Ideally, when children are exposed to trauma, their parents and the other adults in their life (teachers, doctors, coaches) would easily be able to know how they are doing and just how best to help. In reality, this is harder than it may seem. From a host of research studies at CHOP and elsewhere, we know that parents, as well as professionals, can find it hard to know which children have symptoms of acute posttraumatic stress (PTS) that indicate the need for additional support. The good news is that there are many opportunities to detect these symptoms and to offer some help. In the aftermath of an acute trauma exposure, many children are seen in service settings, such as schools, courts, or primary/emergency medical care facilities, where screening for PTS could occur. The challenge is that although “trauma-informed” approaches are growing in acceptance among these child service systems, time constraints and the need to address other priorities often win out.
We set out to address this challenge because, for the millions of children experiencing acute traumatic events, brief validated screening tools could help providers and systems screen for acute PTS quickly and consistently. Our goal was to create very brief screening tools that could be implemented in a wide range of settings. Meghan Marsac, PhD and I recently published a study in the Journal of Traumatic Stress that provides validation of brief practical screeners in English and Spanish that may help fill this gap in screening trauma-exposed children.
Creating A Short Form
Starting with the validated 29-item Acute Stress Checklist for Children (ASC-Kids) in English and its Spanish-language counterpart, the Cuestionario de Estrés Agudo-Ninos (CEA-N), we set out to identify a short form. We wanted to create a screener with six or fewer items that would be feasible for use in nearly any clinical or research setting and in online screening tools for children. We first analyzed data from more than 200 children ages 8 to 17 years who had completed these self-report measures and identified two versions of a new brief screen – a version with six items and a shorter version with three items (a subset of the six items). When we evaluated these new screeners in four samples of over 700 children, those scoring positive on each screener had more acute PTS symptoms, greater impairment in their daily lives, and were more likely to have greater PTS symptoms three months later.
To our knowledge, these are the first validated brief self-report screeners for children’s acute PTS reactions. With a tool like this in hand, the school nurse, court social worker, or primary care/ED doctor can feasibly screen children and then take the appropriate action: either arranging for ongoing monitoring or referring for additional assessment by a trained mental health professional.
And the need for brief screens for acute PTS symptoms is not limited to service settings. We believe that the availability of these very brief screens will allow more researchers to examine the impact of acute PTS even when traumatic stress is not the primary focus of a study. Including even a brief screen for PTS in a broader range of child health research studies promises to advance our understanding of the interplay between PTS and child health outcomes.
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