Trauma-Informed Programs Based in Schools: Linking Concepts to Practices and Assessing the Evidence

Anxiety sensitivity among Black youth: A cross-sectional analysis of the direct and indirect effects of community violence exposure, neighborhood risk, parenting practices, and peer effects

Youth exposed to community violence and neighborhood stressors report devastating mental health consequences. Black youth are at greater risk and experience community violence at rates higher than other youth populations. An underexplored mental health consequence is anxiety sensitivity, the fear of experiencing anxiety-related symptoms, which contributes to maladaptive coping strategies and the development and severity of other mental health problems. This study utilized structural equation modeling (SEM) to examine socio-ecological risk and protective factors associated with community violence exposure and anxiety sensitivity among low-income Black youth. Survey data are from a sample of 320 Black youth residing in public and subsidized housing in a Northeastern city in the United States. Results indicated that neighborhood risk, parenting behaviors, and exposure to delinquent peers were indirectly associated with anxiety sensitivity, which occurred through community violence exposure. Additionally, neighborhood risks had direct effects on anxiety sensitivity. Results point to the need to incorporate social and environmental factors in interventions addressing anxiety sensitivity among Black youth in urban communities.

Statement on the effects of law enforcement in school settings

School-based law enforcement (SBLE) have become increasingly common in U.S. schools over recent decades despite the controversy surrounding their presence and lack of consensus around their associated benefits and harms. Drawing on the history and evidence base regarding SBLE, we advocate for an end to SBLE programs. Grounding our argument in principles of Community Psychology and positive youth development, we outline how the presence and actions of SBLE negatively affect individual students as well as school systems, with particularly harmful outcomes for students with minoritized and marginalized identities. Research on SBLE and school crime does not provide consistent evidence of positive impacts, and many studies find null effects for the relationship between SBLE and school crime or increases in crime and violence in schools. Though funding for SBLE is often prompted by high-profile acts of gun violence in schools, evidence suggests that SBLE neither prevents these incidents, nor lessens the severity when they do occur. Thus, we advocate for removing law enforcement from school settings and redirecting resources into inclusive, evidence-informed responses that are generally safer and more effective than SBLE. We close by outlining the policy landscape governing SBLE programs and ways communities can lobby for change.

Dissociative Identity Disorder in Schools Part II

Dissociation is a well-established outcome of early life trauma, but school nurses may not be aware of resources and recommendations available to support students who experience it. If dissociation or behaviors consistent with dissociation are present, trauma-informed care (TIC) principles can guide individualized care of the student. Part I of this two-part article provided a pertinent background on dissociation, dissociative identity disorder (DID), the effects of social media, and TIC. Part II offers specific recommendations for implementing these principles in school nursing practice and follows the student vignette through the school year. Due to their holistic approach to care and long-standing leadership in providing TIC, nurses can significantly affect health, safety, and access to learning for students expressing dissociative experiences at school.

What's the matter with ACEs? Recommendations for considering early adversity in educational contexts

BACKGROUND

Currently, some trauma-informed education practices use "ACE scores," a number that represents the sum of endorsed items from a survey derived from the Adverse Childhood Experiences (ACEs) study in 1998. We caution that the survey provides limited information within education, and such scores have limited utility for designing and delivering individualized intervention to support students who have experienced adversity.

OBJECTIVE

We sought to illustrate why ACEs are not well-suited for use in trauma-informed education, provide definitions for adversity-related terms from which a broader and common understanding of adversity can stem, and provide recommendations for integration of adversity-informed approaches to the educational context.

METHODS

We compiled definitions of adversity-related constructs and made recommendations based on review of relevant research from the fields of psychology and education.

RESULTS

Rather than tailoring educational practices to specific children based on the "traumatic" events they experience, we recommend educators focus their efforts on building supportive classrooms geared toward supporting students with best practices drawn from the Science of Learning, and with the understanding that early adversity can influence heterogeneous trajectories in student development and behavior. In addition, further research on educational practices, including the use of a shared language for describing and defining adversity-related experiences, are the concrete steps needed to better support a goal of adversity-informed education.

