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.     

Reinforcement magnitude and responding during treatment with differential reinforcement

Basic findings indicate that the amount or magnitude of reinforcement can influence free-operant responding prior to and during extinction. In this study, the relation between reinforcement magnitude and adaptive behavior was evaluated with 3 children as part of treatment with differential reinforcement. In the first experiment, a communicative response was shaped and maintained by the same reinforcer that was found to maintain problem behavior. Two reinforcement magnitudes (20-s or 60-s access to toys or escape from demands) were compared and found to be associated with similar levels of resistance to extinction. The relation between reinforcement magnitude and response maintenance was further evaluated in the second experiment by exposing the communicative response to 20-s or 300-s access to toys or escape. Results for 2 participants suggested that this factor may alter the duration of postreinforcement pauses.     

Further evaluation of the role of protective equipment in the functional analysis of self-injurious behavior

Using a procedure similar to the one described by Le and Smith (in press), we evaluated the effects of protective equipment during a functional analysis for 2 individuals who engaged in severe self-injurious behavior (SIB). Results of our analyses revealed that the use of protective equipment during functional analyses of SIB suppressed levels of responding such that a behavioral function could not be identified.     

Further analysis of idiosyncratic antecedent influences during the assessment and treatment of problem behavior

Recent research findings suggest that idiosyncratic variables can influence the outcomes of functional analyses (E. G. Carr, Yarbrough, & Langdon, 1997). In the present study, we examined idiosyncratic environment-behavior relations more precisely after identifying stimuli (i.e., a particular toy and social interaction) associated with increased levels of problem behavior. Two children, an 8-year-old boy with moderate mental retardation and a 5-year-old boy with no developmental delays, participated. Results of functional analyses for both children indicated that idiosyncratic antecedent stimuli set the occasion for occurrences of problem behavior (hand biting or hand flapping) and that problem behavior persisted in the absence of social contingencies. Further analyses were conducted to identify specific components of the stimuli that occasioned problem behavior. Treatments based on results of the analyses successfully reduced self-injury and hand flapping.     

Outcomes of a practical approach for improving conversation skills in adults with autism

Many individuals with autism spectrum disorder (ASD) have deficits in conversation skills that can interfere with the development of personal and professional relationships. Further research is needed on efficient interventions for targeting conversation skills in adults with ASD and for evaluating the social validity of the outcomes. In this study, 2 practitioners implemented a 4‐week training program for 5 adults with ASD that combined individualized computer‐based instruction (CBI) and practice with peers to promote the acquisition, maintenance, and generalization of conversation skills. Training was associated with improvements in 12 of 13 skills across participants. These findings, along with peer ratings of the participants' conversation skills, suggest that this model is a promising, socially valid approach for improving conversation skills in adults with ASD.     

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.