School-Related Outcomes of Traumatic Event Exposure and Traumatic Stress Symptoms in Students: A Systematic Review of Research from 1990 to 2015

Long-term associations between early attachment and parenting and adolescent susceptibility to post-traumatic distress in a South African high-risk sample

BACKGROUND

It has been proposed that children and young people living in low- and middle-income countries (LMICs) are not only exposed more frequently to trauma but also have a higher likelihood of encountering traumas of greater severity than those living in high-income countries (HICs). This may lead to higher rates of post-traumatic stress symptoms (PTSS). However, developmental pathways to risk or resilience after trauma exposure in LMICs are underresearched.

METHODS

We examined early parenting and attachment as potentially important formative factors for later stress reactivity in a longitudinal cohort of South African children (N = 449). Parenting and attachment were assessed at child age 18 months, and interpersonal trauma exposure, PTSS and parenting stress were measured at 13 years (N = 333; core sample with data on all measures: N = 213). Following a vulnerability-stress approach, separate regression models were run to investigate whether parent-child attachment at 18 months, parental sensitivity and intrusiveness during play at 12 months, and current parenting stress at 13 years, interacted with adolescents' extent of interpersonal trauma exposure to predict their PTSS levels at 13 years.

RESULTS

We found no predictive effects of either early attachment or current parenting stress in relation to child PTSS. There was some evidence for predictive influences of parental early intrusiveness and sensitivity on adolescent outcomes, though associations were unexpectedly positive for the latter. No interaction effects supporting a vulnerability-stress model were found.

CONCLUSIONS

Overall, we found limited evidence that elements of the early parent-child environment predict child risk/resilience to trauma in LMIC children. Future studies should include more frequent assessments of relevant constructs to capture changes over time and consider further what comprises adaptive parenting in high-risk contexts.

Trauma-sensitive school concepts for students with a refugee background: a review of international studies

Children and adolescents with a refugee background are at high risk for traumatization. Once they arrive in safe countries, schools are the institutions where teachers are responsible for caring for them sensitively and competently. Furthermore, schools are organized in learning groups consisting of multiple peers of the same age, which provides excellent opportunities for social learning and experiences of social support. In this respect, schools are the appropriate places where preventive concepts can be applied to students with a refugee background. This systematic review summarizes studies that examine or evaluate existing international concepts of trauma-sensitive schools for supporting traumatized students with a refugee background. Based on N = 41 selected articles, 17 relevant concepts of trauma-sensitive schools were identified. In 35.3% of the concepts, traumatized students with a refugee background are explicitly included in the target group of the concept, while 47.1% of the concepts refer to groups of students with trauma as a result of various adverse childhood experiences, which also occur more frequently within the population of refugee children and adolescents 17.6% of the concepts contain specific adaptations for pupils with a refugee background. The majority of these concepts were developed in the United States. Additional concepts can be reported for Australia, the United Kingdom, Turkey, and Cambodia. Based on available empirical data, no significant effectiveness regarding the researched concepts' effects on academic and other school-related data can be determined. Although some studies indicate positive effects concerning school-related target variables, most of the studies have only limited significance due to inadequate research designs and methodological deficiencies. Therefore, there is a great need for further development, careful implementation, and evaluation of trauma-sensitive concepts in schools, especially for the growing group of refugee students.

Implementing trauma-informed care in a special education setting: An initial exploration of a multi-tiered model

Implementing trauma-informed care in a special education environment serving youth from historically marginalized communities with high levels of exposure to potentially traumatic events (PTEs) requires a systematic tiered approach consistent with public health guidelines. Little is known about the implementation of this framework in special education settings where youth have significant emotional and behavioral difficulties. To address this need, a consultant-community partnership was forged between a hospital providing mental health services and a therapeutic day school that serves a special education cooperative. The current case study explores the design and implementation of a three-tiered model of trauma-informed care in a special education setting. This study will address the specific practices implemented at each tier, discuss successes and challenges, and summarize future directions for research, practice, and policy.

Experiential Avoidance, Post-Traumatic Stress Symptoms, and Academic Impairment

The ways in which Posttraumatic Stress Disorder (PTSD) symptoms lead to impairments in functioning, including academic performance, are not well understood. The present study sought to examine the role of a common maladaptive coping strategy, experiential avoidance, as a moderator of the relationship between posttraumatic stress symptoms (PTSS) and academic achievement. Participants (N = 326) were undergraduate students enrolled in introductory psychology courses at a large university in the Midwestern United States who reported at least one event potentially meeting Criterion A for PTSD. The prospective association of PTSS with current and subsequent semester GPAs, and with experiential avoidance as the moderator, were examined. The interaction between PTSS and experiential avoidance significantly predicted both current semester GPA and subsequent semester GPA, with stronger associations between PTSS and GPA being observed at higher levels of experiential avoidance. These results were not fully explained by control variables of high school performance, standardized test scores, and general negative affect. This study found that experiential avoidance significantly moderates the relationship between PTSS and academic performance. These results suggest that interventions that target PTSS and/or experiential avoidance may increase GPA. Limitations and future directions are discussed.

Trauma-Informed Practice in Physical Activity Programs for Young People: A Systematic Review

Physical activity, sport, and physical education share many similar qualities with trauma-informed practice, including promoting relationships, inclusion, and physical and mental well-being. There is growing research and programs that incorporate trauma-informed practices into physical activity programs for young people. The aim of this systematic review was to explore current evidence-based, Trauma-Informed Physical Activity programs for young people. Four databases were searched using the Preferred Reporting Items of Systematic Review and Meta-Analyses guidelines for systematic reviews. The search identified 19 studies that highlighted most Trauma-Informed Physical Activity programs reviewed resulted in positive social, emotional, behavioral, and academic outcomes for children and adolescents. However, further research and randomized control trials are required to understand the longitudinal outcomes of Trauma-Informed Physical Activity programs for children and adolescents. Program facilitators reported on the benefits of support and professional development opportunities for trauma awareness to administer Trauma-Informed Physical Activity programs with children and young people. Implications from this study emphasize the importance of the continued design, delivery, and research of Trauma-Informed Physical Activity programs for young people exposed to trauma.

