Complex Trauma for NYS Health Homes Serving Children

March 2017

  • Fact Sheet is also available in Portable Document Format (PDF)

Definition Elements

Assessing both exposure to trauma and functional impairment

The term complex trauma describes an infant, child or adolescent´s exposure to multiple traumatic events, and the wide-ranging, long-term impact of this exposure.

In complex trauma, traumatic events are often:

  • severe and pervasive, as in abuse or profound neglect
  • initiated early in life, disrupting healthy development
  • interpersonal, often occurring in the context of the child´s relationship with a caregiver

Many children with complex trauma histories suffer a variety of traumatic events, such as physical and sexual abuse, witnessing domestic and community violence, separation from family members, and re–victimization by others.

Trauma experts indicate that with complex trauma, the clinical diagnoses may be more severe and typically present as co–morbidities or multiple diagnoses.


Understanding the impact of trauma experiences

Complex trauma can disrupt a child´s ability to form a secure attachment bond or a stable sense of self.
These are the domains and areas of children´s functioning that are impacted by complex trauma:

Physiology and Neurodevelopment
  • Significant physiological reactivity such as rapid heart rate or breathing
  • Over–reactive or under–reactive nervous system (i.e., "shutting down")
  • Sensory processing challenges
  • Somatization
Cognitive Processes
  • Deficits in language development, abstract reasoning, or problem–solving
  • Difficulty planning ahead and anticipating the future
  • Learning difficulties
  • Easily distracted
Relationships with Others
  • Re–enactments such as abusive relationships
  • Difficulty forming healthy attachment to caregivers
  • Difficulty trusting others
  • Low self–esteem
  • Feeling powerless to change negative circumstances
  • Feeling worthless or despondent
Impulse Control and Self–Regulation
  • Self–harming behavior such as head banging, cutting, or burning
  • Substance use or abuse
  • Eating disorders
  • Oppositional behavior
Emotional Response
  • Hyper–vigilance
  • Depression and/or anxiety
  • Suicidality
  • Emotional numbing
  • Easily frustrated and overwhelmed
  • Feeling detached from the body or as if watching self from the outside
  • In a dream–like state or feeling as if the world or experiences are not quite real
  • Feeling as if stressful or traumatic experiences are happening to someone else
  • Significantly fractured sense of time and continuity

Tools and Documents for Complex Trauma

New York State eligibility tools and documents for complex trauma

  1. Complex Trauma Exposure Screen Form and Referral Cover Sheet
    Completed by non–licensed professional or licensed professional
  2. Complex Trauma Exposure Assessment (CTEA) Form
    Must be completed by Licensed Professional
  3. Functional Impairment Assessment
    (The completion of the appropriate identified NCTSN guideline list of domain assessment tools)
    Must be completed by Licensed Professional
  4. Complex Trauma Eligibility Determination Form
    Must be completed by Licensed Professional
  5. Other family and child history and info obtained
    Gathered and obtained by non–licensed professional or the assessing licensed professional
Triangle with an exclaimation point insidePlease take measures to avoid redundant assessment of the child and family.

Licensed Professionals

Professionals NYS indicates can complete the CTEA Form, the NCTSN Functional Impairment Tool and the Complex Trauma Eligibility Determination Form

  • Licensed Masters Social Worker, LMSW
  • Licensed Clinical Social Worker, LCSW
  • Licensed Psychiatric Nurse Practitioner, LNPP,
  • Licensed Marriage and Family Therapist, LMFT
  • Licensed Mental Health Counselor, LMHC
  • Psychologist
  • Psychiatrist
  • Pediatrician/Family Medicine Physician or Internist
    with specialization in Behavioral Health

NYS Determination for Health Homes

Documenting the process to determine Health Home eligibility for complex trauma

Need identified by non–Licensed Professional
Licensed Professional without access to tools
  • Complete the Complex Trauma Exposure Screen (CTES)
  • Referral Cover Sheet

If positive screen for Complex Trauma on Exposure Screen: then a referral can be made for Health Home.

.. Health Home connects with a licensed professional to complete the assessment and determination forms, if not already connected.

Eligibility determined by Licensed Professional with access to tools
  • Complex Trauma Exposure Assessment (CTEA) Form
  • Functional Impairment Assessment
  • Complex Trauma Eligibility Determination Form
  • Other family and child history and information obtained

If a determination of complex trauma is made: then the child is eligible to be enrolled in a Health Home under the single qualifying condition of Complex Trauma.


Additional resources for complex trauma