This week’s blog was contributed by Maegan Sady, PhD, ABPP-CN. Maegan is a project director in PAR’s research and development department in addition to being a licensed psychologist and board-certified neuropsychologist. She worked as a pediatric neuropsychologist for nearly a decade before joining PAR.
Add trauma screening to your evaluation checklist
Assessment clinicians are trained to look for hidden problems, and we all know the common ones. If a child comes in with a referral for an ADHD evaluation, we screen for anxiety and sleep problems. When an older adult complains of memory problems, we inquire about symptoms of depression. There’s a new kid on the block, though—trauma. Trauma isn’t new, of course, but more clients may be experiencing its effects along with whatever brought them to you for assessment.
Expanding the definition of trauma
Trauma is a broad term for experiences that are dangerous or threatening. Although abuse or violence quickly come to mind, experiences of losing a loved one, food insecurity, or chronic social isolation can just as readily result in symptoms. The COVID-19 pandemic has increased these experiences, and some argue the pandemic itself may be a form of trauma. The impact of multiple stressful events—say, experiencing displacement due to a wildfire during the pandemic—can be multiplicative. Similarly, existing health and economic disparities have been exacerbated by pandemic-related stressors.
Screening for trauma
Because traumatic experiences have increased, it makes sense that more clients are experiencing trauma effects. Trauma symptoms can mimic other disorders, including anxiety, depression, and even psychosis or personality disorder. Untreated, trauma effects can negatively impact physical health and lead to higher rates of suicide and substance abuse.
To decrease the chance that you miss trauma as a comorbid cause of your client’s problems, make it routine to ask about trauma history. A written checklist (e.g., the Adverse Childhood Experiences Questionnaire) can help clients feel more comfortable disclosing their history. Unless you are specifically trained in trauma-related care, do not ask your client for details, but assure them you will provide resources.
If there is a positive history of trauma, assess for associated symptoms to guide recommendations; structured checklists can identify the severity and breadth. No matter the age of the client, PAR has you covered with the TSCYC, TSCC, TSI-2, FACT, and the DAPS. When time is short, screening versions are also available for most of these measures. And because many digital options are available on PARiConnect, it's easy to add a variety of administrations to your inventory when you need them.
Referring for additional assessment or treatment
When trauma is a contributing factor for your patient, you can provide a referral for evidence-based treatment and/or educational resources. For children, the American Academy of Child and Adolescent Psychiatry and The National Child Traumatic Stress Network have handouts and book recommendations. For adults, visit the National Center for PTSD. For individuals of all ages, see the website for the International Society for Traumatic Stress Studies.
Making trauma screening a routine part of your clinical assessment may uncover important treatment targets, helping your client deal more effectively with their original presenting concerns.
Since 1970, the U.S. has had 1,316 school shootings—18% of which occurred after the Sandy Hook Elementary School tragedy in 2012. In almost every case, the shooter exhibited warning signs beforehand. And in four out of five cases, at least one other person knew about the plan but did nothing to stop it.
The Students Against Violence Everywhere (SAVE) Promise Club, a student-led initiative of Sandy Hook Promise, works year-round to enact change by educating and empowering youth, engaging communities through prevention efforts, and empowering hope through positive peer influences.
One of those programs is National Youth Violence Prevention Week (NYVPW), an annual effort that brings students, parents, educators, business leaders, and more together to raise awareness about youth violence and get communities involved in making schools and neighborhoods safer.
Observed April 25 to 29 this year, NYVPW encourages businesses, government, media outlets, schools, and community organizations, along with parents, teachers, and youth, to get involved and take a stand against violence.
A free Youth Leader Action Kit provides inspiration and ideas for a week of activities that inspire others to educate and inform, encourage respect and inclusion, empathize and connect, empower change, and more.
