Screening for Trauma Symptoms in Child Welfare-Involved Young Children: Findings from a Statewide Trauma-Informed Care Initiative
Young children who experience abuse, neglect, domestic violence, and other interpersonal forms of trauma are at risk for developing complex psychological trauma. Timely referrals by child welfare services for trauma evaluation and intervention is critical, particularly during the developmentally-sensitive period of birth to three. However, few screening instruments exist that are feasible for implementation in child welfare services and none have reported psychometric data for children under three. The aim of this exploratory, retrospective study was to examine developmental differences in detection rates of two brief trauma screening scales, comparing outcomes for toddlers (age 1 and 2 years) and preschoolers (age 3 to 6 years), using the evaluation data from a statewide child welfare demonstration project. The sample included 151 children ages 1 to 6 participating in evidence-based trauma treatment with their caregivers. More than 80% of children, regardless of age group, met the cut-off on one of the screeners; children who met the cut-off on either screener were significantly more likely to have experienced domestic violence, physical abuse or poly-victimization. Implications for future research are discussed.
KeywordsChildren Clinical issues Developmental issues Measurement Trauma
The authors wish to acknowledge Dr. Carolyn Schwartz and DeltaQuest Foundation, Inc. for statistical and conceptual support.
The study was supported by a grant from the Administration for Children and Families, Children’s Bureau (Grant No. 90C01057) to the Massachusetts Department of Children and Families.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts to report.
Ethical Standards and Informed Consent
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation [institutional and national] and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.
- Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA preschool forms & profiles. Burlington: University of Vermont, Research Center for Children, Youth, & Families.Google Scholar
- Barto, B., Bartlett, J. D., Von Ende, A., Bodian, R., Noroña, C. R., Griffin, J., et al. (2018). The impact of a statewide trauma-informed child welfare initiative on children’s permanency and maltreatment outcomes. Child Abuse & Neglect, 81, 149–160. https://doi.org/10.1016/j.chiabu.2018.04.023.CrossRefGoogle Scholar
- Briere, J., Johnson, L., Bissada, A., Damon, L., Crouch, J., Gil, E., et al. (2001). Trauma symptom checklist for young children (TSCYC): Reliability and association with abuse exposure in a multi-site study. Child Abuse & Neglect, 25, 1001–1014. https://doi.org/10.1016/S0145-2134(01)00253-8.CrossRefGoogle Scholar
- Chadwick Trauma-Informed Systems Project. (2013). Creating trauma-informed child welfare systems: A guide for administrators (2nd ed.). San Diego: Chadwick Center for Children & Families.Google Scholar
- Child Welfare Information Gateway (2016). Racial disproportionality and disparity in child welfare. Washington, D.C.: U.S. Department of Health and Human Services, Children’s Bureau. Retrieved from https://www.childwelfare.gov/pubPDFs/racial_disproportionality.pdf. Accessed 15 Nov 2017.
- Cohen, J. A., & Scheeringa, M. S. (2009). Posttraumatic stress disorder diagnosis in children: Challenges and promises. Dialogues in Clinical Neuroscience, 11(1), 91–99.Google Scholar
- Conradi, L., Agost, J., Tullberg, E., Richardson, L., Langan, H., Ko, S., & Wilson, C. (2011). Linking child welfare and mental health using trauma-informed screening and assessment practices. Child Welfare, 90(6), 129–147.Google Scholar
- Cooper, J. L., Banghart, P., Aratani, Y. (2010). Addressing the mental health needs of young children in the child welfare system: What every policymaker should know. National Center for Children in Poverty. New York: Mailman School of Public Health. Columbia University. https://doi.org/10.7916/D8B56SPM.
- Crandal, B. & Conradi, L. (2013). Review of child and adolescent trauma screening tools. San Diego, CA: Rady Children's Hospital, Chadwick Center for Children and Families. Retrieved from http://www.childsworld.ca.gov/. Accessed 15 Nov 2017.
