Schools “Hitch-Up” to Another Bandwagon that is Wasting Time and Delaying Recommended Scientifically-Proven Services (Part I)
Dear Colleagues,
Introduction
While most educators know that they are supposed to implement “evidence-based” academic and behavioral practices in their schools (according to the Elementary and Secondary Education Act), most of our districts and schools still struggle mightily in this area.
Some of the “challenges” here include the fact that many educators:
- Do not know the differences across the terms “evidence-based,” “scientifically-based,” and “research-based;”
- Do not know how to evaluate and discriminate between methodologically and statistically-analyzed “sound” research versus “passable” research versus “unsound” research;
- Assume that “published” research—especially when in a national professional journal—much less in a national foundation’s technical report, an association newsletter or E-blast, or a popular press publication or newspaper is automatically “sound” research;
- Assume that “published” research is “sound” because it was sponsored or advocated by a “trusted” source, a well-regarded “expert,” a social media “giant,” or an entity (for example, the U.S. Department of Education, one of its funded federal Technical Assistance Centers, a State Department of Education) that “would only disseminate sound research” (of course—I am being facetious here);
- Overgeneralize the results of one or a small number of sound studies, while also not understanding that even “sound” research may not be relevant to their districts or schools—because the research does not apply to their settings or demographic conditions, students or staff, or the underlying root cause reasons for their circumstances;
- Do not have the time or the within-district expertise to evaluate the quality of the research in identified and needed areas; and
- Do not have the resources, training potential, staff or staff expertise, or funding to implement even sound research with the needed intensity, integrity, and sustainability.
I am not trying to be disrespectful here. I understand these challenges—given the many schools I consult with across the country and internationally—all too well.
But I still need to note that far too many districts and schools consciously, dismissively, or naïvely “jump on unsound, unproven, or ill-fitting educational bandwagons,” and adopt partially, poorly, or untested programs, practices, or interventions.
All too often, they are then “surprised” when these programs do not succeed.
Parenthetically, it is important to note that some vendors depend on some of the “challenges” above to sell their programs, curricula, or consulting services.
That is, they use their marketing, “sales pitches,” and testimonials to secure contracts—knowing that the district or a school does not have the expertise, resources, or time to do its own objective “due diligence” . . . and that, if the district or school did conduct its own competent and objective product evaluation, it would never purchase the program, curriculum, or consulting service.]
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But, most critically, when districts and/or schools implement programs or curricula that are invalid, untested, or inappropriate to their students. . . and they are unsuccessful, there are real implications.
These include:
- Time, money, and other resources are wasted.
- Staff and student motivation and momentum are hindered.
- Positive and needed student change or improvement is undermined, unrealized, or unraveled.
- And, especially, staff and student trust is damaged, such that staff and student resistance to the next (possible most effective) program increases.
At a surface level, the implementation of unsuccessful programs—that never should have been implemented in the first place—involves poor planning, decision-making, and needless waste.
At a deeper level—not to be an alarmist—this represents educational malpractice.
If a doctor would not use an untested drug on his/her patients, how can a responsible educator rationalize the use of an untested (or poorly matched) program or curriculum in his/her district or school?
At any level, one must question the validity of any district or school’s complaints about its lack of time, money, and other resources when it selects and implements invalid or untested programs that—predictably—are unsuccessful (or worse).
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Trauma-Informed Schools, SEL, Mindfulness, and Meditation Revisited
Over the past few months, I have continued to monitor the research and practice of three areas that are beginning to be linked programmatically in the schools:
- Trauma-Informed or Trauma-Sensitive Care, or Trauma-Informed Systems
- Social-Emotional Learning (SEL)
- Mindfulness and Meditation
In this two-part Blog Series, I will update you on the newest research-to-practice in these areas, while also citing past Blogs that have directly addressed these approaches.
This first Part I discusses a recent study that reviewed over 9,000 studies, published over the past ten years, investigating trauma-informed school programs. Using objective, research-sensitive criteria, this study determined that none of the studies met their criteria for sound research.
