Multi-Tiered Trauma-Informed School Programs to Improve Mental Health Among Youth

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This is a brief summary of the CPSTF finding and systematic review evidence for Mental Health: Multi-Tiered Trauma-Informed School Programs to Improve Mental Health Among Youth. Read a complete summary of the systematic review and CPSTF finding.

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Summary of Community Preventive Services Task Force Recommendation

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.

Major Findings

The CPSTF finding is based on evidence from a systematic review of 11 studies.

  • Included studies showed interventions reduced PTSD symptoms by a median of 34.8% but the studies lacked comparison groups, had small sample sizes, and did not evaluate symptoms for all tiers of the intervention.
  • There were not enough studies to determine intervention effects on other outcomes.

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.
Group of elementary school students showing a thumbs up sign

Evidence Gaps

Additional research and evaluation could help answer the following questions and determine the effectiveness of multi-tiered trauma-informed school programs. CPSTF identified the following questions as priorities for research and evaluation.

      • Using comparative study designs and consistent outcome measures, are multi-tiered trauma-informed school programs effective in:
        • Reducing mental health symptoms, including PTSD, depression, and anxiety, among students?
        • Improving school-related outcomes, including student behaviors, absenteeism, and academic achievement?
      • Does the effectiveness of multi-tiered trauma-informed school programs vary for students who may disproportionately experience trauma, such as students who identify as sexual or gender minorities, and students with disabilities?
      • Does program effectiveness vary with different program and study characteristics, such as the specific interventions implemented within each tier, service deliverers, or intervention duration?
      • What combinations of interventions across the tiers are most effective?
      • What is the impact of multi-tiered trauma-informed school programs implemented after a crisis or mass exposure (e.g., school shooting, natural disaster) in the United States?

Why is This Important?

      • More than two-thirds of children experience at least one traumatic event by 16 years of age.1
      • Early trauma may lead to learning or behavioral problems in childhood and is linked to chronic health problems, poor mental health, risk behaviors, and socioeconomic challenges in adulthood.2,3

Learn More

CDC, Division of Adolescent and School Health

References

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

Established in 1996 by the U.S. Department of Health and Human Services, the Community Preventive Services Task Force (CPSTF) is an independent, nonfederal panel of public health and prevention experts whose members are appointed by the director of CDC. CPSTF provides information for a wide range of decision makers on programs, services, and other interventions aimed at improving population health. Although CDC provides administrative, scientific, and technical support for CPSTF, the recommendations developed are those of CPSTF and do not undergo review or approval by CDC. Find more information at www.thecommunityguide.org.