More Studies Needed on Multi-Tiered Trauma-Informed School Programs

Group of elementary school students showing a thumbs up sign

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).

For More Information


1. Substance Abuse and Mental Health Services Administration. Understanding Child Trauma. Rockville (MD): SAMHSA, 2023. Available from URL: 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: Accessed July 12, 2023.