Abstract
Children in the child welfare system experience high rates of exposure to potentially traumatic events, which are associated with significant impairments in safety, permanency, and well-being. However, child welfare systems have not routinely screened children for trauma, and little is known about such efforts. This paper describes five statewide and tribal projects to implement trauma screening for children in the child welfare system as part of broader, trauma informed care initiatives. Findings indicate that implementation strategies varied considerably but that screening generally resulted in identification of high rates of trauma exposure, trauma symptoms and service referrals. Further, screening was generally perceived favorably by child welfare workers and mental health professionals. However, wide variations were observed in the number of children screened, suggesting that more research is needed to identify optimal strategies. Lessons learned are described and recommendations made for implementing trauma screening in state or tribal child welfare systems.
This is a preview of subscription content, log in via an institution to check access.
Notes
Counties included nine original counties and three expansion counties (Alamance, Chatham, and Rowan) for the trauma screen.
References
Administration for Children and Families. (2017). Resource guide to trauma-informed human services. Retrieved from https://www.acf.hhs.gov/trauma-toolkit.
Beidas, R. S., & Kendall, P. C. (2010). Training therapists in evidence-based practice: A critical review of studies from a systems-contextual perspective. Clinical Psychology: Science and Practice, 17(1), 1–30. doi:10.1111/j.1468-2850.2009.01187.x.
Blaustein, M. E., & Kinniburgh, K. M. (2010). Treating traumatic stress in children and adolescents: How to foster resilience through attachment, self-regulation, and competency. New York: Guilford Press.
Burns, B. J., Phillips, S. D., Wagner, H. R., Barth, R. P., Kolko, D. J., Campbell, Y., & Landsverk, J. (2004). Mental health need and access to mental health services by youths involved with child welfare: A national survey. Journal of the American Academy of Child & Adolescent Psychiatry, 43(8), 960–970.
Child Welfare Collaborative Group & National Child Traumatic Stress Network. (2013). Child welfare training Toolkit: 3rd edition: Trainer’s guide. Los Angeles & Durham: National Center for Child Traumatic Stress.
Conradi, L., Agosti, J., Tullberg, E., Richardson, L., Langan, H., Ko, S., & Wilson, C. (2011). Linking child welfare and mental health using trauma-informed screening and assessment practices. Child Welfare, 90(6), 129–147.
Dorsey, S., Kerns, S. E. U., Trupin, E. W., Conover, K. L., & Berliner, L. (2012). Child welfare caseworkers as service brokers for youth in foster care findings from project focus. Child Maltreatment, 17(1), 22–31.
Dube, S. R., Felitti, V. J., Dong, M., Giles, W. H., & Anda, R. F. (2003). The impact of adverse childhood experiences on health problems: Evidence from four birth cohorts dating back to 1900. Preventive Medicine, 37(3), 268–277.
Ebert, L., Amaya-Jackson, L., Markiewicz, J. M., Kisiel, C., & Fairbank, J. A. (2012). Use of the breakthrough series collaborative to support broad and sustained use of evidence-based trauma treatment for children in community practice settings. Administration and Policy in Mental Health, 39(3), 187–199. doi:10.1007/s10488-011-0347-y.
Fang, X., Brown, D. S., Florence, C. S., & Mercy, J. A. (2012). The economic burden of child maltreatment in the United States and implications for prevention. Child Abuse and Neglect, 36(2), 156–165. doi:10.1016/j.chiabu.2011.10.006.
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245–258.
Fitzgerald, M. M., Torres, M. M., Shipman, K., Gorrono, J., Kerns, S. E., & Dorsey, S. (2015). Child welfare caseworkers as brokers of mental health services: A pilot evaluation of project focus colorado. Child Maltreatment, 20(1), 37–49. doi:10.1177/1077559514562448.
Grasso, D., Boonsiri, J., Lipschitz, D., Guyer, A., Houshyar, S., Douglas-Palumberi, H., et al. (2009). Posttraumatic stress disorder: The missed diagnosis. Child Welfare, 88(4), 157–176.
Grasso, D. J., Webb, C., Cohen, A., & Berman, I. (2012). Building a Consumer Base for trauma-focused cognitive behavioral therapy in a state system of care. Administration and Policy in Mental Health. doi:10.1007/s10488-012-0410-3.
Greer, D., Grasso, D. J., Cohen, A., & Webb, C. (2013). Trauma-focused treatment in a state system of care: Is it worth the cost? Administration and Policy in Mental Health. doi:10.1007/s10488-013-0468-6.
