Definition of Trauma-Informed Screening and Assessment
- Trauma-informed screening refers to a brief, focused inquiry to determine whether an individual has experienced specific traumatic events.
- Trauma assessment is a more in-depth exploration of the nature and severity of the traumatic events, the consequences of those events, and current trauma-related symptoms.
Why Do Trauma Screenings?
- Behavioral health problems, including substance use and mental health conditions, are more difficult to treat if trauma-related symptoms and disorders are not detected early and treated effectively.
- Although the high prevalence of significant psychological trauma among clients/consumers with serious and persistent mental health challenges is well known, and even where it is duly recorded in initial psychiatric histories, such trauma is rarely reflected in the primary (or secondary) diagnosis. A history of trauma, even when significant, generally appears only in the category of “developmental history”, and as such does not become the focus of treatment.
- Trauma-related symptoms are often not evaluated and therefore go unrecognized and untreated. In one multi-site study where 43% met diagnostic criteria for PTSD, only 2% carried the diagnosis in medical records.
- Even in academic and community mental health settings, rates of recognition of trauma are low with a clinical diagnosis of PTSD occurring in as few as 4% of individuals with the disorder.
Why is Trauma Not Recognized?
Two factors contribute to the fact that significant trauma concerns are frequently overlooked in professional settings:
- Underreporting of trauma by survivors
- Underrecognition of trauma by providers
Consequences of Failing to Screen for Trauma
If trauma is not considered when a consumer enters a service setting, there is an increased risk of being diagnosed incorrectly. Additionally, without screening, clients’ trauma histories and related symptoms often go undetected, leading providers to direct services toward symptoms and disorders that may only partially explain client presentations and distress.
Failure to assess for trauma can have important implications for treatment and recovery:
- Increases a consumer’s vulnerability to substance abuse disorders
- Leads to a worse course of serious mental illness.
- Contributes to social isolation and loss of social support, increasing vulnerability to relapse in persons with serious mental health challenges.
Benefits of Inquiry
- Universal screening for trauma history and trauma-related symptoms can help behavioral health practitioners identify individuals at risk of developing more pervasive and severe symptoms of traumatic stress.
- ACE study recommends routine screening of all patients for adverse childhood experiences take place at the earliest possible point.
- This identifies cases early and allows treatment of basic causes rather than vainly treating the symptom of the moment
- A neural net analysis of records of 135,000 consumers screened for adverse childhood experiences as part of their medical evaluation – showed an overall reduction in doctor office visits during the subsequent year of 35%.
- Biomedical evaluation without ACE questions reduced doctor office visits during the subsequent year by 11% .
Reasons for Agencies to do Trauma Screening
- Because trauma screening communicates institutional awareness of and responsiveness to the role of violence and/or trauma in the lives of consumers.
- Because of the benefits to the consumer of opening an area of concern often long kept hidden, and asking questions about his or her traumatic experiences.
For more information about trauma assessment for individuals:
- SAMHSA-TIP 57, Trauma-Informed Care in Behavioral Health Services
- Los Angeles Symptom Checklist www.oregon.gov/oha/amh/trauma-policy/lsac-adult-form.pdf – Adult Version PDF
- Los Angeles Symptom Checklist www.oregon.gov/oha/amh/trauma-policy/lasc-adolescent.pdf – Adolescent Version PDF
- Universal Trauma Screening from The Anna Institute
- Screening and Assessment of Child Trauma -NCTSN
- ACE – Adverse Childhood Experiences
- IES8 – Impact of Traumatic Events Scale
- COJAC screening tool
- The Davidson Trauma Scale (DTS) and the SPAN Startle
- Other Assessment Resources from International Society for Traumatic Stress Studies
- Trauma Symptom Checklist- Adult
- Trauma Symptom Checklist – Child