The impact of toxic stress arising out of experiences of abuse, neglect, community violence, and poverty is being recognized more and more. Many valuable programs are being tested and implemented in communities and schools. Many of these programs are designed within a mental health model, in which children who are showing disordered symptoms or behaviors are provided trauma treatment, usually by professionals with trauma expertise. Studies show that in most cases these interventions are helpful and reduce symptoms. However, I will point out that this model will not be able to successfully address the challenge that we are facing.

The First Problem
The first problem is that the cost of these interventions is high: usually from $3,000 to $10,000 per student. This cost is not outrageous from a mental health perspective, where sessions typically cost $100. But from a social policy point of view, this level of cost is a showstopper.

The Second Problem
It is a showstopper because the problem of toxic stress and abuse is not confined to a small percent of the population: it has become a population-wide problem. Intervention must impact one third to one half of all children. In a typical school district of 20,000 students, evidence-based trauma treatment might require $50 to $70 million dollars a year, far more than any district will ever have.

The Third Problem
The third problem, and this is the most significant, is that these interventions occur after the child has begun to show symptoms or behaviors, well after they were initially exposed to the stress from abuse or trauma. Children do not usually break out into disordered behavior immediately following these experiences; they attempt to manage the stress and only over time, especially if the stressful conditions continue, do they eventually break down. Thus, trauma treatments, no matter how effective, might address those children who are symptomatic, but will not identify or address those children who are about to become symptomatic. The result is an endless cycle of disruption and then expensive repair. Only a preventative program can stop this cycle.

A Public Health Approach is Needed.

A public health approach will include 1) low cost interventions that do not rely on experts, 2) that are offered to the entire population, and 3) before symptoms are evident. It aims to empower the entire populace, not specialists; and it is prevention oriented, not treatment oriented.

We have limited money. Do we spend it on surgical techniques for lung cancer, or teaching the population to stop smoking? Do we spend it on the expense of tooth extractions, or helping children brush their teeth each day? Do we spend it on developing new antibiotics or insisting people wash their hands often? Changing the habits of an entire population seems overwhelming. But in the case of child abuse, we must do that.

How Can We Accomplish This?

How do we know which child has been exposed to severe stress at home, in school, or in their neighborhood? Can a trained observer see the telltale signs of distress and then act?

No. Stress in its early stages may often go undetected. The child does what they can do to adapt, to function, to go on.

This fact means that the only way to tell which children have been exposed to severe stress is to Ask The Child. Not only the quiet child, or the hyperactive child, or the black child, or the poor child……every child. We must ask every child, on a regular basis, if they are okay and if anything has happened to them. In schools, this means everyone, from Kindergarten through 12th grade.

Unless we can address the source of the toxic stress experienced by children, we will never have enough resources to fight back against the catastrophic personal and social consequences of trauma.

The ALIVE Program conducted by the Foundation for the Arts and Trauma in Connecticut is attempting to do just that, and has been successful in partnering with the public schools in implementing a public health approach to identifying and helping students who have experienced high levels of toxic stress. For more information, visit their website:

Stayed tuned at this site for more blogs on addressing trauma in the public schools.