Screening students for trauma is a process that needs to take careful consideration in order to be effective and supportive to both students and clinicians. There are many possible screeners available and every screener is a tool to be used in the context of a safe and trusted relationship with a provider.
When screening for risk and trauma, it is important to also screen for resilience and protective factors and take into account the student’s overall wellbeing. Additionally, it is important to include education for the student as to why screening is taking place.
Screening can be used as a tool for prevention when it is included as a part of psychoeducation and connection to building upon students’ resilience.
Considerations for Trauma Screening
Trauma-informed practices in a clinic setting means a clinic is a safe space where all staff understand the impacts of trauma and how to create nurturing environments.
Some trauma screening tools identify symptoms and severity of symptoms of PTSD according to the DSM 5. Some trauma screening tools screen for whether or not a youth has experienced traumatic events. Some tools screen for both.
There are also tools that screen for other risk factors such as substance use, depression and anxiety. Some tools screen for environmental factors and social determinants of health. Additionally, there are screening tools that can be helpful in identifying resilience and protective factors in young people’s lives.
The capacity of providers to meet the needs identified should determine the ongoing processes for screening. Putting into place active MOUs with referral sources to community providers can increase access to care and the amount of screening that can be conducted.
Have plans in place prior to screening students for how students will be followed up with regarding the screening results. If a classroom of students is screened for trauma symptoms, have the policies in place for the process of who will follow up with the students and how the student will be connected to services.
Before conducting large-scale screenings, identify the service providers in the area and whether they have openings, what the referral processes are like, and how accessible the services are to the students. Have all staff in the SBHC trained in how to connect students to services that may be identified as needs before conducting screenings.
There are many ways to integrate screening into practice. It is important to identify the resources, staff available, and level of preparedness to help determine the best process. Below are some examples of screening protocols:
PC-PTSD 5 is administered as a part of the annual intake screen by the Medical Assistant at least once a year. Results are reviewed by the Medical Provider who is then expected to discuss any positive screens with the patient during the medical visit. Referral or warm handoffs can be made to behavioral health as needed.
With the goal of reaching the whole school, the CBITS classroom screener administered in classrooms as often as possible if there is provider availability to respond to identified needs. Students scoring positive meet individually with behavioral health providers and those who opt in to receive group services participate in a 10-session CBITS group. Students with low risk are invited to participate in a classroom presentation with the Wellness Coordinator to learn about trauma signs, symptoms and supports.
When students are referred for services, screen for both protective factors and trauma symptoms using the Child and Youth Resilience Measure and the PTSD-Reaction Index 12-Item.
One school site administered the RAAPS screening in one classroom at a time with the goal of reaching the whole 6th grade. The screening of one classroom at a time ensured the providers had the capacity to follow up with all the students and connect them to services. After screening the 6th grade, a need for anger management among the 6th grade girls was identified. The providers were able to shift their planned support to meet the newly identified needs and they started offering a group on managing anger for the 6th grade students.
Youth reported feeling more comfortable completing screeners when resilience measures were part of the screening tool. They said it feels more respectful to look at their strengths as well as their challenges. It is recommended to assess the entirety of the screens that students will be asked to complete and ensure that their strengths and protective factors are identified.
Practice Paper: The Role of SBHCs in Addressing ACEs
School-Based Health Centers (SBHCs) are well-positioned to coordinate care for some of California’s most medically underserved youth.
However, there is limited research on trauma-informed care and Adverse Childhood Experiences (ACEs) screening implementation in SBHCs.
ETR and the California School-Based Health Alliance, with funding from ACEs Aware, published a practice paper on emerging practices and barriers and facilitators to implementing trauma-informed care, ACE screening, and care coordination for the prevention and treatment of toxic stress in SBHCs.
