Trauma-Informed Policies and Practices for Higher Education

Institutions of higher education must recognize the prevalence of mental health concerns among college students has been rising in recent years and take mental health crises seriously. To effectively serve students, institutions can employ a trauma-informed care approach that focuses on a holistic, person-centered approach. This article provides guidelines for higher education professionals to use with students who experience a mental health crisis while attending college, using a trauma-informed approach. While not comprehensive, these guidelines provide critical action steps for institutions to follow to effectively serve students dealing with a mental health crisis with trauma. Additionally, colleges can adopt these policies and procedures depending on institutional department committees and department names.

Mental Health Crisis Management Process

The process of mental health crisis management involves notifying the institution and first steps, determining safety risks, setting up a plan with the student, and providing ongoing care.

1. Notifying Institution and First Steps
   
   

When students recognize they are in a crisis, they typically either inform a trusted adult on campus, whether a Residential Life staff member, professor, the Counseling Center, another staff member, or a trusted adult who can take appropriate steps to initiate a crisis management protocol while discussing this with the student.

Once the institution learns that there is a crisis:

• A member of the institution's crisis response team should meet with the student and their family members if the student wants to involve them.
• First, this staff member should ask the student if they have a therapist and/or psychiatrist who may be practicing in the community.
• In the meeting, the student can tell this staff member what is happening to them.

It is imperative that the institution recognize the importance of having the student's medical or mental health team present in all decisions and the importance of a one-on-one meeting with a student, which can be less intimidating for students with trauma.

After this meeting occurs:

• The staff member can communicate with the institution's crisis response team.
• A meeting with the entire team, the student, their family members, and their mental health team can take place, if applicable. The entire crisis response team should be present as well as the student's therapist and/or psychiatrist, if applicable, during this meeting. Each person can introduce themselves, their role in the university, and how they can assist the student in their professional capacity.

The student does not need to share their situation with everyone present or tell those present of existing mental health concerns or treatment to help avoid re-traumatization and intense emotions surfacing during a crisis. As the crisis team meets with the student, they can determine the student's safety risk.

2. Determining Safety Risk

Steps to take if a student is suicidal, homicidal, or threatens to hurt themselves or others:

• If a student has a therapist and/or psychiatrist, then the counseling center can contact them to help determine the student's intent.
• If this individual(s) is not available or if the student does not have a therapist and/or psychiatrist, a mental health counselor on campus can meet with the student to determine the student's intent.

It is necessary for the institution to recognize the importance of the trusted relationship between the student and their therapist and/or psychiatrist.

If the student exhibits a safety risk, then alternative adjustments can be made for the student. It is critical to have multiple choices for the student, including hospitalization, a leave of absence, or an extension for their degree program. The institution should recognize that the student's academic career may need adjusting for the student to complete their college degree successfully.

If hospitalization is the appropriate option for the student, then the student should have the option to contact their family and roommate(s) before leaving. Family and peer support are critical during a mental health crisis. During a team meeting, staff members can lay out a variety of academic options, including taking incompletes, setting up disability accommodations if the student has a mental illness(es), taking a leave of absence, or an extension of their degree program.

3. Setting Up a Plan with the Student

After the initial meeting with a student in crisis occurs, staff members can set up a plan with the student. To ensure collaboration and that the student's voice is heard, the student should be involved in the decision process. The student needs to receive ongoing care, including regular meetings with different departments on campus, such as academic counseling, counseling services, and disability services. Before ongoing care begins, the institution can assist the student in developing a plan:

• Students who have a therapist and/or psychiatrist can continue to meet with this individual(s).
• If the student does not have an established therapist, the student can be strongly encouraged to seek out regular counseling services, particularly with someone with similar cultural backgrounds such as gender and race if that would be more comfortable for them.
• If a student does not want to see a counselor on campus, then the institution can help the student seek therapy off-campus.

The institution should recognize that the student may not feel comfortable seeking counseling services on campus, the counseling staff may not be qualified for their mental health condition(s), and that college counseling services are understaffed and have existing waiting lists. Thus, the institution should provide a list of community mental health providers and organizations available online and in person.

Different departments have various roles in helping a student in crisis, such as:

• Students can receive multiple choices in terms of their academic progress, including an option to take incompletes, if applicable; a leave of absence; or an extension.
• Academic counseling can help students if they choose a leave of absence or an extension.
• If students choose any of these options, then the Dean of Students can initiate the paperwork, and an academic counselor and an academic advisor can work individually with the student to set up a plan for their courses in current and future semesters.
• The Disability Resources Office can provide students with temporary or permanent accommodations that benefit students as they are going through a crisis.
• The Director of Student Life can provide the student with a list of peer support and student organizations on campus.

In all these efforts, the institution exemplifies the importance of relationship-building and peer-to-peer support in trauma-informed care.

4. Providing Ongoing Care

Ongoing care is critical for students exhibiting a mental health crisis, even after a crisis stops.

• If the student lives on campus, their Residence Director can check in with them as frequently as needed, preferably in person.
• If the student has disability accommodations or wants to implement any accommodations, their Disability Specialist can offer to meet with the student weekly.