We discuss this result in the context of the thousands of schools across this country that have potentially implemented invalid, unsound, or wasteful (as above) trauma-informed programs, and describe an evidence-based multi-tiered approach that responsibly addresses the needs of students impacted by trauma. We also address the flawed national PBIS and SEL-CASEL frameworks, recommending that they not be used as the foundation of a more generic school-wide approach for these students.
In Part II, we will discuss the relationship and inappropriate use of mindfulness and mediation with students experiencing trauma. Here, we will describe the biological and neuropsychological underpinnings of trauma-related student emotionality, and how mindfulness and mediation will not change this emotionality— especially when it is classically conditioned (i.e., Pavlovian in nature).
The theme across both Parts of this Series—and consistent with the Introduction above—is that:
Districts and schools need to know the Trauma-Informed Care, SEL, Mindfulness, and Meditation research-to-practice as all of these areas have significant flaws that should result in educators questioning their use in schools.
Recognizing that districts and schools do not always have the time or expertise of evaluate the current research-to-practice, I hope that this two-part Series (and my previous Blogs on these topics) will help to close this gap.
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Trauma-Informed Schools: New Research Says There is No Research
Over the past five years or more, the national discussion on the effects of trauma—especially relative to school-aged students—has increased exponentially. Fueling this discussion is a screening tool that was developed in the mid-1990s, the Adverse Childhood Experiences (ACEs) scale, that we believe is being misinterpreted and misused. The result has been the wasteful adoption by many schools “Trauma-Informed” programs and practices that are not providing the appropriate services, supports, and interventions to students.
We discussed the ACEs in detail in a recent Blog stating:
Aren’t Schools with Positive, Safe Climates Already “Trauma Sensitive”? Unmasking the ACEs, and Helping Students Manage their Emotions in School
The original ACE Study was conducted by the Kaiser Permanente Health Maintenance Organization (HMO) in Southern California from 1995 to 1997 with two waves of data collection. As they were receiving physical exams, over 17,000 HMO members completed confidential surveys regarding their childhood experiences and their current health status and behaviors. Significantly, beyond the fact that the sample was from a limited geographic area, the participants were primarily white and from the middle class.
Below are the actual ACE Study Questions. Each “Yes” response received one point toward the “final score.” As educators, please read these items relative to today’s students. Think about how many of your students have experienced four or more of these events so far in their lives (more on that below).
While you were growing up, during your first 18 years of life:
1. Emotional Abuse. Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt?
2. Physical Abuse. Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?
3. Sexual Abuse. Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?
4. Emotional Neglect. Did you often or very often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other?
5. Physical Neglect. Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
6. Parental Separation or Divorce. Were your parents ever separated or divorced?
7. Mother Treated Violently. Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit at least a few minutes or threatened with a gun or knife?
8. Household Substance Abuse. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
9. Household Mental Illness. Was a household member depressed or mentally ill, or did a household member attempt suicide?
10. Incarcerated Household Member. Did a household member go to prison?
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The most critical concerns with the ACEs’ Questions are:
- They do not discriminate between “finite” events (e.g., having a household member incarcerated) and events that can occur over time or in a repeated way;
- Thus, they do not quantify many of the events (e.g., how long was the separation, how many times was your mother physically threatened);
- They do not identify the age (or age range) when the child or adolescent experienced each event;
- They do not ask for a rating of the intensity of each event (e.g., along a Mild-Moderate-Severe continuum);
- They do not get a rating of the emotional impact of each event at the time that it occurred (e.g., along a None-Low-Mild-Moderate-Significant-Life Changing continuum); and
- They do not get a rating of the current (assuming an event occurred in the past) and/or continuing emotional impact of each event.
Given the absence of this critical contextual information, we do not really know the cumulative depth, breadth, intensity, or impact of an individual’s traumatic history. Indeed, we may just simply know how many events an individual may have experienced.
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New Research Study on the Trauma-Informed Research
In July, 2019, Maynard, Farina, Dell, and Kelly published an article, “Effects of Trauma-Informed Approaches in Schools: A Systematic Review,” in the Campbell Systematic Reviews published by John Wiley & Sons.
