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

When children experience stress and adversity in their homes and communities, schools become a critically important setting in which to intervene and foster their resilience. Changing practices within schools so that vulnerable and traumatized children are better understood and more compassionately served is a goal shared by many school professionals, yet schools remain poorly equipped to address the needs of these children. Any number of school‐based programs have the potential to benefit children with an elevated risk for academic difficulties and mental health disorders, although questions remain as to which programs are most promising, effective, and sustainable. Questions also remain about which programs best serve diverse populations and which have potential to reach the largest number of children, including those who do not outwardly manifest behaviors consistent with an underlying disorder but nonetheless require support. In this review, we take stock of existing programs used in schools to address the social, emotional, and academic needs of children with trauma histories. We summarize components of a various trauma‐focused programs, categorized as: (a) individual and group‐based approaches, (b) classroom‐based approaches, and (c) school‐wide approaches. For each category, we review and comment on the state and quality of research findings and provide illustrative examples from the literature to show how programs address trauma in the school context. Findings of the review suggest that empirical evidence currently favors individual and group‐based approaches, although classroom‐based and school‐wide programs may be better positioned for integration, access to services, and sustainability. Implications and recommendations center on future research, practice, and policy.     

Peripheral and central sex steroids have differential effects on the HPA axis of male and female rats

Sex differences in hypothalamic-pituitary-adrenal (HPA) function were examined in gonadectomized male and female rats given equivalent sex hormone replacement regimens either using subcutaneous silastic implants (Experiment 1) or cannula implants in the medial preoptic area (MPOA) (Experiment 2) containing either dihydrotestosterone (DHT), testosterone propionate (TP), estradiol benzoate (EB), or left empty (control). Plasma was obtained before and after 20 min of restraint stress to determine plasma ACTH, corticosterone, and CBG levels as measures of HPA function. Consistent with the literature, androgens decreased, and estrogen increased these measures of HPA function, although peripheral implants were more effective than MPOA implants. Gonadectomy and sex hormone treatment did not eliminate sex differences; overall, females had higher levels than males on measures of HPA function. Analyses of variance (ANOVA) indicated interactions of sex and sex hormone treatment on CBG levels and post-stress corticosterone levels in Expt. 1. The results suggest that sexual dimorphisms influence HPA function even when males and females are given equivalent physiological doses of gonadal steroids, and that the relevant sexual dimorphisms involve both the periphery and the CNS.     

Cognitive psychometrics: assessing storage and retrieval deficits in special populations with multinomial processing tree models

This article demonstrates how multinomial processing tree models can be used as assessment tools to measure cognitive deficits in clinical populations. This is illustrated with a model developed by W. H. Batchelder and D. M. Riefer (1980) that separately measures storage and retrieval processes in memory. The validity of the model is tested in 2 experiments, which show that presentation rate affects the storage of items (Experiment 1) and part-list cuing hurts item retrieval (Experiment 2). Experiments 3 and 4 examine 2 clinical populations: schizophrenics and alcoholics with organic brain damage. The model reveals that each group exhibits deficits in storage and retrieval, with the retrieval deficits being stronger and occurring more consistently over trials. Also, the alcoholics with organic brain damage show no improvement in retrieval over trials, although their storage improves at the same rate as a control group.     

The dynamics of success and failure: how post-behaviour evaluations relate to subsequent exercise intentions and behaviour

Objective: Exercise behaviour change involves multiple experiences with success and failure. The Model of Action Phases (MAP) offers a dynamic account of how success and failure influence both immediate evaluations and future decisions and actions. However, predictions from the MAP have not been formally tested.

Design: A longitudinal daily diary study was used to examine how post-behaviour evaluations of exercise success and failure influence subsequent exercise intentions and behaviour. Participants (N = 104) set exercise goals, and then kept a daily online exercise diary for four weeks.

Main outcome measures: Participants self-reported exercise behaviour, affective response to exercise, self-evaluations after success or failure at following through on intentions to exercise, and intentions to exercise in the next week.

Results: Multilevel modelling revealed significant within- and between-participant relationships among post-behaviour evaluations, intentions and subsequent behaviour. Findings supported MAP-derived predictions about how success and failure at exercise are associated with feelings about exercise and the self, and inform subsequent exercise intentions and behaviour.

Conclusion: Positive post-behaviour evaluations of success or failure may stabilise positive intentions and aid maintenance of exercise behaviour. Implications of these MAP-based findings for intervention design are discussed.     