Greeson, J. K., Briggs, E. C., Kisiel, C. L., Layne, C. M., Ake, G. S., Ko, S. J., et al. (2011). Complex trauma and mental health in children and adolescents placed in foster care: Findings from the National Child Traumatic Stress Network. Child Welfare, 90(6), 91–108.
Hanson, R. F., & Lang, J. M. (2016). A critical look at trauma-informed care among agencies and systems serving maltreated youth and their families. Child Maltreatment, 21(2), 95–100.
Henry, J., Black-Pond, C., & Richardson, M. (2010). CTAC trauma screening checklist. Retrieved from http://tinyurl.com/y77c59h6.
Kerns, S. E. U., Pullmann, M. D., Negrete, A., Uomoto, J. A., Berliner, L., Shogren, D., et al. (2016). Development and implementation of a child welfare workforce strategy to build a trauma-informed system of support for foster care. Child Maltreatment. doi:10.1177/1077559516633307.
Lang, J. M., & Connell, C. M. (2017). Development and validation of a brief trauma screening measure for children: The child trauma screen. Psychological Trauma: Theory, Research, Practice, and Policy, 9(3), 390–398.
Lang, J. M., Franks, R. P., Epstein, C., Stover, C., & Oliver, J. A. (2015). Statewide dissemination of an evidence-based practice using breakthrough series Collaboratives. Children and Youth Services Review, 55, 201–209.
Lang, J. M., Campbell, K., Shanley, P., Crusto, C. A., & Connell, C. M. (2016). Building capacity for trauma-informed care in the child welfare system: Initial results of a statewide implementation. Child Maltreatment, 21(2), 113–124.
Lee, S., Aos, S., & Pennucci, A. (2015). What works and what does not? Benefit-cost findings from WSIPP (doc. No 15–02-4101). Olympia: Washington State Institute for Public Policy.
Miller, E. A., Green, A. E., Fettes, D. L., & Aarons, G. A. (2011). Prevalence of maltreatment among youths in public sectors of care. Child Maltreatment, 16(3), 196–204. doi:10.1177/1077559511415091.
Montana Board of Crime Control, Youth Justice Advisory Council. (2007). Youth Justice Council’s Report to the Governor and Montana State Legislature.
Pecora, P. J., Jensen, P. S., Romanelli, L. H., Jackson, L. J., & Ortiz, A. (2009). Mental health services for children placed in foster care: An overview of current challenges. Child Welfare, 88(1), 5–26.
Sigel, B. A., Benton, A. H., Lynch, C. E., & Kramer, T. L. (2013). Characteristics of 17 statewide initiatives to disseminate trauma-focused cognitive-behavioral therapy (TF-CBT). Psychological Trauma: Theory, Research, Practice, and Policy, 5(4), 323–333. doi:10.1037/a0029095.
Strand, V. C., Spath, R., & Bosco-Ruggiero, S. (2010). So you have a stable child welfare workforce—: What’s next. Children and Youth Services Review, 32(3), 338–345.
Sullivan, K., Preisler, J., Age, G., Potter, D., & Beck, D. (2013). Project Broadcast Trauma Screening Tool. Unpublished measure.
U.S. Department of Health & Human Services. (2016). Child Maltreatment 2014. Retrieved from http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment
U.S. Department of Health and Human Services. (1999). Mental health: A report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services, Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.
Acknowledgements
The authors wish to acknowledge the Administration for Children and Families, the Connecticut Department of Children and Families, the Massachusetts Department of Children and Families, North Carolina Department of Health and Human Services, North Carolina Department of Social Services, Jessica Bartlett, Kim Campbell, Marilyn Cloud, Dean Duncan, Dina Gerber, Jessica Griffin, Jenifer Goldman Fraser, David Hamolsky, Sandra J. Hoy-Maruschak, Tim Marshall, Robert A. Murphy, Jeanne Preisler, Paul Shanley, Joseph Spinazzola, Carla Stover, Ricka Wolman, and Bethany Zorba. This work was funded by the following grants from the Administration for Children and Families: #90C01055 (CT), #90CO1056 (MT). #90CO1059 (CO), #90C01057 (MA), and #90CO1058 (NC).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Rights and permissions
About this article
Cite this article
Lang, J.M., Ake, G., Barto, B. et al. Trauma Screening in Child Welfare: Lessons Learned from Five States. Journ Child Adol Trauma 10, 405–416 (2017). https://doi.org/10.1007/s40653-017-0155-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40653-017-0155-y