When educators. clinicians, and school psychologists have questions about risk of violence in children and adolescents, PAR tools help them find answers. The Structured Assessment of Violence Risk in Youth (SAVRY), the Psychosocial Evaluation & Threat Risk Assessment (PETRA), and the Adolescent Psychopathology Scale (APS) provide information about a range of concerns to help inform follow-up and intervention—and ultimately help prevent violence.
This week’s blog was contributed by Eric Culqui, MA, PPS, PAR’s educational assessments advisor–regional accounts. Eric is a licensed school psychologist with more than 14 years of experience. He’s a NASP-certified crisis response trainer and first responder.
Across the nation, many schools have opened their doors to welcome students back for face-to-face instruction. After nearly two years of quarantines, remote learning, and potential health scares, many educators are concerned with the overall health of their students. It’s imperative for educational institutions to have a measurement tool to identify emotionally at-risk children as they transition back to the school environment.
The Feifer Assessment of Childhood Trauma (FACT) Teacher Form is a multipurpose rating scale designed to convey how stress and trauma impact children (ages 4–18 years) in a school-based setting. This edition allows for immediate use of the instrument by educators while data collection and normative development of the full instrument, which will include a Parent Form and Self-Report Form, continues through the current school year.
Designed for use by educational diagnosticians, school counselors, school psychologists, school nurses, community mental health providers, school administrators, and pediatricians, the FACT Teacher Form is completed by a classroom teacher or other educator familiar with the student’s typical behavior and day-to-day functioning. It’s designed to quantify the impact of traumatic experiences on school-based functioning to generate specific interventions, not to identify a particular source or subtype of trauma.
The FACT Teacher Form consists of 79 items and is administered and scored on PARiConnect, PAR’s online assessment platform. It takes approximately 10 minutes to complete. Higher scores on the clinical scales indicate increasing symptoms of stress and trauma—information critical for triage and intervention.
Items were written based on the behavioral, emotional, and academic difficulties that arise when students are in a state of physiological and/or psychological dysregulation due to trauma and stress.
Understanding the struggles and trauma of our school-age children is critical to providing them appropriate supports and interventions. The FACT Teacher Form (and upcoming Parent Form and Self-Report Form) provide educators with the tools necessary to identify and assist students most in need.
Learn more about the FACT Teacher Form.
Trauma is the leading cause of mortality in children. Adverse childhood experiences are occurring at a staggering frequency, and they have significant downstream effects on behavior and learning potential. But kids can’t thrive at school unless they feel safe, supported, and ready to learn.
As they return to school this year, it’s imperative to quickly assess how severely your students have been affected by trauma—including pandemic-related trauma—and how it’s impacting their behavior and performance at school.
Developed by noted school psychologist and educational neuropsychologist Steven G. Feifer, DEd, the FACT Teacher Form can help. It’s the first comprehensive instrument measuring the impact of stress and trauma on children’s (ages 4–18 years) behavior and performance in school from the teacher’s perspective. It’s being made available for immediate use now while the full FACT—which will include parent and self-reports—is being developed.
Armed with the information provided by the FACT Teacher Form, you can formulate targeted interventions that better meet your students’ needs. Learn more at parinc.com/FACT_Teacher
This week’s blog was contributed by Jeremy Sharp, PhD, licensed psychologist and clinical director at the Colorado Center for Assessment & Counseling and the host of the Testing Psychologist Podcast. Dr. Sharp earned his undergraduate degree in experimental psychology from the University of South Carolina and earned his master’s degree and doctorate in counseling psychology from Colorado State University. He specializes in psychological and neuropsychological evaluation of children and adolescents and provides private practice consulting for psychologists and other mental health professionals who want to start or grow psychological testing services in their practices. He lives in Fort Collins, Colorado with his wife (also a therapist) and two kids.
