Connecticut Data Indicates Screening Youth in Child Welfare and Juvenile Justice Systems for Trauma is Practical, Useful, and Effective

More than 60% of youth nationally report direct exposure to violence, crime, or abuse in the past year, according to data highlighted by Child Health and Development Institute of Connecticut (CHDI). The COVID-19 pandemic is likely to increase rates of trauma exposure, as risk factors for abuse, such as increased stress and a lack of connection to community supports, have increased, a study published in JAMA Pediatrics 2020 predicts.  And of those exposed to trauma, nearly 16% will develop post-traumatic stress disorder (PTSD) and many more will experience symptoms of PTSD or other traumatic stress reactions, researchers anticipate.

All of which suggests that among Connecticut’s 753,000 youth, approximately 452,000 have experienced trauma in the past year, 72,000 will develop PTSD, and many more will experience significant symptoms that could benefit from treatment or other support, CHDI explains in their latest Issue Brief, published this month.

Among youth in the child welfare and juvenile justice systems, rates of trauma exposure and traumatic stress are much higher, meaning that a significant proportion of the approximately 36,000 youth being seen in the child welfare system and 9,000 youth referred to juvenile court each year may be experiencing PTSD or significant trauma symptoms, the Issue Brief explains.

“Unfortunately, for all youth, trauma exposure is not often disclosed to primary care providers, mental health providers, other staff supporting the family, or even to parents and caregivers,” CHDI points out. “Screening improves the identification of children experiencing traumatic stress and should ensure referrals to effective treatment for those who need it.”

CHDI goes on to explain that “a common barrier to screening is addressing staff concerns about its feasibility and utility, including the potential discomfort that may be experienced by youth and caregivers who are asked about trauma. An analysis of evidence from screening efforts in Connecticut suggests that trauma screening is feasible, helpful for providing effective services, and is rarely associated with significant distress.”

CHDI partnered with the Connecticut Department of Children and Families (DCF) and the Court Support Services Division (CSSD) of the Judicial Branch to implement trauma screening for youth in the child welfare and juvenile justice systems, respectively. Research and information from that effort suggests that trauma screening is feasible to administer and often helpful to practice, and that significant distress among youth and caregivers is rare, CHDI determined. In addition, the data suggests that trauma screening can also be implemented in other child-serving systems as they strive to be trauma-informed, including schools, primary care, and early childhood, according to CHDI. 

A series of recommendations were made for advancing trauma screening in Connecticut and nationally across child-serving systems:

1.      Invest in Workforce Development: Staff who are already screening for trauma should ensure they are screening using best practices, such as those described for the child welfare system.  

2.      Identify and Address Secondary Traumatic Stress and Staff Wellness: Secondary traumatic stress can occur when professionals talk with children and families about distressing or traumatic events. Program administrators should develop procedures to regularly check in with staff who are discussing trauma with children and families, and address staff wellness through training, policy changes, and other supports.

3.      Address Barriers to Screening Unique to Child-Serving Settings: Each child-serving system will need to address different barriers to screening. For example, schools must address issues of parental consent when parents may not be physically present and whether and how to conduct universal screening with larger populations of youth; primary care providers must consider how to include screening in the workflow of a primary care practice.

4.      Conduct Additional Research on Trauma Screening: Research is needed to: 1) understand staff perceptions, barriers, and facilitators of trauma screening in various child-serving systems, such as schools and pediatric primary care; and 2) understand the most effective approaches to screening and how screening results in service connections and improvements in child health and mental health.

5.      Ensure Adequate Reimbursement for Trauma Screening across Systems: Policymakers should ensure that state and private insurers reimburse for trauma screening in pediatric behavioral health, primary care, and other healthcare delivery settings. 

The organizations and agencies gathered staff feedback from those administering the Child Trauma Screen (CTS) as part of routine practice. The CTS is a validated, 10-item measure that assesses trauma exposure and symptomology among youth between the ages of 6-17 that can be administered to both youth and their caregivers. More than 1,300 staff responses were obtained, leading to the conclusions and recommendations.