Transcript Trauma Informed Care: Assessment

Trauma
Informed Care:
Assessment
Susan Sturges, MA, MPA
Mental Health Coordinator
Brooklyn Treatment Court
Brooklyn Treatment Court
(BTC)
•
Full-time problem-solving court
 Adult Drug Court
 DUI Court
 Veterans Court
 Co-Occurring Court
•
Currently 300+ active cases
•
78% graduation rate
•
Estimated 20% of participants have current
mental health diagnosis
Mental Health and Trauma
Services at BTC
Specialized screening and
assessment:
 Post Traumatic
Checklist (PCL)
 Beck Depression
Inventory
 Level of Service
Inventory Revised
 Trauma Symptom
Inventory – 2
 Comprehensive
Psychiatric Evaluation
Specialized services:
 Assigned to a
dedicated case
manager
 Receive treatment for
both substance abuse
and mental health
needs
 Peer support
Why Assess Trauma?
•
High rates of trauma among justice involved
individuals.
•
Underreported by trauma survivors.
•
Trauma-related symptoms often not evaluated
and go unrecognized and untreated.
•
Symptoms of trauma can be mistaken for
symptoms of psychotic or affective disorders
•
Allows for the development of traumainformed responses:
 Increase safety
 Reduce recidivism
 Promote recovery
Trauma Screening vs.
Assessment
•
Screening is brief and focused on specific
traumatic events.
 Example: Post Traumatic Checklist (PCL)
•
Assessment is an in-depth exploration of
the nature and severity of the traumatic
events, the consequences of those events,
and current trauma-related symptoms.
 Example: Trauma Symptom Inventory-2 (TSI-2)
Universal Trauma
Screening
• It
is recommended that all
participants be screened for
trauma as part of the initial intake
or assessment process:
 To determine appropriate follow-up and
referral
 To identify imminent danger requiring
urgent response
 To identify need for trauma-specific
services
Guidelines for Trauma
Screening and Assessment:
•
Maximize participant choice and control as
much as possible
•
Explain directly and clearly the reasons for
the screen and offer explicit options of not
answering questions
•
Give option of taking breaks
•
Give option of Self-administering the
questionnaire
•
De-brief with a discussion of its implications
for service planning, and for any necessary
immediate intervention.
Assessment:
Trauma Symptom Inventory
(TSI-2)
•
136 item self-report measure
•
Assesses impact of traumatic events over
the past six months
–Rated 0 (never) to 3 (often)
•
Relevant for various types of trauma
•
Scoring
–Four overall factors
–12 clinical scales
–2 validity scales
TSI-2 Factors
•
Self-Disturbance
•
Post-Traumatic Stress
•
Externalization
•
Somatization
TSI-2 Clinical Scales
•
Anxious Arousal
•
Somatic Preoccupations
•
Depression
•
Sexual Disturbance
•
Anger
•
Suicidality
•
Intrusive Experience
•
Insecure Attachment
•
Defensive Avoidance
•
Impaired Self-Reference
•
Dissociation
•
Tension-Reduction
Behavior
TSI-2 Scoring
Clinical Cutoffs
Percentile Scores
•
Raw scores are
converted to t-scores
•
Percentiles will range
from 0-100%
•
T-scores have a mean of
50 and a standard
deviation of 10
•
No published clinical
cutoff
•
T-score of 65+ indicates
further assessment is
recommended
•
6.7% of respondents will
score 65+ (1.5 s.d. above
the mean)
Participants
•
Data were collected from 22 drug court
participants
 15 (68.2%) were women
 Average age: 42.8
•
Mental health diagnoses included:
•
Substances used included:
 PTSD
 Depression
 Bi-polar Disorder
 Crack (36.4%)
 Heroin (27.3%)
 Polysubstance (9%)
Findings – Clinical Scales
•
19/22 (86.4%) of participants had a t-score of 65+
on at least one TSI scale
•
On average, participants had clinically significant
scores on 2.13 scales (range 0-9)
•
The most common scales with clinically significant
scores were:
– Defensive Avoidance (12 participants)
– Intrusive Experience (8 participants)
– Tension-Reduction Behavior (6 participants)
Average % Score by Scale
100
80
60
40
20
0
AA
DEP
ANG
IE
DA
DIS
SOM
SXD
SUI
ISA
ISR
TRB
Findings - Validity
•
8 participants had scores on the validity
scale that were above the cutoff (t-score
65+)
•
Using the 90th percentile as the cutoff, 9
participants had scores on the validity
scale that were above the cutoff
•
The tendency to exaggerate symptoms
must be taken into account when using
the TSI-2
Practical Implications:
•
Specialized treatment planning
•
Trauma-informed responses:
 Orientation
 Waiting-room policy
 Toxicology screening process
 Sanctions/Incentives
•
Peer Support
•
Treatment