Abstract
Child trauma screening practices have advanced considerably as child-serving systems have increasingly incorporated early identification and intervention into trauma-informed models of care. While research points to the necessity of screening practices that attend to a child’s developmental capacities, cultural background, relational strengths, contextual details surrounding the traumatic experience, and complex trauma considerations, many of these features remain absent in common brief screening measures used in practice. Pictorial screening measures may offer an innovative opportunity to address attentional concerns and developmental capacities of young and complexly traumatized children, yet are understudied in this area. The purpose of this paper is threefold: 1) highlight areas for expansion within current brief trauma screening models, 2) propose an evidence-informed framework for a pictorial complex trauma screening tool for children, and 3) offer implementation considerations for piloting the proposed screening tool. Piloting and implementation considerations address the importance of cognitive interviewing, cultural sensitivity, development of a companion response and referral protocol, and embedding principles of trauma-informed care in the training and implementation process.
Highlights
Child trauma screening practices have advanced considerably as child-serving systems have increasingly incorporated early identification and intervention into traumainformed models of care
Similar findings have been reported among child welfare-involved samples (Hambrick et al, 2018). These studies assert that relational health holds a more powerful association to child outcomes than a cumulative traumatic exposure score, yet relational health remains absent among brief trauma screening tools
Building from the contemporary body of research on complex trauma screening and identification, we propose a framework for the development of a pictorial child trauma screening tool
Summary
Trauma screening measures that account for the unique and variable symptom presentation associated with complex trauma in children—rather than those defined only by post-traumatic stress disorder (PTSD) diagnostic symptom clusters—may offer a more comprehensive understanding of children’s traumatic reactions. The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (5th ed., DSM-5, American Psychiatric Association, 2013) provides an updated and broadened definition of child PTSD, clinical concern has been raised that the expanded PTSD criteria still do not account for the disruptions to neurodevelopment—and subsequent regulatory challenges and developmental sequelae—that are linked to early and chronic traumatic stress (DeBellis & Zisk, 2014; DePierro et al, 2019; Ford, 2011). Child trauma measures that screen for symptoms defined by DSM-5 PTSD diagnostic criteria may fail to tap broader developmental indicators of complex trauma, including relational dysregulation, attachment difficulties, and physical and somatic complaints, and risk under-identification and missed opportunities for intervention (Ford, 2011). If measurement tools lack the nuance necessary to detect the diversity of complex traumatic reactions, children can be inadequately diagnosed, subjected to faulty treatment decisions, or may not be identified for services at all (McMillen et al, 2007; WhittWoosley, 2020)
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