School-Based Trauma Interventions: A Systematic Review

Background and Purpose: Youth exposed to trauma may experience negative psychological and academic consequences, including anxiety, depression, social avoidance, oppositional defiance in school, and poor academic performance. Other youth who have been exposed to trauma may exhibit no signs or symptomatology at all. Since most youth spend most of their time in school settings, where they are asked to meet cognitive and social learning goals, it is important that these spaces are prepared to care for students who may have been exposed to traumatic events. This systematic review was conducted to meet two objectives: (a) determine what school-based trauma interventions have been created and implemented in education settings across the globe and (b) evaluate the effectiveness of these interventions.

Methods: This review was conducted across a range of academic search engines (e.g ERIC, Academic Search Premier, PubMed, SocIndex, Social Work Abstracts, PsycInfo). Inclusion criteria were as follows: 1) studies had to focus on students in grades K-12; 2) interventions had to be strictly school-based and assessed mental/behavioral health, cognitive, or academic outcomes; 3) student participants had to have been exposed directly or indirectly to traumatic or potentially traumatic events; 4) the work had to be published in English. 103 studies across the field were eligible for a final review. 31 studies have been extracted for the current analysis.

Results: Cognitive Behavioral Intervention for Trauma in Schools (CBITS) was the most common intervention, but still was only used in 5/31 (16%) of studies, suggesting that schools used a wide range of clinical trauma response programming. 19/22 (86%) studies that provided aggregated results for intervention participants showed significant improvement on either mental health or behavioral outcomes, including PTSD (6/7, 86%), depression (5/5, 100%), or behavioral outcomes (2/3, 66%).

Conclusions and Implications: Findings here suggest that there are a range of school based trauma interventions that are effective at reducing the negative mental health and behavioral effects of traumatic experiences. Results to date suggest that these interventions may be particularly effective at addressing PTSD and depression symptoms. Further analyses are needed to establish clearer patters in which types of interventions might be most effective given the wide array of interventions that are being employed. Overall, results here confirm that school-based clinical interventions are a promising approach to trauma response, particularly given that schools may provide the best access and consistency for interventions, particularly in under-resourced communities of color where mental health access and stigma are equity issues.