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Kennedy School Review

Topic / Health

When Trauma-Informed Pedagogy Is Not Enough: The Need for Increased School-Based Mental Health Services in Public Schools

“Where I live, people don’t call the police.”

There’s a palpable stillness in the room. Thirty-five pairs of adolescent eyes are fixed on Mariely[1] as she quietly, bravely describes witnessing a man get stabbed in front of her house, feeling unable to call the cops for help. Some students silently gesture with their pinkies outstretched towards her, thumbs grounded at their own hearts in the hand signal used to show connection.

We were sitting cross-legged on the ground having a community circle, a sight that might have made more conventional sense in a kindergarten classroom, not the eighth-grade English language arts class I taught. There we were, on the blue rug, leveled, shoulder to shoulder, experiencing a feeling of solemnity of which I was equally proud and humbled. It was something we did every Tuesday and Thursday afternoon to share and connect with each other.

As an eighth-grade English teacher in an underserved community, observing my students’ daily journeys to my classroom door was painful. Mariely and many of her classmates came from arduous backgrounds, from losing older cousins to gang warfare, visiting fathers in jail, not getting to say goodbye to deported relatives, or worrying about sick grandparents without health care. Their situations were far from unusual at my school, where 92 percent of students lived below the federal poverty line. The circle space became an ode to their journeys. Within it, I decentered myself as the educator and let students’ firsthand experiences guide our learning.

The highest purpose of my classroom was to make my students feel heard and supported in all aspects of their lives. Or so I told myself, one of the many half-truths I held on to as I navigated a public school system that failed to fully serve the children of color sitting on the rug with me. The stories my students brought to these circles were more than learning opportunities. They were hard, undeniable evidence of trauma located far outside my professional capacity to appropriately address. My community circles, though valiant and worthy in their original iteration, were deeply inadequate—even dangerous¾stand-ins for the psychological counseling that most students in the room urgently needed.

Trauma-informed pedagogy like the kind I was trained to provide in my classroom is not enough. Public schools must be equipped with the resources to hire full-time school-based mental health professionals that can provide one-on-one and small-group mental health interventions to students surviving trauma. Yet my school and many others serving vulnerable populations across the country fail to provide these critical resources. Their lack exacerbates systemic inequities embedded in the public education system.

The American School Counselor Association (ASCA) recommends a 250:1 student-to-counselor ratio in every school in order to meet all students’ socioemotional developmental needs. In ASCA’s view, a comprehensive school counseling program supports student academic achievement and should thus be an integral component of any school’s academic mission.[2] This is an issue of equity, of ensuring students from all backgrounds, especially those most underserved, receive the services they need to take full advantage of their educational opportunities. Take California, for instance, the largest and most diverse state in America.[3] Its population contains some of the greatest socioeconomic diversity in the country, yet the average student-to-counselor ratio is 945:1, almost four times the recommended proportion.[4] In my school district, there was one school-based mental health care provider for 1,250 students split across two middle schools and one high school. In practice, the psychologist only had time for students receiving special education services. For everyone else, families were encouraged to contact community clinics on their own. With parents or guardians working multiple jobs and long hours, many low-income families were often unable to capitalize on these referrals. Without school-based mental health services, additional barriers to access let children like Mariely fall through the cracks.

But it is exactly these students who need access to mental health professionals the most. Within student bodies experiencing high concentrations of poverty, the incidence of trauma tends to follow close behind. According to a 2016 National Education Association report, “poverty influences the emotions, shapes behaviors, changes the structure and processing of the brain, affects cognitive capacity, and influences attitudes” of traumatized students on a daily basis.[5] This not only impairs students’ ability to succeed academically but also has long-term negative impacts on brain development, emotional well-being, and behavioral stability.[6] Trauma is also a gateway for a host of debilitating mental health disorders in adulthood, which in turn perpetuate cycles of poverty.[7]

Untreated trauma can have a significant impact on a child’s adult life.[8] The landmark 1997 Adverse Childhood Experiences (ACEs) study found that youth who had experienced higher “doses” of ACEs (categorized as abuse, household challenges, or neglect) before they were 18 went on to face greater rates of depression, drug use, physiological disease (including cancer and cardiovascular disease), risk for intimate partner violence, financial instability, and poor academic achievement as adults.[9] ACEs in themselves are commonplace—almost 66 percent of study participants reported having experienced at least one ACE—but experiencing at least three ACEs creates the condition for extensive psychosomatic and socioemotional damage.[10]

Since the original ACEs study, several public health and medical studies have shown that poverty exacerbates the accumulation of ACEs and toxic stress, which are correlated with unfavorable health outcomes later in life.[11] We now know that a majority of American students in the public education system come from low-income backgrounds.[12] We cannot turn a blind eye to the challenges they bring in to the classroom with them, especially when these challenges impinge on their ability to realize their full academic and social potential.[13]

Intergenerational poverty finds its roots in the long-term impacts of ACEs and trauma.[14] If America’s public schools are meant to be vehicles of upward social mobility, they must provide services to support the whole child’s academic and socioemotional development. Educators cannot bear the burden alone. Yes, there are important steps teachers can take to mitigate the immediate detrimental impact of trauma, but these pedagogical tools are no substitute for trained counselors, social workers, and school psychologists.

To fill this gap in essential services, schools must start by painting an accurate picture of the mental health services students need. This can be achieved through universal trauma screening to gather student data on mental health conditions.[15] A series of survey-style self-assessments would be administered to students twice throughout the school year: first, as a diagnostic at the beginning of each year to determine supports from which they will benefit and then again, as a mid-year or year-end progress-monitoring assessment. The second assessment would ensure that any challenges that may arise in a student’s life throughout the academic year are recorded and addressed.

