6.5 Trauma-Informed Practice in Schools

Why Trauma Is Tested

The ETS outline asks candidates to know the impact of trauma on social, emotional, behavioral, and academic functioning and practices to reduce the effects of trauma on learning and behavior. Many students have experienced traumatic events, and trauma-related behavior is easily misread as defiance, laziness, or an attention disorder. School psychologists help schools recognize trauma, respond in ways that do not make it worse, and connect students to effective interventions.

Defining Trauma

SAMHSA (2014) describes individual trauma as resulting from an event, a series of events, or a set of circumstances that is experienced as physically or emotionally harmful or life-threatening, with lasting adverse effects on functioning and well-being. The three E's (event, experience, effects) explain why the same event affects children differently.

Common categories:

• Acute trauma: a single event, such as a car crash or a school shooting.
• Chronic trauma: repeated or prolonged exposure, such as ongoing domestic violence or community violence.
• Complex trauma: exposure to multiple, often interpersonal traumas early in life, frequently within caregiving relationships, with wide effects on development.

Adverse Childhood Experiences (ACEs)

The CDC–Kaiser Permanente ACE Study, first reported by Felitti and colleagues in 1998, asked adults about childhood adversity. The widely used ten-category ACE questionnaire that grew out of the study covers:

The study found a dose-response relationship: the more ACEs, the higher the risk of later health problems, risky behavior, and poor social outcomes. Later work broadened the list to community adversities such as violence, discrimination, and poverty.

Two cautions matter in schools:

• An ACE score describes population risk; it does not predict an individual child's outcome or diagnose anything.
• Schools should not collect ACE scores as a screening tool without a clear purpose, consent, and services ready to respond.

How Trauma Affects Learning and Behavior

The Center on the Developing Child at Harvard distinguishes positive stress (brief, normal), tolerable stress (serious but buffered by supportive relationships), and toxic stress (strong, frequent, or prolonged activation of the stress response without adequate adult support). Toxic stress can disrupt developing brain systems for attention, memory, and emotional regulation.

Trauma reactions can resemble ADHD (inattention, restlessness), oppositional behavior, or depression. A careful history is part of any evaluation for these concerns. PTSD criteria appear in Section 6.1.

SAMHSA's Trauma-Informed Approach

A trauma-informed program or school realizes the widespread impact of trauma, recognizes its signs, responds by integrating that knowledge into policies and practices, and seeks to resist re-traumatization. SAMHSA's six key principles:

1. Safety: physical and emotional safety for students and staff
2. Trustworthiness and transparency: clear, consistent expectations and decisions
3. Peer support: mutual support among people with shared experiences
4. Collaboration and mutuality: sharing power and decision making
5. Empowerment, voice, and choice: building on strengths and offering meaningful choices
6. Cultural, historical, and gender issues: recognizing historical trauma and moving past stereotypes and bias

"Trauma-informed" does not mean having no expectations. It means keeping high expectations while teaching skills, preventing triggers, and responding to dysregulation with regulation first (Section 5.4 on Perry's "Regulate, Relate, Reason").

A Multi-Tiered Model of Trauma Supports

CBITS and Related Programs

• Cognitive Behavioral Intervention for Trauma in Schools (CBITS): a school-based group intervention for students (roughly ages 10–15) with trauma exposure and symptoms. It typically includes 10 group sessions, 1–3 individual sessions, parent sessions, and a teacher education session, and teaches psychoeducation, relaxation, cognitive coping, gradual exposure to trauma reminders, trauma narrative work, and social problem solving. It is delivered by school mental health clinicians.
• Bounce Back: an adaptation of CBITS for elementary students (kindergarten through fifth grade), with more parent involvement.
• Support for Students Exposed to Trauma (SSET): a CBITS adaptation designed to be delivered by teachers or school counselors without clinical training.

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

TF-CBT is an individual treatment with strong evidence for children with PTSD symptoms. Its components are often remembered with the acronym PRACTICE: Psychoeducation and parenting skills, Relaxation, Affect modulation, Cognitive coping, Trauma narrative and processing, In vivo exposure, Conjoint child-caregiver sessions, and Enhancing safety. Because it is intensive and involves a trauma narrative, it is usually delivered by trained clinicians, often through a community partner.

Resilience and Protective Factors

Most children exposed to trauma do not develop lasting disorders. Masten called resilience "ordinary magic": it comes from ordinary protective processes, especially a caring relationship with a competent adult, self-regulation skills, a sense of competence, and connection to school and community. Schools can build these directly.

Avoiding Re-Traumatization

• Avoid restraint and seclusion except in true emergencies (Section 5.3 and Section 10.6).
• Replace harsh, public, or exclusionary discipline with predictable, respectful responses.
• Give warnings and choices during transitions and changes.
• Prepare students before drills that may trigger reminders.
• Protect privacy: do not require students to retell trauma to multiple adults.

Caring for Staff

Working with traumatized students can cause secondary traumatic stress in educators and school psychologists. Supervision, peer support, reasonable caseloads, and self-care are part of a trauma-informed system (NASP Standard II.1.2 on not letting personal problems interfere with effectiveness).