Identify and Treat Trauma

Screen Patients for Trauma

As organizations adopt trauma-informed approaches to care, many are integrating trauma screening into care models to assess patient exposure to adverse childhood experiences and trauma. While variation exists regarding when and how to screen for exposure to ACEs and trauma in adult and pediatric populations, following are core considerations to guide screening approaches:

  • Treatment setting and patient population should guide screening. Upfront, universal screening may be more effective in primary care settings and later screening more appropriate in behavioral health settings to allow relationships to form. Variations in the frequency and type of screening might also exist between adult and pediatric populations.
  • Screening should benefit the patient. Providers screening for trauma must have a clear strategy for utilizing the information in a way that supports patients’ health, including an established referral network.
  • Care coordination should be employed to avoid rescreening. Sharing results across treatment settings with appropriate privacy protections may help reduce re-screening and the potential for re-traumatization. In pediatric populations, screening is often done frequently to detect exposure to ACEs and identify the risk of toxic stress.
  • Ample training should precede screening. Health care professionals should be proficient in trauma screening and conducting patient follow-up in a manner that is sensitive to cultural and ethnic characteristics.

Screening/Assessment Tools

Original ACE Questionnaire was used to assess participants in the original Adverse Childhood Experiences study, and is a widely used and validated tool. Centers for Disease Control and Prevention/Kaiser Permanente, 1998

ACE-Q, developed by the Center for Youth Wellness, was based on the original ACE questionnaire, and adapted for a pediatric patient population. Center for Youth Wellness, 2015
Post-Traumatic Stress Disorder Checklist for Civilians (PCL-C) is a shortened version of a screening tool to assess for Post-Traumatic Stress Disorder (PTSD) developed by the U.S. Department of Veterans Affairs. It was adapted for use in primary care or general medical settings. National Center for PTSD, 2013
The Resilience Project: Clinical Assessment Tools, an initiative of the American Academy of Pediatrics, maintains a list of useful clinical assessment tools for providers working with children.
(Note: The Center for Health Care Strategies does not endorse any specific tool to screen for adverse childhood experiences, trauma, or toxic stress.)

Screening-Related Resources

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What is a Trauma Screening Tool or Process? defines different types of screening tools and how to engage families in the screening process. Additional information can be found in their Screening and Assessment: Considerations for Implementation guide. National Child Traumatic Stress Network, 2018

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Montefiore Patient Information Sheet for ACEs Form is designed to inform patients prior to being screened for ACEs. It is also available in Spanish. Montefiore Medical Group, 2017

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National Pediatric Practice Community on Adverse Childhood Experiences is a community and resource center for pediatricians interested in screening for ACEs within their own practices. National Pediatric Practice Community on ACEs, 2018

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Becoming Trauma-Informed & Screening for ACEs: Learning from Montefiore Medical Center details Montefiore Medical Group’s approach to screening adult and pediatric populations for ACEs within its outpatient practice network. Center for Care Innovations, 2018

Addressing Trauma and Creating a Referral Network

A number of evidence-based trauma-specific treatment approaches are available for organizations seeking to adopt a comprehensive treatment approach for adults and children. Providers without on-site behavioral health care providers can also help patients who have experienced trauma by building a referral network of trauma-informed providers.

Opportunities to engage potential trauma-informed referral sources include:

  • Inviting them to participate in internal trainings;
  • Hosting community-wide trauma-informed care training efforts; and
  • Encouraging patients serving on advisory boards to lobby organizations in a given provider network or community to become trauma-informed.
Following are resources that describe available treatments for trauma, and considerations for building a trauma-informed referral network.

Resources

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Trauma-Informed Referral and Treatment Processes features speakers from Montefiore Medical Group in The Bronx, New York and BRICK Academy in Newark, New Jersey discussing how to build and sustain a clinical referral network for patients and students exposed to trauma. CHCS, 2016

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Trauma-Informed Care: Opportunities for High-Need, High-Cost Medicaid Populations provides an introduction to trauma-informed care and describes how this approach can be adopted to better serve Medicaid populations, including examples from three innovative programs. CHCS, 2015

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Training Staff in Trauma Treatments: Considerations for Complex Care Providers draws from the experiences of five complex care sites to outline considerations for training and implementation of trauma-informed care models in health care settings. CHCS, 2017

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Trauma-Informed Interventions details trauma-informed therapies, including Trauma-Focused Cognitive Behavioral Therapy, Integrative Treatment of Complex Trauma for Adolescents, and others. National Child Traumatic Stress Network, 2012

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