Introducing Routine Assessment of Adverse Childhood Experiences For Looked-After Children: The Use and Properties of the Trauma and Adverse Life Events (TALE) Screening Tool

The present study aims to illustrate the process of developing, implementing, and clinically validating a new assessment measure, the Trauma and Adverse Life Events (TALE) screening tool, to assess Adverse Childhood Experiences (ACEs) among looked-after children. The TALE was developed by adapting existing ACEs measures to reflect the experiences of looked-after children. The TALE was completed by the local authority social worker for 218 children placed with Five Rivers Child Care (a UK fostering agency, residential, and educational care provider). Reliability was examined and exploratory factor analysis was conducted. Correlations between TALE scores, background variables, and psychosocial wellbeing using the carer-report Strengths and Difficulties Questionnaire (SDQ) and Child Dissociative Checklist (CDC) were also explored. The TALE was found to have acceptable reliability (α = .71). A three-factor solution was found which explained 46.24% of the variance, with factors labelled 'Direct Experience of Abuse', 'Witnessing Harm', and 'Household Dysfunction'. Exposure score was significantly associated with total difficulties score on the SDQ (rs = .24, p < .001) and Impact score was associated with the SDQ's impact score (rs = .33, p < .001). Exposure and Impact scores were both positively correlated with CDC scores (rs = .16, p = .021 and rs = .22, p = .002). This paper presents evidence of the importance of screening looked-after children for ACEs and demonstrates that the TALE is a valid and reliable tool for this purpose. Adverse and traumatic experiences were highly prevalent in this population and appeared to be closely related with children's psychosocial wellbeing. Results emphasise the importance of routine assessment of past experiences within trauma-informed psychological care and intervention planning for looked-after children.

Cognitive Outcomes of Children With Complex Trauma: A Systematic Review and Meta-Analyses of Longitudinal Studies

Longitudinal studies have shown that children with complex trauma (i.e., exposure to multiple or repeated traumatic events of an interpersonal nature) have poorer cognitive outcomes later in life than children without complex trauma. This association may be moderated by the timing of the trauma, which may explain, in part, some heterogeneity in the findings reported across previous investigations. The objective of the systematic review and meta-analyses was to compare the cognitive outcomes of children with complex trauma and controls and to explore whether the timing of trauma (i.e., its onset and recency) moderated this association. Electronic databases (APA PsycNET, Pubmed Central, ERIC, CINAHL, Embase) and gray literature were systematically searched. To be included, studies had to (1) have a longitudinal design, (2) comprise children with complex trauma and controls, and (3) include a cognitive assessment. Thirteen studies were identified. Meta-analyses were conducted to compare children with complex trauma and controls, while subgroup analyses and meta-regressions explored the impact of potential moderators. Children with complex trauma had poorer overall cognitive functioning than controls, and the timing of trauma (early onset and, to a greater extent, recency of trauma) moderated this association. Thus, findings suggest that children with complex trauma are at risk of cognitive difficulties quickly after trauma exposure. As such, systematic neuropsychological assessment and interventions supporting the optimal development of cognitive functioning among children with complex trauma should be investigated to determine whether prompt interventions lead to better cognitive functioning.

The trauma and learning policy initiative (TLPI)'s inquiry-based process: Mapping systems change toward resilience

Trauma is much more than our individual experiences. Fundamentally, trauma is rooted in our social conditions, interrelated with the oppression and violence in our communities and in societies at large. Trauma is knotted within cycles of harm in our relationships and in our communities and institutions. Not only are our communities and institutions sites of trauma, however, but they can also be sites of great healing, restoration, and resilience. Educational institutions hold the potential for contributing to resilient change toward the creation of transformative communities for children to feel safe and to thrive, even in the face of accumulating adversities that are endemic in the United States and beyond. This study investigated the impact of an initiative that strives to support K-12 schools in transforming towards greater trauma-sensitivity: trauma and learning policy initiative (TLPI). We share findings from our qualitative, situational analysis of the impact of TLPI's support to three schools in Massachusetts, USA. Although TLPI's framework on trauma does not explicitly include an antiracism lens, when engaging in data analysis, with the aim to shed light on possible schoolwide approaches to promote equity, our team of researchers specifically attended to ways intersecting systems of oppression may have impacted student education. A visual diagram, "Map of Educational Systems Change Towards Resilience," emerged from our data analysis, with four themes that represent how educators understood the shifts in their schools. These were: (1) facilitating empowerment and collaboration; (2) integrating whole-child approaches; (3) affirming cultural identity and promoting a sense of belonging; and (4) re-envisioning discipline toward relational accountability. We discuss pathways that educational communities and institutions can take to create trauma-sensitive learning environments for the promotion of greater resilience.

Social resilience and disaster resilience: A strategy in disaster management efforts based on big data analysis in Indonesian's twitter users

Disasters have various causes, disaster management efforts, and actors involved. A systematic big data analysis is needed to identify social resilience to determine the quality of the country's resilience on disasters. This study aims to (1) determine perceptions about the causes of disasters and (2) understand perceptions of disaster management efforts. (3) identify actors involved in disasters. (4) analyze the relationship between social resilience and disaster resilience using large data sources. (5) formulate a disaster management. The research was conducted by describing in detail from the opinions of the twitter user community about disasters using the text mining method. The data retrieval and analysis process was carried out using Computer-Assisted Qualitative Data Analysis Software (CAQDAS) with MAXQDA series 2020, Gephi version 0.10.0 and SWOT analysis. The results of the study show: (1) Most of the perceptions of the causes of disasters are associated with religion; (2) Most of the perceptions about disaster management efforts are based on the application of disaster management at the recovery stage; and (3) The actors who are most involved in disaster management efforts are the security forces countries. (4) There is a strong relationship between social resilience and disaster resilience, as shown by each actor having a role in disaster management efforts. (5) There are nine formulations of development strategies in disaster management efforts. The limitation of this research is that it only uses big data from Twitter and social media sources. The implications of this research can be used as a reference for governments, organizations, communities, or others involved in disaster management efforts, especially in countries that have diversity and are prone to disasters.

