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Asystematicreviewontheimpactoftrauma-informededucationprogramsonacademicandacademic-relatedfunctioningforstudentswhohaveexperiencedchildhoodadversity..pdf
A Systematic Review on the Impact of Trauma-Informed Education Programs on Academic and Academic-Related Functioning for Students
Who Have Experienced Childhood Adversity
Sally Roseby1 and Michael Gascoigne1, 2
1 School of Psychological Science, Australian College of Applied Psychology 2 School of Psychology, The University of Sydney
The purpose of this study was to conduct a systematic review of the existing literature regarding trauma-informed education programs and their impact on academic and academic-related outcomes. The articles included for review (n � 15) contained data on trauma-informed education programs imple- mented in preschool, primary/elementary, and high school settings. Academic and academic-related outcomes reported included attendance, disciplinary referrals, suspension, and academic achievement, as well as student resilience, school attachment, and emotional presentation. Findings from this systematic review highlight that trauma-informed education programs can improve students’ academic and academic-related outcomes; however, results were not consistent across the studies. Moving forward, recommendations include the need for additional trauma-informed school-based research to be conducted and dissemination of this research to ensure school systems are upskilled and responding appropriately to their traumatized students.
Keywords: systemic intervention, adverse childhood experiences, school systems
Adverse childhood experiences (ACEs) are associated with a range of deleterious individual outcomes, such as compromised neurodevelopment (Bick & Nelson, 2016; Chugani et al., 2001; Perry et al., 1995); social, emotional, and behavioral difficulties (Burke et al., 2011; Davis & Petretic-Jackson, 2000; Hanson et al., 2015; van der Kolk, 2005); and reduced cognitive and academic functioning (Australian Childhood Foundation, 2018; Blodgett & Lanigan, 2018; Downey, 2007; Perfect et al., 2016). The impor- tance of mitigating the impact of ACEs is further underscored by their association with several adverse social outcomes, such as lower rates of educational accomplishment (Blue Knot Founda- tion, 2015), lower levels of employment (Hardcastle et al., 2018; Liu et al., 2013), and reduced income and lifetime productivity (Covey et al., 2013; Currie & Widom, 2010; Zielinski, 2009). Therefore, determining whether a school-based intervention may improve academic functioning for those who have experienced childhood adversity is of clinical and social significance. In par- ticular, understanding the impact trauma-informed intervention can have on increasing education participation and academic func- tioning in students with a history of ACEs is important. Further- more, with no systematic reviews and/or meta-analyses located in the peer reviewed literature addressing the impact of trauma-
informed education programs on academic or academic-related outcomes, this research seeks to address a gap in the empirical literature. Additionally, it will help inform future clinical work, including school-based work.
The Prevalence of Childhood Adversity
ACEs are prolonged or cumulative traumatic events that have both an immediate and lifelong impact (Felitti et al., 1998; van der Kolk, 2005). They can occur at an individual or familial level and include child abuse or neglect (i.e., sexual, physical, or verbal abuse; emotional or physical neglect), family dysfunction, or stress (i.e., incarcerated household member, domestic violence, divorce or separation, death of a parent, household substance abuse, and household member with a mental or physical illness; Felitti et al., 1998). Moreover, the National Child Traumatic Stress Network reports that childhood trauma occurs when children experience a traumatic event (i.e., neglect or abuse), which can be either acute or chronic, that can overwhelm a child’s ability to cope with the trauma they have experienced (Iachini et al., 2016).
The prevalence of childhood trauma has been widely re- searched, with an estimated five million Australian adults im- pacted (Blue Knot Foundation, 2015). Furthermore, Australian child protection statistics highlight that approximately 225,000 children were harmed or suspected of being at risk of harm from abuse and/or neglect during 2015–2016 (Australian Institute of Family Studies, 2017). With childhood adversity identified as a common occurrence and child protection figures reportedly in- creasing (Australian Institute of Family Studies, 2017) our concern then shifts to considering the impact of intervention on individuals with a history of ACEs.
Sally Roseby X https://orcid.org/0000-0002-5960-2407 Michael Gascoigne X https://orcid.org/0000-0002-2786-7355 Correspondence concerning this article should be addressed to Michael
Gascoigne, School of Psychological Science, Australian College of Ap- plied Psychology, Level 11, 255 Elizabeth Street, Sydney, New South Wales 2000, Australia. Email: [email protected]
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Traumatology © 2021 American Psychological Association 1085-9373/21/$12.00 https://doi.org/10.1037/trm0000276
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2021, Vol. 27, No. 2, 149-167
This article was published Online First January 18, 2021.
Intervention and Its Impact on Outcomes
Our understanding of intervention as a moderator between childhood adversity and various outcomes is still developing (Perfect et al., 2016). To demonstrate, Skowron and Reinemann (2005) and Weiner et al. (2011) both completed meta-analyses on the effectiveness of psychological interventions for child maltreatment. Although both meta-analyses recognized that in- tervention enhanced functioning, intricacies were noted. Sur- prisingly, neither meta-analysis included academic functioning as an outcome variable. Nevertheless, it has been suggested that mental health treatment can have a positive impact on students’ educational outcomes (Baskin et al., 2010; Becker et al., 2014). Moreover, when discussing intervention, it is vital to emphasize the need for unified systems of care and systemic level inter- vention, that is, trauma-informed school settings (Chafouleas et al., 2016).
School-Based Intervention
Education offers a significant intervention opportunity for stu- dents who have experienced childhood adversity (Brunzell et al., 2016), with schools uniquely situated to support their traumatized students (Soleimanpour et al., 2017). Additionally, recovery from trauma is no longer viewed as taking place solely within counsel- ing settings, with educators supporting this and recognizing they too can help traumatized children, by providing a nurturing and safe school environment (Berardi & Morton, 2017). With the positive impact of school-based trauma-specific interventions on students’ traumatic stress symptoms already accepted (Rolfsnes & Idsoe, 2011), the advantages of trauma-informed approaches in schools is also increasing in acceptance (see Overstreet & Cha- fouleas, 2016).
Being trauma informed means understanding the impact of trauma on neurobiology, neurodevelopment, and attachment (Kin- niburgh et al., 2005). This understanding allows educators to integrate this knowledge into the fabric of the school community and provides a perspective to the complex challenges faced daily by their traumatized students (Morton & Berardi, 2018). Substance Abuse and Mental Health Services Administration (SAMHSA) state that,
A program, organization or system that is trauma-informed realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist retraumatization. (SAM- HSA, 2014, p. 9)
Therefore, trauma-informed schools respond to the needs of their students by integrating effective practices, programs, and proce- dures into all aspects of the school culture (Overstreet & Chafou- leas, 2016). These practices, programs, and procedures may in- clude trauma-informed school leadership, trauma-informed policies and procedures, professional development for school staff, adequate financing, and a safe school environment (Kataoka et al., 2018).
The Current Study
The aim of this systematic review is to summarize the existing literature regarding the impact of trauma-informed education pro- grams on academic and academic-related functioning for students with a history of ACEs. By updating the literature across academic and academic-related functioning more broadly within a single systematic review, this will allow for a broad range of directions for future research to be provided. Furthermore, this research is of clinical and social importance to understanding the impact of trauma-informed intervention on academic functioning.
Method
Literature Search
This systematic review process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA; Moher et al., 2009). PRISMA contains an evidence- based guide for the identification and categorizing of published articles throughout the literature review process. Consistent with these guidelines, this systematic review was prospectively regis- tered on the National Institute for Health Research PROSPERO International Prospective Register of Systematic Reviews website (registration number: CRD42018117662). The following research databases were systematically searched during February and March, 2019: PubMed, Web of Science, PsycINFO, Education Resources Information Centre (ERIC), as well as 11 journals that contain the word “school” (i.e., Journal of School Psychology, School Psychology Quarterly, School Mental Health, School Psy- chology Review, Psychology in the Schools, School Psychology International, Intervention in School and Clinic, Advances in School Mental Health Promotion, Journal of Applied School Psy- chology, Canadian Journal of School Psychology, Preventing School Failure). The databases and journals selected cover a varied range of education, psychological, medical, and sociologi- cal research topics. To review some of the gray literature, a search of dissertations was included within the search of the PsycINFO database.
The following keywords were used in the search: adverse child- hood experiences; negative life events; trauma; childhood adver- sities; posttraumatic stress. Choosing to use broad terminology as opposed to more narrow definitions (i.e., child sexual abuse, neglect) guarded against the limitation of not capturing all the relevant studies as a result of using too narrow definitions of trauma. Additionally, this allowed for the broader definition as outlined by the National Child Traumatic Stress Network to be adopted, that is, childhood trauma occurs when children experi- ence a traumatic event (e.g., abuse, neglect, or victimization), which can be either short term (i.e., acute) or long term (i.e., chronic), that can overwhelm a child’s ability to cope with a traumatic experience (Iachini et al., 2016). The following key- words were then added: intervention; treatment; therapy; counsel- ing; group; program�; trauma-informed; alternate setting. Finally, we added keywords regarding the following outcomes: educat�; achievement; academic; grades; discipline; attendance. The pres- ence of an asterisk in the keywords indicates that all applicable terms beginning with that root were used. Due to the large number of studies being returned and the focus being on school environ-
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ROSEBY AND GASCOIGNE150
ments, limiters were put in place. See Table 1 for the relevant search strategies and limiters used in each database.
Inclusion Criteria
Studies were included in the systematic review if they met the following inclusion criteria: (a) involved a trauma-informed edu- cation program being implemented at a whole school level (even if results were only reported for one segment of the whole school intervention); (b) targeted participants who have been exposed to childhood adversity whether directly or indirectly; (c) measured an academic, that is, grades, attendance, academic achievement, stan- dardized achievement, discipline (as outlined in Perfect et al., 2016), or academic-related outcome, that is, resilience, behavior, school attachment, or student–teacher relationship (as outlined in Baskin et al., 2010); (d) must be in English. Studies were excluded from the systematic review if they (a) did not report evidence of increasing trauma-informed knowledge in school teachers or other education staff (as outlined in Kataoka et al., 2018) or (b) de- scribed a multitier system of support that was not explicitly re- ported as trauma-informed (see Chafouleas et al., 2016, for more information on trauma-informed multitiered systems of support).
Articles chosen for inclusion or exclusion to this systematic review are documented according to the PRISMA Statement (Moher et al., 2009). Figure 1 illustrates the literature search conducted in the four identified databases, subsequent identi- fied journals and articles, and the application of the inclusion and exclusion criteria.
As shown in Figure 1, five articles were unable to be sourced, despite them appearing in the results of our literature search. These articles could not be located, despite attempting to locate or directly approaching the corresponding authors of these articles.
