Counseling

Trauma-Focused School Counseling & Mental Health Services

School counseling originally began as a tool for vocational guidance, but has now evolved from a position, to a service, to a program, and continues to develop so that comprehensive school counseling programs can be offered in every school district (ASCA, 2019). The American School Counselor Association (2019) recommends a school counselor to student ratio of 1:250, yet many schools are unable to hire the number of counselors needed to satisfy the ratio, with the national average closer to 1:400. School counselors are trained in progress monitoring and have the ability to deliver school-based mental health interventions, while also measuring the impact through behavioral evaluations and academic growth (Naik, 2019).

Counseling Interventions in the School Setting

Children who are affected by trauma are often mislabeled with mental health conditions (i.e. attention deficit disorder, oppositional-defiant disorder, or conduct disorder), which could prevent effective interventions from being delivered that could potentially help the child heal from trauma (Walkley & Cox, 2013). Children may also develop maladaptive behavioral coping mechanisms as a response to trauma in an effort to feel safe and in control (Rumsey & Milsom, 2019). Public schools need to be equipped with appropriate mental health professionals that can provide more long-term individual and group counseling supports to students impacted by trauma. While there are steps that teachers and staff can take to become more trauma-informed in their approach, there is no substitute for trained counselors, social workers, and school psychologists (Naik, 2019). Many schools are offering trauma-focused inservice opportunities and professional development to teachers, but it is unclear if this singular approach is enough to enhance the knowledge and skills needed to address students impacted by trauma (Kataoka et al., 2018). The TISM must utilize a variety of services and supports within the school setting to address the individual needs of students.

Clinical interventions implemented within the school setting have shown success in reducing the psychological symptoms of trauma for both children and adolescents (Hansel et al., 2019). Hansel et al. (2019) suggested that the school environment encourages normalcy and is an ideal setting to offer services to students impacted by trauma, minimizing the stigma that can be related to accessing mental health services within the community. The ASCA National Model (ASCA, 2019) suggested that providing long-term counseling services is considered an “inappropriate activity” for school counselors. Additionally, school counselors are not in an ideal position to provide trauma therapy to students because they often do not possess the specialized training necessary to provide these services, nor do they have the time to focus on providing long-term therapy when they are responsible for direct services for an entire population. Thus, it will be important for school districts to consider hiring specialized counselors to provide therapeutic services to students impacted by trauma, or contract with mental health providers to offer these services within the school setting.

Although the process of trauma therapy can be intense and time-consuming, it is possible to offer trauma-specific services within the school setting. Trauma therapists employ a wide variety of specific therapy models, yet there is an underlying structure to trauma therapy that is thought to be most effective (Rhoton, 2019). Rhoton (2019) suggested that the most important components of trauma therapy include (in order of importance): emotion regulation strategies, narration of trauma memory, cognitive restructuring, anxiety and stress management, and interpersonal skills. The Empowerment and Resilience Structure (Rhoton & Gentry, 2014) involves four distinct stages that are essential to trauma therapy: (1) preparation and focus on the therapeutic relationship; (2) psychoeducation and development of self-regulation skills; (3) integration and desensitization; and (4) post-traumatic growth and resilience. Beyond a positive relationship (therapeutic alliance), self-regulation skills are thought to be the single most important area needed by individuals who have experienced traumatic or toxic stress (Rhoton, 2019).

Self-regulation involves the ability to consciously focus attention, develop an awareness of one’s body and the environment, draw on memory to learn from the past and adapt to the present, and maintain or regain positive emotional states that can provide a sense of safety and wellbeing. Consciously focusing attention is a key first step. Each student sees what is relevant to them, so interventions must be tailored to individual needs by understanding what matters to the student, and then helping the student to focus on what they believe is relevant. Self-regulation skills will allow students to prepare their brain and body for successful change. In order for change to take place, students must be able to experience and practice new methods for dealing with the neurological activation of traumatic arousal, which generally occurs within the therapeutic setting (Rhoton, 2019).

Applying the TIA in School Systems

Children need positive, nurturing experiences in early childhood to build the foundation for future learning and healthy development. Teachers interact with their students on a daily basis and play a vital role in identifying, supporting, and providing for the needs of their students (Weist-Stevenson, 2016). Teachers must be educated on the growing needs of students impacted by trauma, and administrators should provide ongoing professional development for faculty members to address the plan, resources, and needs of the students (Weist-Stevenson, 2016). Multi-tiered systems of supports (MTSS) models can emphasize trauma-informed supports at the universal (Tier 1) level with prevention efforts aimed at providing a PBIS framework within the school. The Tier 2 level involves targeted prevention efforts and universal screening, with the Tier 3 level focusing on providing intensive treatment (Kataoka et al., 2018). Universal efforts are aimed at providing trauma-informed professional development for teachers and staff and providing a safe school environment. A TISM must move beyond the Tier 1 level in order to provide a comprehensive program to address trauma. While schools must first identify a crisis or emergency response plan, they should also consider the use of universal screening in the formation of a TIA plan. Evidence-based SEL programs should be reviewed so that a curriculum can be selected for implementation. The Classroom180 framework offers a comprehensive approach for assisting districts with the development of a TIA, while also considering the physical environment and interventions that will be applied within the school setting.

