School-based trauma counseling

There is strong evidence that school-based trauma-specific counseling interventions improve mental health among students and reduce symptoms of childhood anxiety disorders, post-traumatic stress disorder (PTSD), and depression (Avery 2024, Cochrane-James 2020, Fondren 2020, Leenarts 2013, Wethington 2008, Blueprints). School-based trauma counseling is also a suggested strategy to address unmet mental health needs, build resilient recovery, reduce grief symptoms, and support academic success (Nadeem 2014, Saltzman 2001). Several types of cognitive behavioral therapy (CBT), including trauma-focused CBT (TF-CBT), have been shown to reduce symptoms of psychological harm, PTSD, and depression. Additional evidence is needed to confirm effects of some treatments adapted for school settings (Cochrane-James 2020, Leenarts 2013, Wethington 2008).

CBT interventions for children and adolescents reduce childhood anxiety disorders and have positive effects when delivered in both group and individual settings (Cochrane-James 2020, Fondren 2020). Studies of the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program and Bounce Back, two school-based trauma counseling interventions, show reductions in PTSD, depression, and anxiety among participating children (Blueprints, CEBC-CBITS, CEBC-Bounce Back, Fondren 2020, Nadeem 2014). Parents of participants also report greater improvements in their children’s daily functioning than parents of non-participating children (Blueprints). Additional research is needed to determine effects of other school-based trauma counseling interventions, such as the Support for Students Exposed to Trauma (SSET) program, an adaptation of the CBITS program (CEBC-SSET).

Studies of the Trauma-Grief Component Therapy for Adolescents (TGCT-A) program, a trauma and grief counseling intervention often implemented in schools, suggest such interventions can reduce PTSD, depression, and grief. Such interventions can promote resilient recovery and improve school behavior by teaching youth social support recruitment skills, cognitive reframing, relaxation skills, and skills to deal with trauma and loss reminders (CEBC-TGCT-A). Reduced PTSD symptoms are significantly associated with improvements in student grade point average (Saltzman 2001). Bosnia-based studies suggest school-based trauma and grief counseling can reduce symptoms of psychological distress for participating students (Layne 2001).

School-based trauma counseling interventions may vary in effectiveness depending on treatment duration, the number and frequency of counseling sessions, and the length of program participation; additional evidence is needed to assess those variations (Cochrane-James 2020). Early trauma screening and treatment can improve student outcomes and mitigate difficulties with coping and resilient recovery later in life (NCSL-Children mental health 2021). Students attending schools offering counseling and mental health services are six times more likely to receive mental health care than students relying on counseling and mental health services in community settings (NCSL-Children mental health 2021, Bekele 2025).

Available evidence shows that trauma counseling is part of successful and sustainable school-wide trauma-informed interventions, especially when implemented with professional development, stakeholder engagement, staff and teacher buy-in, leadership support, and comprehensive planning components (Wassink-de Stigter 2022). Through school-wide, trauma-informed interventions, teachers and staff receive training that helps them recognize behaviors that may be reactions to trauma and prepares them to assist and refer students to support services, including trauma counseling (Badger 2026, Sun 2024, Cohen 2021c, Wiest-Stevenson 2016).

Available evidence suggests that school mental health programs are cost-effective, with potential national economic savings of nearly $247 billion per year (NCSL-Children mental health 2021). Experts suggest that group trauma counseling offers an efficient and cost-effective way to offer mental health services to more students when school resources to support counseling programs are limited (Bekele 2025).

Experts suggest school-based trauma counseling has the potential to decrease disparities in mental health and academic outcomes experienced by students of color and students from families with lower incomes (Moore 2024, KFF-Panchal 2025, NCSL-Children mental health 2021). The overall effectiveness of school-based trauma counseling is well-established; however, more research is needed to evaluate the effects on disparities in academic achievement outcomes and anxiety, depression, and behavioral health disorders (Moore 2024, NCSL-Children mental health 2021).

Survey data show school-based mental health supports and counseling services are less likely to be available in schools in lower income neighborhoods than in higher income areas (Moore 2024). Surveys also show racial disparities in the availability and receipt of counseling and mental health services among students, with white students more likely to receive counseling than students of color (KFF-Panchal 2025). Experts suggest that improving equitable access to school-based trauma counseling requires resources and support for schools that do not yet have a mental health services system established (Moore 2024, KFF-Panchal 2025). One study suggests universal screening processes may help reduce gender and racial bias in referrals for school-based trauma counseling; in this study female students and white students were more likely to receive counseling referrals than male students and students of color (Bekele 2025).

Experiencing adverse childhood experiences (ACEs) is associated with increased mental health struggles, increased prescription opioid misuse, and increased suicide behaviors among high school students (CDC MMWR-Swedo 2024, Anderson 2022). One national report of high school students under 18 suggests students identifying as multiracial, Native, female, or LGBTQIA+ report experiencing the highest number of ACEs (CDC MMWR-Swedo 2024). Over 60% of these students report experiencing emotional abuse and over 30% report experiencing physical abuse (CDC MMWR-Swedo 2024). In the U.S., Black youth experience disproportionately more ACEs than all other racial or ethnic groups with some estimates suggesting 61% of Black children in the U.S. experience ACEs before the age of 18 compared to 40% of white children (Danforth 2024).