Data Coding
Studies that met the inclusion criteria for the systematic review were individually coded by Sally Roseby to assist in evaluating the research design and fields of interest contained in each article. Based on the inclusion criteria and rationale of the current review, each study was coded along the following methodological and treatment variables and characteristics: (a) authors; (b) journal; (c) sample size/school size; (d) basic study type/design; (e) study setting (i.e., mainstream or alternate school setting); (f) method/s used to gather data (i.e., self- report, assessment, parent report, teacher report, etc.); (g) length of time trauma-informed education program was imple- mented at setting (if applicable); (h) theoretical underpinning of intervention (i.e., was the trauma-informed education program based on one particular approach); (i) outcome areas examined (i.e., academic or academic-related outcome); and (j) overall findings. We also included specific variables of the participants (where applicable) and their experienced childhood adversities, including (a) sex of participants; (b) age mean or age range; (c) types of trauma experienced (i.e., abuse, neglect, various, acute
Table 1 Search Strategy Used (Including Limiters) for Each Database Search Completed
Database Search string Limiters applied
Pub Med (“adverse childhood experiences” OR “negative life events” OR trauma OR “childhood adversities” OR “post-traumatic stress”) AND (intervention OR treatment OR therapy OR counselling OR counseling OR group OR program OR programme OR “trauma-informed” or “alternate setting”) AND (education OR achievement OR academic OR grades OR discipline OR attendance) AND psychology
And psychology added to search string Limited to child-birth–18 years
Web of Science (“adverse childhood experiences” OR “negative life events” OR trauma OR “childhood adversities” OR “post-traumatic stress”) AND (intervention OR treatment OR therapy OR counselling OR counseling OR group OR program OR programme OR “trauma-informed” or “alternate setting”) AND (educat� OR achievement OR academic OR grades OR discipline OR attendance) AND (infant OR child OR adolesce� OR minors OR pediatric OR pediatric)
PsycINFO (included dissertations search)
(“adverse childhood experiences” OR “negative life events” OR trauma OR “childhood adversities” OR “post-traumatic stress”) AND (intervention OR treatment OR therapy OR counselling OR counseling OR group OR program OR programme OR “trauma-informed” or “alternate setting”) AND (educat� OR achievement OR academic OR grades OR discipline OR attendance)
Narrowed by subject age, including preschool age (2–5 years), school age (6–12 years), adolescence (13– 17 years), and childhood (birth–12 years)
ERIC (“adverse childhood experiences” OR “negative life events” OR trauma OR “childhood adversities” OR “post-traumatic stress”) AND (intervention OR treatment OR therapy OR counselling OR counseling OR group OR program OR programme OR “trauma-informed” or “alternate setting”) AND (educat� OR achievement OR academic OR grades OR discipline OR attendance)
No limiters applied
Note. ERIC � Education Resources Information Centre.
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CHILDHOOD ADVERSITY AND ACADEMIC FUNCTIONING 151
or chronic). Lastly, specific consequences associated with the experienced trauma were also included, that is, depression or traumatic stress symptoms (if applicable).
Results
A total of 15 articles were identified that examined trauma- informed education programs and their impact on academic or academic-related outcomes. These articles were conducted in a variety of educational settings including preschools, primary/ elementary schools, and high schools. They included a diverse range of trauma-informed education programs as well as vari- ous academic or academic-related outcomes. These are dis- cussed below, with the trauma-informed theories and models discussed and the articles organized into intervention settings, that is, preschool, primary/elementary, or high school.
Interventions Used Across the Studies
Among the 15 articles reviewed, there were several trauma- informed theories and models employed to support with up- skilling educators and implementing trauma-informed systems. See Table 2 for a summary of the trauma-informed theories and models employed across the 15 articles reviewed. To highlight the diversity, eight different trauma-informed theories and mod- els were identified in this systematic review; however, there was some overlap, with several studies drawing from the same model of implementation. To illustrate, four studies (Dorado et al., 2016; Holmes et al., 2015; Mitchell, 2016; Pfenninger Saint Giles, 2016) used the attachment, self-regulation and compe- tency model (Blaustein & Kinniburgh, 2010) to inform their trauma-informed approach, with four additional studies (Baroni et al., 2016; Crosby et al., 2017, 2018; Day et al., 2015) using
Figure 1 Flowchart of the Literature Search and Documentation of the Screening, Inclu- sion, and Exclusion Processes
3282 ar�cles iden�fied in the Pub Med database
2648 ar�cles iden�fied in the Web of Science database
2503 ar�cles iden�fied in the PsycINFO database
339 ar�cles iden�fied in the ERIC database
7921 ar�cles, a�er 851 duplicates iden�fied
7921 �tles and abstracts screened
135 full text ar�cles were reviewed
10 papers were selected for the systema�c review
15 papers were selected for the systema�c review
0 addi�onal papers were included a�er searching specific journals with the word ‘school’
4 addi�onal papers were included a�er screening reference lists of iden�fied ar�cles and other relevant ar�cles
120 were excluded on the basis of the inclusion and exclusion criteria, with 5 unable to be located
1 addi�onal paper included due to authors knowledge
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Table 2 Description of Trauma-Informed Theories and Models
Intervention Description of intervention Articles that used intervention
Attachment, self-regulation and competency (ARC) model (Blaustein & Kinniburgh, 2010)
The ARC model is a guideline for working with traumatized children in the community
Dorado et al., 2016; Holmes et al., 2015; Mitchell, 2016; Pfenninger Saint Giles, 2016The ARC model addresses trauma in three main areas: (a)
attachment (e.g., building adult affect management and attunement skills as well as building routines and rituals), (b) self-regulation (e.g., developing appropriate emotion identification, modulation, and expression skills in individuals impacted by trauma), (c) competency (e.g., developing executive functioning skills as well as self- development and identity in individuals impacted by trauma).
Berry St education model (BSEM; Brunzell et al., 2016)
BSEM draws on neuro-scientific findings and outlines domains and themes for teachers to work through sequentially with their students.
Stokes & Turnbull, 2016
The BSEM comprises five domains: body, stamina, engagement and character, all anchored by relationships. Within each of these domains there are themes and specific teaching strategies and recommendations provided, e.g., the domain of body includes themes, specific teaching strategies, and recommendations for “de- escalation,” “present, centered, grounded,” “mindfulness,” and “self-regulation.”
Multitiered system of supports Multitiered systems of support offer three tiers of services to students, staff and the wider system; these include universal strategies, targeted strategies and intensive strategies. These supports are further scaffolded with work-force development trainings.
Dorado et al., 2016; Hatchett et al., 2017; Judge, 2018; Shamblin et al., 2016
Intervention components for trauma-informed multitiered systems of support can include universal consultations with teachers on a weekly basis, universal classroom training for students on coping with stress, targeted resiliency and trauma curriculum (i.e. REACH program), intensive crisis support for trauma-impacted school staff.
Work-force development trainings for trauma-informed multitiered systems of support can include the child trauma academy’s neuro-sequential model of therapeutics (Perry & Hambrick, 2008) and trauma-focused cognitive behavior therapy (Cohen et al., 2006) or more individualized training packages that focus on the neurobiological and physiological impact of complex trauma on students.
PACE Centre for Girls PACE Centre for Girls is a nonprofit organization that serves girls of middle and high school age. They use a “gender-responsive” framework for its academic services. “Gender-responsive” treatment approaches are designed for girls, specifically those involved with or at risk of involvement with the juvenile justice system. PACE’s program model promotes safety and positive relationships and uses strengths-based and trauma-informed approaches. PACE also rolled out in-person staff training on its key pillars as a gender-responsive, strengths-based, and trauma-informed program.
Millenky et al., 2019
Risking connection (Saakvitne et al., 2000)
Risking connection is a staff training curriculum for working specifically with survivors of childhood abuse, with an emphasis on “collaboration” with the client as opposed to “control” of the client’s dangerous behaviors. The main components of the Risking Connection curriculum are (a) an understanding of trauma, (b) importance of the relationship between client and “treater,” (c) safety, including maintaining physical and emotional safety while establishing healthy boundaries, (d) transforming vicarious trauma experienced by the treater.
Gonshak, 2011
(table continues)
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CHILDHOOD ADVERSITY AND ACADEMIC FUNCTIONING 153
a modified version of the heart of teaching and learning: com- passion, resiliency and academic success program (Wolpow et al., 2009) as well as the monarch and dream catcher rooms.
Preschool
Three articles were identified that examined trauma-informed education programs and their impact on academic-related out- comes in preschool settings, with these summarized in Table 3. Preschool environments promote emotional regulation and assist children to control their behavioral impulses, essential skills that
help promote (or conversely interfere) with later learning (Sham- blin et al., 2016). As a result, a greater emphasis is placed on academic-related outcomes in the literature regarding preschool settings, as opposed to other direct academic outcomes, such as attendance or grades. All identified articles reported significant impacts on some (not all) academic-related outcomes based on exposure to the trauma-informed education program (Holmes et al., 2015; Pfenninger Sant Giles, 2016; Shamblin et al., 2016).
Improvements were noted in all studies, despite differences in implementation, domains assessed, and study design. Shamblin et
Table 2 (continued)
Intervention Description of intervention Articles that used intervention
School-based collaboration School-based collaboration provides evidence based, trauma- informed models of interventions that support children, teachers, and the school community.
Mitchell, 2016
The school-based collaboration on-site teams provide individual and group therapy services for students, consultation, and staff support regarding critical-incident response, as well as services to the wider school community. On-site staff also provide ongoing psychoeducation and parent–teacher consultation as well as facilitating positive discipline practices and trauma- informed school and classroom procedures.
The heart of teaching and learning: compassion, resiliency and academic success program (Wolpow et al., 2009) as well as the monarch and dream catcher rooms
The heart of teaching and learning: compassion, resiliency and academic success is an integrated, manualized curriculum based on attachment and ecological theories applied using psychoeducational, cognitive–behavioral and relational approaches (Day et al., 2015). Six modules were presented, including (a) background and definitions of trauma, (b) compassionate schools and survival, (c) self-care, (d) curriculum domains and specific strategies, (e) collaborative problem solving, (f) role plays, games, and case vignettes (Day et al., 2015). A modified version was used that also presented diversity-related issues including gender and racial identity, therapy training, and additional emphasis on developing healthy relationships between students and school staff (Day et al., 2015).
Baroni et al., 2016; Crosby et al., 2017, 2018; Day et al., 2015
The monarch room is an alternative to traditional school exclusionary policies. When students become dysregulated, they can self-refer or be referred by school staff to the monarch room. The monarch room is managed by staff trained in counseling, trauma, and sensory-integration interventions. Once in the monarch room, students are provided with coregulation and strategies to assist them in de-escalating and regulating their emotions, to ultimately return back to the classroom. monarch room use is usually restricted to 10 minutes. If students need more than 10 minutes, they are referred to the dream catcher room.
The dream catcher room is an expansion of the monarch room and provides students with additional time and assistance to de-escalate and regulate their emotions. Students can remain in the dream catcher room for the whole school day if necessary (Day et al., 2015).
Individualized model Perry and Daniels (2016) developed an individualized model and framework for the delivery of their trauma-informed education program. Staff training used a combination of online trauma-specific websites and published articles (e.g., NCTSN.org; Australian Childhood Foundation, 2018), with classroom workshops on the impact of stress on behavior informed by student feedback. Cognitive behavioral intervention for trauma in the schools program (Jaycox et al., 2018), a manualized 10-week small group intervention, was also used.
Perry & Daniels, 2016
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ROSEBY AND GASCOIGNE154
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ch ild
re n
an d
fa m
ili es
(f un
de d
sc ho
ol s
on ly
)
Fu nc
tio na
l as
se ss
m en
t of
ch ild
re n
(s oc
ia l,
em ot
io na
l, an
d be
ha vi
or al
fu nc
tio ni
ng to
in di
ca te
re si
lie nc
e) ,
as w
el l
as te
ac he
r co
nf id
en ce
an d
co m
pe te
nc e
to su
pp or
t so
ci al
- em
ot io
na l
de ve
lo pm
en t,
qu al
ity of
th e
pr es
ch oo
l en
vi ro
nm en
t an
d te
ac he
r sa
tis fa
ct io
n w
ith co
ns ul
ta nt
D at
a co
lle ct
ed de
m on
st ra
te d
a po
si tiv
e im
pa ct
on ch
ild re
si lie
nc e.
