The Cognitive Behavioral Intervention for Trauma in Schools: Success in Two School Districts

By Kristen Hayes, CEI Intern

In 2017, the Substance Abuse and Mental Health Services Administration (SAMHSA) reported that about two-thirds of children in the United States experience at least one traumatic event, either as victims or witnesses, by the age of 16. A large public health movement has arisen to address the numerous negative consequences of these experiences. Many organizations have begun to explore what it might look like to bring information on trauma and child development into the educational context to create trauma informed schools. The National Resilience Institute (NRI) has published six recommendations for schools (Reeves, 2017):

  1. Offer staff education and development on the impact of trauma on learning.
  2. Help students feel safe: Provide a physically, emotionally, and academically safe environment.
  3. Meet students’ holistic needs by considering their self-regulation, academic competence, and physical and emotional well-being.
  4. Help students connect to the school community and provide multiple ways in which they can practice new skills.
  5. Share responsibility to care for all students.
  6. Anticipate and adapt to the changing needs of students.

NRI also points out the importance of teaching prosocial skills, using incidents and opportunities to problem solve with youth, and providing access to mental health services with coordination among school psychologists, counselors, and social workers.

The Cognitive Behavioral Intervention for Trauma in Schools

Many organizations have also proposed to develop interventions for schools to use to help offset the effects of traumatic experiences and promote healthy development of children despite adversity. Researchers at the Rand Corporation collaborated with UCLA and Los Angeles Unified School District (LAUSD) to build an evidence-based program that could reach a multitude of students. This collaboration resulted in The Cognitive Behavioral Intervention for Trauma in Schools (CBITS), which incorporates 10 group, 1-3 individual, 2 parent, and 1 teacher sessions. During student sessions, students learn about the effects of trauma; staff help individuals develop a narrative of their trauma, and provide cognitive therapy and social-problem solving techniques. The cognitive-behavioral techniques help reduce symptoms of post-traumatic stress disorder (PTSD), depression, and behavioral problems, and improve grades, school attendance, peer and parent support, and coping skills. All sessions are led by mental health professionals (Jaycox, Langley, & Hoover, 2018).

Effectiveness of the CBITS

A study investigating the effectiveness of CBITS produced four important findings (Rand Corporation, 2019):

  1. CBITS reduced the symptoms of PTSD and depression among students exposed to trauma.
  2. Students who participated earlier in the intervention performed better in reading and math compared to students who participated later in the intervention.
  3. Results from the intervention were fairly consistent.
  4. Students, parents, and teachers were very receptive to the intervention.

Because of its success, CBITS is one of the top recommended trauma based interventions by the U.S. Department of Justice, Center for Disease Control and Prevention Research Center, and SAMHSA’s National Registry of Evidence-Based Programs and Practices.  In further praise, CBITS helps resolve the issues of limited access to mental health care because of the group nature of the interventions.

CBITS in LAUSD

The first schools to incorporate CBITS were in the Los Angeles Unified School District, a district known for its at-risk populations. LAUSD has implemented CBITS in grades six to nine (ages 10-15) with students who have experienced community violence, trauma due to accidents and natural disasters, and trauma involving significant loss. Director of LAUSD Mental Health Pia Escudero speaks in an interview about the benefits of CBITS she has seen for both students and staff members trying to understand how to help students with trauma (Escudero, 2010):

“It has really built the capacity of our school mental health staff… to deal with serious traumatic situations… Here’s an intervention that really breaks down skills- clinical skills- and builds skills for students that they can take for a lifetime… Just as you get skills in math and you get skills in reading better, this is another lesson I need to take on so that I can function better and I can take care of my mental health needs as well as my wellbeing. Because nobody has the skills innately and we have to seek them out one way or the other.”


CBITS In New Orleans

Following the devastation of Hurricane Katrina, Project Fleur-de-lis was created as a collaborative partnership among schools, social service agencies, and national experts to provide mental health services within New Orleans-area schools. Project Fleur-de-lis implements CBITS as the second tier of their three-tiered model of care. One of the unique offerings of Project Fleur-de-lis is coping cubes. The original coping cube has reminders for teens experiencing high levels of stress. There are 3 other types of cubes that are also used: suicide prevention gate keeper cubes with reminders about risk assessments for mental health professionals, the suicide prevention adolescent cube, and the military coping cube for adolescents connected to the military.

Crescent City Schools, one of the project’s partners, is a charter management organization with three Pre K-8 open enrollment schools. Crescent City Schools seeks to help rebuild New Orleans schools to ensure students receive outstanding, high-quality education. Given the significance of the trauma following Hurricane Katrina, there was a substantial need for a program such as CBITS.  Although, the success at Crescent City Schools cannot be attributed solely to CBITS, it is worth noting that Crescent City Schools has seen remarkable leaps in achievement since opening. One of its schools, Paul Habans Charter School, for example, was a failing school when it joined the Crescent City Schools network in 2013. Now it is ranked 1st in the city for ELA growth and 6th in math. In fact, Crescent City Schools is the only charter network in New Orleans with all of its schools ranking in the top 10 for ELA growth.

Expansions of the CBITS  

To further extend the reach of CBITS, researchers created the newest adaptation called Bounce Back, which is designed for use with elementary school students as opposed to the 5th-12th grade target audience of the CBITS. Bounce Back follows the same structure as its parent program with the exception of the teacher session. This program offers free resources to those who register on their website. Because of its appropriateness for use with children and families of diverse ethnic and social backgrounds, Bounce Back is a promising intervention for future implementation (Bounce Back, n. d.).

References

Bounce Back (n. d.). Bounce Back: An elementary school intervention for childhood trauma.

The Cognitive Behavioral Intervention for Trauma in Schools (CBITS). (2019). Success stories.

Crescent City Schools. (2018). Crescent City Schools in the only network in New Orleans with all of its school in the top 10 for student growth in English language arts.

Escudero, P. (2010). What CBITS does for students.

Jaycox, L. H., Langley, A. K., Hoover, S. A. (2018). Cognitive behavioral intervention for trauma in schools: Second edition. Santa Monica, CA: Rand Corporation.

Rand Corporation. (2019). Helping children cope with trauma: A school-based intervention.

Reeves, M. (2017). 6 ways to become a trauma-informed school .

Substance Abuse and Mental Health Services Administration. (2017). Understanding childhood trauma.

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