Adversity, Engagement, and Later Achievement: The Role of Emotion Regulation and Parent-Child Relationship Quality

Background

Students who have experienced adversity tend to demonstrate poorer academic outcomes than their non-maltreated peers. Academic engagement, a multidimensional, motivational construct, associated with a myriad of positive academic outcomes is an important academically-related mechanism that can be leveraged to improve the outcomes of this population.

Objective

The present study aimed to better understanding of how engagement develops in the context of adversity by exploring the effects emotion regulation skills and parent-child relationships have on engagement development.

Participants and setting

Analyses were conducted on 795 participants in the NSCAW dataset.

Methods

Path analysis was used to estimate mediation and moderated mediation models.

Results

Emotion regulation skills significantly mediated the effect experiencing trauma symptoms had on engagement. Parent-child relationship quality moderated the mediation effect emotion regulation skills had on the relationship between experiencing trauma symptoms and engagement.

Conclusions

Emotion regulation skills and parent-child relationship quality are potential intervention targets to improve engagement for students who have experienced adversity.

Utilizing KAP in Schools: An Evaluation of Educators' and Staff Knowledge, Attitudes, and Practices Related to Trauma

We examined differences in knowledge, attitudes, and practices related to student trauma and trauma-informed practices among various educators and certified staff members in a United States, Midwestern school district. We examined three research questions: 1.) Are there significant differences in knowledge, attitudes, and practices among teachers with differing years' experience? 2.) Are there significant differences in knowledge, attitudes, and practices among primary and secondary educators and staff? 3.) Are there significant differences in knowledge, attitudes, and practices among educators and staff who have participated in professional development (PD) regarding student trauma, and those who have not? We utilized a revised version of the Knowledge, Attitudes, and Practices (KAP) survey (Law, 2019) focused on student trauma. The KAP survey was sent via email to all certified staff members in the school district. No significant differences were found among knowledge and attitudes; however, primary school educators implemented significantly more trauma-informed practices compared to secondary educators. Additionally, educators with PD implemented significantly more trauma-informed practices compared to those without PD. Findings revealed our staff members had similar levels of knowledge and attitudes, though practices differed depending on years' experience, PD, and grades taught. Implications for future research relating to student trauma and the research-to-practice gap are discussed.

Michigan Model for HealthTM Learning to Enhance and Adapt for Prevention (Mi-LEAP): protocol of a pilot randomized trial comparing Enhanced Replicating Effective Programs versus standard implementation to deliver an evidence-based drug use prevention curriculum

Background

School-based drug use prevention programs have demonstrated notable potential to reduce the onset and escalation of drug use, including among youth at risk of poor outcomes such as those exposed to trauma. Researchers have found a robust relationship between intervention fidelity and participant (i.e., student) outcomes. Effective implementation of evidence-based interventions, such as the Michigan Model for Health^TM (MMH), is critical to achieving desired public health objectives. Yet, a persistent gap remains in what we know works and how to effectively translate these findings into routine practice. The objective of this study is to design and test a multi-component implementation strategy to tailor MMH to meet population needs (i.e., students exposed to trauma), and improve the population-context fit to enhance fidelity and effectiveness.

Methods

Using a 2-group, mixed-method randomized controlled trial design, this study will compare standard implementation versus Enhanced Replicating Effective Programs (REP) to deliver MMH. REP is a theoretically based implementation strategy that promotes evidence-based intervention (EBI) fidelity through a combination of EBI curriculum packaging, training, and as-needed technical assistance and is consistent with standard MMH implementation. Enhanced REP will tailor the intervention and training to integrate trauma-informed approaches and deploy customized implementation support (i.e., facilitation). The research will address the following specific aims: (1) design and test an implementation strategy (Enhanced REP) to deliver the MMH versus standard implementation and evaluate feasibility, acceptability, and appropriateness using mixed methods, (2) estimate the costs and cost-effectiveness of Enhanced REP to deliver MMH versus standard implementation.