Po si
tiv e
im pa
ct s
w er
e al
so re
po rt
ed on
te ac
he r
co m
pe te
nc e
an d
co nf
id en
ce ,
te ac
he r
ap pr
ec ia
tio n
of se
rv ic
es pr
ov id
ed ,
te ac
he r
sk ill
s an
d st
re ss
re du
ct io
n in
th e
cl as
sr oo
m .
Fu nd
ed pr
es ch
oo ls
ou tp
er fo
rm ed
co ns
ul ta
tio n
by re
qu es
t se
rv ic
es ,
w ith
le ng
th of
in te
rv en
tio n
al so
im pa
ct in
g re
su lts
, i.e
., fu
nd ed
pr es
ch oo
ls w
ith lo
ng er
im pl
em en
ta tio
n pe
ri od
s re
po rt
ed be
tte r
re su
lts .
H ol
m es
et al
. (2
01 5)
H ea
d St
ar t
pr og
ra m
s (p
re sc
ho ol
ch ild
re n
ag ed
3– 5)
.
n �
15 0
(r ec
ip ie
nt s
of in
te ns
iv e
se rv
ic es
); 1,
10 0
to ta
l en
ro lle
d in
sc ho
ol s
(a cr
os s
m ul
tip le
si te
s)
Q ua
nt ita
tiv e
(p ar
en t/c
ar eg
iv er
re po
rt on
tr au
m at
ic hi
st or
y of
ch ild
, pa
re nt
/c ar
eg iv
er re
po rt
on ch
ild be
ha vi
or vi
a C
hi ld
B eh
av io
r C
he ck
lis t,
te ac
he r
re po
rt on
ch ild
be ha
vi or
vi a
T ea
ch er
R ep
or t
Fo rm
an d
cl in
ic ia
n re
po rt
s on
qu al
ity of
re la
tio ns
hi ps
in th
e pr
es ch
oo l
en vi
ro nm
en t
vi a
th e
C la
ss ro
om A
ss es
sm en
t Sc
or in
g Sy
st em
)
20 11
–2 01
2 ac
ad em
ic sc
ho ol
ye ar
H ea
d St
ar t
T ra
um a
Sm ar
t tr
ai ni
ng (b
as ed
on th
e at
ta ch
m en
t, se
lf -
re gu
la tio
n an
d co
m pe
te nc
y m
od el
), as
w el
l as
co ns
ul ta
tio n
an d
ps yc
ho ed
uc at
io na
l su
pp or
t fo
r st
af f
an d
in te
ns iv
e in
di vi
du al
tr au
m a-
fo cu
se d
in te
rv en
tio n
fo r
st ud
en ts
C hi
ld be
ha vi
or an
d qu
al ity
of re
la tio
ns hi
ps in
th e
cl as
sr oo
m en
vi ro
nm en
t
D at
a co
lle ct
ed de
m on
st ra
te d
po si
tiv e
ch an
ge s
in at
te nt
io n,
ex te
rn al
iz in
g pr
ob le
m s,
at te
nt io
n de
fi ci
t/ hy
pe ra
ct iv
ity pr
ob le
m s,
op po
si tio
na l
de fi
an t
pr ob
le m
s an
d in
te rn
al iz
in g
pr ob
le m
s fo
r ch
ild re
n w
ho re
ce iv
ed in
te ns
iv e
se rv
ic es
. W
hi le
tu rn
ov er
is su
es w
er e
re po
rt ed
, th
e ov
er al
l tr
en d
re ga
rd in
g th
e qu
al ity
of re
la tio
ns hi
ps in
th e
cl as
sr oo
m w
as “m
ov in
g in
th e
de si
re d
di re
ct io
n” (H
ol m
es et
al .,
p. 8)
.
(t ab
le co
nt in
ue s)
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an Ps
yc ho
lo gi
ca l
A ss
oc ia
tio n
or on
e of
its al
lie d
pu bl
is he
rs .
T hi
s ar
tic le
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
CHILDHOOD ADVERSITY AND ACADEMIC FUNCTIONING 155
T ab
le 3
(c on
ti nu
ed )
C ita
tio n
Se tti
ng Pa
rt ic
ip an
ts (n
) M
et ho
ds us
ed to
ga th
er in
fo rm
at io
n L
en gt
h of
in te
rv en
tio n
In te
rv en
tio ns
us ed
D om
ai ns
as se
ss ed
(o ut
co m
es )
Su m
m ar
y of
re su
lts
Pf en
ni n-
ge r
Sa in
t G
ile s
(2 01
6)
H ea
d St
ar t
pr es
ch oo
l (c
hi ld
re n
ag es
3– 4)
n �
10 6
(S pl
it in
to a
tr au
m a
an d
no tr
au m
a co
nd iti
on ba
se d
on A
C E
sc or
es )
Q ua
lit at
iv e
(m en
ta l
he al
th an
d ad
m in
is tr
at iv
e st
af f
se lf
-r ep
or t
on T
ra um
a- In
fo rm
ed A
ge nc
y A
ss es
sm en
t, di
re ct
ob se
rv at
io ns
of te
ac he
r pr
ac tic
es ,
te ac
he r
se lf
- re
po rt
on sa
tis fa
ct io
n w
ith im
pl em
en ta
tio n
of pr
og ra
m )
Q ua
nt ita
tiv e
(q ua
lit y
of re
la tio
ns hi
ps in
th e
pr es
ch oo
l en
vi ro
nm en
t, te
ac he
r an
d ca
re gi
ve r
ra tin
gs of
ch ild
be ha
vi or
an d
tr au
m a
ex po
su re
, te
ac he
r se
lf -r
ep or
t of
se co
nd ar
y tr
au m
a)
4 m
on th
s pr
et es
t to
po st
te st
(2 01
4 sc
ho ol
ye ar
)
T ea
ch er
an d
te ac
he r
as si
st an
ts pa
rt ic
ip at
ed in
tw o,
ha lf
-d ay
tr ai
ni ng
s ov
er th
e pe
ri od
of 6
w ee
ks re
ga rd
in g
tr au
m a-
in fo
rm ed
pr ac
tic e
(b as
ed on
th e
at ta
ch m
en t,
se lf
- re
gu la
tio n
an d
co m
pe te
nc y
m od
el ).
T hi
s w
as co
m pa
re d
w ith
an in
te rv
en tio
n as
us ua
l pr
og ra
m (A
l’ s
Pa ls
).
So ci
al an
d em
ot io
na l
ou tc
om es
fo r
H ea
d St
ar t
st ud
en ts
w ho
ex pe
ri en
ce d
tr au
m a
an d
th ei
r pe
er s
w ho
ha ve
no t.
H ea
d St
ar t
ag en
cy at
tit ud
es ,
te ac
he r
pr ac
tic es
, an
d cl
as sr
oo m
cl im
at e
w er
e al
so in
ve st
ig at
ed .
In fo
rm at
io n
an d
da ta
co lle
ct ed
di d
no t
de m
on st
ra te
si gn
if ic
an t
di ff
er en
ce s
in ex
te rn
al iz
in g,
at te
nt io
n de
fi ci
t hy
pe ra
ct iv
ity di
so rd
er ,
an d
pr ot
ec tiv
e fa
ct or
s be
tw ee
n th
e tw
o gr
ou ps
; ho
w ev
er ,
si gn
if ic
an t
di ff
er en
ce s
be tw
ee n
ch ild
re n
in th
e tw
o gr
ou ps
on th
e co
m bi
na tio
n of
st ud
en t’
s pr
ot ec
tiv e
fa ct
or s,
be ha
vi or
al co
nc er
ns ,
an d
in te
rn al
iz in
g an
d ex
te rn
al iz
in g
be ha
vi or
s w
er e
fo un
d. T
he se
ef fe
ct s
w er
e ev
id en
t fo
r al
l ch
ild re
n, ir
re sp
ec tiv
e of
tr au
m a
hi st
or y.
Im po
rt an
tly ,
ch ild
re n
w ith
tr au
m a
hi st
or ie
s an
d in
th e
in te
rv en
tio n
gr ou
p sh
ow ed
fe w
er co
nc er
ns re
ga rd
in g
in te
rn al
iz in
g be
ha vi
or s
po st
in te
rv en
tio n.
N ot
e. A
C E
� ad
ve rs
e ch
ild ho
od ex
pe ri
en ce
.A l’
s Pa
ls is
a cl
as sr
oo m
cu rr
ic ul
um an
d te
ac he
r tr
ai ni
ng pr
og ra
m th
at te
ac he
s so
ci al
em ot
io na
ls ki
lls in
ch ild
re n
ag ed
3– 8
ye ar
s. H
ea d
St ar
tT ra
um a
Sm ar
t tr
ai ni
ng is
a tr
ai ni
ng pr
og ra
m de
ve lo
pe d
fo r
H ea
d St
ar te
ar ly
le ar
ni ng
ce nt
er s,
us in
g ex
is tin
g ev
id en
ce -i
nf or
m ed
m od
al iti
es an
d m
ak in
g m
od if
ic at
io ns
as ne
ed ed
to cr
ea te
a un
iq ue
ap pr
oa ch
to w
or ki
ng w
ith ch
ild re
n ag
ed 3–
5 an
d th
ei r
fa m
ili es
.
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an Ps
yc ho
lo gi
ca l
A ss
oc ia
tio n
or on
e of
its al
lie d
pu bl
is he
rs .
T hi
s ar
tic le
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
ROSEBY AND GASCOIGNE156
al. (2016) found that embedded trauma-informed education pro- grams were more effective than consultation by request services for improving relational resilience and classroom behavior of students. Interestingly, teachers working within these embedded programs also reported increased competence and confidence in managing classroom behaviors and also demonstrated a reduction in the use of negative behavior management strategies (Shamblin et al., 2016). Holmes et al. (2015) reviewed the impact of Head Start Trauma Smart training and intensive services on child out- comes for children referred to the program whom may have also experienced chronic trauma, with improvements in attention, ex- ternalizing, and internalizing problems reported. Lastly, for chil- dren with a trauma history who received a trauma intervention (i.e., their teachers had undergone trauma training), improvements regarding internalizing behaviors post intervention were reported; however, no differences were found regarding attention, external- izing behavior, or protective factors (Pfenninger Saint Giles, 2016).
Primary/Elementary School
Five articles were identified that examined trauma-informed education programs and their impact on academic or academic- related outcomes in a primary/elementary school setting. Where articles included participants across settings, that is, from Kinder- garten to Year 8, articles were categorized based on the majority of participants included. Three articles reviewed the impact of em- bedded trauma-informed education interventions (Dorado et al., 2016; Perry & Daniels, 2016; Stokes & Turnbull, 2016), with an additional two articles reviewing the impact of targeted support, that is, use of targeted funding for students identified as home- less (Hatchett et al., 2017) and targeted psychotherapeutic ser- vices within a wider trauma-informed education setting (Mitch- ell, 2016). Four out of the five identified articles reported improvements on some (but not all) academic or academic- related outcomes. Details related to all five articles are summa- rized in Table 4.
