Trauma-Informed High Schools: A Systematic Narrative Review of the Literature

Adverse childhood and school experiences: a retrospective cross-sectional study examining their associations with health-related behaviours and mental health

BACKGROUND

Adverse childhood experiences (ACEs) increase individuals' risks of poor health across the life course. For children that suffer household-based ACEs, experiences in other settings such as schools have the potential to exacerbate or mitigate risks of poor health. However, few studies have examined such effects. This study aimed to examine relationships between household-based ACEs, school experiences and adult health outcomes.

METHODS

A national cross-sectional household survey (N = 1,868 aged 18+) was undertaken in Wales using random quota sampling (November 2022 to March 2023). Measures included nine household-based ACEs; two measures of childhood school experience (having been bullied, sense of school belonging); and adult health outcomes (smoking, binge drinking, low mental wellbeing, mental illness, violence). Associations between ACEs, school experience and health outcomes were examined using chi squared tests and binary logistic regression.

RESULTS

The proportion reporting both having been bullied and lower school belonging increased with ACE count (0 ACEs 6%, 4 + ACEs 51%). Higher ACE count was independently associated with increased risk of all adult health outcomes except binge drinking, while poorer school experience (having been bullied, lower school belonging) was associated with increased risk of low mental wellbeing, mental illness and violence victimisation. For example, adjusted odds of current mental illness rose to 3.98 in those reporting 4 + ACEs (vs. 0 ACEs) and 3.37 in those reporting both having been bullied and lower school belonging (vs. not bullied, higher school belonging). In individuals with 4 + ACEs, adjusted prevalence of current mental illness reduced from 44% in those reporting both having been bullied and lower school belonging to 19% in those reporting not having been bullied and higher school belonging.

CONCLUSIONS

For children who grow up in adverse home environments, exposure to further adversity at school may amplify risks of poorer health and life outcomes. However, schools are opportune settings for children who lack safety and support at home to recover from stress, develop resilience and access support. Trauma-informed approaches in schools that recognise the impacts of adversity and support children to overcome it have the potential to improve educational and health outcomes. Further research is needed to identify effective approaches.

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.

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.

A Systematic Review of School-Based Suicide Prevention Interventions for Adolescents, and Intervention and Contextual Factors in Prevention

Suicide is the fourth leading cause of death among adolescents, globally. Though post-primary, school-based suicide prevention (PSSP) has the potential to be a key strategy for preventing adolescent suicidal thoughts and behaviours (STBs), there are persisting challenges to translating PSSP research to practice. Intervention and contextual factors relevant to PSSP are likely key to both PSSP effectiveness and implementation. As such, this systematic review aimed to summarise the effectiveness of PSSP for adolescent STBs and highlight important intervention and contextual factors with respect to PSSP. PsycINFO, Medline, Education Source, ERIC, Web of Science, and the Cochrane Central Register of Controlled Trials were searched to identify randomised and non-randomised studies evaluating the effectiveness of interventions located in post-primary, school-based settings targeting adolescent STBs. PSSP effectiveness and intervention and contextual factors were synthesised narratively. Twenty-eight studies were retained, containing nearly 47,000 participants. Twelve out of twenty-nine trials comparing intervention and independent control comparators reported statistically significant reductions in STBs postintervention, and 5/7 trials comparing preintervention and postintervention scores demonstrated significant reductions in STBs over time. Reporting and analysis of intervention and contextual factors were lacking across studies, but PSSP effectiveness and intervention acceptability varied across type of school. Although school personnel commonly delivered PSSP interventions, their input and perspectives on PSSP interventions were lacking. Notably, adolescents had little involvement in designing, inputting on, delivering and sharing their perspectives on PSSP interventions. Twenty out of twenty-eight studies were rated as moderate/high risk of bias, with non-randomised trials demonstrating greater risks of bias and trial effectiveness, in comparison to cluster randomised trials. Future research should prioritise complete reporting and analysis of intervention and contextual factors with respect to PSSP, involving key stakeholders (including adolescents and school personnel) in PSSP, and investigating key stakeholders' perspectives on PSSP. Given the inverse associations between both study quality and study design with PSSP effectiveness, particular consideration to study quality and design in PSSP research is needed. Future practice should consider PSSP interventions with universal components and PSSP which supports and involves key stakeholders in engaging with PSSP.