NCTSN Assessment and Framework

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How to Conduct a Comprehensive Assessment of Complex Trauma

The assessment of complex trauma is by definition "complex" as it involves both assessing children’s exposure to multiple traumatic events, as well as the wide-ranging and severe impact of this trauma exposure across domains of development. It is important that mental health providers, family members, and other caregivers become aware of specific questions to ask when seeking the most effective services for these children.

The following are some key steps for conducting a comprehensive assessment of complex trauma:

  1. Assess for a wide range of traumatic events. Determine when they occurred so that they can be linked to developmental stages.
  2. Assess for a wide range of symptoms (beyond PTSD), risk behaviors, functional impairments, and developmental derailments.
  3. Gather information using a variety of techniques (clinical interviews, standardized measures, and behavioral observations.
  4. Gather information from a variety of perspectives (child, caregivers, teachers, other providers, etc).
  5. Try to make sense of how each traumatic event might have impacted developmental tasks and derailed future development. Note: this may be challenging given the number of pervasive and chronic traumatic events a child may have experienced throughout his or her young life.
  6. Try to link traumatic events to trauma reminders that may trigger symptoms or avoidant behavior. Remember that trauma reminders can be remembered both in explicit memory and out of awareness in the child’s body and emotions.

The assessment should be conducted by a clinically trained provider who understands child development and complex trauma. Ideally, the assessment should involve a multi-disciplinary team. An ideal team would include a pediatrician, mental health professional, educational specialist, and, where appropriate, an occupational therapist. In residential, day treatment, and juvenile justice settings, a multi-disciplinary team might also include direct care staff familiar with the child.

Developing a Common Framework across Systems of Providers

Children with complex trauma often end up in multiple child-serving systems (e.g., mental health, child welfare, education, juvenile justice) with needs that are both complex and severe. These children may carry multiple diagnoses (e.g., bipolar disorder, attention deficit hyperactivity disorder, etc.) and may be taking various types of medications to address their symptoms, especially when the professional making the diagnoses is unaware of their trauma histories. Furthermore, professionals in each system may use different frameworks to understand children and have varying degrees of understanding of complex trauma. This situation leaves children with complex trauma at risk of being misunderstood, misdiagnosed, and thus "mis-treated." Child-serving systems must work together to develop a common framework for assessment of complex trauma that can still work within the context of each particular system. Such a comprehensive framework can improve communication across providers and caregivers, and ultimately improve the care of the children and families entrusted to these systems.