Positive results were reported for student well-being, achieve- ment, behavior, and engagement as a result of a trauma-informed positive education program, with positive changes on the devel- opment of relationships and self-awareness also reported (Stokes & Turnbull, 2016). Although findings were not consistent across settings (possibly due to implementation differences), positive impacts were reported on student’s literacy and numeracy achieve- ment, with decreases in suspension rates also reported (Stokes & Turnbull, 2016). For students who received targeted intervention within a wider trauma-informed program, positive changes were reported regarding their school attendance, their ability to learn, their time spent in the classroom, their time on task in the class- room, and reduced disciplinary incidents (e.g., physical aggression and school suspensions; Dorado et al., 2016).
Perry and Daniels (2016) reviewed the impact of trauma- informed practices (universal and targeted) on students’ acquisi- tion of coping skills and posttraumatic stress disorder (PTSD) symptomology (as a result of the established link between healthy socioemotional development and academic success; SAMHSA, 2014, as cited in Perry & Daniels, 2016). Students who attended universal classroom workshops reported having a better under-
standing of how to relax, trust others, and worry less (Perry & Daniels, 2016). Furthermore, students who received targeted in- tervention experienced a reduction in meeting criteria for PTSD; however, many students still met symptom criteria for at least one of the reaction indices (i.e., reexperiencing, avoidance, or in- creased arousal; Perry & Daniels, 2016).
Hatchett et al. (2017) reviewed the impact of targeted funding, including trauma-informed services implemented as a result of this funding, on the academic outcomes of homeless students in a school district. Despite the additional targeted funding and trauma- informed support for students identified as homeless, no positive impact was found on attendance, achievement, or behavior be- tween students identified as homeless and controls (Hatchett et al., 2017). Regarding student social and emotional needs, it was hy- pothesized that existing universal supports may have already been effective in meeting the needs of students identified as homeless (Hatchett et al., 2017). Lastly, Mitchell (2016) reviewed the impact of targeted psychotherapeutic services (offered within a wider trauma-informed education program) on the academic and school needs, emotional and behavioral needs, cultural factors, and health and basic needs of students. Although therapeutic services were shown to not positively impact student’s academic, cultural fac- tors, health, or basic needs, improvements were noted for students social and emotional needs (Mitchell, 2016).
High School
Seven studies were identified that examined trauma-informed education programs and their impact on academic or academic- related outcomes in a high school setting (see Table 5). Four of these studies appear to have been conducted in the same educa- tional setting, with one of these studies (Baroni et al., 2016) conducted during the same academic years as the three other studies (Crosby et al., 2017, 2018; Day et al., 2015). Six articles reviewed the impact of embedded trauma-informed education in- terventions (Baroni et al., 2016; Crosby et al., 2017, 2018; Day et al., 2015; Gonshak, 2011; Millenky et al., 2019), with an addi- tional article reviewing the impact of a targeted tier of a trauma- informed multitier system of supports (Judge, 2018). One located article did not find positive impacts on either academic or academic-related outcomes as a result of the trauma-informed education program (Gonshak, 2011). Nonetheless, a majority of identified articles reported positive impacts on some (not all) academic or academic-related outcomes based on exposure to the trauma-informed education program.
Crosby et al. (2018) found that students (and teachers) used a trauma-informed disciplinary alternative (the monarch room) to effectively manage student emotion dysregulation, with most users of the monarch room successfully returning to class after their visit, instead of escalating to the point of suspension. Furthermore, Baroni et al. (2016) found an association between the implemen- tation of the monarch room (combined with an upskilling of education staff via a trauma-informed training program) and a reduction in the use of suspension as a method of school discipline. Day et al. (2015) also reported positive impacts as a result of the implementation of the monarch room (combined with an upskill- ing of education staff via a trauma-informed training program) with a decrease in student PTSD symptoms reported. However, no difference in student needs, self-esteem, and perceptions of the
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an Ps
yc ho
lo gi
ca l
A ss
oc ia
tio n
or on
e of
its al
lie d
pu bl
is he
rs .
T hi
s ar
tic le
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
CHILDHOOD ADVERSITY AND ACADEMIC FUNCTIONING 157
T ab
le 4
T ra
um a-
In fo
rm ed
E du
ca ti
on P
ro gr
am s
D el
iv er
ed W
it hi
n P
ri m
ar y/
E le
m en
ta ry
Sc ho
ol Se
tt in
gs
C ita
tio n
Se tti
ng Pa
rt ic
ip an
ts (n
) M
et ho
ds us
ed to
ga th
er in
fo rm
at io
n L
en gt
h of
in te
rv en
tio n
In te
rv en
tio ns
us ed
D om
ai ns
as se
ss ed
(o ut
co m
es )
Su m
m ar
y of
re su
lts
St ok
es an
d T
ur nb
ul l
(2 01
6) Pr
ep (P
)– Y
r 6
P– Y
r 12
(Y r
5– 8
an d
fl ex
ib le
le ar
ni ng
su pp
or t
st ud
en ts
in cl
ud ed
in sa
m pl
e)
M t
E xc
el n
� 15
0 (e
nt ir
e sc
ho ol
po pu
la tio
n) L
at im
er V
al le
y n
� 13
5; 1,
90 0
st ud
en ts
en ro
lle d
ac ro
ss th
e sc
ho ol
Q ua
lit at
iv e
(s tu
de nt
s, te
ac he
rs an
d sc
ho ol
le ad
er sh
ip fo
cu s
gr ou
ps )
Q ua
nt ita
tiv e
(s tu
de nt
w el
lb ei
ng da
ta dr
aw n
fr om
a m
od if
ie d
ve rs
io n
of th
e St
ud en
t A
tti tu
de to
Sc ho
ol Su
rv ey
, A
us V
E L
S da
ta [D
ec em
be r
20 14
an d
D ec
em be
r 20
15 ]
an d
sc ho
ol su
sp en
si on
da ta
[2 01
4– 20
15 ])
12 -m
on th
tr ia
l at
bo th
ed uc
at io
na l
se tti
ng s
(d ur
in g
20 15
)
T he
be rr
y St
ed uc
at io
n m
od el
(a tr
au m
a- in
fo rm
ed po
si tiv
e ed
uc at
io n
pr og
ra m
) w
as pr
es en
te d
to st
af f
th ro
ug h
w or
ks ho
ps ,
se m
in ar
s, an
d tr
ai ni
ng se
ss io
ns .
St ud
en t
ac hi
ev em
en t
(i nc
lu di
ng A
us V
E L
S re
ad in
g, w
ri tin
g an
d nu
m be
r da
ta ),
st ud
en t
en ga
ge m
en t
(i nc
lu di
ng st
ud en
t be
ha vi
or ),
an d
te ac
he r–
st ud
en t
re la
tio ns
hi ps
(i nc
lu di
ng te
ac he
r em
pa th
y)
In fo
rm at
io n
an d
da ta
fr om
bo th
sc ho
ol s
af fi
rm ed
th e
po si
tiv e
im pa
ct of
B er
ry St
E du
ca tio
n M
od el
on st
ud en
t w
el l-
be in
g, ac
hi ev
em en
t, be
ha vi
or ,
an d
en ga
ge m
en t.
H ow
ev er
, di
ff er
en ce
s in
th e
de gr
ee of
po si
tiv e
im pa
ct w
er e
no te
d, w
ith th
is pr
im ar
ily re
la te
d to
th e
m od
e of
de liv
er y
at ea
ch se
tti ng
.
D or
ad o
et al
. (2
01 6)
K in
de r-
ga rt
en (K
)– fi
ft h
gr ad
e K
–f if
th gr
ad e
K –e
ig ht
h gr
ad e
K –f
if th
gr ad
e
Sc ho
ol A
n �
29 1
Sc ho
ol B
n �
25 3
Sc ho
ol C
n �
41 7
Sc ho
ol D
n �
28 2
Q ua
nt ita
tiv e
(s ta
ff re
po rt
of pr
og ra
m ev
al ua
tio n,
di sc
ip lin
ar y
re fe
rr al
an d
su sp
en si
on da
ta [f
or sc
ho ol
A on
ly ],
cl in
ic ia
n re
po rt
ut ili
zi ng
C hi
ld an
d A
do le
sc en
t N
ee ds
an d
St re
ng th
s sc
al e)
Sc ho
ol A
� 5
ye ar
s Sc
ho ol
B �
4 ye
ar s
(w ith
a on
e- ye
ar ga
p be
tw ee
n th
ir d
an d
fo ur
th ye
ar )
Sc ho
ol C
� 2
ye ar
s Sc
ho ol
D �
1. 5
ye ar
s
H ea
lth y
en vi
ro nm
en ts
an d
re sp
on se
to tr
au m
a in
sc ho
ol s
pr og
ra m
, a
tr au
m a-
in fo
rm ed
m ul
tit ie
re d
sy st
em of
su pp
or t
in cl
ud in
g un
iv er
sa l,
se le
ct ed
an d
ta rg
et ed
su pp
or ts
fo r
st ud
en ts
, st
af f/
ca re
gi ve
rs an
d th
e “s
ys te
m ”
in ge
ne ra
l (b
as ed
on th
e at
ta ch
m en
t, se
lf -r
eg ul
at io
n an
d co
m pe
te nc
y m
od el
)
St ud
en ts
sc ho
ol en
ga ge
m en
t, be
ha vi
or al
pr ob
le m
s, tr
au m
a- re
la te
d sy
m pt
om s
(i n
st ud
en ts
w ho
re ce
iv e
ta rg
et ed
th er
ap y)
. Sc
ho ol
pe rs
on ne
l’ s
kn ow
le dg
e ab
ou t
ad dr
es si
ng tr
au m
a an
d th
ei r
us e
of tr
au m
a- in
fo rm
ed pr
ac tic
es w
as al
so as
se ss
ed .
D at
a co
lle ct
ed pr
ov id
ed su
pp or
t fo
r th
e ef
fe ct
iv en
es s
of th
e H
ea lth
y E
nv ir
on m
en ts
an d
R es
po ns
e to
T ra
um a
in Sc
ho ol
s pr
og ra
m in
: in
cr ea
si ng
sc ho
ol pe
rs on
ne l’
s kn
ow le
dg e
an d
us e
of tr
au m
a- in
fo rm
ed pr
ac tic
es ;
in cr
ea si
ng st
ud en
t’ s
tim e
on ta
sk an
d at
te nd
an ce
; de
cr ea
si ng
di sc
ip lin
ar y
re fe
rr al
s an
d in
ci de
nt s
of ph
ys ic
al ag
gr es
si on
an d
ou t-
of -s
ch oo
l su
sp en
si on
; de
cr ea
si ng
tr au
m a-
re la
te d
sy m
pt om
s (f
or st
ud en
ts w
ho re
ce iv
ed ps
yc ho
th er
ap y)
. (t
ab le
co nt
in ue
s)
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an Ps
yc ho
lo gi
ca l
A ss
oc ia
tio n
or on
e of
its al
lie d
pu bl
is he
rs .
