What is Trauma Screening and Assessment?

Overview

Trauma screening involves the use of a culturally competent, standardized, and validated trauma screening tool. A trauma screener is designed to be administered to every child within a given system.

Trauma screening tools are brief and should evaluate the presence of two critical elements: (1) exposure to potentially traumatic events/experiences, including traumatic loss, and (2) traumatic stress symptoms/reaction.

A trauma screening typically covers the following types of traumatic stress reactions:

• Avoidance of trauma-related thoughts or feelings
• Intrusive memories of the event or nightmares about the event
• Hyper-arousal or exaggerated startle response
• Irritable or aggressive behavior
• Behavioral problems
• Interpersonal problems
• Other problems based on the developmental needs and age of the child

Why Screen?

If you do not ask, they will/may not tell. Trauma-informed screening and assessment practices help providers identify children’s and families’ needs early in the intake/therapy process and to tailor services to meet those needs. Trauma exposure and its impact on a child can be varied and may occur over different developmental periods.

Trauma exposure has the potential to impact all domains of functioning, cognition, and emotional regulation. However not all children who experience a traumatic event(s) suffer posttraumatic or trauma-specific reactions as a result. Screening for exposure to trauma can help to gain a better understanding of what a child has experienced and identify or clarify other clinical presentations

The overall goal is for trauma to be factored into eligibility for services, service recommendations, and assessment and treatment planning. Screening for traumatic stress symptoms among those with a history of potentially traumatic experiences can identify children who may benefit from an evidence-based trauma treatment. Staff who administer the screening tool should be trained in the administration, scoring and interpretation of the results

For those mental health providers working in a CMHSP the MDHHS BHDDA Trauma Policy: Section IV states the following:

Screening for trauma exposure and related symptoms for each population. CMHSP, through direct service operations and provider network, shall use a culturally competent, standardized and validated screening tool appropriate for each population during the intake process and other points as clinically appropriate.

Trauma Screening is the first opportunity to normalize the effects of trauma. It is an opportunity for non-judgmental engagement and a transition to trauma treatment. The child and their caregiver can learn about common reactions to stress and normalize some of the reactions they may be experiencing. Trauma Screening can also provide a rationale for further trauma assessment and treatment.

Types of Trauma Screening Tools

What makes a good screening tool? The NCTSN states: providers using a screening tool should consider (1) factors such as the child’s age, language skills, and cognitive capabilities; (2) whether the child is among the populations for which the tool has been validated and normed; and (3) if there are other factors that might affect the reliability and validity of the tool for this particular child.

There are a variety of screening tools, below are a couple of examples:

• University of Minnesota’s Traumatic Stress Screen for Children and Adolescents (TSSCA)
• Juvenile Victimization Questionnaire (JVQ-R2)

What is a Trauma Assessment?

A trauma assessment typically occurs after a trauma screening has been completed and the child or caregiver has indicated trauma exposure. The assessment utilizes a formal, standardized measure to assess for a range of trauma exposures as well as behavioral reactions/coping skills that may have resulted from the trauma exposure. The assessment measure typically gathers information from both a child/youth and their caregiver.

Why is a Trauma Assessment Completed?

A trauma assessment typically occurs after a trauma screening has been completed and the child or caregiver has indicated trauma exposure. The assessment utilizes a formal, standardized measure to assess for a range of trauma exposures as well as behavioral reactions/coping skills that may have resulted from the trauma exposure. The assessment evaluates the ways in which a child/youth’s current functioning might have been affected by the experience of trauma. The assessment measure typically gathers information from both a child/youth and their caregiver.

There are three dimensions of the trauma assessment:

1. Has the child/youth been exposed to potentially traumatizing events?
2. Does the child/youth display symptoms associated with posttraumatic stress?
3. Determining if the youth meets the criteria for a formal diagnosis of Posttraumatic Stress Disorder (PTSD) as per the DSM-IV or ICD-10 diagnostic manuals.
   It should be noted a PTSD diagnosis is not required to receive TF-CBT or CPP.

Trauma assessments can help to determine, trauma responses that are currently occurring, whether a child is developmentally on target in their social, emotional, and behavioral functioning; as well as, inform case conceptualization and drive treatment planning. Treatment goals can also be established from the assessment, specifically targeting ongoing trauma responses and identifying any barriers to treatment. A trauma assessment can also monitor progress over time as the child, youth and family proceed through treatment.

Types of Trauma Assessments

What makes a good trauma assessment tool? When reviewing assessment tools the NCTSN states: providers using a trauma assessment tool should consider (1) factors such as the child’s age, language skills, and cognitive capabilities; (2) whether the child is among the populations for which the tool has been validated and normed; and (3) if there are other factors that might affect the reliability and validity of the tool for this particular child.

There are a variety of trauma assessment tools, below are a couple of examples:

• Young Child PTSD Checklist (YCPC) for children ages 1-6 years’ old
• UCLA Posttraumatic Stress Disorder Reaction Index for the DSM IV (UCLA-PTSD RI)

The NCTSN also has a database of searchable detailed reviews of screening and assessment measures utilized in the field of child traumatic stress, designed to allow comparison across measures.

Training Qualifications

Trauma Screening and Assessment Learning Collaboratives are provided on a regular basis throughout the year to Community Mental Health Services Programs (CMHSPs) and their provider agencies. To qualify for a Learning Collaborative in our Trauma Screening and Assessment program, you must be a licensed clinician employed by a CMHSP or provider agency.

Please speak with your agency supervisor if you are interested in participating in an upcoming Learning Collaborative.