Crisis response plan. The Katrina Inspired Disaster Screenings and Services (KIDSS) kit provides a flexible set of guidelines and four-step approach that schools can use to assist communities in understanding the needs for students following natural disasters or traumatic events affecting a large population (Hansel et al., 2019). The first step involves collaboration between the school and community, and the second step utilizes a screening to assess behavioral health needs of children and adolescents. Once data is gathered from the screening, the third step is to connect students with referrals for additional services. A crucial part of this step is to provide follow up for any students who met the criteria (from the screening) to ensure they actually become connected with services that are needed. The fourth step for this framework involves increasing access to quality mental health care for children who would otherwise not have access to care.

Universal screening. Schools must start by gaining accurate data on the mental health services that students need, which can be achieve through universal trauma screening (Naik, 2019). Trauma screening is crucial to identify potential mental health interventions needed for the student body. The current referral process for many schools relies on teacher or parent referrals, which are subject to bias and prejudice (Naik, 2019). This means that students who are in need of mental health services could be “missed,” because typically students with the most maladaptive behaviors are the first to be referred. Universal screening can help to correct imbalances within the system and allow schools to survey the needs of all students to strategically plan interventions.

Trauma-Informed Approach plan. A Trauma Approach plan for schools should provide a model to help combat the impact of trauma on students. Guidelines for this approach include outlining a plan to: (a) maintain a sense of routine; (b) give students a sense of control by allowing choices when appropriate; (c) have a designated support staff for children exposed to trauma; (d) develop boundaries for appropriate behavior which incorporates a positive behavior model; (e) provide time to have children process the trauma; (f) clarify misconceptions about the trauma; (g) be mindful to environmental factors which may trigger a stress response after the trauma; (h) make sure students are not bombarded with questions after a trauma; and (i) be aware of at-risk behaviors and refer students to identified services (Weist-Stevenson, 2016).

Implementing SEL. Social and emotional learning (SEL) involves the “processes through which children and adults acquire and effectively apply the knowledge, attitudes, and skills necessary to manage emotions, set and achieve positive goals, feel and show empathy for others, establish and maintain positive relationships, and make responsible decisions” (CASEL, 2012, p. 6). Social and emotional development is considered to be important for success in school. Similar to concepts involving emotional intelligence, SEL involves the ability of children to develop competencies in the areas of self-awareness, self-management, social awareness, relationships, and responsible decision-making. These skills are critical for children to be good students, citizens, and workers (CASEL, 2012). SEL programs promote positive behavior (i.e. caring, empathy, and kindness) to improve relationships (Hulvershorn & Mulholland, 2018).

SEL programming recommends a combination of classroom instruction, student engagement in positive activities, and parent and community involvement. SEL curricula “directly teach children appropriate actions and provide a safe environment for them to practice what they learn” (Hulvershorn & Mulholland, 2018, p. 114). SEL provides a foundation for increased adjustment and academic performance, reflected by increased positive social behaviors and peer relationships, decreased behavioral problems, less emotional distress, and improved grades and test scores (CASEL, 2012).

The Classroom180 framework. The Classroom180 framework was designed to give teachers (K-12) a comprehensive outline for how to create, implement, and sustain a trauma-informed classroom (Forbes, 2020). Classroom180 is divided into five domains: (1) relationships and family culture; (2) regulation; (3) the language of trauma; (4) safety; and (5) discipline and empowerment. Each domain is further broken down into three or more components, with practical suggestions for implementation offered in each section of the framework.

Physical environment. The physical space of the classroom should foster safety and security. Some of the guidelines for teachers include an emphasis on desk arrangement, color selection, light, music, and scent to help promote a comfortable, warm environment (Weist-Stevenson, 2016). The classroom must be a place where students feel connected to each other and support by their teacher(s). The classroom teacher should foster a culture of community in the classroom where peers can support each other, so that students are aware that people care about them during times of need. Weekly classroom meetings allow a structured time where students can share concerns and give input into the overall learning environment, as well as join together to have a sense of ownership for their behavior and actions (Weist-Stevenson, 2016).

Interventions. Interventions must be designed to respond appropriately on an individual basis, with the consideration that the developmental impact at the time of the trauma exposure will differ for each child (Walkley & Cox, 2013). Beyond universal implementation of trauma-informed policies and procedures, specialized mental health services can be offered to students within the school setting. While a focus on the self-regulation framework is essential, several other evidence-based interventions could be utilized within the school setting, including: Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS); The Sanctuary Model; Attachment, Self-Regulation, and Competency (ARC); Trauma Affect Regulation: Guide for Education and Therapy (TARGET); or Trauma Systems Therapy (Ford & Blaustein, 2013). Regardless of the model chosen, the most important factors to build into a school-based Trauma Approach Plan (or TISM) involve positive relationships and the development of self-regulation skills for both students and adults.