Screening for Trauma in Pediatric Primary Care
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CHILD AND ADOLESCENT DISORDERS (TD BENTON, SECTION EDITOR)
Screening for Trauma in Pediatric Primary Care Brooks Keeshin 1
&
Kara Byrne 1 & Brian Thorn 1 & Lindsay Shepard 1
# The Author(s) 2020
Abstract Purpose of Review Provided the high prevalence of trauma exposure in childhood as well as the risk for morbidity, this article examines evidence, a recommended approach, and key implementation factors relevant to screening for trauma in pediatric primary care. Recent Findings A standardized approach to trauma screening is possible, but previous attempts have relied heavily upon exposure screening and failed to guide an individualized response specific to the impact of trauma on the child and family. Trauma screening tools for pediatric primary care should be brief and inform the care response based on screening for trauma exposure, traumatic stress symptoms, functional impact, and suicidality. Summary Clinicians should use trauma screening to (1) identify if the child has any ongoing risk of harm and report where required; (2) determine risk of suicidality and respond appropriately; (3) assess need for evidence-based trauma treatment based on symptoms and functional impact; and (4) provide a skill or guidance targeting the most severe or pressing traumatic stress symptoms. Keywords Trauma . Traumatic stress . Adverse childhood experiences (ACES) . Trauma screening . Pediatric primary care
Introduction As many as 80% of children are exposed to a potentially traumatic experience in childhood. A potentially traumatic experience, or trauma, is “a significant event or experience that causes or threatens harm to one’s emotional and/or physical well-being” [1••]. Examples include sexual or physical abuse, family or community violence, life-threatening accidents or medical diagnoses, natural disasters, war, and terrorism. There is a large and compelling body of evidence that demonstrates that exposure to potentially traumatic experiences in childhood is associated with both short-term and long-term morbidity [2]. Furthermore, the type, chronicity, and number of exposures all likely contribute to the risk of
This article is part of the Topical Collection on Child and Adolescent Disorders * Brooks Keeshin [email protected] 1
Department of Pediatrics, Center for Safe & Healthy Families, University of Utah, 81 N. Mario Capecchi Dr., Salt Lake City, UT 84113, USA
ongoing emotional and behavioral challenges after traumatic events. Given the broad range of potential exposures that can occur over a multitude of developmental periods in childhood, the impact of trauma can be quite varied—and has the potential to impact all domains of functioning, cognition, and emotional regulation. However, there are a number of symptoms that are predictably seen in many youth who continue to be impacted by at least one potentially traumatic experience. These symptoms are likely related to changes in the function and coordination between the sympathetic and autonomic nervous systems and together make up the constellation of symp
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