Discussion

This research will design and test a multi-component implementation strategy focused on enhancing the fit between the intervention and population needs while maintaining fidelity to MMH core functions. We focus on the feasibility of deploying the implementation strategy bundle and costing methods and preliminary information on cost input distributions. The substantive focus on youth at heightened risk of drug use and its consequences due to trauma exposure is significant because of the public health impact of prevention. Pilot studies of implementation strategies are underutilized and can provide vital information on designing and testing effective strategies by addressing potential design and methods uncertainties and the effects of the implementation strategy on implementation and student outcomes.

Trial registration

NCT04752189—registered on 8 February 2021 on ClinicalTrials.gov PRS

Animation Narrative on Stress Relief and Psychological Cognitive Development in Adolescents

As the atmosphere of domestic animation is getting stronger and stronger in recent years, its proportion in the process of public aesthetics, entertainment, and consumption is increasing; thus, the relationship between the audience and works has become an important academic focus. The theatrical animation in the animation industry has become the category that needs to be focused on and changed in the development process of domestic animation because of its characteristics of receiving attention from all-age audiences. Because of the diversified audience levels faced by theatrical animation, it is particularly difficult to coordinate the needs of each audience level, coupled with the long-term influence of Japanese and American animation; the trend of pop culture led by network culture; the inheritance, excavation, and reconstruction of national culture; and other cultural environment and creative thinking intertwined, making the construction of the independence of domestic animation appear more and more difficult. The purpose of this paper is to analyze the theoretical study of the healing elements of Natsume Yojimbo and to analyze the creation of Chinese traditional ink and wash in the creation of our own works. It is concluded that the thematic choices are based on two categories: emotions and dreams, which focus on personal life experience and universal concern for human life. The character construction is divided into three aspects: self-resistance and self-reflection, self-vision and self-actualization, and traumatic experience and self-rescue to explain the complexity and diversity of the characters' growth connotation. The narrative perspective constitutes the perspective from which the issues are viewed. The omniscient perspective allows for the coexistence of complex character relationships and a clear storyline, while the limited perspective reveals certain emotional tendencies. The narrative mode presents the moral of the text with cause-and-effect narrative, embellished group narrative, and dreamlike polyphony narrative. Finally, the article discusses the realistic dilemma of the growth narrative of domestic online animation and tries to put forward feasible development suggestions in response to the problems at this stage.

Assessment of adult learning outcomes from a school-based training on adverse childhood experiences science and trauma-informed care

BACKGROUND

Implementing trauma-informed care (TIC) practices in educational settings requires preparing school staff to understand adverse childhood experiences (ACEs) and their impact to provide a restorative rather than a punitive response.

OBJECTIVES

To assess learning outcomes of a TIC training delivered to kindergarten to 12-grade (K-12) staff.

PARTICIPANTS AND SETTING

A TIC training informed by the Substance Abuse and Mental Health Service Administration (SAMHSA) Framework was delivered August to December 2017 to twenty-seven K-12 staff in Southeastern U.S. Majority were women (93 %) aged 25 to 58 years; 52 % were White and 48 % were Black/African American (48 %).

METHODS

Curricular content included an overview of ACEs; stress physiology; recognition of symptoms in self and others; strategies for response; and self-care. A post-training questionnaire with 11 learning statements was administered to assess participants' level of agreement with learning each concept using a 5-point Likert scale. Self-reflective narratives of challenging situations with students were also submitted and qualitatively analyzed for applications of TIC.

RESULTS

Between 62.9 % to 96 % of participants agreed/strongly agreed with learning new concepts related to ACEs and their symptoms. Qualitative data indicated that participants were able to recognize stress symptoms in students and in themselves and integrate strategies learned such as breathing and creating safe space to allow students to have voice and choice.

CONCLUSIONS

TIC training curriculum that includes ACEs and toxic stress science is a critical component that promotes recognition of trauma symptoms in themselves and others. Self-reflective practice using narratives is an essential training tool for implementing TIC.

