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CPSTF Calls for More Studies on Multi-Tiered Trauma-Informed School Programs

The Community Preventive Services Task Force (CPSTF) finds insufficient evidence to determine whether multi-tiered trauma-informed school programs reduce symptoms of post-traumatic stress disorder (PTSD) or improve mental health and school-related outcomes including student behaviors, disciplinary actions, and absenteeism. This does NOT mean the intervention is ineffective; it means more research is needed to determine the effectiveness of these multi-tiered interventions.

What are Multi-Tiered Trauma-Informed School Programs? These programs aim to minimize students’ exposure to adversity, strengthen their coping skills, and improve their mental health and well-being. These programs offer universal (tier 1), targeted (tier 2), and individualized (tier 3) approaches based on students’ exposure to trauma and trauma-related symptoms. For inclusion in this systematic review, studies had to have interventions implemented at all three tiers. Tiers include the following: Tier 1: Universal interventions designed to create safe environments and support a trauma-informed school community for all students. Interventions may offer training and psychoeducation for teachers, staff, parents, or community partners, or social, emotional, and behavioral learning. Tier 2: Early interventions for students who have been exposed to trauma and exhibit mild symptoms or are considered to be at high risk. Interventions include psychoeducation, trauma-specific group therapy, or classroom supports. Tier 3: Mental health services for students who have experienced trauma and show severe symptoms. Trained counselors or providers deliver services in school settings or refer students out, and interventions may include trauma-focused cognitive behavioral therapy or wraparound services that integrate support systems around the student.

Why is this important? Traumatic events in childhood, referred to as adverse childhood experiences, or ACEs, are experienced by more than two-thirds of children by the age of 16 (SAMHSA 2023). Childhood experiences of trauma may lead to learning or behavioral problems or both, such as inability to focus on schoolwork, or intense outbursts of anger (Burke et al 2011). In adolescence and adulthood, ACEs are linked to: Chronic health problems Poor mental health (e.g., post-traumatic stress disorder [PTSD], feeling sad or hopeless) Risk behaviors (e.g., substance use) Socioeconomic challenges in adulthood (CDC 2022). Preventing and reducing underlying trauma in childhood could reduce negative outcomes in adulthood and promote safer communities for children (CDC 2022). CPSTF calls for more research to understand how multi-tiered trauma-informed school programs can help improve mental health in students.

Share this information with others! Please encourage more research on this topic when sharing these materials. More evidence is needed to determine the effectiveness of multi-tiered trauma-informed school programs.

Intervention Summary—Mental Health: Multi-Tiered Trauma-Informed School Programs

News and Announcement—include this story in your newsletter, or share the link with colleagues

One Pager: Multi-Tiered Trauma-Informed School Programs to Improve Mental Health Among Youth—use this one-pager as a quick reference.

X (formerly known as Twitter)—retweet @CPSTF messages about the new finding or tweet one of the following examples: Calling all school health researchers! @CPSTF calls for more studies are needed to learn how multi-tiered trauma-informed school programs affect educational and health outcomes. Find out more about the finding: https://www.thecommunityguide.org/findings/mental-health-multi-tiered-trauma-informed-school-programs-improve-mental-health-among-youth.html Researchers: CPSTF calls for more studies on the effectiveness of multi-tiered trauma-informed school programs. More evidence is needed to learn how these programs affect student mental health and educational outcomes. Learn more: https://www.thecommunityguide.org/findings/mental-health-multi-tiered-trauma-informed-school-programs-improve-mental-health-among-youth.html LinkedIn Researchers: Multi-tiered trauma-informed school programs aim to prevent and reduce the impact of trauma among all students while offering additional help to those who need intensive support. CPSTF calls for more studies on the effectiveness of these programs to learn more about the effects on educational and health outcomes. Learn more about the finding: https://www.thecommunityguide.org/findings/mental-health-multi-tiered-trauma-informed-school-programs-improve-mental-health-among-youth.html Facebook Schools play an important part in students' lives. Multi-tiered trauma-informed school programs aim to prevent and reduce the impact of trauma among all students while offering help to those who need intensive support. A recent CPSTF finding notes that more studies are needed to learn how these programs can help improve student’s mental health. Learn more about the CPSTF finding: https://www.thecommunityguide.org/findings/mental-health-multi-tiered-trauma-informed-school-programs-improve-mental-health-among-youth.html

We encourage you to share these materials with your colleagues and constituents. If you do, please e-mail us at communityguide@cdc.gov with a description of who your audience is and the approximate size of your audience. If possible, please include a copy of or link to your communication materials. As always, we appreciate your interest and support, The Community Guide

The Guide to Community Preventive Services (The Community Guide) is a website that is a collection of all the evidence-based findings and recommendations of the Community Preventive Services Task Force.

References 1. Substance Abuse and Mental Health Services Administration. Understanding Child Trauma. Rockville (MD): SAMHSA, 2023. Available from URL: https://www.samhsa.gov/child-trauma/understanding-child-trauma. Accessed August 7, 2023. 2. Burke NJ, Hellman JL, Scott BG, et al. The impact of adverse childhood experiences on an urban pediatric population. Child Abuse & Neglect 2011;35(6):408–13. 3. Centers for Disease Control and Prevention. Health Youth at Risk for ACEs. Atlanta (GA); 2022. Available from URL: www.cdc.gov/violenceprevention/aces/help-youth-at-risk.html. Accessed July 12, 2023.

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