Screening and assessing for trauma symptoms, especially in regard to determining how trauma affects healthy functioning, are essential in determining a child’s overall social and emotional well-being. Children usually present to a child welfare agency as a result of a specific incident of maltreatment. For effective case planning and treatment, it is critical that child welfare practitioners be aware of the child’s history, including the child’s cumulative trauma experiences, in order to ensure a holistic, trauma-informed approach to the child.
Developing the capacity to screen and assess for trauma in the child welfare system can also address broader policy considerations. The 2011 Child and Family Services Innovation and Improvement Act, for example, requires states to include in their health care oversight plans a description of how they will screen for and treat foster children for trauma associated with maltreatment. Consequently, it is very important that an agency’s plan address emotional trauma for children involved in the child welfare system. States should consider integrating trauma-informed screening and assessment tools into their daily practice and carefully consider selecting tools from the wide variety available that meet their specific needs.
As appropriate, trauma assessments should be completed, initially and on an ongoing basis, to determine whether treatment strategies employed are effective and to plan further treatment.
Trauma-Informed Screening and Assessment Tools
There are distinct differences between trauma screening and trauma assessment tools. Screening tools are brief, used universally, and designed to detect exposure to traumatic events and symptoms. They help determine whether the child needs a professional, clinical, trauma-focused assessment. Functional assessments are more comprehensive and capture a range of specific information about the child’s symptoms, functioning, and support systems. A trauma assessment can determine strengths as well as clinical symptoms of traumatic stress. It assesses the severity of symptoms, and can determine the impact of trauma (how thoughts, emotions, and behaviors have been changed by trauma) on the child’s functioning in the various well-being domains.
If properly trained, the frontline caseworker within a child welfare setting can administer a screening tool when a child initially enters the system. Information obtained from that screening can help the caseworker determine whether a more comprehensive trauma-informed assessment is needed. If the initial screening indicates that additional assessment is needed, the child can be referred to a mental health practitioner for a trauma-informed assessment. This will provide the agency and caregiver with a fuller understanding of the child’s needs and behaviors; guide the treatment plan; and determine a trauma-focused, evidence-based intervention that will stabilize and help the child heal.
Selecting a Tool
When selecting a tool, factors to consider include how well it meets the needs of the target population and fits within the agency’s service delivery system. There are also properties specific to each tool that must be considered. As part of any selection process for a trauma-informed screening or assessment tool, the National Child and Traumatic Stress Network (NCTSN) recommends examining these specific properties:
- Validity – the degree to which the tool, including each of its specific items, accurately accomplishes its purpose, or whether the tool measures what it is intended to measure
- Reliability – the degree to which the tool is consistent across time and different raters
- Standardization of Norms – a process in instrument and measure development that allows for comparisons between data from the screening/assessment tool with general populations of the same age group
In addition to the screening tools and functional assessments summarized in the links below, there are also other assessment models/tools available. These trauma-informed screenings and assessments are similar to other types of assessments in that information is gathered as early as possible or on an ongoing basis from multiple sources such as the child, caregiver, and provider. However, they differ from traditional types of assessments in that they differentiate trauma effects from mental health disorders, which will be a critical factor in assisting child welfare practitioners to choose an appropriate course of treatment.
The NCTSN Webinar speaker series, Screening and Assessment for Trauma in Child Welfare Settings (Link), contains valuable information about trauma-informed screenings and assessments. The series contains several modules focused on the rationale for and utility of screening and assessing for trauma, specific tools and measures for conducting screening/assessment, the application of this knowledge and these tools within the direct as well as the systemic levels of child welfare systems, and important developmental considerations for screening and assessment. Note that you may have to create a free account on the NCTSN website to view this speaker series.
Additional sites with information about trauma-informed screenings and assessments are located on the Additional Resources page of this module.