As the head of mental health and crisis response in Los Angeles schools in the late 1990s, Marleen Wong could sense that violence and trauma were having a serious effect on children.
When she responded to one of the approximately 3,000 serious incidents that occurred on an annual basis in local schools, such as a stabbing or assault, she would often ask students involved in the traumatic event whether they had similar experiences in the past.
“More often than not, they would say yes—my brother was beat up on the way to the store or I saw my father hurt my mother,” Wong said.
Without empirical proof of the problem, however, she was limited in terms of marshaling resources and support for those students, so Wong approached researchers at UCLA and RAND Corporation. That initial contact in 1998 spawned a series of groundbreaking studies on the prevalence and effects of trauma in Los Angeles schools and ultimately led to the creation of the Trauma Services Adaptation (TSA) Center for Resiliency, Hope and Wellness in Schools, the primary national source of strategies and materials to combat issues such as violence and bullying in schools.
Wong, now associate dean of field education and clinical professor at the USC School of Social Work, recently received a fifth round of federal funding to support the center in the form of a four-year, $2.4-million grant.
“It’s very gratifying to see that the work you do is helpful, is relevant to the challenges that people are facing in real life, not just here in Los Angeles but in different parts of the country and the world,” she said. “What is also gratifying is that the level of knowledge and comfort that people have with providing trauma interventions has really increased in schools across the country.”
The funding will enable the TSA Center to continue its mission of developing and disseminating school-based interventions focused on trauma and offering specialized training to school leaders and teachers. However, the center is expanding its focus with the new grant, including initiatives to develop a curriculum for teachers designed to improve trauma resiliency among students, using technology to broaden the reach of the center, and identifying and addressing the needs of vulnerable students such as LGBT youth.
Developing strategies to reduce secondary trauma is also a new objective of the TSA Center as it continues its work during the next four years. Comparing the phenomenon to secondhand smoke, Wong explained that research has shown that teachers who are exposed to students who have been traumatized can also experience stress and depression.
“You don’t have to smoke the cigarette, but you’re in the room with all this toxic matter,” she said. “The same thing is true with teachers. They can’t get it out of their minds—the violence or trauma their students have talked to them about—and they can’t sleep at night, they are irritable, and their primary relationships can suffer.”
Another main focus of the project is offering advice and guidance as school officials adapt interventions to address their specific needs. One high-profile tool developed by Wong and her colleagues, the Cognitive Behavioral Intervention for Trauma in Schools (CBITS), has been used in a wide array of settings, from Native-American populations in Montana to those affected by hurricanes and the BP oil spill in New Orleans.
The intervention was developed in response to initial studies in the Los Angeles Unified School District that found an astonishing level of trauma among young students.
“More than 90 percent of children in living in certain zip codes here in Los Angeles, in South L.A. and East L.A., had been exposed to violence—kicked, punched, threatened with a gun or knife, assaulted—within the past year of our studies,” Wong said. “It was consistent every year.”
The research project culminated in a survey of every sixth-grade student in the school district. It confirmed that those living in areas with high rates of crime and gang activity had similarly high rates of behavioral health issues. Additionally, the study revealed that 27 percent of students who experienced a traumatic event had post-traumatic stress disorder, whereas 16 percent struggled with clinical symptoms consistent with depression.
But it wasn’t until the research team published an article in 2003 in the Journal of the American Medical Association reporting on the development of CBITS as a strategy to address trauma in schools that the issue gained national attention.
“It was shocking to everybody that the children we studied had higher rates of PTSD than what was going on in the Middle East at that time, or in any war zone,” Wong said. “I think that is what really brought attention to the work we were doing.”
The intervention proved effective, significantly reducing the levels of stress and depression among students who participated in the group and individual therapy sessions. CBITS is now used across the United States and abroad in countries such as Australia, China, and Japan.
As independent research on the effectiveness of the tool in different cultural and social settings emerges, the TSA Center has provided guidance and suggestions on how best to adapt CBITS and other school trauma-related interventions, particularly through ongoing consultations and a national summit held annually.
Wong credited her strong relationship with her fellow researchers for the success of the center throughout the years, noting that the team has participated in weekly phone calls and meetings for more than a decade, creating a unique and lasting collaboration.
“This has been one of the longest community-based research partnerships I know about,” she said. “I certainly couldn’t have done this work without my RAND and UCLA colleagues.”
The extended funding, provided by the Substance Abuse and Mental Health Services Administration, will support the center through September 2016.