[CLICK HERE for Original Article]
The goal of the study was to systematically and objectively review the empirical research in Trauma-Informed approaches in schools so that the research-based efficacy of the different approaches being implemented could be evaluated.
The authors contextualize their research in this way:
Exposure to different types of trauma have been associated with varying types and complexity of adverse outcomes, including adverse effects on cognitive functioning, attention, memory, academic performance, and school‐related behaviors. Given the growing research on trauma and increased knowledge about the prevalence, consequences and costs associated with trauma, there have been increased efforts at the local, state and federal levels to make systems “trauma‐informed” (Lang et al., 2015). Indeed, federal legislation has been proposed to advance trauma‐informed practice, with approximately 49 bills introduced between 1973 and 2015 that explicitly mentioned trauma‐informed practice, with more than half introduced in 2015 alone (Purtle & Lewis, 2017).
The promotion and provision of trauma‐informed approaches in school settings in particular is growing at a rapid rate across the United States. At least 17 states have implemented trauma‐informed approaches at the school, district, and even state‐wide levels (Overstreet & Chafouleas, 2016). This rapid increase in the growth of trauma-informed approaches in schools has been fueled by a number of local, state, and federal initiatives and increasing support by education related organizations.
While the intent of creating trauma‐informed approaches in schools is a noble one, relatively little is known about the benefits, costs, and how trauma‐informed approaches are being defined and evaluated (Berliner & Kolko, 2016). Adopting a trauma‐informed approach in a complex system such as a school building or district is a time consuming and potentially costly endeavor, and there is potential for harm; therefore, it is important to assess the effects of this approach to inform policy and practice.
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In order to evaluate the current research, the authors set the following selection criteria so only those studies that used appropriate research and statistical methods were included in their analysis.
According to the authors, the criteria for inclusion in the review included:
1. Must have used a randomized or quasi‐experimental study design in which participants who received an intervention were compared with a wait‐list, no treatment, treatment‐as‐usual or an alternative treatment comparison group.
2. Studies must have been conducted in a school setting serving PreK‐12 (or equivalent) students.
3. Studies must have assessed effects of a trauma‐informed approach, defined as a program, organization, or system that realizes the impact of trauma, recognizes the symptoms of trauma, responds by integrating knowledge about trauma policies and practices, and seeks to reduce re-traumatization. At last two of the three key elements of a trauma-informed approach must have been present: Workforce development, trauma‐focused services, and organizational environment and practices (Hanson & Lang, 2016). This approach is distinguished from trauma‐specific interventions, which are specific interventions designed to treat or otherwise address the impact/symptoms of trauma and facilitate healing.
4. Studies must have measured a student‐level outcome related to trauma symptoms/mental health, academic performance, behavior, or socioemotional functioning.
5. We did not limit studies based on publication status, geographical location or language. We searched for studies that had been published in the last 10 years, as this is a relatively recent movement.
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Eventually, the authors did a comprehensive research review that identified 9,102 possible school-based, trauma-related articles that were published during the last ten years. After removing duplicate articles from the review, they began to apply the criteria above to the remaining 7,173 studies—eventually excluding 7,106 studies.
Of the remaining 67 studies: All 67 were excluded. 49 did not use random controlled trials or quasi-experimental design methods; 12 did not examine the effects of a trauma-informed approach; and 5 examined only one aspect of a trauma-informed approach.
Thus: These authors determined that there were no school-based, trauma-informed research studies over the past ten years that were conducted using sound research methodologies such that the programs investigated could be objectively determined to be effective in addressing the trauma-related needs of school-aged students.
The authors concluded:
From this review, it seems like the most prudent thing for school leaders, policymakers, and school mental health professionals to do would be proceed with caution in their embrace of a trauma-informed approach as an overarching framework and conduct rigorous evaluation of this approach. We simply do not have the evidence (yet) to know if this works, and indeed, we do not know if using a trauma‐informed approach could actually have unintended negative consequences for traumatized youth and school communities.
We also do not have evidence of other potential costs in implementing this approach in schools, whether they be financial, academic, or other opportunity costs, and whether benefits outweigh the costs of implementing and maintaining this approach in schools. That said, calling for caution in adopting TIC in schools does not preclude schools from continuing to implement evidence‐informed programs that target trauma symptoms in youth, or that they should simply wait for the research to provide unequivocal answers.