T hi
s ar
tic le
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
158 ROSEBY AND GASCOIGNE
T ab
le 4
(c on
ti nu
ed )
C ita
tio n
Se tti
ng Pa
rt ic
ip an
ts (n
) M
et ho
ds us
ed to
ga th
er in
fo rm
at io
n L
en gt
h of
in te
rv en
tio n
In te
rv en
tio ns
us ed
D om
ai ns
as se
ss ed
(o ut
co m
es )
Su m
m ar
y of
re su
lts
Pe rr
y an
d D
an ie
ls (2
01 6)
Pr e-
K –Y
r 8
n �
41 0
(a ll
st ud
en ts
re ce
iv ed
un iv
er sa
l su
pp or
t fr
om up
sk ill
ed te
ac he
rs ,
96 re
ce iv
ed ad
di tio
na l
cl in
ic al
in te
rv en
tio n)
Q ua
lit at
iv e
(p ro
fe ss
io na
l de
ve lo
pm en
t pa
rt ic
ip an
t re
sp on
se s
re ga
rd in
g sa
tis fa
ct io
n, te
ac he
r at
te nd
an ce
at cl
as sr
oo m
w or
ks ho
ps )
Q ua
nt ita
tiv e
(s tu
de nt
pa rt
ic ip
an t
re sp
on se
s on
w or
ks ho
p su
rv ey
, st
ud en
t se
lf -r
ep or
t on
tr au
m a
ex po
su re
an d
sy m
pt om
s vi
a th
e U
C L
A PT
SD In
de x
fo r
D SM
–I V
)
Pi lo
t ye
ar –1
2- m
on th
im pl
em en
t- at
io n
T ra
um a-
in fo
rm ed
pr of
es si
on al
de ve
lo pm
en t
to sc
ho ol
st af
f, ca
re co
-o rd
in at
io n
an d
cl in
ic al
se rv
ic es
(i .e
., cl
as sr
oo m
w or
ks ho
ps an
d co
gn iti
ve be
ha vi
or in
te rv
en tio
n fo
r tr
au m
a in
th e
sc ho
ol ’s
gr ou
ps )
St ud
en t
PT SD
sy m
pt om
s an
d ac
qu is
iti on
of co
pi ng
sk ill
s, as
w el
l as
sc ho
ol st
af f
an d/
or co
m m
un ity
m em
be rs
’ kn
ow le
dg e
of tr
au m
a- in
fo rm
ed pr
ac tic
es ,
id en
tif ic
at io
n of
st ud
en ts
re qu
ir in
g tr
au m
a- in
fo rm
ed su
pp or
t, an
d sy
st em
ic im
pl em
en ta
tio n
of tr
au m
a- in
fo rm
ed se
rv ic
es to
st ud
en ts
In fo
rm at
io n
an d
da ta
co lle
ct ed
de m
on st
ra te
d th
at sc
ho ol
st af
f an
d/ or
co m
m un
ity m
em be
rs ac
qu ir
ed kn
ow le
dg e
on tr
au m
a- in
fo rm
ed pr
ac tic
es ,
st ud
en ts
re qu
ir in
g ad
di tio
na l
tr au
m a-
in fo
rm ed
su pp
or t
at te
nd ed
co gn
iti ve
be ha
vi or
in te
rv en
tio n
fo r
tr au
m a
in th
e sc
ho ol
gr ou
ps (w
ith a
de cr
ea se
in PT
SD sy
m pt
om ol
og y
re po
rt ed
), sy
st em
ic tr
au m
a- in
fo rm
ed ch
an ge
w as
re po
rt ed
, an
d a
m aj
or ity
of st
ud en
ts re
po rt
ed un
de rs
ta nd
in g
ho w
to re
la x,
w or
ry le
ss ,
an d
tr us
t ot
he rs
. H
at ch
et t
et al
. (2
01 7)
U rb
an sc
ho ol
di st
ri ct
(c om
po se
d of
12 pu
bl ic
sc ho
ol s)
se rv
in g
K –Y
r 6
n �
52 0
(1 30
ra nd
om ly
se le
ct ed
st ud
en ts
w ho
w er
e el
ig ib
le as
ho m
el es
s an
d 39
0 “v
ir tu
al tw
in s”
co m
pr is
in g
ra nd
om ly
se le
ct ed
no nh
om el
es s
st ud
en ts
)
Q ua
lit at
iv e
(e du
ca tio
n st
af f
se lf
-r ep
or t
on ba
rr ie
rs ob
se rv
ed ,
pa re
nt /c
ar eg
iv er
se lf
- re
po rt
on pe
rc ep
tio n
of se
rv ic
es )
Q ua
nt ita
tiv e
(t ea
ch er
re po
rt on
St ud
en t
R is
k Sc
re en
in g
sc al
e fo
r in
te rn
al iz
in g
an d
ex te
rn al
iz in
g be
ha vi
or s,
A IM
Sw eb
un iv
er sa
l sc
re en
er fo
r st
ud en
t re
ad in
g an
d m
at h,
m ea
su re
s of
ac ad
em ic
pr og
re ss
)
3 ye
ar s
(2 01
4– 20
15 ,
20 15
–2 01
6, an
d 20
16 –2
01 7
sc ho
ol ye
ar s)
M cK
in ne
y- V
en to
A ct
fu nd
in g
w hi
ch in
cl ud
ed se
rv ic
es an
d re
so ur
ce s
su ch
as m
ul tit
ie re
d sy
st em
s of
su pp
or ts
an d
tr au
m a-
se ns
iti ve
sc ho
ol pr
ac tic
es .
A ca
de m
ic da
ta fo
r re
ad in
g an
d m
at h,
ac ad
em ic
pr og
re ss
io n,
st ud
en t
at te
nd an
ce ,
an d
in te
rn al
iz in
g an
d ex
te rn
al iz
in g
be ha
vi or
s. A
dd iti
on al
in fo
rm at
io n
co lle
ct ed
in cl
ud ed
id en
tif yi
ng re
so ur
ce s
an d
se rv
ic es
of fe
re d,
ba rr
ie rs
ob se
rv ed
by ed
uc at
io n
st af
f an
d pa
re nt
s’ pe
rc ep
tio ns
of th
ei r
ch ild
’s ac
ce ss
to se
rv ic
es ,
ad ve
rs ity
an d
pr ot
ec tiv
e fa
ct or
s.
In fo
rm at
io n
an d
da ta
co lle
ct ed
de m
on st
ra te
d th
at ho
m el
es s
st ud
en ts
at te
nd an
ce w
as hi
gh ly
in co
ns is
te nt
, w
ith at
te nd
an ce
re su
lts ac
ro ss
th e
ye ar
s “m
ix ed
,” bo
th ho
m el
es s
an d
no nh
om el
es s
st ud
en ts
w er
e m
ak in
g si
m ila
r gr
ow th
in m
at h
an d
re ad
in g
(h ow
ev er
, no
di ff
er en
ce w
as fo
un d
be tw
ee n
th e
ho m
el es
s an
d no
nh om
el es
s gr
ou ps
as a
re su
lt of
th e
in te
rv en
tio n/
s im
pl em
en te
d) an
d te
ac he
rs id
en tif
ie d
m or
e in
te rn
al iz
in g
be ha
vi or
s th
an ex
te rn
al iz
in g
be ha
vi or
s of
ho m
el es
s st
ud en
ts (w
ith no
di ff
er en
ce fo
un d
be tw
ee n
th e
ho m
el es
s an
d no
nh om
el es
s gr
ou ps
as a
re su
lt of
th e
in te
rv en
tio n/
s im
pl em
en te
d) .
(t ab
le co
nt in
ue s)
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an Ps
yc ho
lo gi
ca l
A ss
oc ia
tio n
or on
e of
its al
lie d
pu bl
is he
rs .
T hi
s ar
tic le
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
159CHILDHOOD ADVERSITY AND ACADEMIC FUNCTIONING
school climate were reported (Day et al., 2015). Crosby et al. (2017) reported school attachment, that is, level of school connect- edness, was associated with lower reported trauma symptoms, with lower reported support from peers associated with higher trauma symptoms. Furthermore, Millenky et al. (2019) found that engage- ment in a trauma-informed alternate education setting designed for girls and women decreased suspension rates and increased stu- dents’ successful completion of attempted classes.
Judge (2018) reviewed the impact of a 9-week trauma and resiliency curriculum delivered within a multitier system of sup- ports (that also included teachers working from a trauma-informed approach) on student resilience. Although they found improve- ments on two of the resiliency measures, with another six resil- iency measures demonstrating growth, the remaining four resil- iency measures demonstrated decline following the intervention. Lastly, Gonshak (2011) reviewed the impact of a trauma-informed teacher training curriculum (for working specifically with survi- vors of childhood abuse) on outcomes for students who attend an on-campus school within a residential treatment center. Although no improvements were reported regarding teacher knowledge or practices in the classroom or on student’s trauma symptomology or perceptions of their relationship with their teacher, it was demon- strated that teacher beliefs about trauma-informed care and student trauma symptomology are predictors of student–teacher relation- ship quality (Gonshak, 2011).
Discussion
Reproducibility and transparency are considered important fea- tures of systematic reviews. By adhering to this process, this systematic review highlighted that trauma-informed education pro- grams can have a positive impact on academic and academic- related functioning for students with a history of childhood adver- sity. Although results were not always consistent, improvements were found regarding students internalizing behaviors (Holmes et al., 2015; Pfenninger Saint Giles, 2016), self-regulatory abilities (Crosby et al., 2017; Perry & Daniels, 2016), resilience (Judge, 2018; Shamblin et al., 2016), achievement (Stokes & Turnbull, 2016), attention (Holmes et al., 2015), and attendance (Dorado et al., 2016), with a reduction in suspension rates also noted (Baroni et al., 2016; Millenky et al., 2019). Interestingly, preschool studies with year-long intervention lengths demonstrated positive impacts on the outcomes assessed. This trend was also observed across both primary/elementary and high school settings. Furthermore, the majority of identified primary/elementary studies (particularly those with an embedded trauma-informed education programs) reported improvements on some (but not all) academic or academic-related outcomes. Lastly, the majority of identified high school studies reported positive impacts on a range of academic or academic-related outcomes, which were associated with exposure to the trauma-informed education program. However, this litera- ture review highlights the dearth of studies available that review the impact of trauma-informed education programs on academic or academic-related functioning. Furthermore, of the 15 studies lo- cated, four were unpublished dissertations and two were research reports, further highlighting the limited amount of peer-reviewed research on this topic.
Interestingly, despite the many existing trauma-informed mod- els and theories, researchers at Berry Street (www.berrystreet.orgT
ab le
4 (c
on ti
nu ed
)
C ita
tio n
Se tti
ng Pa
rt ic
ip an
ts (n
) M
et ho
ds us
ed to
ga th
er in
fo rm
at io
n L
en gt
h of
in te
rv en
tio n
In te
rv en
tio ns
us ed
D om
ai ns
as se
ss ed
(o ut
co m
es )
Su m
m ar
y of
re su
lts
M itc
he ll
(2 01
6) A
ge s
4– 22
in th
e Sa
n Fr
an ci
sc o
B ay
A re
a sc
ho ol
s (4
el em
en ta
ry sc
ho ol
s, 2
m id
dl e
sc ho
ol s,
an d
1 co
nt in
ua tio
n hi
gh sc
ho ol
).
n �
72 0
Q ua
nt ita
tiv e
(s ch
oo l-
ba se
d co
lla bo
ra tio
n cl
in ic
ia n
co m
pl et
ed in
iti al
as se
ss m
en t
an d
cl os
in g
as se
ss m
en t.)
