Trauma-Informed Mental Health Assessment
What is a Trauma-Informed Mental Health Assessment and Why is it Important?
Trauma-informed mental health assessment offers a structured framework for (1) gathering information across several key domains of functioning, (2) identifying and addressing the needs of children and families exposed to traumatic events, and (3) coding and summarizing this information, so that it can be communicated to families and other providers.
Engaging Families in the Assessment Process
The following practical strategies have been adapted from the TAP training. Clinicians should facilitate child and family engagement in the process by addressing their concerns, answering their questions, validating their observations, and demystifying the process. When administering measures, describe for caregivers (and children, as appropriate), the purpose and importance of the assessment process and the various tools used to gather information.
- Make time in the therapy session to complete measures with family members by putting it on the session agenda and explaining to caregivers how the measures can aid the treatment process and support the development of treatment goals and plans.
- Allow the parent and child to choose the language in which they will complete the measures.
- Describe the measures as a way you gather information on child and family functioning in order to help them as much as possible. This is not just more paperwork to complete.
- Use developmentally appropriate strategies when completing measures with youth, including the following:
- Have a dry erase board or chalk board, as an alternative to pencil and paper, for marking answers.
- Let them decide the order in which they complete measures, when possible.
- Select a fun pen or pencil to use when marking items.
- Use visuals to clarify constructs such as frequency (e.g., calendar).
- If the child opposes doing the measures, read aloud the items to him or her. This interviewing will allow you to collect additional “data,” such as affective and physiological responses (Is he nervous completing the measure? Is she indecisive in responding? Does he fully understand the question?)
- For youth, ask follow-up questions to probe more deeply after you have completed the measure.
- Offer to complete the assessment over 1-3 sessions and give the child and caregiver some choice in this (e.g., complete all today or one today and one next week?).
- Praise all children (and parents) for their “hard work” and patience completing questions.
- Check the endorsement of critical items (e.g., hurting oneself) and develop a safety plan.
- Take time to explain what will happen next (i.e., how the measures will be scored and how you will review the results with the youth and caregiver).
- Clarify that you will re-administer the measures on an ongoing basis, share the results, and use those results as you develop and monitor the treatment plan.
- Review the purpose of the measures with the child and caregiver.
- When applicable, explain that the measures provide information on how the child is doing related to other children.
- Highlight the strengths the child exhibits, whether indicated by a measure or domain related to resiliency, or strengths revealed as they were not identified as problematic (i.e., doing well in school). Explain to family members how you will integrate these strengths into the treatment plan to support recovery from trauma.
- Assess the child and caregiver’s level of interest in the feedback; you may want to provide more or less detailed information and assessment data.
- Consider drawing diagrams or pictures to explain results on some measures (e.g., using bar graphs to indicate progress).
- Highlight areas where the caregiver and child were consistent in their report on the measures (i.e., both agree the youth client is experiencing problems in school). If they are very consistent, this is a potential strength, indicating that they are “on the same page.”
- Highlight discrepancies between the child and caregiver report; explain that this suggests child and caregiver experience the same symptom very differently.
- Ask the caregiver and child if the results are consistent with their experiences (Does this seem accurate? Does it provide any new information? If they disagree, why?). This helps reconcile differences between caregiver and youth responses or varying responses on different measures.
- Share initial assessment results and use this information to engage in collaborative treatment planning with caregivers and youth as appropriate. Summarize the findings, noting two or three main points.
- Use the feedback process to provide psychoeducation about trauma reactions with the child and caregivers (e.g., noting common responses to trauma or areas of need that are related to each other) and tie this information to the treatment selected (e.g., “This treatment can help reduce those physical reactions and improve your sleep.”).
- Remind the caregiver and child that you will re-administer the measures in the future, and that the results will show the progress of therapy, the areas where you may want to continue work, and how helpful the treatment has been for the child and family.
Examples of Trauma-Focused Mental Health Assessment Strategies
The following are three examples of tools and processes that can be used for trauma-informed assessment.
- Assessment-Based Treatment for Traumatized Children: A Trauma Assessment Pathway Model. Developed by the Chadwick Center for Children and Families, with funding from the Substance Abuse and Mental Health Services Administration, the Trauma Assessment Pathway (TAP) was designed for children 0 to 18 years of age who have experienced any type of trauma and who may or may not be in the child welfare system. TAP is a multifaceted assessment process enabling clinicians to screen clients and, if appropriate for the treatment setting, to gain an in-depth understanding of the child, developmental level, traumatic experience, and the child’s family, community, and cultural systems.
- Child and Adolescent Needs and Strengths (CANS) – Trauma Comprehensive Version. The “CANS-Trauma” is a flexible, multi-purpose tool utilized in different capacities depending on the needs of a particular child-serving system (Kisiel, Lyons, et al., 2010). The CANS methodology is intended to gather information on a range of domains relevant to the functioning of the child and caregiving system (e.g., trauma experiences, traumatic stress symptoms, emotional and behavioral needs, risk behaviors, life domain functioning, strengths, and caregiver needs and strengths) and incorporate this information directly into individualized plans of care.
- Transactional Model. Spaccarelli (1994) proposed a transactional or interactive model for understanding the effects of child abuse (and its associated events) on the presentation of symptoms. This model examines factors related to the abuse of the child, as well as those associated with the investigation (i.e., disclosure events) and related events that may occur subsequent to the investigation (e.g., placement outside the home and court hearings). This model also incorporates age, sex, and personality factors; social support; and previous coping styles and cognitive appraisal schemes (i.e., the way a child organizes and understands events in his or her world).