Social Work, 6(2).
34 Lorig 2022 - Lorig, C. E., Krupina, A., & Varjas, K. (2022). Social justice and trauma-informed care in schools. International Journal of School Social Work, 6(2).
35 NCTSN - The National Child Traumatic Stress Network (NCTSN). (n.d.). Trama types, trauma treatments, trauma-informed care, and NCTSN resources. Accessed April 10, 2026.
36 SAMHSA-NCTSI - Substance Abuse and Mental Health Services Administration (SAMHSA). (n.d.). National Child Traumatic Stress Initiative (NCTSI). Accessed April 12, 2026.
37 NASBE-Hoover 2019 - Hoover, S. A. (2019). Comprehensive mental health support makes students safer and better able to learn. National Association of State Boards of Education.
38 Palma 2024 - Palma, C., Abdou, A. S., Danforth, S., & Griffiths, A. J. (2024). Are deficit perspectives thriving in trauma-informed schools? A historical and anti-racist reflection. Equity & Excellence in Education, 57(1), 76–92.
39 RAND-Kennedy 2024 - Kennedy, K.E., & Walls, J. (2024). Social-emotional well-being for high school students: Guidance for school and system policy and practice. RAND Corporation.
40 Gonzalez 2022 - González, T., Etow, A., & De La Vega, C. (2022). An antiracist health equity agenda for education. Journal of Law, Medicine & Ethics, 50(1), 31–37.
41 Sedillo-Hamann 2022 - Sedillo-Hamann, D. (2022). Trauma-informed restorative justice practices in schools: An opportunity for school social workers. Children & Schools, 44(2), 98–106.
42 Gherardi 2021 - Gherardi, S. A., Garcia, M., & Stoner, A. (2021). Just trauma-informed schools: Theoretical gaps, practice considerations and new directions. International Journal of School Social Work, 6(1).
43 Sun 2025 - Sun, Y., Skouteris, H., Tamblyn, A., Berger, E., & Blewitt, C. (2025). Cross-disciplinary collaboration to promote trauma-informed practices in early childhood and primary education. Trauma, Violence, & Abuse, 1-21.
Related What Works for Health Strategies
To see all strategies:
countyhealthrankings.org/whatworks