5 ye
ar s
(a rc
hi va
l da
ta fr
om 20
09 to
20 14
) T
ar ge
te d
ps yc
ho th
er ap
eu tic
se rv
ic es
. T
he sc
ho ol
-b as
ed co
lla bo
ra tio
n al
so pr
ov id
ed co
ns ul
ta tio
n an
d su
pp or
ts to
th e
w ho
le sc
ho ol
en vi
ro nm
en t
(i .e
., on
go in
g ps
yc ho
ed uc
at io
n ab
ou t
po si
tiv e
di sc
ip lin
e pr
ac tic
es an
d tr
au m
a- in
fo rm
ed sc
ho ol
an d
cl as
sr oo
m pr
oc ed
ur es
).
Pr es
en tin
g pr
ob le
m fr
eq ue
nc y
an d
se ve
ri ty
, ac
ro ss
fi ve
do m
ai ns
: ac
ad em
ic an
d sc
ho ol
ne ed
s, em
ot io
na l
an d
be ha
vi or
al ne
ed s,
cu ltu
ra l
fa ct
or ,
an d
he al
th an
d ba
si c
ne ed
s
D at
a co
lle ct
ed de
m on
st ra
te d
im pr
ov em
en ts
in st
ud en
t so
ci al
an d
em ot
io na
l pr
ob le
m s.
In ge
ne ra
l, th
er ap
eu tic
se rv
ic es
w er
e ob
se rv
ed to
ha ve
no im
pa ct
on ac
ad em
ic ,
cu ltu
ra l
fa ct
or s,
he al
th ,
an d
ba si
c ne
ed s.
N ot
e. Y
R �
ye ar
; U
C L
A �
U ni
ve rs
ity of
C al
if or
ni a,
L os
A ng
el es
; PT
SD �
po st
tr au
m at
ic st
re ss
di so
rd er
; D
SM –I
V �
D ia
gn os
ti c
an d
St at
is ti
ca l
M an
ua l
of M
en ta
l D
is or
de rs
, F
ou rt
h E
di ti
on .
A us
V E
L S
w as
th e
Fo un
da tio
n to
Y ea
r 10
cu rr
ic ul
um fo
r V
ic to
ri an
go ve
rn m
en ta
nd C
at ho
lic sc
ho ol
s an
d ha
s be
en re
pl ac
ed by
th e
V ic
to ri
an C
ur ri
cu lu
m Fo
un da
tio n
to Y
ea r
10 .H
ea lth
y E
nv ir
on m
en ts
an d
R es
po ns
e to
T ra
um a
in Sc
ho ol
s (H
E A
R T
S) is
a sc
ho ol
-b as
ed pr
og ra
m ,w
ith its
m is
si on
to pr
om ot
e sc
ho ol
su cc
es s
fo r
tr au
m a-
im pa
ct ed
ch ild
re n
an d
yo ut
h by
cr ea
tin g
m or
e tr
au m
a- in
fo rm
ed ,s
af e
an d
su pp
or tiv
e sc
ho ol
co m
m un
iti es
. T
he M
cK in
ne y-
V en
to H
om el
es s
A ss
is ta
nc e
A ct
is a
U .S
. fe
de ra
l la
w th
at pr
ov id
es fe
de ra
l m
on ey
to as
si st
in di
vi du
al s
id en
tif ie
d as
ho m
el es
s. T
he Sc
ho ol
-B as
ed C
ol la
bo ra
tio n
pr ov
id es
ev id
en ce
-b as
ed ,
tr au
m a-
in fo
rm ed
m od
el s
of in
te rv
en tio
n th
at su
pp or
t ch
ild re
n, te
ac he
rs ,
an d
th e
sc ho
ol co
m m
un ity
.
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an Ps
yc ho
lo gi
ca l
A ss
oc ia
tio n
or on
e of
its al
lie d
pu bl
is he
rs .
T hi
s ar
tic le
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
160 ROSEBY AND GASCOIGNE
T ab
le 5
T ra
um a-
In fo
rm ed
E du
ca ti
on P
ro gr
am s
D el
iv er
ed W
it hi
n H
ig h
Sc ho
ol Se
tt in
gs
C ita
tio n
Se tti
ng Pa
rt ic
ip an
ts (n
) M
et ho
ds us
ed to
ga th
er in
fo rm
at io
n L
en gt
h of
in te
rv en
tio n
In te
rv en
tio ns
us ed
D om
ai ns
as se
ss ed
(o ut
co m
es )
Su m
m ar
y of
re su
lts
C ro
sb y
et al
. (2
01 8)
Y r
9– Y
r 12
(s er
vi ng
gi rl
s w
ho re
si de
in a
re si
de nt
ia l
pr og
ra m
lo ca
te d
on ca
m pu
s)
n �
94 Q
ua lit
at iv
e (s
em is
tr uc
tu re
d in
te rv
ie w
re ga
rd in
g st
ud en
ts ’
ex pe
ri en
ce s
w ith
th e
M on
ar ch
R oo
m an
d th
ei r
pe rs
pe ct
iv es
on ho
w it
ha s
in fl
ue nc
ed th
ei r
m oo
d an
d be
ha vi
or ).
Q ua
nt ita
tiv e
(s ec
on da
ry an
al ys
is of
sc ho
ol da
ta re
ga rd
in g
us e
of th
e M
on ar
ch R
oo m
).
9 m
on th
s (d
ur in
g 20
14 –2
01 5
ac ad
em ic
sc ho
ol ye
ar )
M on
ar ch
R oo
m —
a tr
au m
a- in
fo rm
ed al
te rn
at iv
e to
sc ho
ol di
sc ip
lin e,
su sp
en si
on ,
an d
ex pu
ls io
n po
lic ie
s
C ha
ng e
in tim
e sp
en t
in th
e M
on ar
ch R
oo m
ov er
th e
sc ho
ol ye
ar ,
th e
im pa
ct of
th e
M on
ar ch
R oo
m on
st ud
en t’
s m
oo d
an d
fo cu
s in
sc ho
ol ,
su gg
es tio
ns fo
r im
pr ov
em en
ts ,
as w
el l
as be
ha vi
or (e
.g .,
su sp
en si
on ra
te s)
D at
a co
lle ct
ed de
m on
st ra
te d
th at
M on
ar ch
R oo
m us
e in
cr ea
se d,
an d
m os
t M
on ar
ch R
oo m
us er
s re
tu rn
ed to
cl as
s (a
ft er
th ei
r M
on ar
ch R
oo m
vi si
t) in
st ea
d of
es ca
la tin
g to
th e
po in
t of
su sp
en si
on .
St ud
en ts
al so
fo un
d th
e M
on ar
ch R
oo m
he lp
ed im
pr ov
e th
ei r
m oo
d an
d be
ha vi
or at
sc ho
ol .
C ro
sb y
et al
. (2
01 7)
Y r
9– Y
r 12
(s er
vi ng
gi rl
s w
ho re
si de
in a
re si
de nt
ia l
pr og
ra m
lo ca
te d
on ca
m pu
s)
n �
14 1
Q ua
nt ita
tiv e
(s tu
de nt
se lf
- re
po rt
on th
e C
hi ld
R ep
or t
of Po
st tr
au m
at ic
Sy m
pt om
s, st
ud en
t se
lf -
re po
rt on
sc ho
ol at
ta ch
m en
t/ co
nn ec
te dn
es s
an d
sc ho
ol in
vo lv
em en
t as
w el
l as
st ud
en t
se lf
-r ep
or t
on th
e C
hi ld
an d
A do
le sc
en t
So ci
al Su
pp or
t Sc
al e
[t hr
ee su
bs ca
le s
ut ili
ze d]
)
9 m
on th
s (d
ur in
g th
e 20
13 –2
01 4
ac ad
em ic
sc ho
ol ye
ar )
T ra
um a-
in fo
rm ed
te ac
hi ng
in te
rv en
tio n
(m od
if ie
d ve
rs io
n of
T he
H ea
rt of
T ea
ch in
g an
d L
ea rn
in g:
C om
pa ss
io n,
R es
ili en
cy an
d A
ca de
m ic
Su cc
es s
[m H
T L
]) as
w el
l as
th e
M on
ar ch
R oo
m
Sc ho
ol at
ta ch
m en
t/ in
vo lv
em en
t an
d its
as so
ci at
io n
w ith
st ud
en ts
’ tr
au m
a sy
m pt
om at
ol og
y as
w el
l as
te ac
he r
so ci
al su
pp or
t, cl
as sm
at e
so ci
al su
pp or
t, an
d sc
ho ol
st af
f so
ci al
su pp
or t
an d
its as
so ci
at io
n w
ith st
ud en
t’ s
tr au
m a
sy m
pt om
ol og
y
D at
a co
lle ct
ed de
m on
st ra
te d
hi gh
tr au
m a
sy m
pt om
ol og
y as
w el
l as
re la
tiv el
y st
ro ng
sc ho
ol at
ta ch
m en
t, sc
ho ol
in vo
lv em
en t
an d
su pp
or t
fr om
te ac
he rs
, ye
t m
od er
at e
su pp
or t
fr om
ot he
r sc
ho ol
pe rs
on ne
l an
d lo
w er
su pp
or t
fr om
cl as
sm at
es .
Sc ho
ol at
ta ch
m en
t w
as as
so ci
at ed
w ith
lo w
er tr
au m
a sy
m pt
om s,
w ith
lo w
er su
pp or
t fr
om cl
as sm
at es
as so
ci at
ed w
ith hi
gh tr
au m
a sy
m pt
om s.
D ay
et al
. (2
01 5)
A ge
s 14
–1 8
(s er
vi ng
gi rl
s w
ho re
si de
in a
re si
de nt
ia l
pr og
ra m
lo ca
te d
on ca
m pu
s)
n �
70 (o
nl y
th os
e w
ith m
at ch
ed da
ta [b
ot h
pr e-
an d
po st
te st
da ta
] w
er e
in cl
ud ed
in th
is st
ud y)
Q ua
nt ita
tiv e
(s oc
io de
m og
ra ph
ic ch
ar ac
te ri
st ic
s, st
ud en
t se
lf -r
ep or
t on
th e
St ud
en t
N ee
ds Su
rv ey
, C
hi ld
R ep
or t
of Po
st tr
au m
at ic
Sy m
pt om
s an
d R
os en
be rg
Se lf
-E st
ee m
Sc al
e as
w el
l as
st ud
en t
pe rc
ep tio
ns of
ch an
ge s
in sc
ho ol
cl im
at e)
9 m
on th
s (d
ur in
g th
e 20
12 –2
01 3
ac ad
em ic
sc ho
ol ye
ar )—
72 %
of th
e sa
m pl
e w
er e
ex po
se d
to th
e in
te rv
en tio
n fo
r 6
m on
th s
or m
or e
m H
T L
(T ra
um a-
in fo
rm ed
te ac
hi ng
in te
rv en
tio n
de liv
er ed
ov er
2 ha
lf da
ys ,
w ith
bo os
te r
tr ai
ni ng
s oc
cu rr
in g
m on
th ly
) as
w el
l as
tr au
m a-
in fo
rm ed
sc ho
ol di
sc ip
lin ar
y pr
ac tic
es (M
on ar
ch an
d D
re am
C at
ch er
R oo
m s)
Po st
tr au
m at
ic st
re ss
sy m
pt om
s, se
lf -
es te
em ,
an d
st ud
en t
at tit
ud es
to w
ar d
te ac
he rs
, le
ar ni
ng an
d sc
ho ol
cl im
at e
D at
a co
lle ct
ed de
m on
st ra
te d
no di
ff er
en ce
in st
ud en
t ne
ed s,
se lf
-e st
ee m
, an
d pe
rc ep
tio ns
of sc
ho ol
cl im
at e.