In these meetings, the staff member can establish trust and rapport, build a professional relationship, and listen wholeheartedly to the student. Healing does not occur right away, and recovery can take many turns, meaning that the student may need more support at certain times than others.

A Note to Higher Education Professionals

We want to acknowledge the significance of trauma-informed work in professional practices without clinical training. Even though higher education professionals do not typically have clinical training in psychology or a related field, they can offer effective support by implementing trauma-informed care components in their practice and referring students to appropriate clinical support. This proposed partial solution does not replace counseling, but it is a supplement to supporting students during college. Counseling and other mental health treatment, such as medication, are vital for students dealing with current and/or past trauma. We encourage professionals to seek out trusted colleagues when helping students with traumatic experiences, including what is working and what is not working for them. We encourage participants to seek resources on trauma-informed care. In the next section, we provide a detailed but not complete list of trauma-informed care resources that have been beneficial for us professionally.

A Trauma-Informed Care Resource List

From our research, we compiled a resource list focusing on trauma-informed care to help higher education professionals understand trauma-informed care and how to implement it in their practice. This resource list is not complete but highlights various books, articles, and websites that have helped us professionally. The below resource list has 3 sections: trauma-informed care, trauma-informed care in a school setting, and resources for professionals:

Trauma-Informed Care:

• Bath, H. (2008). The three pillars of trauma-informed care. Reclaiming Children & Youth, 17(3), 17-21. http://www.twi.org.au/3PHealingInTheOther23Hours.pdf
• Bonanno, G. A. (2021). The end of trauma: How the new science of resilience is changing how we think about PTSD. Basic Books.
• Haines, S. K. (2019). The politics of trauma: Somatics, healing, and social justice. North Atlantic Books.
• Herman, J. (1992). Trauma and Recovery: The aftermath of violence - from domestic abuse to political terror. Basic Books.
• Hübl, T. (2020). Healing collective trauma: A process for integrating our intergenerational and cultural wounds. Sounds True.
• Levine, P. A. (1997). Waking the tiger: Healing trauma. North Atlantic Books.
• Lietz, C. A., Lacasse, J. R., Cheung, J. (2014). A case study approach to mental health recovery: Understanding the importance of trauma-informed care. Ethical Human Psychology and Psychiatry. 16(3), 167-182.
• Rapp, L., & Anyikwa, V. A. (2016). Trauma-informed care: Intervening across systems. Journal of Evidence-Informed Social Work, 13(5), 433. https://doi.org/10.1080/23761407.2016.1166846
• Skeens, L. M. (2017). Guided imagery: A technique to benefit youth at risk. National Youth-At-Risk Journal, 2(2), 92-106.
• Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). SAMHSA's concept of trauma and guidance for a trauma-informed approach [PDF]. Retrieved from https://s3.amazonaws.com/static.nicic.gov/Library/028436.pdf
• Van Der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.

Trauma-Informed Care in a School Setting:

• Carello, J. & Butler, L. D. (2015) Practicing what we teach: Trauma-Informed educational practice. Journal of Teaching in Social Work. 35(3), 262-278. https://doi.org/10.1080/08841233.2015.1030059
• Frazier, P., Anders, S., Perera, S., Tomich, P., Tennen, H., Park, C., & Tashiro, T. (2009). Traumatic events among undergraduate students: Prevalence and associated symptoms. Journal of Counseling Psychology, 56(3), 450-460. https://doi.org/10.1037/a0016412
• Hallett, R. E., Westland, M. A., & Mo, E. (2018). A trauma-informed care approach to supporting foster youth in community college. New Directions For Community Colleges, 2018(181), 49-58.
• McCauley, H. L., & Casler, A. W. (2015). College sexual assault: A call for trauma-informed prevention. The Journal of adolescent health: official publication of the Society for Adolescent Medicine, 56(6), 584-585. https://doi.org/10.1016/j.jadohealth.2015.03.012
• Morton, B. M., & Berardi, A. A. (2017). Trauma-informed school programming: Applications for mental health professionals and educator partnerships. Journal of Child & Adolescent Trauma, 11(4), 487-493. https://doi.org/10.1007/s40653-017-0160-1
• Perry, B. D. (2006). Fear and learning: Trauma-related factors in the adult education process. New Directions for Adult & Continuing Education, 2006(110), 21-27. https://doi-org.ezproxy.stthomas.edu/10.1002/ace.215
• Wiest-Stevenson, C., & Lee, C. (2016). Trauma-Informed schools. Journal of Evidence-Informed Social Work, 13(5), 498-503. https://doi-org.ezproxy.stthomas.edu/10.1080/23761407.2016.1166855

Resources for Professionals:

• van Dernoot Lipsky, L., & Burk, C. (2009). Trauma stewardship: An everyday guide to caring for self while caring for others. Berrett-Koehler Publishers, Inc.
• van Dernoot Lipsky, L. (2018). The age of overwhelm: Strategies for the long haul. Berrett-Koehler Publishers, Inc.