How do we know if a client has history of trauma? Do we need to know the specific types of trauma someone has experienced?

• Each organization and each professional will need to answer these questions for themselves based on the nature of their work with clients
• Some organizations and professionals may truly need to know the specifics of a client’s trauma history in order to serve them appropriately
• Many organizations and helping professionals may not need to delve into the specifics or ask clients the kinds of intrusive and difficult questions that are required in order to do a trauma assessment. For these organizations, a “Universal Precautions” approach may make sense.

In a “Universal precautions” approach, organizations:

• Assume virtually everyone has experienced trauma at some point, and
• Adopt universal trauma-informed practices that will serve everyone - without having to know specifics of their trauma history.

For those organizations or professionals who do need to know the specifics of each client’s trauma history, they may decide to do some type of trauma assessment, but before making a decision about this, there are some very important considerations and cautions:

• Select an appropriate assessment tool for your type of client, agency, programs/services
• Who will you assess and why do you think it’s necessary?
• How will you administer assessments? Via client self-report/self-completion or by having agency staff administer via structured interview or other method?
  1. If staff will administer assessments, need to train staff thoroughly, including:
     1. cultural competence/cultural humility
     2. recognizing risk of potential triggering/re-traumatizing that trauma assessments may cause for clients, including flashbacks, nightmares, panic attacks, dissociation, thoughts of self-harm, suicidal ideation, etc
     3. Thorough knowledge of local resources for referral and warm hand-off if trauma assessment reveals additional needs not met by your organization
  2. Having staff do trauma assessments will also increase the risk of vicarious trauma (VT) & secondary traumatic stress (STS) for staff, so agency must also provide supervision, support, monitoring of intensity of case load, and additional resources for those staff 

• How do you plan to use the gathered information for decision-making regarding treatment, referrals, program eligibility or other decisions regarding how to serve the client?
• When & where to administer (at intake? After relationship established? Care coordination to avoid re-screening; Appropriate, comfortable and calm setting for conducting the assessment?) NOTE: if trauma assessments will be conducted early in the client/professional relationship, trust may be a significant issue and you may not get complete or accurate information which may then impact any decisions you plan to make using the results of the assessment
• Privacy/confidentiality issues: How and where will the info from the trauma assessment be stored, documented, shared? Who will have access?
• Mandated reporter concerns - asking the kinds of questions that would be part of a trauma assessment may put staff in position of having to then report to authorities; Agency has an obligation to inform client of this up front before starting the assessment to provide client choice about what to divulge
• Appropriate resources/referrals for follow-up - agency staff must be knowledgeable about local resources and services to address any needs identified by the trauma assessment that your own organization cannot address; collaboration with other local agencies is key to provide for warm hand-off and release of information/information-sharing agreements if possible to avoid re-traumatizing people by requiring them to continually re-tell their story

References:

American Journal of Preventive Medicine, “Inside the Adverse Childhood Experiences Score: Strengths, Limitations and Misapplications”, Anda, Porter, Brown. March, 2020

https://www.ajpmonline.org/art...(20)30058-1/fulltext

Center for HealthCare Strategies, Inc - Technical Assistance Tool: Feb 2019 “Screening for Adverse Childhood Experiences and Trauma” -

https://www.chcs.org/media/TA-...nd-Trauma_020619.pdf

SAMHSA Trauma-Informed Care in Behavioral Health Services, Chapter 4: Screening and Assessment, https://www.ncbi.nlm.nih.gov/books/NBK207188/