Trauma-Informed Care Screening and Assessment

Introduction

• Part of a continuing education series on trauma-informed care.
• Based on the treatment improvement protocol by SAMHSA.
• Objectives:
  • Review 16 principles for trauma-informed assessment and screening.
  • Explore reasons providers may not screen for trauma.
  • Understand misdiagnosis or underdiagnosis of trauma-related disorders.

16 Principles for Trauma-Informed Assessment

1. Promote Trauma Awareness: Understand that childhood events considered non-traumatic by adults can be overwhelming for children.
2. Recognize Symptoms as Adaptations: Traumatic symptoms are adaptive responses to extraordinary events.
3. Contextual View of Trauma: Impact varies based on individual environments (supportive vs chaotic).
4. Minimize Retraumatization: Avoid disempowering assessments and detailed questioning that can retraumatize.
5. Create a Safe Environment: Ensure clients feel emotionally and physically safe.
6. Identify Trauma Recovery as Primary Goal: Focus on trauma recovery as a distinct therapeutic goal.
7. Support Client Autonomy: Encourage control and choice in their treatment process.
8. Create Collaborative Relationships: Engage clients with trauma-informed services.
9. Universal Routine Screening: Advocate for routine trauma screenings in all settings.
10. View Trauma Through a Socio-Cultural Lens: Consider factors like intergenerational trauma.
11. Use Strengths-Focused Perspective: Foster resilience and trauma-resistant skills.
12. Commit to Trauma-Informed Care: Demonstrate organizational commitment.
13. Address Secondary Trauma: Acknowledge and manage secondary trauma among staff.
14. Provide Hope: Reinforce the possibility of recovery.
15. Explain Screening and Assessment: Clarify the difference between screening and assessment.
16. Use Validated Instruments: Employ validated tools for trauma screening and assessment.

Screening and Assessment Process

• Initial Screening: Offer psychoeducation from the start.
• Domains to Screen:
  • Trauma-related symptoms
  • Depressive/dissociative symptoms
  • Past/present mental health issues
  • Severity/characteristics of trauma
  • Substance abuse
  • Social support and coping styles
  • Risk of self-harm/suicide
  • Health screening

Client Interaction and Safety

• Approach clients with sensitivity.
• Allow clients control over the pace and detail of trauma discussions.
• Employ strategies for grounding and safety.
• Ongoing assessments to track changes in symptoms.

Challenges in Trauma Screening

• Difficulty identifying trauma survivors.
• Providers may overlook trauma due to lack of training or reticence.
• Misclassification of trauma symptoms as other disorders.
• Cultural factors affecting perception and expression of trauma.

Cultural Considerations

• Awareness of cultural norms in trauma expression and help-seeking.
• Recognize culture-bound symptoms and their interpretations.

Legal and Ethical Considerations

• Understanding mandatory reporting obligations.
• Maintaining client confidentiality and safety.

Conclusion

• Emphasize the importance of a safe space for assessment.
• Acknowledge the need for ongoing training and awareness among providers.
• Encourage continuous improvement in trauma-informed practices.