The benefit of the trauma‐informed approach being made freely available by SAMHSA and other policymakers is that these components can form the basis for a school (or school district) to begin to adapt and apply this approach in schools.
An additional potential space for implementing a trauma-informed approach could be within the various 3‐tier models currently active in schools (often referred to as multi‐tiered systems of supports [MTSS]) to give some form and structure to these efforts. Indeed, recent scholarship has argued for the trauma‐informed approach to be embedded within MTSS to take advantage of the primary prevention focus inherent in MTSS Tier 1 and Tier 2 efforts, along with the use of data via screening tools to identify students who are impacted by trauma (Cavanaugh, 2016; Stephan, Suagi, Lever, & Connors, 2015; Zakzeski, Ventresco, & Jaffe, 2017).
The process of screening students for trauma is not without its own controversy; however, as parent groups and school stakeholders sometimes oppose the idea of screening youth in schools for issues that they believe are the domain of parents and mental health systems to handle (Dowdy, Ritchey, & Kamphaus, 2010).
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Expanding on the Concerns with the Trauma-Sensitive/Informed School Movement
As noted, we published two Blogs dedicated to this topic during 2019.
If you CLICK on the date of the Blogs below, you will link directly to the Blog that is posted on my website (www.projectachieve.info/blog).
Aren’t Schools with Positive, Safe Climates Already “Trauma Sensitive? Unmasking the ACEs, and Helping Students Manage their Emotions in School
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The Traps and Trouble with “Trauma Sensitive” Schools: Most Approaches Are Not Scientifically-Based, Field-Tested, Validated, or Multi-Tiered. A National Education Talk Radio Interview (Free Link Included) Puts it All into Perspective
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In those two Blogs devoted to this subject, we stated our beliefs that:
- Some educators have become over-sensitized to this issue—for example, incorrectly attributing some students’ emotional or behavioral issues to “trauma” when they are due to other factors;
- Some schools do not understand and are misusing the Adverse Childhood Experiences (ACEs) scale and research; and
- Some districts—with all good intents—have adopted “trauma sensitive” programs and protocols that are either not needed or not advisable.
Clearly, Maynard, Farina, Dell, and Kelly’s systematic review of the trauma-informed “research” demonstrates the validity of the third concern above. Indeed, given the innumerable states and districts that have already adopted trauma sensitive or informed programs, protocols, and practices, Maynard’s review suggests that many of these implemented programs are NOT scientifically-based, have NOT been well field-tested, and are NOT validated using objective and methodologically-sound approaches. In addition, some districts and schools are likely using approaches that are NOT directly applicable to their students and needs, and are NOT being implemented along a multi-tiered continuum.
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To support these statements, the August 17th Blog described in detail answers to the following questions:
Issue #1: Do Practitioners Understand the Original ACEs Research, Its Strengths, and Its Limitations to School-Based Practice?
Here, we described the original ACEs Study, and then analyzed and discussed the field-based limitations and psychometric flaws in the ACEs Questionnaire. We emphasized that, if it is used at all, the ACEs Questionnaire needs to be used as a screening tool, and that any of its results need to be validated using more sensitize psychological assessments.
We concluded:
Given the absence of the critical contextual and functional assessment information underlying a student’s responses on the ACEs Survey. . .
When a student scores above the ACEs “cut-off” (representing a concern), we do not really know the cumulative depth, breadth, intensity, or impact of that individual’s traumatic history. Indeed, we may just simply know how many events an individual may have experienced.
Beyond this, relative to students, staff, and schools, another critical issue is that there is no well-established and validated science-to-practice connection to group or individual ACEs results and effective approaches to trauma awareness, programming, or interventions in schools.
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Issue #2. Are Schools Implementing Specialized “Trauma Sensitive” Programs When They Should be Implementing More Comprehensive (Pervasive and Preventative) Positive School Climate Practices?
