Making the Case for Early Screening Tools for Trauma-Informed Care

Understanding the prevalence and impact of trauma is necessary in helping clients move toward healing and growth. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), trauma-informed care (TIC) screening tools assist mental health care professionals in determining and implementing the behavioral health needs of someone who has experienced a traumatic event.

SAMHSA also states that although TIC screening is recognized as the most fundamental aspect of a clinical trauma-informed approach, expert opinions often differ on when and how to screen patients for trauma.

We therefore conferred with Cheryl Step, MS, NCC, NCSC, LPC a trauma-informed care training and consultant professional who launched her own business, Creating Resilience, LLC, on her experiences and expertise utilizing early screening tools.

To gather a full breadth understanding of the onset, severity, and symptoms of traumatic events, are there specific early screening tools that you feel are more useful than others? 

Most importantly, I want to emphasize the importance of calm, reflective conversation as one of the best screening tools. Using open-ended questions can elicit more information than paper and pencil screening. For example, “Can you tell me more about ___?”

Trauma is not the event itself, but our responses to it, and our experiences, perceptions, and emotions all impact these reactions. Screening tools should include not only adversities faced, but support systems, resources, and positive experiences, too. Research shows that the difference between tolerable and toxic stress is largely the availability of caring and competent support persons and access to general resources. Let’s say two different people experience the same traumatic event, e.g., their parents get divorced. The person who knows how to identify, regulate, and express their emotions and has positive relationships to confide and converse with will have much less risk for negative impacts.

Here are tools I recommend for both traumatic and positive experiences:

• Some clinical settings use the Trauma Screening Questionnaire or the Primary Care PTSD Screener for quick screening.
• The Traumatic Events Screening Inventory Parent Report Revised guides parental conversations through adversities that happened to their child.
• The Center for Integrated Research on Childhood Abuse has been working to develop Protective and Compensatory Childhood Experiences.
• Tufts Medical Center offers resources and research supporting Healthy Outcomes from Positive Experiences.

Finally, Dr. Rob Anda, co-principal investigator of the Adverse Childhood Experiences (ACEs) study, emphasizes that when screening an individual, the original ACEs survey was just that—a survey. It was not designed for individual screening or diagnosis; it was a tool to determine the risk of different populations as part of a larger epidemiological study. 

How much do you vary your early screening tools depending on a client’s demographics? 

Screening tools should be given to a client in their native language. The interviewer should also be aware of any cultural nuances and environmental/community stressors. 

It would be presumptuous to assume that any client is immune from demographic adversities. The original ACEs study revealed that 64% of respondents experienced at least one ACE, and 17.3% experienced four or more. Those surveyed were primarily part of the middle class, college educated, and had access to supportive health care. Subsequent research shows that people living in communities with adversities, such as violence, poor transportation/school/food access, and discrimination, are at high risk for negative outcomes.

How crucial are early screening tools in determining whether a client is on target toward social, emotional, and/or behavioral healing?

Early screening tools are vital. If we can assist a young child, their life may take a completely different trajectory. We must create systems that help parents, families, and children prevent potential negative impacts in the future.I love the saying, “Our brains are wired for connection, but trauma rewires them for protection. That's why healthy relationships are difficult for wounded people.” The behaviors and relationships we observe in someone who experiences trauma may be the product of how they survived in a chaotic environment. Therefore, we need to help them feel safe and encourage new ways for them to survive in a less chaotic environment so that they can learn about themselves and heal. 

Are there specific resources that you would suggest for other counselors?

• The Center on the Developing Child at Harvard University is a collection of resources on child development and trauma experiences. 
• The International Society for Traumatic Stress Studies (ISTSS) is an international interdisciplinary organization that promotes the advancement and sharing of information about traumatic stress.
• The Neurosequential Network develops state-of-the-art programs and practices to improve life for children, families, and communities.
• I recommend books, videos, and podcasts from four doctors who study trauma: Bessel van der Kolk, Dan Seigel, Stephen Porges, and Gabor Mate.
• The Attachment, Regulation, and Competency (ARC) Framework helps schools and mental health professionals build safety, connection, emotional skills, and competency. It is the basis for the training I present through my business, Creating Resilience.
• Trust Based Relational Intervention (TBRI) focuses on creating safety and belonging. 

Is there anything else you would like to share about your experiences with early screening tools? 

We cannot possibly screen everyone with accuracy, so it is imperative that we create spaces for everyone to experience safety, connection, and a sense of control. Learning and teaching occur only when these basic needs are met. We can then move from responding with our instinctive reactions to our thoughtful responses where task initiation, problem solving, and goals can be achieved.

The true goal of being trauma informed is creating systems and communities that interact with all people in ways that create universal respect and understanding. When a school or organization is truly trauma informed, they have a trauma responsive framework that changes who they are individually and collectively.

Cheryl Step, MS, NCC, NCSC, LPC, earned her master’s degree in counselor education from Syracuse University and has extensive knowledge regarding the impact of Adverse Childhood Experiences. She trains and coaches others about the impact of trauma, utilizing a framework of strategies that help empower people to create collective well-being. She also consults with leadership to build trauma-informed agencies. Previously, Step was a school counselor for 17 years. She is certified in Traumatic Stress Studies and ARC Trauma Treatment for Children and Adolescents and established her own training and consulting company, Creating Resilience.