Creative expressive therapy in schools to address childhood trauma: a mixed methods study of a whole school trauma-informed approach.

Introduction: Schools offer unique opportunities to deliver mental health support for students impacted by trauma. The current mixed-methods study explored the implementation and early effectiveness of the KidsXpress School Partnership Program, a school-based partnership that embeds creative-expressive therapists and trauma-informed consultants within primary schools to deliver targeted therapy for students and whole-school capacity-building for staff. Methods: Five primary schools in Australia participated. Implementation was assessed via online surveys and interviews from schoolteachers, KidsXpress therapists and trauma-informed consultants. Thematic analysis with a hybrid inductive-deductive approach was used, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Data was collected from students via routine assessments as part of the School Partnership Program. Effectiveness was evaluated via changes in wellbeing scores among students referred for creative-expressive therapy sessions from first to last therapy assessment using the Child Outcome Rating Scale (CORS), as well as quantitative and qualitative data from teachers, therapists and trauma-informed consultants. Results: 87 school staff and seven KidsXpress staff participated in online surveys. Nine participants were interviewed, including six KidsXpress staff and three school staff members. Pre-post data on the CORS was available for 233 students. Feedback from teachers and KidsXpress staff indicated strong perceived student benefits, including enhanced emotional regulation and coping, increased confidence, and greater help-seeking. This was supported by wellbeing scores, which were significantly higher at post-assessment compared to first assessment. Teachers reported increased understanding of trauma-informed practice, classroom strategies, and valuable mentoring from KidsXpress staff. The most frequently cited challenges were insufficient staffing and cultural differences in perceptions of mental health. While participants generally felt that trauma-informed practice had improved since the program's introduction, confidence in sustaining these changes without ongoing support was low. Conclusions: The KidsXpress School Partnership Program is effective in improving student wellbeing following exposure to traumatic experiences and in improving trauma-informed practice at the whole of school level. Nonetheless, implementation barriers exist, and low confidence, early in the partnerships, in the maintenance of trauma-informed practice underscores the need for strategies to embed trauma-informed approaches into school systems to ensure continuity.