Coping Methods Used by College Undergraduate and Graduate Students while Experiencing Childhood Adversities and Traumas

Experiences in childhood, both positive and negative, are crucial to a child's progression. Childhood traumas and adversities are detrimental to children's development and can have long term consequences that manifest themselves in young adulthood. The purpose of this study is to inductively explore coping strategies used by young adults during their experience of childhood traumas and adversities. A sample of college students from a diverse northeastern university (N = 146) provided quantitative and qualitative survey responses. Students were asked, "What were the tools you used to cope with adversity and/or traumatic events?" Participants responded to the prompt based on their experiences from childhood. The researchers analyzed the qualitative data using a mixed-method, thematic approach to coding participant responses. Additional quantitative information is explored to explain emerging qualitative themes. Two salient themes of coping strategies emerged, providing support for Machado et al. (2020): (1) Emotion-Focused Coping and (2) Problem-Focus Coping. Minor themes built on the findings in the area of Emotion-Focused Coping, highlighting processes of (i) emotional regulation, (ii) emotional expression, and (iii) emotional avoidance. Excerpts from this study's participants suggest that individuals dealing with adversities and traumas find a variety of ways to cope. These coping strategies can be implemented into institutions' everyday practices to aid children during their time of vulnerability. The article provides recommendations for school administrators, leadership teams, and any professional specializing in school culture, curriculum, and social work.

Actions Against Racism:

Racism is a social determinant of health with dire consequences for the health, education, and mental health of students of color. Thus, there is an urgent need to develop and test evidence-based strategies to combat racism in schools. In response to this need, our team has developed a multi-tiered school-based intervention to build capacity for combatting racism in educators, students, and families. The “Actions Against Racism” intervention synthesizes three evidence-based practices: trauma-informed practices, social-emotional learning (SEL), and racial socialization. The multiple tiers of intervention aim to cultivate skills for combatting individual and structural racism in educators, families, and students across the school ecology. In this paper, we present the rationale for this intervention and provide an overview of the “Actions Against Racism” components.

A mixed methods investigation of implementation determinants for a school-based universal prevention intervention

Background

Effective implementation of evidence-based prevention interventions in schools is vital to reducing the burden of drug use and its consequences. Universal prevention interventions often fail to achieve desired public health outcomes due to poor implementation. One central reason for suboptimal implementation is the limited fit between the intervention and the setting. Research is needed to increase our understanding of how intervention characteristics and context influence intervention implementation in schools to design implementation strategies that will address barriers and improve public health impact.

Methods

Using a convergent mixed methods design we examined qualitative and quantitative data on implementation determinants for an evidence-based health curriculum, the Michigan Model for HealthTM (MMH) from the perspective of health teachers delivering the curriculum in high schools across the state. We examined data strands independently and integrated them by investigating data alignment, expansion, and divergence.

Results

We identified three mixed methods domains: (1) Acceptability, (2) intervention-context fit, and (3) adaptability. We found alignment across data strands as teachers reporting low acceptability also reported low fidelity. The fit between student needs and the curriculum predicted fidelity (expansion). Teachers mentioned instances of poor intervention-context fit (discordance), including when meeting the needs of trauma-exposed youth and keeping updated on youth drug use trends. Teachers reported high adaptability (concordance) but also instances when adaptation was challenging (discordance).

Conclusions

This investigation advances implementation research by deepening our understanding of implementation determinants for an evidence-based universal prevention intervention in schools. This will support designing effective implementation strategies to address barriers and advance the public health impact of interventions that address important risk and protective factors for all youth.

Plain Language Summary

(1) What is Already Known About the Topic? While many evidence-based interventions (EBIs) exist to address key health issues among youth including substance use and mental health, few of these interventions are effectively implemented in community settings, such as schools. Notable multilevel barriers exist to implement universal prevention in schools. Researchers identify that misalignment between the intervention and the context is a key reason why many implementation efforts do not achieve desired outcomes. (2) What Does This Paper Add? This paper combines the strengths of qualitative and quantitative research methods to identify and understand challenges to intervention-context fit for a comprehensive health curriculum, the Michigan Model for HealthTM (MMH) which is widely adopted throughout Michigan, from the perspective of end users. This paper also utilizes the consolidated framework for implementation research and implementation outcomes framework to guide our understanding of implementing complex interventions and key barriers to implementation in schools. This research provides a foundation to design effective strategies that will balance curriculum fidelity and adaptation to achieve public health objectives. (3) What are the Implications for Practice, Research, or Policy? We need implementation strategies that guide flexibility and fidelity in EBI delivery in schools. While overall teachers felt the curriculum was adaptable and met student needs, they also mentioned specific instances when they would benefit from additional implementation support, such as making adaptations to meet the needs of trauma-exposed youth and keeping up-to-date with emerging drugs. Implementation strategies designed to address these challenges can improve fidelity and ultimately student well-being.

