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When a client screens positive for substance abuse, trauma-related symptoms, or mental disorders, the agency or counselor should follow up with an assessment. The most important domains to screen among individuals with trauma histories include:
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Screening processes can be developed that allow staff without advanced degrees or graduate-level training to conduct them, whereas assessments for trauma-related disorders require a mental health professional trained in assessment and evaluation processes. Trauma-informed screening is an essential part of the intake evaluation and the treatment planning process, but it is not an end in itself.
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Clinical supervision is helpful-and sometimes necessary-in judging how to proceed. The screening procedures detail the actions to take after a client scores in the positive range. That is, the screening process establishes precisely how to score responses to screening tools or questions and clearly defines what constitutes a positive score (called a “cut-off score”) for a particular potential problem. Screening procedures should always define the steps to take after a positive or negative screening. Thus, how screening is conducted can be as important as the actual information gathered, as it sets the tone of treatment and begins the relationship with the client. Screening is often the first contact between the client and the treatment provider, and the client forms his or her first impression of treatment during this intake process. Screening, early identification, and intervention serves as a prevention strategy. Without screening, clients’ trauma histories and related symptoms often go undetected, leading providers to direct services toward symptoms and disorders that may only partially explain client screening for trauma history and trauma-related symptoms can help behavioral health practitioners identify individuals at risk of developing more pervasive and severe symptoms of traumatic stress.
People with histories of trauma often display symptoms that meet criteria for other disorders. Screening can also prevent misdiagnosis and inappropriate treatment planning. Unrecognized, unaddressed trauma symptoms can lead to poor engagement in treatment, premature termination, greater risk for relapse of psychological symptoms or substance use, and worse outcomes. Not addressing traumatic stress symptoms, trauma-specific disorders, and other symptoms/disorders related to trauma can impede successful mental health and substance abuse treatment. Furthermore, behavioral health problems, including substance use and mental disorders, are more difficult to treat if trauma-related symptoms and disorders aren’t detected early and treated effectively ( Part 3, Section 1, of this Treatment Improvement Protocol, available online, summarizes research on the prevalence of trauma and its relationship with other behavioral health problems). Why screen universally for trauma in behavioral health services? Exposure to trauma is common in many surveys, more than half of respondents report a history of trauma, and the rates are even higher among clients with mental or substance use disorders.