Here, we emphasized the importance that schools first:
Focus on establishing and sustaining prosocial and safe school climates, and positive and supportive classrooms interactions.
As part of this school discipline, classroom management, and student self-management process, identify how trauma—and other critical factors—are affecting students’ social, emotional, and behavioral readiness for and interactions in school, and integrate prevention and early-response services, supports, and strategies to address high-hit circumstances or needs.
For students with significant social, emotional, behavioral, or mental health needs (whether trauma-based or not), schools need a multi-disciplinary team of diverse experts who can analyze the root causes of the problems, and link the assessment results to effective, research-based multi-tiered services, supports, strategies, and interventions.
In other words, as recommended by Maynard and her co-authors, we believe that educators should first establish comprehensive, evidence-based, multi-tiered school discipline (or positive behavioral support/social-emotional learning) systems that integrate trauma as but one factor affecting students’ behavior, interactions, and academic readiness and engagement.
Indeed, we provided a number of critical reasons why schools should not implement a dedicated Trauma-Sensitive Program as their core (or even secondary) systems relative to school safety and discipline, classroom climate and management, and student self-management and academic engagement.
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Issue #3. Do Schools (Have the Time to) Evaluate the Integrity and Utility of their Trauma Sensitive Programs Prior to Implementation, and How Many Schools Choose their Programs Due to Cost and Not Outcomes?
Here, we discussed the reality that the ACEs study has spawned a “cottage industry” of “experts and consultants” who have generated their own (what they call) “research-based trauma programs.”
Unfortunately, many of these programs have never been fully and objectively field-tested (if at all). . . in multiple settings, under multiple conditions, and with students who have experienced different types and intensities of trauma.
Said a different way: While many of these programs cite research that explains why they have included certain components or activities, they have not—themselves—been researched.
In fact, even from a research perspective, many of these programs are not psychologically and neuropsychologically grounded. That is, they do not use the “deep science” of trauma—including the clinical, multi-tiered psychoeducational elements needed for student and staff success.
Moreover, many of these programs are “stand alone” programs. They do not integrate their approaches into the school’s existing discipline, behavior management, and student self-management systems, and they often are seen by staff as a disconnected thread of information that represents “another thing to do” . . . in an already impossibly busy day, week, and month.
Finally, too many of these programs recommend global and generic components and activities that are not strategically-chosen or sustainable. The programs present a fixed package. . . rather than presenting sound strategies on how to identify and then analyze the root causes of students’ trauma— so that the assessment results can be strategically linked to needed services, supports, and interventions.
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Issue #4. Do Schools Understand the Science-to-Practice Components that Facilitate Students’ Emotional Self-Management—The Key Preventative “Skill” Needed by All Students?
The August 17 Blog addressed one of the ultimate goals of a comprehensive, multi-tiered school discipline (Positive Behavioral Support/Social-Emotional Learning, PBSS/SEL) system: To teach and motivate students to learn, master, and independently apply social, emotional, and behavioral self-management skills.
We further defined “Emotional Self-management Skills” as those skills that all students need to learn, master, demonstrate, and apply in the areas of: emotional awareness, emotional control, and emotional coping.
Here, we described these three components and their characteristics from a psychological and neuropsychological science-to-practice perspective—a perspective that often is missing in many “trauma-sensitive” programs. We then addressed these components from a multi-tiered perspective, identifying a number of specific Tier II and Tier III interventions for students with significant trauma-related needs.
Finally, we noted the importance that schools not become “trauma-rigid”—interpreting all students’ emotional reactions as trauma related.
To demonstrate this point, we identified a large number of other triggers of students’ emotions that do not involve traumatic situations:
- Academic Frustration
- Test/Homework/Work Completion Anxiety
- Peer (including Girlfriend/Boyfriend) Conflicts/Rejection
- Teasing and Bullying—Direct, Indirect, Social, and Social Media
- Gender Status or Discrimination
- Racial or Multi-Cultural Status or Discrimination
- Sexual Identification or Orientation Discrimination
- Socio-economic Status or Discrimination
- Circumstances Related to Poverty/Parental Income
- Family Moves/Housing Mobility/Homelessness
- Competition/Losing
- Physical or Other Limitations or Disabilities
Our Take-Aways were:
- There are multiple circumstances or events that trigger students’ emotionality in school. Many of them are not specifically (or by definition) traumatic events and, thus, schools that are using trauma-sensitive programs may easily miss them.