Potentially Traumatic Events, Socioemotional and Adaptive Functioning: Associations with Self-Regulatory Skills in a Community Sample of Primarily Black and Latinx 3-5-year-olds

Early childhood is a heightened risk period for exposure to potentially traumatic events (PTEs) and a critical period for the development of foundational self-regulatory competencies that have potential cascading effects on future socioemotional functioning. This cross-sectional study examined associations between PTE exposure and socioemotional and adaptive functioning, and self-regulatory skills, in a community-based sample of 280 primarily Black and Latinx 3-5-year-olds. Results supported direct relations between PTE exposure and socioemotional and adaptive functioning. Attentional regulation was associated with PTEs and internalizing behaviors, externalizing behaviors, and adaptive behaviors. There was also a significant association of emotional regulation on the relationship between PTEs and internalizing and externalizing behaviors, but not adaptive functioning. Findings have implications for early intervention and educational and public policy, including the importance of scaffolding the development of self-regulatory skills among preschoolers with high PTE exposure.

Reflections on the Process of Implementing Trauma-Informed Education Lunch and Learns

BACKGROUND

The trauma-informed education (TIE) framework can help create an equitable learning environment supportive of all learners.

PROBLEM

Stress and trauma can be impediments to academic success for students, particularly from backgrounds historically excluded from nursing.

APPROACH

This article shares the initial steps of a training program on implementing a series of Lunch and Learns (LLs) on TIE in a school of nursing to introduce TIE to faculty and staff and obtain their feedback on facilitators and barriers to implementing recommended approaches.

OUTCOMES

The series was well attended, averaging 33 participants per session. Using experts in TIE positively impacted the learning but contributed to inconsistencies in presentation style and scaffolding of content across sessions.

CONCLUSION

Purposeful recruitment and engagement of faculty during the development of the LLs were effective in increasing attendance. Multiple sessions require early planning and meetings with team and presenters to ensure consistency and better use of resources.

Minding the gap: Evidence, implementation and funding gaps in mental health services delivery for school-aged children

State and local educational agencies are grappling with growing mental health needs among school-aged children that intensified during the COVID-19 pandemic. We undertake a case study of the experiences of one state, Tennessee, to examine the landscape of mental health interventions that are being deployed and to illuminate contextual factors that can support their implementation or exacerbate state and local challenges in addressing children's fast-rising mental health needs. We begin with an examination of the knowledge base on interventions and approaches that are commonly employed in K-12 schools to address children's mental health needs, including in Tennessee, with the aim to identify notable gaps in what we understand about their implementation and impacts on student outcomes. We find a lack of rigorous research that can inform efforts to improve the implementation and effectiveness of school-based mental health interventions. We bring this insight to our case-study analysis, which shows that this lack of guidance from research is compounded by inadequate, time-limited and fluctuating public funding that hinders local efforts to establish strong, ongoing programs that provide or connect K-12 students to essential mental health services. We call for more federal funding to support state and local implementation of proven and promising interventions for addressing children's mental health needs and more rigorous evaluations to strengthen the evidence base on their implementation and impacts.

Utilizing KAP in Schools: An Evaluation of Educators' and Staff Knowledge, Attitudes, and Practices Related to Trauma

We examined differences in knowledge, attitudes, and practices related to student trauma and trauma-informed practices among various educators and certified staff members in a United States, Midwestern school district. We examined three research questions: 1.) Are there significant differences in knowledge, attitudes, and practices among teachers with differing years' experience? 2.) Are there significant differences in knowledge, attitudes, and practices among primary and secondary educators and staff? 3.) Are there significant differences in knowledge, attitudes, and practices among educators and staff who have participated in professional development (PD) regarding student trauma, and those who have not? We utilized a revised version of the Knowledge, Attitudes, and Practices (KAP) survey (Law, 2019) focused on student trauma. The KAP survey was sent via email to all certified staff members in the school district. No significant differences were found among knowledge and attitudes; however, primary school educators implemented significantly more trauma-informed practices compared to secondary educators. Additionally, educators with PD implemented significantly more trauma-informed practices compared to those without PD. Findings revealed our staff members had similar levels of knowledge and attitudes, though practices differed depending on years' experience, PD, and grades taught. Implications for future research relating to student trauma and the research-to-practice gap are discussed.

Disentangling the Associations Between Attention Deficit Hyperactivity Disorder and Child Sexual Abuse: A Systematic Review

BACKGROUND

An association between child sexual abuse (CSA) and attention deficit hyperactivity disorder (ADHD) has been documented. However, the temporal relationship between these problems and the roles of trauma-related symptoms or other forms of maltreatment remain unclear. This review aims to synthesize available research on CSA and ADHD, assess the methodological quality of the available research, and recommend future areas of inquiry.

METHODS

Studies were searched in five databases including Medline and PsycINFO. Following a title and abstract screening, 151 full texts were reviewed and 28 were included. Inclusion criteria were sexual abuse occurred before 18 years old, published quantitative studies documenting at least a bivariate association between CSA and ADHD, and published in the past 5 years for dissertations/theses, in French or English. The methodological quality of studies was systematically assessed.

RESULTS

Most studies identified a significant association between CSA and ADHD; most studies conceptualized CSA as a precursor of ADHD, but only one study had a longitudinal design. The quality of the studies varied greatly with main limitations being the lack of (i) longitudinal designs, (ii) rigorous multimethod/ multiinformant assessments of CSA and ADHD, and (iii) control for two major confounders: trauma-related symptoms and other forms of child maltreatment.

DISCUSSION

Given the lack of longitudinal studies, the directionality of the association remains unclear. The confounding role of other maltreatment forms and trauma-related symptoms also remains mostly unaddressed. Rigorous studies are needed to untangle the association between CSA and ADHD.

Supporting student learning and development through trauma-informed campuses

Many students come to higher education with a history of trauma. College life may also expose students to traumatizing events. While the past decade has witnessed greater discussion of trauma-informed frameworks, it has not regularly been applied to the college environment. We advance the concept of a trauma-informed campus, where administrators, faculty, staff, and students from diverse disciplines create an environment that recognizes the widespread nature of trauma, integrates knowledge about trauma into practices and procedures, and minimizes further re-traumatization for all community members. A trauma-informed campus is prepared for students' past or future traumatic experiences, while also recognizing and responding to structural and historical harms. In addition, it recognizes the role of the surrounding community challenges, particularly how violence, substance use, hunger, poverty, and housing insecurity may contribute to further trauma or negatively impact healing. We use an ecological model to frame and shape the construct of trauma-informed campuses.