Parental Social Isolation and Child Maltreatment Risk during the COVID-19 Pandemic

On March 11, 2020, COVID-19 was declared a pandemic by the World Health Organization. The social isolation and economic stress resulting from pandemic have the potential to exacerbate child abuse and neglect. This study examines the association of parents' perceived social isolation and recent employment loss to risk for child maltreatment (neglect, verbal aggression, and physical punishment) in the early weeks of the pandemic. Participants (N = 283) were adults living in the U.S. who were parents of at least one child 0-12 years of age. Participants completed an online survey approximately 2 weeks after the World Health Organization declared that COVID-19 was a pandemic. The survey asked about recent changes (i.e., in the past 2 weeks) to employment status, parenting behaviors, use of discipline, use of spanking, and depressive symptoms. Nearly 20% of parents had hit or spanked their child in the past two weeks alone. Parents' perceived social isolation and recent employment loss were associated with self-report of physical and emotional neglect and verbal aggression against the child, even after controlling for parental depressive symptoms, income, and sociodemographic factors. Parents' perceived social isolation was associated with parental report of changes in discipline, specifically, using discipline and spanking more often in the past 2 weeks. Associations were robust to analyses that included two variables that assessed days spent social distancing and days spent in "lockdown." Study results point to the need for mental health supports to parents and children to ameliorate the strain created by COVID-19.

Community-Based Trauma-Informed Care Following Immigrant Family Reunification: A Narrative Review

Many immigrant families made the decision to separate from their children and migrate to the United States (US) hoping to reunite when able. Contrary to what is envisioned, the ultimate reunification can be a challenging transition. Reestablishing the parent-child relationship can be hindered by the anger, distress, vulnerability, and abuse the child may have experienced during the separation leading to behavioral concerns and depressive symptoms. The culmination of trauma and adverse childhood events prior to and following reunification is associated with an increased risk of anxiety, depression, behavioral disorders, and toxic stress. Unaddressed, these issues can lead to poor adult psychiatric health and limit a child's educational success and potential lifetime earnings. Trauma-informed programming has been an effective tool in addressing the mental health needs of refugee and immigrant children and may benefit this particular group of reunified families when held in a community setting alongside peer support. Familias Reunidas and Family Reunification and Resiliency Training (FUERTE) are 2 community-based programs that successfully guided recently reunified families through the process of reconnecting. Review of these programs suggests there is significance in the collaboration of health care providers, education specialists, and community liaisons in program creation, cultivation of a supportive group environment, incorporation of trauma-informed principles, and partnership with a community establishment. These components can lead to a reunification program that provides access to mental health services in order to work toward eliminating the health disparities affecting these families. Brief Summary: Family reunification can be a challenging transition for recently immigrated children whose parent(s) immigrated to the US years before them. Community programming could provide access to trauma-informed care to overcome the emotional distress reunification can cause within families.

The Perfect Storm: Hidden Risk of Child Maltreatment During the Covid-19 Pandemic

The Covid-19 pandemic upended the country, with enormous economic and social shifts. Given the increased contact from families living in virtual confinement coupled with massive economic disarray, the Covid-19 pandemic may have created the ideal conditions to witness a rise in children's experience of abuse and neglect. Yet such a rise will be difficult to calculate given the drop in official mechanisms to track its incidence. The current investigation utilized two studies conducted early in the pandemic to evaluate maltreatment risk. In the first cross-sectional study, parents (n = 405) reported increased physical and verbal conflict and neglect which were associated with their perceived stress and loneliness. In the second study, parents (n = 106) enrolled in a longitudinal study reported increased parent-child conflict, which was associated with concurrent child abuse risk, with several links to employment loss, food insecurity, and loneliness; findings also demonstrated increases in abuse risk and psychological aggression relative to pre-pandemic levels. Findings are discussed in the context of a reactive welfare system rather than a pro-active public-health oriented approach to child maltreatment, connecting with families through multiple avenues. Innovative approaches will be needed to reach children faced with maltreatment to gauge its scope and impact in the pandemic's aftermath.