- Schools need to assess and identify the emotional triggers that are most prevalent across their student bodies, and the emotional triggers (if different) that are most often present for the students presenting with the most frequent, significant, or severe social, emotional, and behavioral challenges.
For the former group, these triggers need to be integrated into the social skills curriculum at the prevention and early response levels.
For the latter group, these triggers need to frame the strategic or intensive interventions or therapies that related services personnel need to be prepared to deliver.
- Finally, schools and districts need to be prepared to deliver the full multi-tiered continuum of services, supports, strategies, and interventions. This includes the necessary training, resources, and personnel both in general, and as needed on a year-to-year basis.
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The October 12th Blog updated the August discussion, and provided a link to a national radio broadcast interview that I did on this subject with Larry Jacobs, the host of Education Talk Radio—on October 4, 2019.
[CLICK HERE for this 28-minute Education Talk Radio Interview]
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Once again, please feel free to re-read the original Blogs to get a more detailed analysis of the Reports and summary discussed above.
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Multi-Tiered Strategic/Intensive Interventions for Students with Significant Trauma Issues
As noted above—and in our August 17th Blog, when districts and schools use comprehensive, systematically-implemented multi-tiered Positive Behavioral Support/Social-Emotional Learning (PBSS/SEL) systems that teach and motivate students to learn, master, and independently apply social, emotional, and behavioral self-management skills, they will automatically be addressing the emotionality that many students experience due to trauma.
But the evidence-based PBSS/SEL system that we advocate is not grounded by either the flawed national PBIS framework or the flawed national SEL-CASEL framework.
The PBSS/SEL system that we advocate is grounded by individual, group, and organizational principles of psychology and well-established research-to-practice. This system has been integrated into the Project ACHIEVE model that was designated as an evidence-based program in 2000 by the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA; www.projectachieve.info).
We have discussed this issues before. Please note two previous Blogs that described and analyzed the flaws in both the PBIS and CASEL-SEL frameworks:
The Year in Review (Part II): Schools’ Pursuit of Effective School Discipline, Classroom Management, and Student Self-Management Strategies
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Analyzing Your School Discipline Data and Your SEL (PBIS or School Discipline) Program: Students’ Discipline Problems are Increasing Nationally Despite Widespread SEL/PBIS Use (Part I)
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And, please note two additional earlier Blogs that described the evidence-based components of an effective, valid, and multi-tiered science-to-practice PBSS/SEL system that has been implemented nationwide for over 35 years:
Redesigning Multi-Tiered Services in Schools: Redefining the Tiers and the Differences between Services and Interventions
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Solving the Disproportionate School Discipline Referral Dilemma: When will Districts and Schools Commit to the Long-term Solutions? There are No Silver Bullets—Only Science to Preparation to Implementation to Evaluation to Celebration (Part III)
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But—as noted in Maynard, Farina, Dell, and Kelly’s systematic review of the trauma-informed research—a multi-tiered system needs to have services, supports, strategies, and interventions to address the strategic or intensive needs of students who experience frequent and/or high levels of emotionality due to trauma.
To accomplish this, a sound multi-tiered system needs to have:
- Data-based problem-solving and functional assessment processes that determine the root causes of a student’s emotionality. These assessment processes validate that the student’s emotionality is triggered by past or present traumatic events, and not by the many other emotional triggers that are not trauma-related (see the section immediately above); and
- Evidence- or research-based services, supports, strategies, and/or interventions that are linked to the root cause analyses and that have a high probability of student-centered success.
For students who need small group or individual intervention—due to their social, emotional, behavioral, or mental health challenges, the school’s mental health and related service professionals (e.g., school psychologists, counselors, and social workers) need to be directly involved. This is because some of these students need more clinical intervention, and these mental health professionals are the best-trained and skilled people to deliver them.