Evaluating the impact of Hazelwood mine fire event on students' educational development with Bayesian interrupted time-series hierarchical meta-regression

BACKGROUND

Environmental disasters such as wildfires, floods and droughts can introduce significant interruptions and trauma to impacted communities. Children and young people can be disproportionately affected with additional educational disruptions. However, evaluating the impact of disasters is challenging due to difficulties in establishing studies and recruitment post-disasters.

OBJECTIVES

We aimed to (1) develop a Bayesian model using aggregated school-level data to evaluate the impact of environmental disasters on academic achievement and (2) evaluate the impact of the 2014 Hazelwood mine fire (a six-week fire event in Australia).

METHODS

Bayesian hierarchical meta-regression was developed to evaluate the impact of the mine fire using easily accessible aggregated school-level data from the standardised National Assessment Program-Literacy and Numeracy (NAPLAN) test. NAPLAN results and school characteristics (2008-2018) from 69 primary/secondary schools with different levels of mine fire-related smoke exposure were used to estimate the impact of the event. Using an interrupted time series design, the model estimated immediate effects and post-interruption trend differences with full Bayesian statistical inference.

RESULTS

Major academic interruptions across NAPLAN domains were evident in high exposure schools in the year post-mine fire (greatest interruption in Writing: 11.09 [95%CI: 3.16-18.93], lowest interruption in Reading: 8.34 [95%CI: 1.07-15.51]). The interruption was comparable to a four to a five-month delay in educational attainment and had not fully recovered after several years.

CONCLUSION

Considerable academic delays were found as a result of a mine fire, highlighting the need to provide educational and community-based supports in response to future events. Importantly, this work provides a statistical method using readily available aggregated data to assess the educational impacts in response to other environmental disasters.

Early Childhood Professionals’ Perspectives on Dealing with Trauma of Children

Childhood trauma is a significant concern in Australia and internationally. Professionals working in the early childhood education sector (i.e., providing early childhood education and care to infants, toddlers, and children from birth to age eight) are positioned to provide valuable support for children affected by trauma. However, there is less research on early childhood professionals’ perspectives and experiences of supporting trauma-exposed children compared to other education professionals (e.g., primary and secondary school teachers). This study explored early childhood professionals’ perspectives and experiences in relation to supporting children exposed to trauma. Semi-structured interviews were conducted with 14 early childhood professionals in Victoria, Australia, and data were analysed using thematic analysis. The findings illustrate that while educators develop valuable skills and experience growth from supporting trauma-exposed children and their families, they also experience emotional distress and challenges. Educators noted that there are limited professional development opportunities to learn about childhood trauma, and limited access to qualified and knowledgeable staff who can help them when supporting these learners. Implications from this study emphasise the importance of designing and delivering trauma-based professional learning opportunities and policies for early childhood educators.

Academic Outcomes Among Children Who Experienced or Were Exposed to Physical Abuse

All forms of family violence may negatively affect a child's development. However, research on child maltreatment is primarily focused on the child who is directly maltreated and does not often account for how other children in the family experience the abuse. The central aim of our study was to better understand how children's direct experience of physical abuse and exposure to physical abuse influence their academic outcomes. Data were taken from the Minnesota Departments of Education and Human Services. The sample was developed from a population-level cohort of 8-10 years old children (N = 1740) from two groups: Child Protective Service (CPS)-involved (a child who allegedly experienced physical abuse or a child who was exposed to the alleged physical abuse of another child in their household) and the matched comparison. Exposure to intimate partner violence (IPV) was also measured for CPS-involved children. School attendance and academic achievement were examined over 4 years. Descriptive statistics and Generalized Estimating Equations (GEE) were used to answer the three research questions. Over time, declines in attendance for children exposed to physical abuse were significantly greater than those of their matched peers. Exposure to IPV for CPS-involved children resulted in further declines in attendance. Math proficiency of children who experienced physical abuse declined at a significantly faster rate than their matched peers. The decline in reading proficiency of both children who experienced physical abuse and children exposed to physical abuse was more significantly pronounced than that of their matched peers. Differences in math and reading proficiency were eliminated when IPV exposure was taken into account. Child protection workers and school professionals should be aware of negative effects of experiences of and exposures to child maltreatment and work collaboratively to provide academic support, counseling, and other interventions to support children's academic stability.

Multi-informant Assessment of Internalizing Concerns: Rater Concordance and Implications for Decision-Making

Rising rates of mental health challenges among youths have become a significant concern following the COVID 19 pandemic. Although strong evidence supports the implementation of universal screening as a preventative approach to address unmet mental health concerns, the research is less clear surrounding the use of such data in decision-making processes when significant discrepancies between informants (e.g., students and teachers) exist. The purpose of the study was twofold. First, the study aimed to determine the degree of rater concordance between teachers and students on students' internalizing concerns. The second objective was to determine whether concordance on internalizing behaviors differs across ages/grades and if this differentially impacts distal (i.e., academic) outcomes. Results indicated that teachers and students demonstrated limited agreement on ratings of internalizing behaviors. However, when students and teachers agreed, higher and more positive emotional behaviors were linked to higher reading/math performance. Furthermore, patterns of informant dis/agreement and relationships between internalizing concerns and academic outcomes were similar across grade levels. Implications and areas for future research are discussed.

An Investigation of Secondary Traumatic Stress and Trauma-informed Care Utilization in School Personnel

Trauma-informed practices in schools are designed to address the impacts of trauma on students and increase supports for school personnel who are delivering this care The impact of a trauma-informed school-based intervention. Journal of Adolescence, 43, 142-147, Mendelsonet al., 2015. Research has established that professionals trained to implement the approach may have secondary traumatic stress (STS) reactions that could interfere with successful implementation (Stevens al., 2020). In this study it was hypothesized that increased use of trauma-informed care strategies would be associated with decreases in total STS scores, as well as all STS subscale scores at the end of a system's transformation initiative, controlling for sex, age, education, years worked in schools, and exposure to student trauma awareness at baseline. The Trauma Sensitive Schools Checklist (TSSC) and the Secondary Traumatic Stress Scale (STSS) were used to measure study outcomes in a sample of 205 school personnel at baseline and follow up. Statistically significant improvement in STSS scores and TSSC score were noted from Time 1 to Time 2. As hypothesized, improvements in TSSC scores were associated with decreased levels of STS over time, controlling for the covariates. However, the symptom domains of intrusion and arousal impacted this relationship in a differential manner than avoidance and alterations in cognitions and mood. This study provides evidence that increased use of trauma-informed care practices can positively impact the STS levels of school personnel, though special attention should be paid to those with high levels of intrusion or arousal.

