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 rehabilitation (Leenarts 2013*), others use a 4-phase process of skill building, trauma processing, grief processing, and return to developmental progression (CEBC-TGCT-A). 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 initiatives (McInerney 2014).

Expected Beneficial Outcomes (Rated)

  • Reduced post-traumatic stress

  • Improved mental health

Other Potential Beneficial Outcomes

  • Increased resilient recovery

  • Improved academic outcomes

Evidence of Effectiveness

There is some evidence that school-based trauma-specific counseling interventions reduce symptoms of post-traumatic stress disorder (PTSD) and depression (Leenarts 2013*, Wethington 2008*, Blueprints). School-based trauma counseling is also a suggested strategy to address unmet mental health needs, build resilience, reduce grief symptoms, and support academic success (Nadeem 2014*, Saltzman 2001*). 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 settings (Leenarts 2013*, Wethington 2008*).

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 children (Blueprints, CEBC-CBITS, CEBC-Bounce Back, Nadeem 2014*). Parents of participants also report greater improvements in their children’s daily functioning than parents of non-participating children (Blueprints). 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 program (CEBC-SSET). 

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 reminders (CEBC-TGCT-A). Reduced PTSD symptoms are significantly associated with improvements in student grade point average (Saltzman 2001*). Bosnia-based studies suggest school-based trauma and grief counseling can reduce symptoms of psychological distress for participating students (Layne 2001*).

Impact on Disparities

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 DC (CBITS). Schools in Madison, WI; Baltimore, MD; Los Angeles, CA; and New Orleans, LA have successfully sustained CBITS programs (CBITS-Success stories). The Support for Students Exposed to Trauma (SSET) program is a recent adaptation of the CBITS program that has not yet been implemented widely (SSET).

The Bounce Back program, an elementary school program for trauma intervention, has been implemented in California, Illinois, Connecticut, Louisiana, Nebraska, and New York (Bounce Back-Learn more). 

Implementation Resources

TSAC-Trauma services - Treatment and Services Adaptation Center (TSAC), National Child Traumatic Stress Network (NCTSN). Trauma services in schools: Essential 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.

ACEsCN-TIC Toolkits - ACEs Connection Network (ACEs CN). Trauma-informed care (TIC) toolkits: Education resources.

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).

Citations - Evidence

* Journal subscription may be required for access.

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.

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.

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

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 US; 2014:145-157.

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.

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

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

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

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

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.

Citations - Implementation Examples

* Journal subscription may be required for access.

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

CBITS-Success stories - Cognitive Behavioral Intervention for Trauma in Schools (CBITS). Success stories: CBITS dissemination and sustainability.

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

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

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