As we track survey results for our clients, we see that some behavioral health organizations continue to be challenged by the TJC requirements for trauma assessment. There have been several survey findings on this topic in 2015 and 2016. So, let’s recap the requirements and take a look at some resources. The TJC standard on trauma assessment is in the Behavioral Health manual; standard CTS.02.02.05 (added in 2011): “The organization identifies individuals served who may have experienced trauma, abuse, neglect, or exploitation.” Specific requirements are as follows:
- The organization must educate staff about trauma, abuse, neglect, and exploitation.
- The organization must identify individuals who have experienced trauma, abuse, neglect, or exploitation.
- Staff must be able to screen for trauma, abuse, neglect, and exploitation.
- The organization must assess the individual who has experienced trauma, abuse, neglect or exploitation or refer the individual for this assessment.
Recent survey findings have included the following issues:
- Lack of staff training on trauma
- Assessment of trauma limited to physical and sexual abuse; not other types of trauma
- Identifying trauma history but not assessing current impact and implications for treatment
- Not identifying if the individual had experienced exploitation
If you’re looking for resources for conducting trauma assessment, there are a couple of tools that we routinely recommend to our clients. The Trauma History Questionnaire (THQ) available through Georgetown University is a 24 item self-report measure that collects information about experiences with crime related events, general disaster and trauma experiences, and physical/sexual abuse. The Life Events Checklist for DSM-5 (LEC-5) is a self-report measure designed to screen for potentially traumatic events in a client’s lifetime. It gathers information about exposure to 16 events known to potentially result in PTSD or distress. The individual is asked to respond to the 16 stressful life events by indicating one of the following:
- It happened to me personally.
- I witnessed it happen to someone else.
- I learned about it happening to a close family member or close friend.
- I was exposed to it as part of my job.
- I’m not sure if it fits.
- It doesn’t apply to me.
Many clinicians report that the use of a structured tool to gather trauma history prompts clients to report more information on these types of experiences than they would in a typical interview process. However, it’s important to emphasize that whatever tool is used to gather trauma history, this information must be assessed by a clinician to evaluate the impact of the trauma and the implications for treatment.
So, to be fully compliant with TJC requirements, we recommend that you determine if the following processes are in place within your organization:
- Have you educated staff about trauma and its potential effect on the clients they serve?
- Are you collecting information about an individual’s trauma history? Does it include other types of trauma in addition to abuse and neglect?
- If a trauma history is identified, is there an assessment of the impact of that trauma and the implications for treatment?
Looking for additional resources on trauma assessment and treatment?
Check out the following websites:
- SAMHSA’s National Center for Trauma-Informed Care
A technical assistance center with a wealth of resources on various models of trauma-informed care, staff training, and best practices.
- International Society for Traumatic Stress Studies
An international collection of studies, research, and education on trauma; publishes the Journal of Traumatic Stress.