Fostering Informed and Responsive Systems for Trauma in Early Care and Education (FIRST:ECE): A Preliminary Evaluation

Children with histories of trauma exposure experience a wide-range of developmental, social, emotional, and behavioral symptoms. The effects of traumatic life experiences can impact children's ability to learn and function within the school environment. Trauma-informed (TI) schools seek to create environments in which children with experiences of trauma can build resilience and be successful and must begin as early as possible in the child's educational experience. The current paper summarizes preliminary evaluation results from a two-year initiative focused on implementing TI organizational change in two school district pre-kindergarten (pre-k) systems in a Southern state. Site 1 (urban) had 7 pre-k locations with 31 classrooms, while site 2 (micropolitan) had 5 locations with 12 classrooms (43 classrooms total). In surveys across two years, participating teachers (N = 91) reported gains in trauma-related knowledge and implementation of TI teaching strategies. Surveys of a subset of staff who were involved in district-level teams focused on implementation of broader TI organizational changes (e.g. adapting policies and procedures) revealed that most staff felt they developed an effective and sustainable process for facilitating organizational change. Theoretical implications and future directions are discussed.

Australian Educators' Perceptions and Attitudes Towards a Trauma-Responsive School-Wide Approach

Staff perceptions and attitudes regarding the introduction of the Reframing Learning and Teaching Environments (ReLATE) trauma-responsive school-wide approach were investigated in three Catholic primary schools in Victoria, Australia. School leaders, teachers, and support staff were interviewed regarding their experiences of the approach either individually or in focus groups. Educator attitudes towards trauma-responsive education was evaluated using the ARTIC-ED Scale, prior to and after participating in the six-month intervention. Qualitative data were interpreted using ecological analysis of the themes arising guided by the trauma informed principles and frameworks of the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Trauma Learning Policy Initiative (TLPI). Findings indicated significant shifts towards trauma-responsive practice following the introduction of ReLATE. Strong themes emerged relating to the influence of improved trauma knowledge on perceptions of student behavior, consequent reported adaptations to behavior management practices, strengthened sense of trust and respect in the school climate, the centrality of leadership to effect change, and importance of school-fit to program uptake. Strengths and limitations of ReLATE are considered, along with implications for teacher professional learning, the role of leadership in effecting change and significance of perceived school-fit and collaboration.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-021-00394-6.

A study in University of Ruhuna for investigating prevalence, risk factors and remedies for psychiatric illnesses among students

There is no comprehensive study on the mental health of Sri Lankan undergraduate in higher education, as most existing studies have been done for medical students only. It is unknown how academic and environmental factors contribute for the prevalence of psychiatric illnesses. Further, there is no sufficient information on the student/university based remedies to reduce the psychological distress of students. This research is carried out to find the overall psychological distress, well-being, prevalence percentages of psychiatric illnesses, associated risk factors, and student/university remedies to overcome them. We use standard questionnaires to screen for psychiatric illnesses, and we analyze the responses for our own questionnaire using Binary logistic regression analysis to identify demographic factors, academic factors, and environmental factors causing each mental disorder. We use Pearson correlation coefficient to identify correlation between prevalence of each psychiatric illnesses. All 13 psychiatric illnesses were found with a moderate correlation among diseases having a mean prevalence percentage of 28 and a standard deviation of 14.36, despite the prevalence of well-being factors among students and only 8% are clinically diagnosed. 89% of the students were suffering from at least one psychiatric illness and 68% were found to be psychologically distressed. Sets of overall and individual demographic, academic, and environmental risk factors contributing for the prevalence of a psychiatric illness in general and in particular were identified respectively after a binary logistic regression analysis. 61% of the students don’t receive psychiatric help from the university and are using their own remedies. The universities must consider the environmental and academic risk factors associated with psychiatric illnesses and design curriculum, expand resources, and provide counseling services to reduce the impact of risk factors.

Assessment of adult learning outcomes from a school-based training on adverse childhood experiences science and trauma-informed care

BACKGROUND

Implementing trauma-informed care (TIC) practices in educational settings requires preparing school staff to understand adverse childhood experiences (ACEs) and their impact to provide a restorative rather than a punitive response.

OBJECTIVES

To assess learning outcomes of a TIC training delivered to kindergarten to 12-grade (K-12) staff.

PARTICIPANTS AND SETTING

A TIC training informed by the Substance Abuse and Mental Health Service Administration (SAMHSA) Framework was delivered August to December 2017 to twenty-seven K-12 staff in Southeastern U.S. Majority were women (93 %) aged 25 to 58 years; 52 % were White and 48 % were Black/African American (48 %).

METHODS

Curricular content included an overview of ACEs; stress physiology; recognition of symptoms in self and others; strategies for response; and self-care. A post-training questionnaire with 11 learning statements was administered to assess participants' level of agreement with learning each concept using a 5-point Likert scale. Self-reflective narratives of challenging situations with students were also submitted and qualitatively analyzed for applications of TIC.

RESULTS

Between 62.9 % to 96 % of participants agreed/strongly agreed with learning new concepts related to ACEs and their symptoms. Qualitative data indicated that participants were able to recognize stress symptoms in students and in themselves and integrate strategies learned such as breathing and creating safe space to allow students to have voice and choice.

CONCLUSIONS

TIC training curriculum that includes ACEs and toxic stress science is a critical component that promotes recognition of trauma symptoms in themselves and others. Self-reflective practice using narratives is an essential training tool for implementing TIC.

