Screening Tools Help in Assessing Trauma
Symptoms of trauma often taken multiple forms, and those who've experienced a traumatic event are often unwilling to discuss it. This is especially the case with adolescents. The following listing can help clinicians locate the tested, validated tools.
When choosing screening tools to assess for trauma and post-traumatic symptoms, clinicians should keep in mind that general questions such as "Have you ever had a trauma?" don't often make an adolescent comfortable enough to disclose traumas like childhood physical or sexual abuse. The surveys and questionnaires designed to assess for trauma and post-traumatic symptoms have been tested and determined to be reliable. The questions are usually neutral and specific, such as "When you were younger, did a parent or other person hit or punch you in a way that made you bruise or bleed?" is much more likely to produce a useful response.
Many different screening instruments measuring trauma history and post-traumatic symptoms are available, some in interview format and some as self-reports. Which instruments are most appropriate for you will depend upon what your adolescent population is like, the skill and experience of the clinician implementing the program, and additional practical factors. In selecting a screening tool, we ask clinicians to think through the following questions:
What types of traumas are you most interested in finding out about?
Do you want to survey a wide range of possible traumas or focus on a particular group of traumas such as physical and sexual assault?
Do you want a survey that only screens for traumas included in the DSM-IV diagnostic criteria for PTSD?
Do you want a survey that simply screens for the presence of PTSD symptoms or one that also gives you information about frequency and intensity of symptoms? How much time do you have to assess for trauma, PTSD symptoms, and associated conditions?
What is the privacy level of the setting for administering the surveys?
What is the literacy level of the teen being assessed?
What is the primary language of the teen being assessed?
What is the cost of using the surveys? (Some are free and some are not.)
The National Center for PTSD has compiled a list of assessment instruments for trauma and PTSD. Information on the measures is available on its website (www.ptsd.va.gov), and the measures themselves are available to qualified mental health professionals or can be obtained by contacting sources listed on the site. The site includes information about how long each survey takes to administer and whether it is appropriate for adolescents. More information is available in the book Assessing Psychological Trauma and PTSD, edited by John P. Wilson and Terence M. Keane (2004).
Depending on the circumstances and level of detail required, it is quite possible to assess for trauma exposure in ten or fifteen minutes and for PTSD symptoms in roughly the same amount of time. We have successfully used the following self-report instruments with adolescents.
The Brief Trauma Questionnaire (BTQ) is a ten-item self-report trauma exposure screen that can be quickly administered and is suitable for special populations such as persons with severe mental illness as well as for general population groups. The BTQ asks respondents for a simple "yes" or "no" answer to the question "Have you experienced this event?" and lists ten types of traumatic events. For each "yes" response, the respondent is also asked two additional "yes/no" questions: "Did you think your life was in danger or you might be seriously injured?" and "were you seriously injured?" The BTQ is designed to quickly screen for many different and prevalent types of traumatic experiences, including war traumas, serious car accidents, natural disasters, exposure to violent death, life-threatening illness, and physical or sexual abuse.
The Upsetting Events Survey that we designed is a modification of the Traumatic Life Events Questionnaire (TLEQ). It assesses effectively for trauma history.
Probably the most widely used and researched screen for PTSD in adults is a self-report rating scale called the PTSD Checklist (PCL). The PCL has good psychometric properties, including internal and test-retest reliability and convergent validity. Several versions of the PCL are tailored for specific populations, and a short form containing six questions is also available for use in primary care settings. The PCL contains seventeen questions that map onto the three DSM-IV PTSD symptom clusters: re-experiencing, avoidance, and arousal. Respondents are asked to look at a list of "problems and complaints that people sometimes have in response to stressful life experiences" and then decide how much each problem has bothered them over the last three months. Psychometrics for the PCL in an adolescent population have not been published, but it is still used with an adolescent population.
The Child Post-traumatic Symptom Scale (CPSS) has been shown to be reliable and valid as a screening tool for use with children and adolescents. The CPSS assesses symptom criteria for PTSD, as well as whether the respondent is experiencing impairment in functioning.
The UCLA Reaction Index is the most commonly used measure for PTSD symptoms in children and adolescents. There are versions of this measure for children, adolescents, and parents. The UCLA Index has two parts: The first part includes a brief screen on the respondent's trauma history, and the second part assesses the frequency with which post-traumatic stress symptoms were experienced over the past month.
Additional Screening Tools
The Beck Depression Inventory-II is a well-validated self-report scale for depression that has been used with a wide range of different populations and disorders.
The CRAFFT screening tool is a six-item screen that does not specifically ask the respondent to reveal exactly how much he or she uses substances. Instead, it uses more indirect queries. For example, the screen includes questions such as "Have you ever ridden in a car driven by someone (including yourself) who was ‘high' or had been using alcohol?" and "Do you ever forget things you did while using alcohol or drugs?"