First, what IS trauma? The DSM-5 definition is easy to find, but the very first requirement for a PTSD diagnosis (“Exposure to actual or threatened death, serious injury, or sexual violence…”) does not capture the broad range of experiences that may lead to a trauma response. Right away, we find the categorical nature of the DSM-5 may not adequately conceptualize or capture the huge continuum of traumatic experiences. I think we can all agree that not all “traumatic” experiences involve exposure to death, serious injury, or sexual violence. What about neglect? What about emotional or psychological abuse? It is necessary to further define trauma and the many ways it can occur. One way to break it down a little further is to distinguish between acute (“Big T”) trauma and developmental or complex (“little T”) trauma.
Acute trauma refers to a discrete event that occurs at a single point in time. With acute trauma, one can generally identify a clear change in functioning from before the event to after the event. An acute trauma may be something like a sexual assault, a car accident, or being held up at gunpoint. Complex trauma is more complicated and refers to ongoing, recurrent traumatic experiences. When these recurrent traumatic experiences happen during childhood, the collective experience is called developmental trauma.
Related post: Assess the impact of the pandemic on kids—the PASS-12 is now available!
Why is this distinction relevant for us as clinicians? Because it affects how we assess and treat individuals. We know that individuals with acute trauma typically may have a quicker path to recovery, while individuals with complex trauma tend to show more chronic symptoms. Acute trauma is also easier to assess in the sense that we are only gathering information about one event, with a relatively clear before and after, while complex trauma tends to be multilayered.
Regarding the assessment process specifically, detailed questions about trauma should be included in nearly all diagnostic interviews. As mentioned earlier, many parents and individuals can overlook or downplay potentially traumatic experiences. Kids also may not share their traumatic experiences with their parents or others unless asked directly. There are a couple of ways to get at these concerns without coming across as too heavy-handed. One is to say something like, “Tell me about some of the most important events in your life” or “What are the top three hardest/worst things that you can remember?” or “Have you held any secrets for a long time that you’d like to share?” Note that forensic interviewing is a clear subspecialty in our field. Do NOT practice outside the scope of your expertise! Another way to explore these questions is to use a broadband questionnaire as a guide for topics/events to inquire about. If your client shares anything that warrants further exploration, you can integrate a narrower questionnaire to drill down on specific trauma symptoms.
Moving further down the path of the assessment process, it is important to think through the relationship between trauma and other mental health diagnoses. A question that comes up often is, how to separate trauma from ADHD/autism/anxiety, etc. As Dr. Maggie Sibley and Dr. Julia Strait noted on past Testing Psychologist podcast episodes, maybe we don’t. Maybe we need to stop thinking about how to separate these diagnoses, because it is nearly impossible to do so, particularly in the case of developmental trauma. Even going by the DSM-5 definition of PTSD or acute stress disorder, there are many PTSD symptoms that occur in other diagnoses. These symptoms include repetitive play (autism), intrusive memories/thoughts (OCD), distress when exposed to certain cues (specific phobia), poor memory (ADHD), and alterations in cognition (depression, anxiety, ADHD), just to name a few. Unless we have a clear picture of functioning before the trauma started, it is extremely challenging to know if these symptoms “belong” to the trauma or something else. In these (and all) cases, gathering an accurate history is crucial to establishing context to interpret an individual’s symptoms and assessment results.
In cases when an accurate history is not available from the primary caregiver, clinicians may need to expand the scope of the evaluation and incorporate a broader record review or interviews with additional people in the client’s life. Even then, we sometimes must simply do our best with what we’ve got to come up with meaningful conceptualization and recommendations.
Ultimately, we want our assessment to guide treatment and provide helpful recommendations for our clients. By conducting a thorough clinical interview; utilizing well-standardized assessment instruments; and providing realistic, evidence-based recommendations, testing psychologists play a vital role in helping individuals identify and heal from their adverse experiences.
Catch up with the Testing Psychologist podcast on their website, via Apple Podcasts, Google Podcasts, or on Spotify.
With a global pandemic, remote learning in many areas, and increased isolation from friends and family, it’s more important than ever to screen students for exposure to trauma and related symptoms this school year.