A case study addressing trauma needs during COVID-19 remote learning from an ecological systems theory framework

Mental health conditions related to trauma among American children are a concern, particularly because of the impacts of the COVID-19 pandemic. Children, as students, carry the trauma they encounter with them into the classroom. Students impacted by trauma learn differently due to effects on the brain that relate to several impairments, causing them to perform poorly in school. However, teachers may not always understand this issue. This case study shows how certain dynamics within the EST layers impacted one school during the pandemic. The purpose of this study was to examine how teachers at the school experienced a trauma-informed online PD and SEL program intended to improve student outcomes, teacher perceptions, and teacher–student relationships. The six participants included teachers in a K-8 low-income, minority population charter school. The assessment tools used were the Teacher–Student Relationship Scale, Teacher Perception Scale, and Student Outcomes Survey. The teachers’ outlook on SEL improved, particularly online. This improvement helped the teachers implement community circles and SEL infused with mindfulness in their online classrooms, which may have helped them maintain their relationships with the students and may have helped the students with academic and stress outcomes. During unprecedented times, the maintenance, rather than the deterioration, of student outcomes and teacher–student relationships is an accomplishment and an area that necessitates further research.

Actions Against Racism:

Racism is a social determinant of health with dire consequences for the health, education, and mental health of students of color. Thus, there is an urgent need to develop and test evidence-based strategies to combat racism in schools. In response to this need, our team has developed a multi-tiered school-based intervention to build capacity for combatting racism in educators, students, and families. The “Actions Against Racism” intervention synthesizes three evidence-based practices: trauma-informed practices, social-emotional learning (SEL), and racial socialization. The multiple tiers of intervention aim to cultivate skills for combatting individual and structural racism in educators, families, and students across the school ecology. In this paper, we present the rationale for this intervention and provide an overview of the “Actions Against Racism” components.

Cognitive behavioral treatments for children and adolescents exposed to traumatic events: A meta-analysis examining variables moderating treatment outcomes

Due to the negative impact of trauma exposure, effective treatments are necessary to prevent and improve negative trauma-related outcomes. Cognitive behavioral therapy (CBT) is considered an efficacious treatment for children and adolescents exposed to traumatic events. Despite the various meta-analyses that have examined trauma treatments, there is a paucity of research on the moderating variables that may impact treatment outcomes. This meta-analytic CBT study addressed those limitations by examining the moderating effects of treatment components on outcomes. A search identified 94 CBT studies with 97 relevant effect sizes for children and adolescents exposed to traumatic events. Consistent with prior meta-analytic studies, CBT was shown to be effective for trauma-exposed youth. CBT subtreatments did not produce significantly different results from one another. Moderators shown to significantly impact CBT treatment outcomes for posttraumatic stress symptom were trauma type, Q = 24.09, p = .004, ds = -0.22 to -1.42, and gender, Q = 10.68, p = .005, ds = -0.53 to -1.36, whereas moderators shown to impact treatment outcomes for depression were study design, Q = 10.95, p = .004, ds = -0.26 to -0.50, and treatment setting, Q = 10.98, p = .004, ds = -0.31 to -0.56. The implications of these findings for research and practice are discussed.

Trauma-Informed School Programming: A Partnership Approach to Culturally Responsive Behavior Support

Despite significant investments and reforms, First Nations students have poorer educational outcomes than non-indigenous students. Scholars have pointed to the need to improve the cultural competence of teachers and school leaders, revise punitive and exclusionary disciplinary procedures. and promote the use of culturally responsive practices to mitigate the impacts of colonization, transgenerational trauma and ongoing structural inequities on students. The development of such trauma-informed, culturally responsive systems in schools requires educators to respectfully work in partnership with First Nations communities, as well as health and community services supporting First Nations families. This pilot study evaluates the impact of multi-tier trauma-informed behavior support practices in a regional primary school with a large population of First Nations students. Utilizing a multiple time series, quasi-experimental, within-subjects design, data on the rates of school attendance and problem behaviors were analyzed. Staff knowledge and attitudes related to trauma-informed care were assessed using a self-reporting measure, before and after the two-year implementation of the program. A reduction in behavior difficulties was found, as well as noted improvements in staff reports of knowledge and attitudes. The implications of the findings for the program and future research on culturally responsive practices in schools are discussed.

Prevalence of Adverse Childhood Experiences in Students with Emotional and Behavioral Disorders in Special Education Schools from a Multi-Informant Perspective

Adverse childhood experiences (ACEs) are associated with an increased risk of developing severe emotional and behavioral problems; however, little research is published on ACEs for students with emotional and behavioral disorders (EBD) in special education (SE) schools. We therefore systematically explored the prevalence, type and timing of ACEs in these students from five urban SE schools in the Netherlands (M_age = 11.58 years; 85.1% boys) from a multi-informant perspective, using students’ self-reports (n = 169), parent reports (n = 95) and school files (n = 172). Almost all students experienced at least one ACE (96.4% self-reports, 89.5% parent reports, 95.4% school files), and more than half experienced four or more ACEs (74.5% self-reports, 62.7% parent reports, 59.9% school files). A large majority of students experienced maltreatment, which often co-occurred with household challenges and community stressors. Additionally, 45.9% of the students experienced their first ACE before the age of 4. Students with EBD in SE who live in poverty or in single-parent households were more likely to report multiple ACEs. Knowledge of the prevalence of ACEs may help understand the severe problems and poor long-term outcomes of students with EBD in SE.

Childhood Maltreatment, Educational Attainment, and IQ: Findings From a Multicentric Case-control Study of First-episode Psychosis (EU-GEI)

BACKGROUND AND HYPOTHESIS

Evidence suggests that childhood maltreatment (ie, childhood abuse and childhood neglect) affects educational attainment and cognition. However, the association between childhood maltreatment and Intelligence Quotient (IQ) seems stronger among controls compared to people with psychosis. We hypothesised that: the association between childhood maltreatment and poor cognition would be stronger among community controls than among people with first-episode of psychosis (FEP); compared to abuse, neglect would show stronger associations with educational attainment and cognition; the association between childhood maltreatment and IQ would be partially accounted for by other risk factors; and the association between childhood maltreatment, educational attainment, and IQ would be stronger among patients with affective psychoses compared to those with nonaffective psychoses.

STUDY DESIGN

829 patients with FEP and 1283 community controls from 16 EU-GEI sites were assessed for child maltreatment, education attainment, and IQ.

STUDY RESULTS

In both the FEP and control group, childhood maltreatment was associated with lower educational attainment. The association between childhood maltreatment and lower IQ was robust to adjustment for confounders only among controls. Whereas childhood neglect was consistently associated with lower attainment and IQ in both groups, childhood abuse was associated with IQ only in controls. Among both patients with affective and nonaffective psychoses, negative associations between childhood maltreatment and educational attainment were observed, but the crude association with IQ was only evident in affective psychoses.

