How to Conduct a Comprehensive Assessment of Complex Trauma
The assessment of complex trauma is by definition “complex” as it involves both assessing children’s exposure to multiple traumatic events, as well as the wide-ranging and severe impact of this trauma exposure across domains of development. It is important that mental health providers, family members, and other caregivers become aware of specific questions to ask when seeking the most effective services for these children.
The following are some key steps for conducting a comprehensive assessment of complex trauma:
- Assess for a wide range of traumatic events. Determine when they occurred so that they can be linked to developmental stages.
- Assess for a wide range of symptoms (beyond PTSD), risk behaviors, functional impairments, and developmental derailments.
- Gather information using a variety of techniques (clinical interviews, standardized measures, and behavioral observations.
- Gather information from a variety of perspectives (child, caregivers, teachers, other providers, etc).
- Try to make sense of how each traumatic event might have impacted developmental tasks and derailed future development. Note: this may be challenging given the number of pervasive and chronic traumatic events a child may have experienced throughout his or her young life.
- Try to link traumatic events to trauma reminders that may trigger symptoms or avoidant behavior. Remember that trauma reminders can be remembered both in explicit memory and out of awareness in the child’s body and emotions.
The assessment should be conducted by a clinically trained provider who understands child development and complex trauma. Ideally, the assessment should involve a multi-disciplinary team. An ideal team would include a pediatrician, mental health professional, educational specialist, and, where appropriate, an occupational therapist. In residential, day treatment, and juvenile justice settings, a multi-disciplinary team might also include direct care staff familiar with the child.
After conducting an assessment, it may be difficult to determine if the child’s various symptoms are related to outcomes of trauma or if they also reflect other diagnoses such as ADHD, oppositional defiant disorder, or bipolar disorder. However, when using a complex trauma framework, it may be more meaningful to suspend judgment and labeling at first. Engage instead in an open, flexible, and ongoing process that addresses the traumatic stress reactions initially and over the course of a child’s treatment. It is crucial to monitor how symptoms and behaviors change over the course of time and in response to trauma-focused treatment. Make sure to engage the child, family, and all providers in a continuing dialogue about what makes sense, what is working, and the most useful next steps for intervention.