St ud
en ts
re po
rt ed
th at
a m
aj or
ity of
te ac
he rs
re sp
on de
d ap
pr op
ri at
el y
to th
ei r
ne ed
s pr
ei nt
er ve
nt io
n, w
ith no
di ff
er en
ce in
th ei
r re
sp on
si ve
ne ss
re po
rt ed
po st
in te
rv en
tio n.
H ow
ev er
, a
de cr
ea se
in po
st tr
au m
at ic
st re
ss sy
m pt
om s
w as
re po
rt ed
.
(t ab
le co
nt in
ue s)
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an Ps
yc ho
lo gi
ca l
A ss
oc ia
tio n
or on
e of
its al
lie d
pu bl
is he
rs .
T hi
s ar
tic le
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
161CHILDHOOD ADVERSITY AND ACADEMIC FUNCTIONING
T ab
le 5
(c on
ti nu
ed )
C ita
tio n
Se tti
ng Pa
rt ic
ip an
ts (n
) M
et ho
ds us
ed to
ga th
er in
fo rm
at io
n L
en gt
h of
in te
rv en
tio n
In te
rv en
tio ns
us ed
D om
ai ns
as se
ss ed
(o ut
co m
es )
Su m
m ar
y of
re su
lts
B ar
on i
et al
. (2
01 6)
Y r
9– Y
r 12
(s er
vi ng
gi rl
s w
ho re
si de
in a
re si
de nt
ia l
pr og
ra m
lo ca
te d
on ca
m pu
s)
n �
62 0
Q ua
nt ita
tiv e
(s ch
oo l
ad m
in is
tr at
iv e
da ta
an d
da ily
M on
ar ch
R oo
m tr
ac ki
ng lo
gs )
3 ye
ar s
(2 01
1– 20
14 ac
ad em
ic sc
ho ol
ye ar
s)
M on
ar ch
R oo
m —
a tr
au m
a- in
fo rm
ed al
te rn
at iv
e to
sc ho
ol di
sc ip
lin e
su sp
en si
on an
d ex
pu ls
io n
po lic
ie s
H is
to ry
of su
sp en
si on
s/ ex
pu ls
io ns
an d
hi st
or y
of M
on ar
ch R
oo m
us e
(s us
pe ns
io n
da ta
w er
e on
ly av
ai la
bl e
fo r
ye ar
s 2
an d
3 of
th e
ob se
rv at
io n
pe ri
od s.
M on
ar ch
R oo
m us
e w
as ca
pt ur
ed ov
er al
l 3
ye ar
s) .
D at
a co
lle ct
ed de
m on
st ra
te d
an as
so ci
at io
n be
tw ee
n th
e im
pl em
en ta
tio n
of th
e M
on ar
ch R
oo m
an d
a re
du ct
io n
in th
e us
e of
su sp
en si
on as
a m
et ho
d of
sc ho
ol di
sc ip
lin e.
Fr eq
ue nt
sc ho
ol m
ob ili
ty ,
hi gh
er nu
m be
r of
sc ho
ol ab
se nc
es ,
an d
ra ce
pr ed
ic te
d M
on ar
ch R
oo m
us e
(i n
lin e
w ith
fa ct
or s
th at
ha ve
pr ed
ic te
d us
e of
su sp
en si
on in
th e
lit er
at ur
e) .
M ill
en ky
et al
. (2
01 9)
A lte
rn at
e se
tti ng
se rv
in g
11 –1
8- ye
ar -o
ld gi
rl s
n �
1, 12
5 (a
cr os
s 14
ce nt
er s—
67 3
in pr
og ra
m gr
ou p
an d
45 2
in th
e co
nt ro
l gr
ou p)
Q ua
lit at
iv e
(f ol
lo w
-u p
su rv
ey an
d se
m is
tr uc
tu re
d ph
on e
in te
rv ie
w s
co nd
uc te
d w
ith st
ud en
ts an
d pa
re nt
s) Q
ua nt
ita tiv
e (b
as ic
de m
og ra
ph ic
da ta
an d
re co
rd s
on pa
rt ic
ip at
io n,
ad m
in is
tr at
iv e
re co
rd s
fr om
th e
Fl or
id a
D ep
ar tm
en t
of Ju
ve ni
le Ju
st ic
e, ad
m in
is tr
at iv
e re
co rd
s fr
om th
e Fl
or id
a D
ep ar
tm en
t of
E du
ca tio
n an
d pr
og ra
m co
st da
ta )
2 ye
ar s,
2 m
on th
s (A
ug us
t 20
13 an
d N
ov em
be r
20 15
)
A lte
rn at
iv e
sc ho
ol se
tti ng
(P A
C E
C en
tr e)
. E
nr ol
le d
st ud
en ts
re ce
iv e
a co
m bi
na tio
n of
ac ad
em ic
an d
so ci
al se
rv ic
es .
St af
f w
er e
tr ai
ne d
on PA
C E
’s ke
y pi
lla rs
as a
ge nd
er -
re sp
on si
ve ,
st re
ng th
s- ba
se d,
an d
tr au
m a-
in fo
rm ed
pr og
ra m
.
E du
ca tio
na l
ou tc
om es
(i nc
lu di
ng at
te nd
an ce
, ac
ad em
ic pr
og re
ss ,
su sp
en si
on ,
an d
ex pu
ls io
n ra
te s)
, in
te rp
er so
na l
re la
tio ns
hi ps
w ith
fa m
ily m
em be
rs ,
PA C
E st
af f
m em
be rs
an d
fr ie
nd s,
as w
el l
as ri
sk y
be ha
vi or
an d
ju ve
ni le
ju st
ic e
in vo
lv em
en t
In fo
rm at
io n
an d
da ta
co lle
ct ed
de m
on st
ra te
d th
at PA
C E
ce nt
er s
in cr
ea se
d ac
ad em
ic en
ga ge
m en
t, in
cr ea
se d
su cc
es sf
ul co
m pl
et io
n of
“c re
di ts
” at
te m
pt ed
an d
de cr
ea se
d su
sp en
si on
. O
ve ra
ll, gi
rl s
re po
rt ed
fe el
in g
po si
tiv e
ab ou
t th
ei r
fu tu
re s.
H ow
ev er
, PA
C E
gi rl
s di
d no
t ea
rn m
or e
“c re
di ts
” ov
er al
l, w
ith pr
og ra
m st
ud en
ts us
ua lly
ta ki
ng fe
w er
cl as
se s
th an
gi rl
s at
tr ad
iti on
al sc
ho ol
s.
Ju dg
e (2
01 8)
Pu bl
ic al
te rn
at iv
e hi
gh sc
ho ol
n �
53 Q
ua nt
ita tiv
e (T
ea ch
er se
lf -
re po
rt on
pr og
ra m
de liv
er y,
st ud
en t
se lf
- re
po rt
on re
si lie
nc y
in cl
ud in
g B
ri ef
R es
ili en
ce Sc
al e,
Pe rc
ei ve
d St
re ss
Sc al
e, G
ro w
th M
in ds
et Sc
al e,
Fl ou
ri sh
in g
Sc al
e, B
ri ef
In ve
nt or
y of
T hr
iv in
g Sc
al e,
Sa tis
fa ct
io n
w ith
L if
e sc
al e,
St ud
en t
Se lf
-R ep
or t
of A
ca de
m ic
Se lf
- Su
ff ic
ie nc
y, T
ra um
a C
og ni
tiv e
Sk ill
s, C
op in
g Sk
ill s
R at
in g
Sc al
e, E
xe rc
is e,
Sl ee
p an
d C
op in
g Sk
ill s
Fr eq
ue nc
y Sc
al es
)
9 w
ee ks
. H
ow ev
er ,
th e
sc ho
ol ha
d be
en im
pl em
en t-
in g
m ul
tit ie
re d
tr au
m a-
in fo
rm ed
su pp
or ts
fo r
se ve
ra l
ye ar
s.
M ul
tit ie
re d
sy st
em of
su pp
or ts
— sp
ec if
ic al
ly a
tr au
m a-
in fo
rm ed
in te
rv en
tio n
(R E
A C
H —
tr au
m a
an d
re si
lie nc
y cu
rr ic
ul um
) de
liv er
ed to
w ho
le cl
as se
s (t
ie r
2) .
T ea
ch er
s al
so w
or k
fr om
a tr
au m
a- in
fo rm
ed ap
pr oa
ch .
St ud
en ts
’ pe
rc ep
tio ns
of th
ei r
le ve
l of
re si
lie nc
y an
d te
ac he
r pe
rc ep
tio ns
on ac
ce pt
ab ili
ty ,
fe as
ib ili
ty ,
ap pr
op ri
at en
es s,
an d
ef fe
ct iv
en es
s of
th e
R E
A C
H pr
og ra
m .
D at
a co
lle ct
ed de
m on
st ra
te d
im pr
ov em
en ts
in co
pi ng
sk ill
s an
d sl
ee p,
w ith
an ot
he r
si x
re si
lie nc
y m
ea su
re s
de m
on st
ra tin
g gr
ow th
fo llo
w in
g tr
ea tm
en t.
H ow
ev er
, th
e re
m ai
ni ng
fo ur
re si
lie nc
y m
ea su
re s
de m
on st
ra te
d de
cl in
e. It
w as
re po
rt ed
th at
th e
pr og
ra m
m ay
ne ed
m or
e re
fi ne
d m
ea su
re m
en t
an d
tr ea
tm en
t. O
ve ra
ll, te
ac he
rs ex
pr es
se d
po si
tiv e
vi ew
s of
th e
R E
A C
H pr
og ra
m ;
ho w
ev er
, so
m e
ch al
le ng
es w
er e
al so
ou tli
ne d.
(t ab
le co
nt in
ue s)
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an Ps
yc ho
lo gi
ca l
A ss
oc ia
tio n
or on
e of
its al
lie d
pu bl
is he
rs .
T hi
s ar
tic le
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
162 ROSEBY AND GASCOIGNE
.au) developed their own trauma-informed positive education pro- gram (Brunzell et al., 2016; Stokes & Turnbull, 2016). This model may offer benefits over the other models reviewed due to the implicit teaching that occurs for educators, that is, a trauma- informed system wide change filtering down to individual inter- actions with students, as well as the explicit teaching that occurs universally for students through specific classroom lessons and activities on stress and trauma, that is, curriculum integration of trauma-informed domains and themes delivered by classroom teachers (not external teachers/clinicians; Stokes & Turnbull, 2016).