CONCLUSIONS

Our findings underscore the role of childhood maltreatment in shaping academic outcomes and cognition of people with FEP as well as controls.

Trauma moderates the development of the oscillatory dynamics serving working memory in a sex-specific manner

Working memory, the ability to hold items in memory stores for further manipulation, is a higher order cognitive process that supports many aspects of daily life. Childhood trauma has been associated with altered cognitive development including particular deficits in verbal working memory (VWM), but the neural underpinnings remain poorly understood. Magnetoencephalography (MEG) studies of VWM have reliably shown decreased alpha activity in left-lateralized language regions during encoding, and increased alpha activity in parieto-occipital cortices during the maintenance phase. In this study, we examined whether childhood trauma affects behavioral performance and the oscillatory dynamics serving VWM using MEG in a cohort of 9- to 15-year-old youth. All participants completed a modified version of the UCLA Trauma History Profile and then performed a VWM task during MEG. Our findings indicated a sex-by-age-by-trauma three-way interaction, whereby younger females experiencing higher levels of trauma had the lowest d' accuracy scores and the strongest positive correlations with age (i.e. older performed better). Likewise, females with higher levels of childhood trauma exhibited altered age-related alpha changes during the maintenance phase within the right temporal and parietal cortices. These findings suggest that trauma exposure may alter the developmental trajectory of neural oscillations serving VWM processing in a sex-specific way.

Temporal Relationships between PTSD Symptoms and Social Functioning among Adolescents in Residential Care

OBJECTIVE

Theoretical and conceptual models of posttraumatic stress disorder (PTSD) symptom progression in youth have identified social functioning as having a central influence. Yet a dearth of research has examined the bidirectional temporal associations between PTSD symptoms and social functioning.

METHOD

This study is the first to investigate these temporal dynamics in a sample of adolescents in trauma-informed residential treatment (N= 453; M age = 15.77 [range = 12.12-18.95], SD = 1.55; 57.2% female). The UCLA PTSD Reaction Index for DSM-5 was analyzed as a measure of youth-reported PTSD symptoms and the Interpersonal Problems subscale of the Children's Depression Inventory, 2nd edition was analyzed as a measure of youth-reported social functioning issues. The Social Problems subscale from the Child Behavior Checklist was analyzed as a measure of clinician-reported social functioning difficulties. Measures were completed at baseline and then approximately every three months for the duration of treatment. Multivariate lagged analyses were used to examine the temporal, bidirectional associations between PTSD symptoms and social functioning.

RESULTS

Results indicated that while controlling for length of stay, trauma exposure, age, and gender, reductions in PTSD symptoms predicted subsequent reductions in social functioning problems across both measures (prs = .12-.16), and that improvement in interpersonal relationships predicted subsequent decreases in PTSD symptoms (pr = .12).

CONCLUSIONS

Taken together, these findings highlight the importance of healthy social relationships for decreasing adolescent's psychological distress. Treatments that include components that target social functioning in addition to symptom reduction may maximally benefit youth with trauma-related psychopathology.

Systematic Review of School-Wide Trauma-Informed Approaches

Extensive research on traumatic life experiences reveals how healthy development can be derailed and brain architecture altered by excessive or prolonged activation of the body's stress response, impacting health, mental health, learning, behavior and relationships. Schools offer a unique environment to prevent and counter the impacts of childhood trauma. This study aimed to investigate empirical evidence for school-wide trauma-informed approaches that met at least two of the three essential elements of trauma-informed systems defined by SAMSHA (2014). SAMHSA's concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14-4884. Rockville: Substance Abuse and Mental Health Services Administration. https://store.samhsa.gov/shin/content/SMA14-4884.pdf) and consider commonalities in approaches, drivers of change, challenges and learnings related to implementation, sustainability and outcomes for students. A systematic review searching foremost databases was conducted for evidence of trauma-informed school-wide approaches used between 2008 and 2019. Four papers were identified, incorporating four school-wide approaches, The Healthy Environments and Response to Trauma in Schools (HEARTS) Model; The Heart of Teaching and Learning (HTL): Compassion, Resiliency, and Academic Success Model; The New Haven Trauma Coalition (NHTC) and The Trust-Based Relational Intervention. Although heterogeneous, the models shared core elements of trauma-informed staff training, organization-level changes and practice change, with most models utilizing student trauma-screening. Generalizability of the findings was low given the small number of studies, the mix of mainstream and specialist schools and high risk of bias. Given the limitations of research in this emergent but rapidly accelerating field, future research is urgently required to understand the interaction between core elements of a trauma-informed approach, teaching pedagogy and organizational factors that support the embedding, use and transferability of school-wide approaches.

The longitudinal effects of maltreatment class membership on post-traumatic stress & depression

BACKGROUND

While the link between maltreatment and mental illness has been largely established, there is a need to better understand how certain types or profiles of maltreatment place youth at heightened risk for depression and traumatic stress, and when the risk of developing symptoms may be greatest.

OBJECTIVE

We examined the extent to which youth experiences of maltreatment co-occur and how certain combinations of maltreatment work to influence the subsequent development of depression and post-traumatic stress over time.

PARTICIPANTS & SETTING

Data were drawn from NSCAW-II, a nationally representative longitudinal sample of 5872 child welfare involved youth, aged 0-18.

METHODS

Latent Class Analysis was used to investigate profiles of child maltreatment. We then used a longitudinal three-wave panel design to examine whether membership in various maltreatment classes predicted development of depression and post-traumatic stress measured at two future time points.

RESULTS

Three classes emerged: Class 1 (68 %) the "Neglect and Adverse Parental Behaviors Class", Class 2 (20 %) the "Physical Abuse Class", and Class 3 (12 %) the "Sexual Abuse Class". Membership in Class 2 increased depression and trauma symptoms at Wave 2, compared to Class 1 (b = 1.8 and 1.4, respectively; p < 0.05). Membership in Class 3 increased trauma symptoms at Wave 3, compared to Class 1 and Class 2 (b = 2.3 and 2.7, respectively; p < 0.01).