- D’Andrea, W., Ford, J., Stolbach, B., Spinazzola, J., & van der Kolk, B. A. (2012). Understanding interpersonal trauma in children: Why we need a developmentally appropriate trauma diagnosis. American Journal of Orthopsychiatry, 82, 187–200. https://doi.org/10.1111/j.1939-0025.2012.01154.x.CrossRefGoogle Scholar
- Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8.CrossRefGoogle Scholar
- Fraser, J. G., Griffin, J. L., Barto, B. L., Lo, C., Wenz-Gross, M., Spinazzola, R., et al. (2014). Implementation of a workforce initiative to build trauma-informed child welfare practice and services: Findings from the Massachusetts child trauma project. Children and Youth Services Review, 44, 233–242. https://doi.org/10.1016/j.childyouth.2014.06.016.CrossRefGoogle Scholar
- Hanson, R. F., Lang, J. M., Fraser, J. G., Agosti, J. R., Ake, G. S., Donisch, K. M., & Gewirtz, A. H. (2017). Trauma-informed care: Definitions and statewide initiatives. In J. R. Conte & J. B. Klika (Eds.), The APSAC handbook on child maltreatment, Fourth Edition. Thousand Oaks: Sage Publications, Inc..Google Scholar
- Lang, J. M., Ake, G., Barto, B., Caringi, J., Little, C., Baldwin, M. J., & Connell, C. M. (2017). Trauma screening in child welfare: Lessons learned from five states. Journal of Child & Adolescent Trauma. https://doi.org/10.1007/s40653-017-0155-y.
- Lieberman, A. F., & Van Horn, P. (2007). Assessment and treatment of young children exposed to traumatic events. In J. Osofsky (Ed.), Young children and trauma (pp. 111–138). New York: Guilford Press.Google Scholar
- Lieberman, A. F., Ghosh Ippen, C. & Van Horn, P. (2015). Don’t hit my mommy!: A manual for child-parent psychotherapy with young children exposed to violence and other trauma. Zero to three. Washington, D.C.Google Scholar
- National Child Traumatic Stress Network (2010). Core clinical characteristics trauma detail form. Retrieved from http://www.nctsn.org
- Osofsky, J.D., Lewis, M.L., & Szrom, L. (2018). The adverse childhood experiences of very young children and their parents involved in infant-toddler court teams: A policy brief from the Quality Improvement Center for Research-Based Infant-Toddler Court Teams. Retrieved from http://www.qicct.org/sites/default/files/ACES%20Policy%20Brief% 20%20v4%20%28003%29.pdf. Accessed 1 June 2018.
- Scheeringa, M.S. (2010). Young child PTSD and young child PTSD Screen. Retrieved from https://www2.tulane.edu/som/departments/psychiatry/ScheeringaLab/manuals-training.cfm. Accessed 15 Nov 2017.
- Scheeringa, M.S., & Zeanah, C.H. (1994). PTSD Semi-Structured Interview and Observational Record for Infants and Young Children. New Orleans, LA: Department of Psychiatry and Neurology, Tulane University Health Sciences Center.Google Scholar
- Scheeringa, M. S., Peebles, C. D., Cook, C. A., & Zeanah, C. H. (2004). Toward establishing procedural criterion and discriminant validity for PTSD in early childhood. Journal of the American Academy of Child & Adolescent Psychiatry, 40(1), 52–60. https://doi.org/10.1097/00004583-200101000-00016.CrossRefGoogle Scholar
- StataCorp. (2015). Stata statistical software: Release 14. College Station: StataCorp LP.Google Scholar
- Taylor, N., Steinburg, A., & Wilson, C. (2006). The child welfare trauma referral tool. San Diego: Chadwick Center for Children and Families, Rady Children’s Hospital - San Diego.Google Scholar
- U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau (2017). Child Maltreatment 2015. Retreived from http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment.
- Zero to Six Collaborative Group, National Child Traumatic Stress Network. (2010). Early childhood trauma. Los Angeles & Durham: National Center for Child Traumatic Stress.Google Scholar
- Zero to Three. (2005). Diagnostic classification of mental health and developmental disorders of infancy and early childhood: Revised edition (DC: 0--3R). Washington, D.C.: Zero to Three Press.Google Scholar
- Zero to Three (2016). DC:0-5™ Diagnostic classification of mental health and developmental disorders of infancy and early childhood: Revised edition. Washington, D.C., Zero to Three Press.Google Scholar