Although most studies reported improvements in academic or academic-related outcomes, some studies did not report improve- ments as a result of the trauma-informed education program (Day et al., 2015; Gonshak, 2011; Hatchett et al., 2017; Mitchell, 2016). Day et al. (2015) highlighted a vast majority of teachers were reported by students as responsive to their needs before the staff training being implemented, possibly explaining their results. However, Day et al. (2015) did report positive impacts on student self-reported PTSD symptoms as a result of the implementation of the Monarch Room (combined with an upskilling of education staff via a trauma-informed training program). Furthermore, Mitchell (2016) did not report improvements in academic need; however, improvements in social and emotional problems were reported. It has been established that higher levels of mental health symptoms are associated with an increase in school functioning difficulties (Threlfall et al., 2017), adding to our understanding of the implication of this reduction in self-reported PTSD symptoms and improvement in emotional functioning. Furthermore, Gonshak (2011) highlighted that their results of no change to teacher’s knowledge of trauma, no change to their beliefs about trauma- informed care, or no changes in their emotionally supportive behaviors in the classroom were explained by the low sample size of teachers. Furthermore, they also concluded that student out- comes may need to be tracked over “many months” to observe “considerable changes in the student-teacher relationship” (Gon- shak, 2011, p. 87). Lastly, when discussing their results, Hatchett et al. (2017) also acknowledged that low sample sizes may have impacted on the results they obtained.
Although it would not be possible for all variables to be matched between identified studies, it is nonetheless important to acknowl- edge the heterogeneity in the research articles reviewed and the implications for our findings. The studies described in this article differed with respect to a number of important parameters, includ- ing overall sample size, length of intervention, physical setting, and outcomes assessed, to name a few. Although our studies were not matched on these parameters, it was still possible to assess the general impact of trauma-informed education programs, as similar outcomes were noted between studies conducted in similar aca- demic environments.
SAMHSA (2014) delineated that for a system to be considered trauma informed, individuals within the system need to “realize” the prevalence of trauma and its profound impact, they need to “recognize” traumatic stress symptoms in individuals, and they need to “respond” by applying a trauma-informed approach to all areas of operating, therefore “resisting retraumatizing” individuals who access the system (SAMHSA, 2014). Consistent with these statements, a systematic review was conducted to provide a syn- thesis of the trauma-informed education literature, to ultimatelyT
ab le
5 (c
on ti
nu ed
)
C ita
tio n
Se tti
ng Pa
rt ic
ip an
ts (n
) M
et ho
ds us
ed to
ga th
er in
fo rm
at io
n L
en gt
h of
in te
rv en
tio n
In te
rv en
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163CHILDHOOD ADVERSITY AND ACADEMIC FUNCTIONING
assist school systems to be trauma-informed. This will allow school systems to further realize the prevalence and impact of trauma, further recognize its presentation in their students, and ultimately equip them to understand the importance of being trauma-informed in their response, thereby avoiding the retrauma- tization that can occur through more traditional or established school approaches (SAMHSA, 2014). The current study provided a systematic review summarizing the impact of trauma-informed education programs on academic and academic-related functioning for students with a history of childhood adversity. To the authors’ knowledge, no such study had been completed to date; therefore, this research makes a distinctive contribution to the existing trauma and trauma-informed literature. After reviewing the liter- ature, it appears that programs that are embedded and “system- wide” in their implementation, provide intensive initial staff train- ing and regular booster sessions as well as programs that are implemented over longer periods of time have a greater prospect of positively impacting students’ academic or academic-related out- comes.
To move forward, recommendations will be offered regarding future research into the impact of trauma-informed education pro- grams on academic functioning. This will enhance knowledge about the effect of these programs on students functioning and underscore the importance of disseminating this knowledge to the systems that will benefit from it the most, that is, schools. Fur- thermore, additional focus should be placed on developing “system-friendly” approaches that enhance the school system’s ability to effectively respond to their students’ traumatic stress symptoms (the “respond” element of SAMHSA’s key assumptions in a trauma-informed approach).
Implications for Future Research
Key suggestions for future research arose from several chal- lenges that occurred while conducting this systematic review. Areas for development regarding this include: (a) clear and con- sistent reporting and implementation of trauma-informed educa- tion programs (the independent variable); (b) conducting addi- tional trauma-informed research within school settings; (c) establishing a greater appreciation for the dissemination of this research and knowledge; (d) recognizing possible moderators and mediators of the association between trauma-informed education programs and various academic and academic-related outcomes. To tackle these current limitations, suggestions for future research analyzing the impact of trauma-informed education programs on students functioning will be presented.
Trauma-Informed Education Programs
As previously discussed, SAMHSA (2014) provided guidance for the adoption and implementation of trauma-informed ap- proaches within existing systems of care. This guidance allows systems to adopt trauma-informed approaches in such a way that suits their staff and student population as well as their existing school culture. Furthermore, although it is recognized that schools may not traditionally attend to trauma as “an aspect of how they conduct business, understanding trauma and a trauma-informed approach may help them meet their goals and objectives” (SAM- HSA, 2014 p. 12). The flexibility offered by SAMHSA’s guide- lines ultimately means that various systems of trauma-informed
care have been developed in schools, with this need borne out of the prevalence and impact of trauma and traumatic stress symp- toms on their student population. To illustrate, the studies within this systematic review used a variety of models and theories when implementing their trauma-informed education programs within their individual school settings. Moving forward, researchers need to clearly report the theories and models used for their trauma- informed education program as well as the advantages of using this system instead of the other models available. This will lend itself to strengthening future trauma-informed school-based research.
Trauma-Informed School-Based Research
As our understanding of trauma, its prevalence and impact has increased, the need for school systems to become trauma-informed has been acknowledged (SAMHSA, 2014). Likewise, the routine and consistency characteristic of the standard school day makes the education system well suited to providing trauma-informed interventions (SAMHSA, 2014).
Furthermore, with school-based trauma-specific interventions shown to reduce traumatic stress symptoms for students (Rolfsnes & Idsoe, 2011), it is only natural for school systems to be looked at as a place for successful intervention for traumatized students. Yet, implementing a trauma-informed approach means generating shifts of thought at the “system level,” which is no small task, with this change often taking years to occur (Phifer & Hull, 2016). Furthermore, it has been identified that systems-level change re- quires buy in from educators and school staff to be given the best chance of success (Zakszeski et al., 2017). Therefore, it is essential that future researchers understand the importance of cultivating the buy in of relevant stakeholders, including outlining how “trauma- informed” approaches can assist schools in achieving their educa- tional goals and objectives (SAMHSA, 2014).
To illustrate, during their study, Perry and Daniels (2016) fo- cused on building relationships within the school system, to ensure the foundations of successful system change were laid and their trauma-informed change would be sustained over time. It should be noted that a shift in educator “identity” may be required to allow teachers to meaningfully employ trauma-informed ways of responding to their students (Morgan et al., 2015). This investment of time may explain the lack of research located in this systematic review. Dorado et al. (2016) tracked outcomes over 5 years in four school settings, outlining the significant investment required to adequately track systems level change and its impact on students’ academic outcomes. Notwithstanding the difficulty of time and systems-level change in general, the benefits of conducting further research into trauma-informed education programs and their im- pact on academic and academic-related functioning can be seen to far outweigh the challenges. Tracking these outcomes over time allows for a better understanding of the long-term impact of trauma-informed education programs on academic functioning, and possibly life course outcomes, for individuals with a history of childhood adversity.
Disseminating Research
For educators and wider school systems to respond effectively to their students with a history of childhood adversity, it is essen- tial that the findings presented in this systematic review (and the studies within it) are disseminated. To respond appropriately,
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164 ROSEBY AND GASCOIGNE
educators and schools need to be aware of the trauma-informed responses they can employ to resist retraumatization of their stu- dents. Furthermore, a key feature that may be missed by educators is the notion that “readiness to learn” is mostly a function of an individual’s emotional, behavioral, and social skills (Bettencourt et al., 2018). Therefore, an overly anxious and dysregulated student will have difficulty participating effectively in the school environ- ment, including students who have experienced childhood adver- sity. It is anticipated that dissemination of relevant trauma- informed information and research will assist educators in making the theory to practice links needed to respond effectively to their overly anxious and dysregulated traumatized students. Further- more, an interesting point to note is the response of teachers to their student’s presentation, with teachers’ opinions about the nature of their student’s difficulties, that is, wilful disobedience versus difficulties as a result of childhood adversity, determining the behavior intervention used (Watson & Westby, 2003). Hence, lack of knowledge can lead to inappropriate interventions, with the need for dissemination of trauma-informed knowledge and the impact of trauma-informed education programs clear if school systems are to make a meaningful impact on the lives of their students (Chafouleas et al., 2016; Downey, 2007; Watson & Westby, 2003).
Considering Moderators and Mediators
This review focused on trauma-informed education programs and the impact they can have on academic and academic-related outcomes. However, there are other characteristics of the individ- ual, educators or the wider trauma-informed environment that may affect the impact of trauma-informed education programs on aca- demic and academic-related outcomes. Therefore, future studies should consider mediator and moderator variables that influence outcomes. Moderator variables may include, age, gender, school- setting or trauma-informed model used. In addition, a theme that is emerging more generally is the need for additional research on factors correlated with positive results among those with a history of childhood adversity, that is, studies of resilience (Soleimanpour et al., 2017).
Limitations
Before completing this literature review, the decision was made to use general search terms, including “adverse childhood experi- ences” and “trauma.” As a result, keywords pertaining to specific types of trauma or adverse events were not used, such as sexual or physical abuse. Consequently, relevant articles may not have been located. Furthermore, a reverse search of identified articles was not completed, which may have also resulted in relevant articles not being located. Additionally, Sally Roseby undertook the system- atic review and subsequent coding, with valuable advice and direction provided by Michael Gascoigne; however, a detailed review of this process was not undertaken by Michael Gascoigne. Given that only 15 articles met the inclusion criteria for this systematic review, the decision was made to include all identified articles within a high school setting, despite several of these articles occurring within the same high school setting. This deci- sion may have inflated the findings identified; however, these studies are from disparate cohorts within the same institution which were studied at different times. Although the location may
be the same, the subjects of these studies were different, as were the teachers implementing the program. As mentioned above, it is acknowledged that the identified studies differed with respect to a number of variables. This is a limitation, as stronger conclusions could be drawn if all studies were matched on a range of critical factors, such as setting and length of intervention. Lastly, we may not have located articles published in journals that were not located within the selected databases searched. Nevertheless, the used approach is believed to have led to a data set that is reproducible.
Conclusion
Although results were not consistent across the studies re- viewed, this review highlights the possibility for trauma-informed education programs to positively impact students’ academic and academic-related outcomes. This is promising, as not only are schools well posited to support their students with a history of childhood adversity, the responsibility for schools to support the academic, social, emotional, and behavioral needs of their students is greater than ever before (Hatchett et al., 2017).
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Received October 18, 2019 Revision received April 15, 2020
Accepted May 27, 2020 �
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167CHILDHOOD ADVERSITY AND ACADEMIC FUNCTIONING
- A Systematic Review on the Impact of Trauma-Informed Education Programs on Academic and Academic ...
- The Prevalence of Childhood Adversity
- Intervention and Its Impact on Outcomes
- School-Based Intervention
- The Current Study
- Method
- Literature Search
- Inclusion Criteria
- Data Coding
- Results
- Interventions Used Across the Studies
- Preschool
- Primary/Elementary School
- High School
- Discussion
- Implications for Future Research
- Trauma-Informed Education Programs
- Trauma-Informed School-Based Research
- Disseminating Research
- Considering Moderators and Mediators
- Limitations
- Conclusion
- References