IMPLICATIONS

Child welfare involved youth need to be appropriately screened for psychiatric health annually and provided with services that correspond with their level of need.

Community Violence Exposure and School Functioning in Youth: Cross-Country and Gender Perspectives

Background: Many children and adolescents experience violent events which can be associated with negative consequences for their development, mental health, school, and social functioning. However, findings between settings and on the role of gender have been inconsistent. This study aimed to investigate cross-country and gender differences in the relationship between community violence exposure (CVE) and school functioning in a sample of youths from three countries. Methods: A self-report survey was conducted among school students (12-17 years old) in Belgium (Antwerp, N = 4,743), Russia (Arkhangelsk, N = 2,823), and the US (New Haven, N = 4,101). Students were recruited from within classes that were randomly selected from within schools that had themselves been randomly selected (excepting New Haven, where all students were included). CVE was assessed with the Screening Survey of Exposure to Community Violence. School functioning was assessed with four measures: the Perceived Teacher Support scale, Negative Classroom Environment scale, and Academic Motivation and Perception of Safety at School scales. Multivariate Analyses of Covariance were performed to assess differences in the levels of school-related problem behaviors in boys and girls, who reported different degrees of CVE. Results: Participants in all three countries reported a relatively high prevalence of violence exposure (36.2% in Belgium, 39.3% in Russia and 45.2% in the US who witnessed violence), with a higher proportion of girls than boys witnessing violent events (varied from 37.4 to 51.6% between the countries), whereas boys reported more episodes of victimization by violence than girls (varied from 32.3 to 49.9% between the countries). Youths who experienced increased CVE (from no exposure to witnessing to victimization) reported an increase in all school functioning problems in all of the countries and this association was not gender-specific. Conclusions: Our findings suggest that regardless of differences in the level of CVE by country and gender, violence exposure is negatively associated with school functioning across countries. Nonetheless, even though reactions to community violence among adolescents may be expressed in a similar fashion, cross-country differences in social support systems should also be taken into account in order to provide culturally sensitive treatment modalities.

The Role of Trauma-Informed Training in Helping Los Angeles Teachers Manage the Effects of Student Exposure to Violence and Trauma

Exposure to trauma, such as community violence, has far-reaching effects on childrens' learning and behavior. While schools are a critical place to provide positive and safe spaces for students, teachers have self-reported a lack of knowledge on how to work effectively with traumatized students. In response to this, there has been an increase in teacher training on trauma-related topics. However, it is unclear how training impacts teachers' trauma knowledge and difficulty responding to traumatized students in the classroom. As such, this exploratory study used a survey (N = 94) with Los Angeles teachers to assess whether training on violence and trauma is related to trauma knowledge and reported difficulty responding to traumatized students. Regression analyses indicate that total training increased teachers' trauma knowledge, which was found to mediate teachers' difficulty responding to traumatized students. Findings from this study support the need for a focus on trauma-informed training within the education context.

Qualitative experiences of Australian mental health staff with students exposed to domestic violence

The prevalence of domestic violence is concerning due to its debilitating impact on the psychological, social and academic functioning of children. This study explored the experiences, strengths and challenges of school mental health staff in relation to students exposed to domestic violence. Interviews with 10 school wellbeing staff working in Victoria, Australia, showed that these staff felt confronted and distressed, and were unsure of their role in managing the complexities associated with students’ exposure to domestic violence. Staff reported the need for educators, students and parents to be educated on domestic violence, and for improved school structures and policies that encourage staff consultation and self-care following students’ disclosures of domestic violence. The results of this study are discussed within the context of trauma-informed practice and multi-tiered mental health promotion in schools.

Prevalence and Characteristics of Posttraumatic Nightmares in War- and Conflict-Affected Students

INTRODUCTION

Recurrent nightmares, frequently associated with traumatic experiences, may impair quality of life and daily functioning. However, there have been few studies of posttraumatic nightmares occurring among children and youth, in particular for trauma-exposed populations in conflict zones.

METHODS

Using two quantitative data sets, this study investigates the prevalence and characteristics of recurrent nightmares among conflict-exposed young people in the Gaza Strip (N = 300) and examines the characteristics of posttraumatic nightmares and their association with academic functioning among treatment-seeking students in Gaza (N = 1093).

RESULTS

Among 300 students (10-12 years old) who lived in the ongoing conflict area in Gaza, nightmares were often mentioned, with 56% reporting recurrent nightmares with an average weekly frequency of 4.20 nights in the past week (SD = 1.94) and a mean duration of 2.48 years (SD = 2.01). Similarly, the large sample of 1093 students (6-17 years of age) who sought help for nightmares and sleep disturbance reported recurrent traumatic nightmares on average 4.57 nights per week, with an average duration of 2.82 years. Their self-reported academic functioning was negatively affected by whether they experienced nightmares but was not associated with nightmare frequency or intensity.

DISCUSSION

Given the high prevalence of nightmares and the relation between nightmares and academic functioning, students in conflict-affected areas appear to be a particularly vulnerable group. This study proposes screening and treating conflict-affected students for recurrent posttraumatic nightmares.

Mitigating adolescent social anxiety symptoms: the effects of social support and social self-efficacy in findings from the Young-HUNT 3 study

Adolescents' exposure to negative life events (NLEs) and potentially traumatic events is highly prevalent and increases their risk of developing psychological disorders considerably. NLE exposure has also been linked to the development of social anxiety disorder (SAD) among older children and young adolescents. Despite the relatively low treatment efficacy reported for children and adolescents suffering from SAD, few studies have addressed the extent to which resilience factors, such as social support and social self-efficacy, are associated with SAD symptoms. This study examined whether social support and social self-efficacy predict, and buffer against SAD symptoms using a large, population-based sample of adolescents, among whom a large proportion have experienced NLEs. The results reveal that NLEs are significantly associated with SAD symptoms, while social support and social self-efficacy are both negatively associated with SAD symptoms. Only the NLEs × social support interaction significantly predicted SAD symptoms, with social support attenuating the association between NLEs and SAD symptoms. Moreover, increases in both social self-efficacy and social support were associated with reduced SAD symptoms, over and above variance explained by social support alone. Our cumulative results suggest that interventions that can modify both social support and social self-efficacy may help reduce SAD symptoms in at-risk adolescents.