School-based mental health and counseling services are less likely to be available in schools in rural areas and towns than in urban and suburban areas (Moore 2024). School-wide trauma-informed programs that include school-based trauma counseling can be beneficial for students in rural and urban areas (Frankland 2021, Blitz 2020). In rural areas, trauma-informed programs that include trauma counseling are suggested to help mitigate the effects of ACEs and reduce academic achievement gaps for students (Frankland 2021). Data shows that 25% of children in the U.S. attend school in rural areas, and ACEs and trauma disproportionately affect rural schoolchildren (Frankland 2021). In a rural Minnesota-based study, teacher and staff surveys and classroom observations suggest implementing the SAFE Model (Structured Approach to Formulating a trauma-informed Environment) – that includes trauma counseling – helps schools meet the needs of students who have experienced trauma. Implementing the SAFE Model is associated with improved student learning, behaviors, and relationships, which helps students who have experienced trauma improve academic achievement rather than falling behind their peers (Erickson 2023). In many urban areas, communities have experienced disinvestment and concentrated poverty; children in these communities are frequently exposed to stress and trauma that negatively impacts academic achievement (Blitz 2020). A study of urban school implementation of the trauma-informed Sanctuary Model, a framework that supports the use of CBT and school counseling, suggests positive improvements addressing students' trauma (Blitz 2020).

Trauma experiences are exacerbated when combined with inequality, poverty, racism, or community violence (O'Toole 2022). The 1998 Adverse Childhood Experiences (ACEs) prevalence study and subsequent research found a strong association between early trauma experiences and several long-term behavioral, mental, and physical health issues (Lorig 2022). In response in 2000, Congress established the National Child Traumatic Stress Initiative (NCTSI) and the National Child Traumatic Stress Network (NCTSN), which funded school-based trauma-informed care to increase services, including school-based trauma counseling, for children exposed to trauma and their families (NCTSN, SAMHSA-NCTSI). The 2015 Every Student Succeeds Act (ESSA) provided more resources for schools to implement trauma-informed policies and programming and to increase comprehensive school mental health services (NASBE-Hoover 2019). In 2018, the U.S. House of Representatives approved HR 443, a resolution that acknowledges the importance of trauma-informed care, designates May as national trauma awareness month, and designates the third Wednesday of May as national trauma awareness day (NASBE-Hoover 2019).

Children in the U.S. continue to be exposed to trauma and have many mental health and well-being challenges (Palma 2024, RAND-Kennedy 2024). In the 2010s and 2020s, across the U.S. schools experienced school shootings, community unrest in response to police shootings, the COVID-19 pandemic, and more awareness of persistent systemic inequalities (NCSL-Children mental health 2021, Gonzalez 2022). After the disproportionate effects of the COVID-19 pandemic, many policymakers, researchers, and educators called for school-wide trauma-informed interventions to be combined with broader social justice and restorative justice efforts to address systemic and institutional oppression and to prevent ongoing trauma in youth populations (Lorig 2022, Sedillo-Hamann 2022, Gherardi 2021). Many schools and school districts expanded trauma-informed interventions with mental health, counseling, and social-emotional support systems (Palma 2024, RAND-Kennedy 2024, Sun 2025). Over time definitions of ACEs developed to include multiple, different types of traumatic experiences. More sensitive screening processes aim to better serve youth populations with diverse trauma experiences (Lorig 2022).

• In your community, how available is school-based trauma counseling? Are mental health specialists, counselors, and support staff available for students and teachers? How are your schools supporting mental health services and trauma-informed care, especially for students exposed to trauma?
• How are efforts to increase mental health services and school-based trauma counseling supported in your community? What collaborations could support trauma counseling services?
• What kinds of professional development and training are available to support teachers and staff identifying and assessing trauma symptoms to refer students to trauma counseling? Are multi-tier trauma-informed schools implemented in your district? How can your community encourage implementation of trauma-informed schools, which include school-based trauma counseling?

As of 2025, 70% of public schools in the U.S. have a school or district-level licensed mental health professional on staff; however, about one-third of schools reported that they could not effectively provide mental health services to their school community, most often due to funding limitations and mental health professional staff shortages (KFF-Panchal 2025). In the 2024-25 school year, 83% of public schools offered individual-based interventions such as counseling or therapy of some kind (KFF-Panchal 2025).

The Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program has been implemented in California, Colorado, Connecticut, Illinois, Louisiana, Maryland, Mississippi, Missouri, Montana, New Jersey, New Mexico, Pennsylvania, Tennessee, Washington, Wisconsin, and Washington, D.C. (CBITS). The CBITS program has also been translated into Spanish and Arabic (CBITS). The Support for Students Exposed to Trauma (SSET) program is an adaptation of the CBITS program that has been implemented in many communities across the country (SSET).

The Bounce Back program, an elementary school program for trauma intervention, has been implemented in California, Illinois, Connecticut, Louisiana, Nebraska, and New York (CSRSW-Bounce Back). Bounce Back is also available in Spanish (CSRSW-Bounce Back).

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Center-TIS resources - Center for Resiliency, Hope, and Wellness in Schools. Promoting trauma-informed school (TIS) systems that provide prevention and early intervention strategies that create supportive and nurturing school environments: Resources.

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