How COVID-19 Is Placing Vulnerable Children at Risk and Why We Need a Different Approach to Child Welfare

The onset of the COVID-19 pandemic brings new worries about the welfare of children, particularly those of families living in poverty and impacted other risk factors. These children will struggle more during the pandemic because of financial pressures and stress placed on parents, as well as their limited access to services and systems of support. In this commentary, we explain how current circumstances reinforce the need for systemic change within statutory child welfare systems and the benefits that would accrue by implementing a continuum of services that combine universal supports with early intervention strategies. We also focus on promising approaches consistent with goals for public health prevention and draw out ideas related workforce development and cross-sector collaboration.

Moving Policy Toward a Whole School, Whole Community, Whole Child Approach to Support Children Who Have Experienced Trauma

BACKGROUND

As attention to the potential negative outcomes of childhood trauma has grown, so have calls for schools to take an active role in supporting students experiencing trauma. These calls extend beyond efforts initiated by individual schools to include those mandated by state law, which largely focus on teacher training and on screening for adversity.

METHODS

This article explores the evidence base and limitations for current approaches in state law and explores how policies to address other student health, safety, and wellness issues can help either ameliorate or exacerbate students' experiences with trauma.

RESULTS

Few trainings for nonclinical staff have rigorous evidence of effectiveness, and based on evidence of teacher trainings on other topics, cannot work in environments that do not actively reinforce and encourage the application of that knowledge. Trainings also largely do not acknowledge the structures and systems, including systemic racism within schools, that may contribute to disparate rates of adversity for black and American Indian and Alaskan Native children. Screening carries several risks, including confounding adversity with experiencing trauma, missing broader contextual adversity, and potentially retraumatizing children.

CONCLUSIONS

State policymakers need to take a more holistic approach in creating policies to support students experiencing trauma.

Reducing the Biological and Psychological Toxicity of Poverty-related Stress: Initial Efficacy of the BaSICS Intervention for Early Adolescents

This proof-of-concept study tests the initial efficacy of the Building a Strong Identity and Coping Skills (BaSICS) intervention, a selective prevention of internalizing problems program for early adolescents exposed to high levels of poverty-related stress. Eighty-four early adolescents (M_age  = 11.36 years) residing in very low-income neighborhoods were randomized to receive the 16-session intervention (n = 44) or to an assessment-only control condition (n = 40). BaSICS teaches coping skills, social identity development, and collective social action to empower youth with the ability to connect with members of their communities and cope with poverty-related stress in positive and collaborative ways. Pretest-posttest analyses showed that intervention adolescents acquired problem-solving and cognitive-restructuring skills and reduced their reliance on avoidant coping. In addition, HPA reactivity was significantly reduced in the intervention youth, but not controls. Finally, intervention youth's internalizing and somatic symptoms as reported by both youth and their parents, showed significant reductions over time, whereas control youth had no such changes. Results provide strong support for this approach to strength-building and symptom reduction in a population of early adolescents exposed to poverty-related stress.

Applied and Translational Research on Trauma-Responsive Programs and Policy: Introduction to a Special Issue of the American Journal of Community Psychology

The special issue highlights work across systems that include child welfare, education, juvenile justice and health, as well as agencies serving adults who are at-risk for high levels of childhood and adult trauma exposure. While articles appearing in the special issue are not divided equally across these systems, they cover important and overlapping concepts within each. Some articles span more than a single system or domain of research, whereas others fit primarily within single area or domain. Articles provide new insights from research on practices, programs, and policies that help to transform systems so they are increasingly more responsive to the needs of vulnerable populations.