What is a Trauma Screening Tool or Process?

Trauma screening is designed to be able to be administered to every child within a given system (such as child welfare) to determine whether he or she has experienced trauma, displays symptoms related to trauma exposure, and/or should be referred for a comprehensive trauma-informed mental health assessment. Trauma screening can include a particular tool or a more formalized process. Trauma screening should evaluate the presence of two critical elements: (1) Exposure to potentially traumatic events/experiences, including traumatic loss, and (2) Traumatic stress symptoms/reactions.

Not all children who experience negative events suffer posttraumatic or trauma-specific reactions as a result. Trauma screening should measure a wide range of experiences and identify common reactions and symptoms of trauma (e.g., PTSD, dissociation), as well as other commonly reported difficulties (e.g., anger, behavior problems, depression, anxiety). With proper training, professionals or paraprofessionals from various child-serving systems—healthcare, schools, home visiting programs, and domestic violence shelters—can administer the screening.

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

Types of Screening Tools

Providers may administer trauma screening in a number of ways depending on the age and developmental stage of the child and on the child’s relationship with the caregiver and other collateral informants in his or her life. For example, with very young children, it is difficult to screen specifically for “trauma symptoms.” Rather, a provider may screen for exposure to traumatic events and social and emotional difficulties, such as attachment difficulties or mood dysregulation. As the child gets older, it may be more appropriate to screen specifically for trauma symptoms.

Most screening tools are developed for use by professionals with a range of training and experience. 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.

• Child-Completed Tool (Self-Report). Child-completed tools are appropriate for children, typically ages eight and above, who are able to read and complete the questions. These measures provide the child with an opportunity to verbalize his or her responses aloud or in writing.
• Caregiver-Completed Tool. For infants, toddlers, young children (ages 0-8), or children with developmental delays, it is more appropriate to have a caregiver complete the trauma screening either by providing written responses to the items or through an interview by the provider.
• Provider-Completed. The caseworker, clinician, or other professional can administer certain tools while reviewing and integrating available information on a child (e.g., court reports, interviews with caregivers and teachers, other questionnaires, and behavioral observations). These tools can be useful in consolidating a range of information in one place so that it is readily accessible.

Engaging Families in the Screening Process

To engage families in the screening process, the individual administering the tool should consider the following:

• Explain the purpose and use of the screening tool and process. Say why you need to know this information, how you will use what you gather, how it may benefit the child and family, and who will have access to the information in the future. Emphasize that the information is confidential in most cases, unless the child endorses harm to self or others or the clinician has concerns regarding child abuse.
• After the child or family has completed the trauma screening, share the results and show how you are using the information. For example, “It’s clear from the forms that you filled out that your daughter is having a really hard time with nightmares and fear of things that remind her of her brother getting hurt. We call this Posttraumatic Stress. To help her, I would like to refer you to a therapist who specializes in treating children with these problems.”
• Make sure to thank the child for completing the tool or process, particularly if he or she disclosed a new trauma. Explain that the child’s feelings and trauma reactions are normal and expected, given what he or she has lived through.
• Consider the potential burden of the trauma screening to family members in terms of time and effort, and highlight the potential benefits, such as helping to link them to appropriate providers and services. Some families may be discouraged by the process; others may be comfortable with it. When providers explain the purpose and use of the screening tools and share the results, they enhance the benefits to families.