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  • Trauma-Informed Schools Part 2: Trauma Sensitive Practices

    Dr. Briana Woods-Jaeger

    Assistant Professor

    Rollins School of Public Health

    Licensed Clinical Psychologist

  • Briana Woods-Jaeger, PhD, MS

    Rollins School of Public Health, Emory University

    Southeast Region MHTTC

    Disclaimer: The opinions expressed herein are the views of the presenters and do not reflect the official

    position of the Department of Health and Human Services (DHHS), SAMHSA. No official support or

    endorsement of DHHS, SAMHSA, for the opinions described in this document is intended or should be


  • Objectives Describe approaches to implement

    trauma-informed practices in schools

    Provide examples of trauma-informed programs and practices

    Discuss staff wellness as a foundation for trauma-informed


    Describe staff wellness tools and resources





  • School Mental Health Interventions


    Multi-Tiered Approach

    Universal: target whole

    school or classrooms

    • Least intrusive, lowest cost

    • Greatest chance of adoption

    • Can be easier than other approaches

    • Need buy in from administrative leaders and

    all school staff

    Fazel et al., 2014

  • School Mental Health Interventions


    Multi-Tiered Approach

    Selective: targeted to

    population subgroups,

    address risk factors

    within higher risk


    • Promote awareness of alternative coping


    • Reduce development of some problem


    • Can be delivered in classrooms or small

    groups for students at high risk

    • Strong evidence for students with risk factors

    and for students with anxiety or depressive


    Fazel et al., 2014

  • School Mental Health Interventions


    Multi-Tiered Approach

    Indicated: overlap

    conceptually with

    mental health

    treatments; can

    include services

    delivered by staff

    employed by



    • Generally show stronger outcomes for clinical

    impairment than universal or selective


    • Community-partnered mental health services

    • Consultation in mainstream schools by mental

    health specialists

    • Some schools provide onsite individual, family

    and group treatment

    • Intensive treatment can take place during the

    school day – more efficient for students and


    Fazel et al., 2014

  • Core Areas of a Trauma-Informed School

    1. Identifying and Assessing Traumatic Stress

    2. Addressing and Treating Traumatic Stress

    3. Trauma Education and Awareness

    4. Partnerships with Students and Families

    5. Creating a Trauma-Informed Learning Environment

    6. Cultural Responsiveness

    7. Emergency Management/Crisis Response

    8. Staff Self-Care and Secondary Traumatic Stress

    9. School Discipline Policies and Practices

    10. Cross System Collaboration and Community Partnerships

    NCTSN, 2017

  • Barriers to Becoming and Sustaining a Trauma-Informed School

    • Limited staffing and funding to screen for trauma

    • Lack of availability of appropriate tools and resources

    • Limited capacity of schools to follow-up with students identified as needing services

    • District-level leadership changes

    • Workforce instability

    • Shifting school and district priorities

    Overstreet & Chafouleas, 2016

  • Poll Question: “What are barriers you have

    faced in becoming a trauma-informed school?”

  • Facilitators to Becoming and Sustaining a Trauma-Informed School

    • Use of familiar frameworks (e.g., MTSS) to align trauma-informed

    approaches with existing educational practices

    • Building from effective school-based mental health models and practices

    • Use of naturalistic resources (i.e., teachers, peers) within schools to

    implement and sustain supports

    • Peer-selected key opinion leader (KOLs) teachers to promote new


    • Inclusion of integrated models

    • Strengthening the active involvement of parents

    Atkins et al., 2008; Atkins et al., 2010; Overstreet & Chafouleas, 2016

  • Examples of Trauma-Informed Programs & Practices in Schools

  • MTSS Approach to TIS

    Brymer et al., 2012; CBITS, n.d.

  • Trauma-Informed Training

    • Increase staff knowledge about prevalence and effects of trauma

    • Increase staff’s ability to recognize signs and symptoms of trauma

    • Improve staff skills in appropriately responding to students exhibiting trauma symptoms

    • Effectively address student behavior

    • Make appropriate referrals

    • Recognize and address secondary traumatic stress and burnout • Staff Wellness*

    Maynard et al. 2019

  • Psychological First Aid for Schools (PFA-S)

    • Designed to reduce the initial distress caused by emergencies and to foster short- and long-term adaptive functioning and coping

    • Identifies individuals who may need additional services and links them to such services as needed

    • Potential to mitigate the development of mental health problems or long-term difficulties in recovery

    Brymer et al., 2012

  • PFA Core Actions Goal: To initiate contacts or to respond to contacts by students and staff in a non-intrusive, compassionate, and helpful manner

    Contact and Engagement

    Goal: To enhance immediate and ongoing safety, and provide physical and emotional comfort Safety and Comfort

    Goal: To calm and orient emotionally overwhelmed or disoriented students and staff Stabilization (if needed)

    Goal: To identify immediate needs and concerns, gather additional information, and tailor Psychological First Aid for Schools interventions to meet these needs

    Information Gathering:

    Current Needs and Concerns

    Goal: To offer practical help to students and staff in addressing immediate needs and concerns Practical Assistance

    Goal: To help establish brief or ongoing contacts with primary support persons or other sources of support, including family, friends, teachers, and other school and/or community resources

    Connection with

    Social Supports

    Goal: To provide information about stress reactions and coping to reduce distress and promote adaptive functioning

    Information on Coping

    Goal: To link students and staff with available services needed at the time or in the future

    Linkage with

    Collaborative Services

    Brymer et al., 2012

  • PFA-S Resources

    Schools can find training resources including the PFA-S Field Operations Guide, resources.

    • PFA-S Field Operations Guide: provides guidance on responding to

    disaster, violence, or terrorism events using the Psychological First Aid


    • PFA-S Webinar: describes the fundamentals of Psychological First Aid

    for Schools. This webinar offers information on how PFA-S helps to

    reduce the distress that school communities can experience after a

    disaster or violent event.

  • PFA Example Intervention: Link

    Communication Skills

    Stress Screener

    Referral to Resources

    Link in Schools Video

  • Link in Schools Pilot Data: Depressive & PTSD Symptoms

    1 Repeated measures ANOVA model controls for student race, grade and sex, flood versus other disaster and correlation within schools


  • Hospital-based Link Study

    Children who received LINK

    had significantly improved

    child behaviors compared to

    children who received

    educational materials:

    Peer relationships

    problems (p=.0240)

    Conduct problems (p=


    UI Children’s Hospital

    Blank Children’s Hospital

    Children’s Minnesota

    Children’s Mercy, Kansas City

  • Link in Schools Process

    summer/early fall summer/early fall fall & spring end of year

    Trauma Informed

    Care training

    delivered to all

    school staff

    Implement Link Program:

    At-risk youth (identified using existing

    school systems) receive one-on-one

    Link session

    End-of-year Link


    On-going Link



    receive Link


  • Cognitive Behavioral Intervention for Trauma in Schools (CBITS)

    • School-based, group and individual intervention; used with students 5th-12th grade

    • Evidence-based intervention program developed for diverse youth exposed to trauma

    • Reduce symptoms of post- traumatic stress disorder (PTSD), depression, and behavioral problems

    • Improves functioning, grades and attendance, peer and parent support and coping skills

    21 CBITS, n.d.

    Program Components

    10 g

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