It is important that such screenings happen within a culture of informed consent between schools, students, and families. The results of such screenings must be protected as private health information. Universal screening should not simply search for deficits. It should uncover students’ strengths and resiliencies, which can be drawn upon in the course of their academic and socioemotional development. Though logistically challenging, trauma screening is crucial for identifying the need for mental health interventions throughout the student body.[16] Many schools currently rely on teacher or parent referrals to conduct comprehensive mental health evaluations. Unfortunately, referral systems lack objectivity and may be subject to implicit bias and prejudice. As a result, often only students with the most maladaptive behavioral challenges get referred. A universal-screening system would correct for such imbalances, allowing schools to objectively survey all students’ needs and strategically plan for targeted interventions.

With data in hand, schools need stable, long-term funding for mental health professionals. Just as Congress created the National School Lunch Program in 1946 to combat child hunger, it must institutionalize a comprehensive mental health program to combat childhood trauma.[17] In 2018, Senator Jeff Merkley (D-OR) introduced the Elementary and Secondary School Counseling Act to increase ratios of school counselors, school psychologists, and school social workers.[18] The bill, which failed to leave the Senate floor, would have been a promising start to enacting such an ambitious national program. Going forward, leading national mental health organizations—such as the American School Counselor Association, the National Association of School Psychologists, the National Alliance on Mental Illness, and Mental Health America—must create a broad-based coalition in partnership with teacher unions and parent advocacy groups that demands passage of sweeping federal legislation to institutionalize school-based mental health services.

Achieving this goal will have an immense measurable impact on students and school communities. Since school counselors and psychologists are already trained in progress monitoring, the spirit of impact measurement is naturally built in to the delivery of school-based mental health services.[19] At the individual level, schools could measure intervention impact through behavioral evaluations and academic growth, using universal-screening results as individual benchmarks.

At the community level, schools could measure the ripple effects of mental health interventions through school climate and culture evaluations. The Comprehensive School Climate Inventory is an example of one such school-climate survey that measures indicators like socioemotional safety and interpersonal relationships, which are at the core of any counseling or therapy program.[20]

Our public schools are often the first and most intimate sites of interaction between an individual and the state. They are a point of convergence for the social policies that shape the landscapes of people’s lives. Even if today’s public schools reflect systemic injustices, they remain our most hopeful pressure points for catalyzing social change. Closing the resource gap begins with addressing and treating the emotional and psychological needs that students carry with them into the classroom. We as a nation must commit to providing school-based mental health interventions to achieve equity for all students and empower them to achieve their fullest potential.

Edited by: Samantha Batel

Photo by: Feliphe Schiarolli


[1] Names have been changed to protect student privacy.

[2] ASCA National Model: A Framework For School Counseling Programs (technical paper, Alexandria, VA: American School Counselor Association), accessed 5 February 2019 [PDF file], https://www.schoolcounselor.org/asca/media/asca/ASCA National Model Templates/ANMExecSumm.pdf.

[3] Adam McCann, “Most & Least Diverse States in America,” WalletHub (blog), 18 September 2018, accessed 6 February 2019, https://wallethub.com/edu/most-least-diverse-states-in-america/38262/.

[4] “Research on School Counseling Effectiveness | Research | Counseling/Student Support | Learning Support,” California Department of Education, 18 December 2017, accessed 6 February 2019, https://www.cde.ca.gov/ls/cg/rh/counseffective.asp.

[5] Ernest Izard, Teaching Children from Poverty and Trauma (Washington, DC: National Education Association, 2016) [PDF file].

[6] Nicki Anselmo et al., Sounding the Alarm: Building the Climate & Culture Our Students Need (Educators for Excellence, June 2017) [PDF file].

[7] Anselmo et al., Sounding the Alarm.

[8] “About the CDC-Kaiser ACE Study,” Centers for Disease Control and Prevention, 14 June 2016, accessed 6 February 2019, https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/about.html.

[9] “About the CDC-Kaiser ACE Study.”

[10] “About the CDC-Kaiser ACE Study.”

[11] Michelle Hughes and Whitney Tucker, “Poverty as an Adverse Childhood Experience,” North Carolina Medical Journal 79, no. 2 (2018): 124–6.

[12] “The Cycle of Educational Failure and Poverty,” Stand Together, 24 July 2017, accessed 6 February 2019, https://www.stand-together.org/cycle-educational-failure/.

[13] “The Cycle of Educational Failure and Poverty.”

[14] Hughes and Tucker, “Poverty as an Adverse Childhood Experience.”

[15] Potential Assessments could include the BASC-3 Behavioral and Emotional Screening System (BESS), the Strengths and Difficulties Questionnaire (SDQ), Child and Adolescent Needs and Strengths (CANS) Trauma Version, the Childhood Trauma Questionnaire (CTQ), and the Pediatric Emotional Distress Scale (PEDS).

[16] Katie Eklund and Eric Rossen, Guidance for Trauma Screening in Schools (Delmar, NY: The National Center for Mental Health and Juvenile Justice, 2016) [PDF file].

[17] “National School Lunch Program (NSLP),” Food and Nutrition Service, accessed 6 February 2019, https://www.fns.usda.gov/nslp/national-school-lunch-program-nslp.

[18] Elementary and Secondary School Counseling Act, S.3427, 115th Cong. (2018).

[19] ASCA National Model.

[20] The 13 Dimensions of School Climate Measured by the CCSI (National School Climate Center, n.d.) [PDF file].