Symptoms of trauma include:
Trauma is widespread
View our infographic to learn more about how trauma affects children – click here to view.
Trauma can result from any type of adverse childhood experience (ACE) including physical abuse, substance abuse, divorce, witnessing violence, and certainly a global pandemic and ongoing quarantine. More than two thirds of children report at least one traumatic event by the age of 16 years.
Trauma can affect learning
No matter the cause of your students’ trauma, the effects can have a real impact on their academic success. Classroom problems like behavioral issues, difficulty focusing, and disengagement from social activities can prevent them from learning and succeeding in school.
Screen for trauma to help children sooner
The Trauma Symptom Checklist for Children Screening Form (TSCC-SF) and Trauma Symptom Checklist for Young Children Screening Form (TSCYC-SF) now offer online administration and scoring via PARiConnect to help you connect with your students in the classroom—or remotely—and determine if they need help.
In just 5 minutes, the TSCC-SF (for ages 8-17 years) and TSCYC-SF (for ages 3-12 years) indicate whether a child or youth is at risk for clinically significant psychological disturbance so you can determine if follow-up evaluation and treatment are needed. These important tools support the trauma-informed care approach, and convenient scoring on PARiConnect provides the information you need in minutes.
This week’s blog was written by PAR Project Director Carrie Champ Morera, PsyD, NCSP, LP
Millions of children have experienced some type of trauma including, but not limited to neglect, abuse, natural disasters, death of a parent, and violence. These negative experiences subsequently can alter brain development, contribute to health problems, and impair functioning in multiple areas. We now know through the Adverse Childhood Experiences (ACES) study that the effects of stressful and traumatic events can have immediate and lifelong impacts. Trauma manifests itself in various ways. In the short term, behavioral issues, academic issues, and emotional dysregulation may be observed in the school, community, and home settings as a result of trauma. Years later, substance abuse, cancer, depression, and even heart disease can be linked to childhood trauma. Education, prevention efforts, and strategies to develop resilience in children are needed to break the cycles of abuse, addiction, and disease, which in turn, will lead to more positive outcomes in children and provide them with the opportunity to live emotionally stable and productive lives.
Assessments are like puzzles, and addressing trauma is one of the many pieces needed in a comprehensive evaluation. In the school setting, one would not imagine leaving out academic measures as part of a psychoeducational evaluation. That is the way we need to think about trauma in school and community-based evaluations. As a starting point, we need to address whether the child experienced any type of trauma, how often, and to what extent. We need to intervene if there are immediate safety concerns. We need to uncover what supports, coping skills, and resources the child or adolescent utilizes. Trauma does manifest itself in many ways, and children and adolescents will respond to traumatic experiences differently, some in a more complex manner than their peers. However, if an assessment of trauma is not at least considered in our evaluations, this could lead to misdiagnosis, implementation of inappropriate interventions, and/or treatments that do not address the root cause of the problem. If an assessment of trauma is incorporated in an ethical, safe, and caring manner, we are minimizing the risk of harm and increasing the risk at a chance for positive outcomes in all children we evaluate.
Further reading on trauma:
Essentials of Trauma-Informed Assessment and Intervention in School and Community Settings
“Trauma is there, it is happening. We can either chose not to acknowledge it and continue to fall short in meeting needs, or we can acknowledge it is there and figure out how to help. We need to know how to effectively and ethically assess for its presence and then use assessment data to drive intervention planning.” -coauthor Kirby L. Wycoff, PsyD, EdM, NCSP
The Neuropsychology of Stress and Trauma: How to Develop a Trauma Informed School
“The ACES study has unveiled that childhood trauma is much more prevalent than previously thought; therefore, it is imperative that schools are better informed of the cognitive, academic, and social-emotional manifestations of trauma in order to provide appropriate accommodations to help ensure student success."-Steven G. Feifer, DEd
To learn more about what school professionals can do to understand trauma in light of the COVID-19 crisis, visit PAR’s YouTube channel to watch a recorded webinar presented by Terri Sisson, EdS, and Carrie Champ Morera, PsyD, NCSP, LP.
