Healthy Environments and Response to Trauma in Schools (HEARTS)
Video: Recognizing Student Trauma
Joyce Dorado, Ph.D. and Miriam Martinez, Ph.D. co-founded the Healthy Environments and Response to Trauma in Schools (HEARTS) Program in 2008, in close collaboration with San Francisco Unified School District (SFUSD) personnel. Prior to the inception of HEARTS, through their experiences working in schools, they learned that providing onsite, trauma-specific treatment was not enough to truly address the needs of trauma-impacted students. While providing evidence-based interventions for the students at the school was effective in building their coping skills in the therapy room, too often students were returning to their classrooms only to be inadvertently triggered into survival mode by stressors in the school environment such as a sudden change in classroom routine, a challenging interaction with another student, or a disciplinary practice that the student perceived as a threat. They also bore witness to the extremely high level of chronic stress experienced by school staff. The anecdotal evidence began to mount for a different kind of approach.
HEARTS partnered with Heart Core Consulting in 2023 to expand the reach of the HEARTS program and approach beyond grant-driven funding models to schools and districts nation-wide.
HEARTS is a research-based, award-winning, whole school, prevention and intervention framework. HEARTS is guided by six core principles that are grounded in extensive research on trauma-interventions and trauma-informed systems, modified for educational settings.
HEARTS Guiding Principles
HEARTS is guided by six core principles that are grounded in science and applied at the:
Student level (e.g., educational practices with students)
Adult level (e.g., how administrators, staff, and caregivers interact with each other)
Systems level (e.g., classroom procedures and school policies, as well as how leadership is carried out)
HEARTS utilizes a multi-tiered system of support (MTSS) framework to address trauma and chronic stress at the student, adult, and systems levels. This tiered system of support is intended to augment, not replace, existing school initiatives (e.g., SEL, PBIS).
Multi-Tiered System of Supports
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Examples of Tier 3 HEARTS supports
Students: School-based, trauma-specific individual, group, and family therapy services for students with trauma-related mental health difficulties; includes intensive collateral work with students’ teachers, as well as consultation around Individualized Education Program (IEP) assessment and plans when IEP is warranted
Adults (Staff And Caregivers): Brief crisis support for trauma-impacted school staff, and referral for more intensive services if needed; engaging and supporting parents/caregivers as part of their children’s psychotherapy
System: Consultation around improving the district-wide procedure for trauma-impacted students who need mental health services to access culturally responsive, trauma-informed psychotherapy
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Examples of HEARTS Supports
Students: Psychoeducational skill-building interventions for at-risk students
Adults (Staff and Caregivers): Wellness (non-treatment) support for school staff that addresses stress, burnout, and secondary trauma (e.g., teacher wellness groups); participating in Coordinated Care Team meetings that address the needs of at-risk students and coordinate integrated responses, as well as respond to school-wide concerns
Systems: Consultation around school or district efforts to re-examine and revise discipline policies and procedures, and alternatives to suspension
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Examples of HEARTS Supports
Students: Classroom training for all students on coping with stress
Adults (Staff and Caregivers): Training and consultation for all school staff (e.g., teachers, administrators, support staff, paraprofessionals, and school medical and mental health staff) around (a) trauma-sensitive practices, and (b) addressing stress, burnout, and secondary trauma; psychoeducation and skill-building workshops for parents/caregivers on coping with stress
System: Providing a trauma-informed lens to school staff in their implementation of school-wide supports and interventions (e.g., PBIS, Restorative Justice/ Practices, social emotional learning curricula)
The journey towards becoming a trauma-informed, safe, supportive, and equitable school is typically a multiple-year culture change process. We use a systems change process to guide schools and districts along a continuum from increasing their readiness towards becoming trauma-informed.
Systems Change Process
Step 1
Increase readiness.
Readiness is characterized by having the infrastructure, capacity, and motivation to work towards becoming a trauma-informed school. School leadership is essential for determining a school’s readiness and increasing readiness factors.
Step 2
Form a team.
This team champions the effort to adopt and model the HEARTS principles within their own sphere of influence. They also lead efforts to assess school-wide practices and policies; and develop, implement, and monitor an improvement plan.
Step 3
Develop awareness.
Through foundational professional development, school staff develop an awareness of the impact of trauma and chronic stress on individuals, relationships, and organizations and begin applying HEARTS principles in their sphere of influence.
Step 4
Cycles of change.
As schools become more trauma-informed, they iterate through cycles of change by assessing school-wide policies, procedures and practices, setting improvement goals, and monitoring their progress towards those goals. This cycle occurs amidst ongoing professional development and consultation that supports staff to implement small tests of change within their own professional roles.
Research and Evaluation
HEARTS Full Site-Based Program Evaluation
At four schools where the full site-based HEARTS program had been implemented for more than one year, school personnel reported:
significant increases in their understanding of trauma
significant increases in their use of trauma-sensitive practices
significant improvements in their students’ ability to learn, time on task, and school attendance
Where the full site-based HEARTS program was implemented for five years, the school experienced the following changes compared to the year prior to HEARTS implementation:
After one year of HEARTS:
32% decrease in total disciplinary office referral incidents
43% decrease in incidents involving physical aggression
After 5 years of HEARTS:
87% decrease in total incidents
86% decrease in incidents involving physical aggression
95% decrease in out-of-school suspensions