Indeed, some of the clinical interventions that address students’ needs at the deeper multi-tiered and trauma-focused levels include:
- Progressive Muscle Relaxation Therapy and Stress Management
- Emotional Self-Management (Self-awareness, Self-instruction, Self-monitoring, Self-evaluation, and Self-reinforcement) Training
- Emotional/Anger Control and Management Therapy
- Self-Talk and Attribution (Re)Training
- Thought Stopping approaches
- Systematic Desensitization
- Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
- Cognitive-Behavioral Intervention for Trauma in Schools (CBITS)
- Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS)
- Trauma Systems Therapy (TST)
Relative to these interventions, the critical question is:
Do schools’ related service professionals have the assessment skills to identify, and the intervention skills to clinically deliver (based on their student-centered assessments) some or all of these strategies or therapies.
If they do not, the related questions is: Are these services available from mental health professionals who are practicing and available in the community?
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A Brief Description of the Latter Four Clinical Therapies
Below are brief descriptions of the latter four clinical therapies from the strategic/intensive intervention list above.
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Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
TF-CBT is a short-term individual treatment that involves sessions with children and adolescents (ages 4 to 18) and their parents—as well as parent-only sessions. TF-CBT is for students who have significant behavioral or emotional problems related to traumatic life events, even if they do not meet the full diagnostic criteria for PTSD (Post Traumatic Stress Disorder).
The primary goal of TF-CBT is to reduce PTSD symptoms (e.g., depressive symptoms, behavior problems including aggression and inappropriate sexual behaviors, and unhelpful thoughts and feelings—such as cognitive distortions, guilt, and shame) among children and adolescents using cognitive-behavioral principles and techniques. Originally designed to address child sexual abuse, TF-CBT has also been applied to a broad range of traumatic events, such as other forms of child maltreatment, domestic violence, community violence, accidents, natural disasters, war, and other events involving traumatic loss.
Through 12 to 16 weekly clinic-based individual sessions, TF-CBT helps students to process through their traumatic memories and distressing feelings, thoughts, and behaviors. TF-CBT also uses joint parent and student sessions to provide parenting and family communication skills training so that the approach can generalize to home settings. To help children and adolescents develop coping skills, TF-CBT providers teach students relaxation skills, affective modulation skills, and cognitive coping and restructuring skills.
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Cognitive-Behavioral Intervention for Trauma in Schools (CBITS)
CBITS is a school-based, group and individual intervention designed to reduce symptoms of post-traumatic stress disorder (PTSD), depression, and behavioral problems, and to improve functioning, grades and attendance, peer and parent support, and coping skills. It has been used with 5th through 12th grade students who have witnessed or experienced traumatic life events such as community and school violence, accidents and injuries, physical abuse and domestic violence, and natural and man-made disasters.
CBITS uses cognitive-behavioral techniques (e.g., psychoeducation, relaxation, social problem solving, cognitive restructuring, and exposure) in ten group sessions and one to three individual sessions. It also includes a parent and teacher psychoeducation component.
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Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS)
SPARCS is a strengths-based group model for adolescents between the ages of 12 and 21 who have been exposed to chronic trauma and/or stress (from, for example, ongoing physical abuse, community violence, sexual assault). The intervention is appropriate for traumatized adolescents with or without current/lifetime PTSD.
SPARCS is organized in 16 one-hour sessions focus on helping participants to regulate their emotions, behaviors, and impulses; manage the physical complaints and other symptoms of chronic trauma and stress; pay attention and process information effectively; and maintain healthy relationships. The SPARCS manual has been specifically developed for use with adolescents and includes experiential activities that emphasize adolescents’ increased capacity for abstract thought, as well as areas of development that are particularly relevant for teenagers (e.g. issues related to autonomy and identity).
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Trauma Systems Therapy (TST)
TST is a both a clinical and an organizational model of care for traumatized children and adolescents—aged 6 to 19—to address both their emotional needs, as well as the social environments in which they live. The model focuses on breaking down barriers between service systems, understanding students’ symptoms in the context of their worlds, and building on their families’ strengths and goals.
