Development of a Differential Assessment Guide to Improve Engagement with Youths & Families Living with Chronic Trauma

Richard Kagan; Jana Pressley; Rosa Espinoza; Cheryl Lanktree; Jim Henry; Angel Knoverek; Sophia Duffy; Victor Labruna; Mandy Habib; Margaret E Blaustein; Joseph Spinazzola

doi:10.1007/s40653-022-00479-w

Development of a Differential Assessment Guide to Improve Engagement with Youths & Families Living with Chronic Trauma

J Child Adolesc Trauma. 2022 Sep 27;16(1):145-159. doi: 10.1007/s40653-022-00479-w. eCollection 2023 Mar.

Authors

Affiliations

¹ Training Programs on Traumatic Stress, Family Treatment Center Foundation, The Institute for Adolescent Trauma Treatment and Training at Adelphi University, Garden City, USA.
² The Foundation Trust, Richmont Graduate University, Chattanooga, USA.
³ The Foundation Trust, Children's Hospital Los Angeles/USC UCEDD, Los Angeles, USA.
⁴ Department of Psychiatry & Behavioral Sciences, Keck Medical School, University of Southern California Adolescent Trauma Training Center, University of Southern California, Los Angeles, USA.
⁵ School of Social Work and Children's Trauma Assessment Center, Western Michigan University, Kalamazoo, USA.
⁶ School of Counselor Education, Culver-Stockton College, Adams State University, Alamosa, USA.
⁷ Dominican University, River Forest, USA.
⁸ The Institute for Adolescent Trauma Treatment and Training at Adelphi University, Garden City, USA.
⁹ Center for Trauma Training, Inc, Brookline, USA.

Abstract

Youths and parents/caregivers who have experienced multiple forms of severe interpersonal trauma may demonstrate severe and persistent symptoms of complex trauma including high-risk behaviors. Engagement, and sustaining engagement, of these youths and parents/caregivers in evidence-supported trauma treatment is a critical challenge, especially when youths or parents/caregivers have experienced chronic traumas that may be expected to continue into the foreseeable future. An extensive literature review was conducted leading to development of an assessment framework that could increase engagement of youths and parents/caregivers in trauma treatment based on research on chronic trauma, complex trauma, Developmental Trauma Disorder (DTD), and factors that promote engagement. A multi-dimensional assessment guide was developed to enable clinicians to differentiate types of chronic trauma based on a continuum of past, current and expected exposure over time and then to use this guide collaboratively with youths and parents/caregivers to develop priorities for treatment and service planning that matches their needs and strengths. The assessment guide incorporates exposure to intra-familial and community forms of interpersonal trauma, attachment disruptions, established symptoms of PTSD, Complex PTSD and DTD, as well as social-emotional development. The assessment and treatment planning guides proposed in this article expand applicability of evidence-supported trauma-informed therapy to youths and families who have not been engaged by programs offering treatments that are focused on past or single incident traumas or do not address disrupted attachments, multi-generational experiences of adversity, discrimination and community violence, life-threatening dangers or the impact of chronic trauma on youth, parent/caregiver and family development.

Keywords: Assessment; Chronic Trauma; Complex Trauma; Developmental Trauma Disorder; Dropouts; Engagement; Ongoing Trauma.

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