Reducing stereotype threat in urban schools

Research suggests student performance may be negatively influenced by stereotype threat, “being at risk of confirming, as self-characteristic, a negative stereotype about one’s group” (Steele and Aronson in J Personal Soc Psychol 69(5):797, 1995). However, studies have also found that educating students about stereotype threat and the nature of intelligence can attenuate its effects. This paper explored whether a brief intervention could improve performance and attitudes for 109 at-risk students in a large urban school. Results found the intervention did not result in statistically significant differences in grades, or increases in student beliefs about their ability to succeed in school. Educational implications are discussed.     

Text‐message reminders plus incentives increase adherence to antidiabetic medication in adults with type 2 diabetes

Some adults with Type 2 diabetes mellitus have difficulty adhering to their oral medication regimens. The current study used a multiple baseline design with 3 adults with Type 2 diabetes. Medication taking was monitored remotely in real time via an electronic pill bottle. During the intervention, monetary incentives were delivered contingent on evidence of adherence to taking medication at specified times. Text‐message reminders were also sent if medication was not taken. Adherence increased for all participants. Future studies should separate the relative contributions of text‐message and incentive components of the intervention.     

Cognitive schemas as longitudinal predictors of self-reported adolescent depressive symptoms and resilience

Given that depression risk intensifies in adolescence, examining associates of depressive symptoms during the shift from childhood to adolescence is important for expanding knowledge about the etiology of depression symptoms and disorder. A longitudinal youth report was employed to examine the trajectory of both the content and structure of positive and negative schemas in adolescence and also whether these schemas could prospectively predict depressive symptoms and youth-reported resilience. One hundred and ninety-eight participants (aged 9 to 14) were recruited from four schools to complete measures of youth depressive symptoms, resilience, and schema content and structure. Those who consented to a follow-up study completed the same measures online (50 participants completed). Negative and positive schema content and structure were related over time. After controlling depressive symptoms/resilience at Time 1, negative schema content was the only significant predictor (trend level) of depressive symptoms and resilience at Time 2. Implications for cognitive theories and clinical practice are discussed.     

Information processing biases and panic disorder: relationships among cognitive and symptom measures

To test cognitive models of panic disorder, a range of information processing biases were examined among persons with panic disorder (N=43) and healthy control participants (N=38). Evidence for automatic associations in memory was assessed using the Implicit Association Test, interference effects related to attention biases were assessed using a modified supraliminal Stroop task, and interpretation biases were assessed using the Brief Body Sensations Interpretation Questionnaire. In addition, the relationship between information processing biases and clinical markers of panic (including affective, behavioral, and cognitive symptom measures) was investigated, along with the relationships among biases. Results indicated more threat biases among the panic (relative to control) group on each of the information processing measures, providing some of the first evidence for an implicit measure of panic associations. Further, structural equation modeling indicated that the information processing bias measures were each unique predictors of panic symptoms, but that the bias indicators did not relate to one another. These findings suggest that cognitive factors may independently predict panic symptoms, but not covary. Results are discussed in terms of their support for cognitive models of panic and the potential for automatic versus strategic processing differences across the tasks to explain the low relationships across the biases.     

Explicit and implicit cognition: a preliminary test of a dual-process theory of cognitive vulnerability to depression

Two studies were conducted to test a dual-process theory of cognitive vulnerability to depression. According to this theory, implicit and explicit cognitive processes have differential effects on depressive reactions to stressful life events. Implicit processes are hypothesized to be critical in determining an individual's immediate affective reaction to stress whereas explicit cognitions are thought to be more involved in long-term depressive reactions. Consistent with hypotheses, the results of study 1 (cross-sectional; N=237) showed that implicit, but not explicit, cognitions predicted immediate affective reactions to a lab stressor. Study 2 (longitudinal; N=251) also supported the dual-process model of cognitive vulnerability to depression. Results showed that both the implicit and explicit measures interacted with life stress to predict prospective changes in depressive symptoms, respectively. However, when both implicit and explicit predictors were entered into a regression equation simultaneously, only the explicit measure interacted with stress to remain a unique predictor of depressive symptoms over the five-week prospective interval.     

High School Biology/Life Science Teachers’ Presentation of Genetic Counseling and Health Care Career Options in Their Classrooms

Studies show teachers play an influential role in the career decision-making process of students and early knowledge of genetic counseling (GC) increases the likelihood students will consider this career option. This quantitative study is the first to explore the presentation of GC and other health care career options by high school (HS) biology/life science (B/LS) teachers in their classrooms. Our findings indicate most B/LS teachers present GC as a career option to HS students, agree it complements classroom activities, and perceive students as interested in learning about the profession. However, teachers note many barriers to spending class time presenting GC careers. Consequently, a substantial number of teachers spent a minimal amount of time presenting health care careers in general. We discuss ways genetic counselors can enhance career resources, reduce barriers, and foster student interest in pursuing a career in GC by developing partnerships with HS B/LS teachers.