Screening for Trauma Mental Health Needs in the CAC

An introduction to the topic from Teresa Huizar, Executive Director, National Children's Alliance.

Key Points for CAC Directors to Know

Why Is Screening Important?

Many children served by CACs are affected by trauma or other mental health-related problems and may benefit from behavioral health treatment. In most cases, the CAC will be aware of alleged events, which if true, could lead to posttraumatic mental health symptoms. It is also important to understand, however, that the events that bring the child to the CAC may be just the tip of the iceberg. In many cases, children may be affected by prior traumas (e.g., car accidents, exposure to domestic violence, earlier maltreatment), or preexisting mental health problems unrelated to trauma. Unrecognized trauma or other mental health conditions can lead to a host of problems over the lifespan. On the other hand, some children experience potentially traumatic events but do not have treatment needs, and referring them to treatment would unnecessarily burden the family while placing demands on the limited availability of therapy. It is important for CACs to refer children for treatment who really need it. CAC screening provides an opportunity to determine whether children have symptoms of child traumatic stress or other mental health needs (regardless of whether these symptoms are related to the allegation that brought the child to the CAC) and connect the child to a more thorough assessment.

What Is Screening and How Is It Different from Assessment?

CAC screening is a “wide-net” process of identifying children with significant mental health needs, including needs related to traumatic experiences that require a referral for a comprehensive trauma-informed assessment by a behavioral health professional. Screenings are brief, simple to administer tools that offer "yes" or "no" information. They do not usually require advanced degrees or even significant training to administer. The result of a screening process leads to either no referral for further assessment at this time (but offering information should the child require behavioral health therapy in the future) or referral to a comprehensive assessment that might lead to treatment. The comprehensive assessment is typically conducted by trained mental health professionals and is used to obtain a complete trauma history, understand the impact of traumatic experiences, establish a diagnosis, and inform treatment planning if therapy is required.

How Should Screening Tools Be Selected?

Effective screening for CACs usually requires using two very brief tools (a general mental health screen and a trauma screen). While innumerable screening tools exist for both purposes, many are not well suited for the CAC environment. Many of the common tools designed to screen for mental health symptoms (e.g., symptoms of depression, ADHD) do not include specific items related to childhood trauma. Most trauma screening tools focus on measuring posttraumatic stress symptoms and are not effective at picking up other mental health symptoms. For these reasons, the use of two screening tools is recommended. In most health care or even child welfare settings, screening typically does not occur during a period of acute crisis for the child, as short-term symptoms may resolve on their own. This is not the case with CACs, however. It is not typically feasible in a CAC to delay the screening process, so screening in the immediate aftermath of traumatic events is indicated. There are a range of empirically-supported screening tools available for CACs to use (see the handout under Additional Resources, below).

 

Questions and Answers

Q: Why Is Screening Important?

Dr. Ben Saunders, from the Medical University of South Carolina, explains how trauma can lead to emotional and behavioral problems and how understanding the child requires understanding his or her trauma history and symptoms.

 

Length of the video - 1 minute and 20 seconds

Q: What Is Screening and How Is It Different from Assessment?
 
Dr. Saunders explains that screening can be applied to almost all children coming through a CAC, to detect cases that might be in need of mental health services. In contrast, assessment is used to understand the child’s history and symptoms and for treatment planning.

 

Length of the video - 1 minute and 31 seconds

Q: When Should Screening Be Administered?

According to Dr. Saunders, information about young children should be obtained from the parent or another adult familiar with the child. The language used for school-age children and adolescents should be developmentally appropriate for the age of the child.

Length of the video - 1 minute and 25 seconds

Q: How Should Screening Tools Be Selected?

 A key consideration when selecting a tool is to make sure it is appropriate for your population, including the child‘s developmental stage and preferred language. A list of recommend tools suitable for CACs is included at the bottom of this page.

Length of the video - 1 minute and 25 seconds

Q: Who Can Conduct Trauma Screening?

 The environment where screening occurs is important, as children need to feel safe. With proper training, many professionals can conduct screening.

Length of the video - 1 minute and 26 seconds

 

Additional Resources

Click here to download a printable summary of the information on this page.

 

Recommended Screening Tools for CACs

 

An Approach to Screening for Mental Health and Trauma-Related Needs among Children and Youth Involved in Child Welfare Services

 

California Evidence Based Clearinghouse for Child Welfare: Resource on the science supporting many commonly used screening and assessment tools. 

 

National Child Traumatic Stress Network: Measures Review Database