TST is implemented within an organization as a framework to coordinate the interventions implemented by its multi-disciplinary team of providers. There are three phases of treatment in TST: Safety Focused Treatment, Regulation Focused Treatment, and Beyond Trauma Treatment. While the typical treatment length is between 7 and 9 months, it also varies depending on where the student is starting from a clinical perspective.
TST has been adapted for use with several populations, including refugee and immigrant groups, substance abusing adolescents, medical trauma, school based treatments, foster care, and residential settings. It has most often been used with children and adolescents who have experienced complex, chronic traumatic events—for example, in settings such as foster care, inpatient units, and residential treatment centers.
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Summary
This two-part Blog Series is dedicated to helping districts, schools, educators, and mental health practitioners understand the research to-practice limitations of specific trauma-informed programs, as well as those built on the SEL-CASEL and PBIS frameworks. This discussion will include mindfulness and meditation programs and approaches—again, within a trauma-treatment context.
In this first Part I, we summarized a recent study that reviewed over 9,000 studies, published over the past ten years, investigating trauma-informed school programs. Using objective, research-sensitive criteria, this study determined that none of the studies met their criteria for sound research.
We then discussed this result in the context of the thousands of schools across this country that have potentially implemented invalid, unsound, or wasteful (as above) trauma-informed programs, and describe an evidence-based multi-tiered approach that responsibly addresses the needs of students impacted by trauma. We also addressed the flawed national PBIS and SEL-CASEL frameworks, recommending that they not be used as the foundation of a more generic school-wide approach for these students.
In Part II, we will discuss the relationship and inappropriate use of mindfulness and mediation with students experiencing trauma. Here, we will describe the biological and neuropsychological underpinnings of trauma-related student emotionality, and how mindfulness and mediation will not change this emotionality— especially when it is classically conditioned (i.e., Pavlovian in nature).
The theme across both Parts of this Series—and consistent with the Introduction above—is that:
Districts and schools need to know the Trauma-Informed Care, SEL, Mindfulness, and Meditation research-to-practice as all of these areas have significant flaws that should result in educators questioning their use in schools.
Recognizing that districts and schools do not always have the time or expertise of evaluate the current research-to-practice, we hope that this two-part Series (and my previous Blogs on these topics) will help them to choose effective, multi-tiered approaches to address the social, emotional, and behavioral needs of students impacted both by trauma and by other emotionally-triggering situations, circumstances, and/or conditions.
We also hope to encourage districts and schools that have already adopted and implemented trauma-informed or sensitive programs to objectively and comprehensively evaluate their research, practice, and student-centered outcomes— especially with students who have strategic or intensive clinical needs.
Virtually all of the research-to-practice discussion in this Blog suggests that these districts and schools may be wasting money, time, and other resources using programs that (a) are invalid, unsound, or unproven; and (b) will not “mature” over time to produce the results that they are not demonstrating right now.
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Now that the New Year has passed and we (as educators) are “back in session” (I am flying right now to a full week consultation in the Northeast), I want to remind everyone that:
- There is still at least five months left in the school year, and that there is still time to start a new academic and/or social, emotional, or behavioral initiative to benefit your students; and
- Most districts are fully into their strategic planning mode for the next school year.
Relative to both areas, I am fully prepared to help you “add value” to the great things that you are already doing, or to evaluate your current initiatives—especially those that are not producing the results that you desired.
I am currently working with over ten different districts—from inner city to extremely rural. While most of my consultations are long-term (from three to five years), I usually start most of them by completing a “Plan for Planning” process that includes (a) a strategic Current Status and Needs Assessment in the area of desire or concern; (b) a Resource and Outcomes Analysis; and (c) an Action Plan that provides a one to three year change or value-added process that includes resources and training, components and content, implementation timelines and actions, short- and long-term outcomes, and formative and summative evaluations needed.
In most cases, my consultations start with a free, one-hour telephone conversation with a district or school leadership team where we clarify needs and goals, generate and answer critical questions, and decide—mutually—if we are a good match.
I encourage you to contact me to set up this free conversation. As noted above, it is not too late to (re)start a new, focused initiative right now, or to begin planning for the 2020 to 2021 school year.
Best,
