Two school-based trauma intervention programs—Enhancing Resiliency Amongst Students Experiencing Stress (ERASE-Stress) and Teaching Recovery Techniques (TRT)—were found to have a high level of evidence for effectiveness, according to a review appearing in Psychiatric Services. Four other interventions met criteria for a moderate level of evidence.
John Cosgrove, Ph.D., of Westat, and colleagues conducted a systematic review of 25 school-based interventions intended to alleviate the effects of trauma and prevent additional mental health challenges among primary and secondary school students. Eligible studies tested the intervention effects on posttraumatic stress and other mental health outcomes, including depression, anxiety, psychological distress, conduct problems, and other internalizing or externalizing symptoms.
Cosgrove and colleagues assessed the effectiveness of the interventions according to the following criteria:
- High evidence: Three or more randomized controlled trials (RCTs) with positive findings, or two RCTs plus two quasi-experimental studies with adequate designs.
- Moderate evidence: Two positive RCTs with adequate designs, or one RCT plus one quasi-experimental study, or three or more quasi-experimental studies with adequate designs, or four with methodological weaknesses.
- Low evidence: One positive RCT, or two or fewer quasi-experimental studies with adequate design.
ERASE-Stress, rated as having a high level of evidence, was tested across four RCTs with students in Israel who had experiences with war and students in Sri Lanka affected by the 2004 tsunami; the program showed reductions in posttraumatic stress symptoms, depression, anxiety, somatic complaints, and functional impairment. TRT, also rated as having a high level of evidence, was tested across three RCTs with students affected by war in Palestine or Australia; it showed reductions in posttraumatic stress symptoms, depression, and a composite measure of mental health symptomatology.
“Interventions that included cognitive-behavioral and creative-expressive techniques were consistently effective across myriad settings and cultures,” Cosgrove and colleagues wrote. “These findings provide decision makers with valuable information for implementing effective trauma interventions across a multitude of school settings.”
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