Recently, PAR Project Director Carrie Champ Morera, PsyD, NCSP, LP, interviewed Kirby Wycoff, PsyD, EdM, MPH, NCSP, the coauthor of Essentials of Trauma-Informed Assessment and Intervention in School and Community Settings to learn more about what inspired her to write this book, who would benefit from reading it, why it’s important to assess trauma in schools and community settings, and what she learned while writing it.
Check out the article under the Resources tab on the product page to learn from childhood trauma expert Dr. Wycoff!
This week’s blog was written by Carrie Champ Morera, PsyD. Dr. Champ Morera is a project director at PAR. She is also a nationally certified school psychologist and licensed psychologist with more than 20 years of experience in the field. She enjoys traveling and exploring beaches.
Traumatic experiences are widespread. More than 38% of children have experienced a traumatic event. Though many children are able to demonstrate resiliency and continue to thrive in school after experiencing an adverse event, others are not as fortunate without intervention. The impact of trauma too often interferes with children’s behavior and learning in school. On average, children spend about 1,000 out of 6,000 waking hours in school each year; therefore, it is critical for school professionals to become knowledgeable about trauma and learn how to help children improve their emotional, behavioral, and academic functioning so that they can be successful.
PAR author Steven G. Feifer, DEd, has written a new book, The Neuropsychology of Stress & Trauma: How to Develop a Trauma Informed School, meant to educate and help professionals, parents, and other caregivers. The book includes a foreword by Robert B. Brooks, PhD, faculty at Harvard Medical School, provides information on the physiological, psychological, environmental, and educational impacts of childhood trauma. The book also provides an abundance of additional resources for trauma information including evidence-based interventions for addressing trauma in the schools and at home. Key learning points, figures, and tables are provided in each chapter, making the information easy to digest and providing the reader with major takeaways.
Furthermore, the book examines how trauma and stress impact the brain. Dr. Feifer explores how the impact of trauma can disrupt behavior and learning, particularly in the school setting, an area that only has been explored recently. Strategies and interventions on how to develop a trauma-informed classroom are provided. Finally, Dr. Feifer provides guidance in the area of assessment by providing a framework for trauma-informed assessment, with a review of important areas to assess and suggested tools.
Dr. Feifer will present on trauma at the National Association of School Psychologists (NASP) annual convention in February. In his workshop, The Neuropsychology of Trauma: Trauma-Sensitive Assessment, Dr. Feifer will discuss steps in developing trauma-informed schools, cover trauma assessment techniques, and explore classroom and school-wide interventions to foster emotional growth. If you attend the convention, feel free to stop by the PAR booth to learn more about how PAR can meet your assessment needs.
Dr. Feifer is also the author of the Feifer Assessment of Math (FAM), the Feifer Assessment of Reading (FAR), and the Feifer Assessment of Writing (FAW).
We’re proud to announce the latest addition to the PAR Training Portal!
Our newest course, Overview of the PAR Trauma Suite, provides FREE training for some of PAR’s most in-demand trauma instruments. Course content includes the Trauma Symptom Checklist for Young Children (TSCYC), Trauma Symptom Checklist for Children (TSCC), TSCC and TSCYC Screening Forms, the Trauma Symptom Inventory-2 (TSI-2), and the Detailed Assessment of Posttraumatic Stress (DAPS).
Whether you are a long-time user or are considering a purchase, this course provides greater insight into each of the products. You’ll also learn when each is most appropriate for use and see examples of how they can be used for intervention.
Remember, PAR’s Training Portal is always free and includes interactive courses, videos from test authors, and supplemental materials that serve as a resource to help you to learn more about select products. To learn more about the Training Portal or register for your free account, visit the PAR Training Portal web page.