Table 1 Pragmatic adaptions to the UCLA brief screen for the pediatric traumatic stress screening tool
From: Screening for symptoms of childhood traumatic stress in the primary care pediatric clinic
Validated UCLA Brief Screen | Adapted UCLA Brief Screen | Rationale |
|---|---|---|
Self-report form | Parent and self-report forms | The UCLA Brief Screen relied on patient self-report of trauma and trauma symptoms in trauma-exposed youth 7–18 years of age seen for mental health concerns in a specialized clinical setting. In general pediatric clinics, adolescents are often asked to self-report symptoms of depression or anxiety at 11 years of age. Due to concerns regarding literacy and comfort related to self-report of PTEs among younger patients in a general pediatric setting, we developed a parent-report UCLA Brief Screen version for children 6–10 years of age. |
Detailed history of trauma exposure | Brief capture of any potentially traumatic event (PTE) | The UCLA Brief Screen was validated among youth with a trauma history captured with a detailed Trauma History Profile of the full-scale UCLA PTSD Reaction Index. The Profile lists 14 specific PTEs, and a final option to endorse any other “really scary or upsetting” experience. We adapted this final question to capture parent or child endorsement of either a recent or past “violent or very scary or upsetting event” as an indicator of PTE exposure and examined whether this history was positively associated with trauma symptoms reported on the UCLA Brief Screen among general pediatric patients. |
Trauma symptom severity based on PTSD probability | Trauma symptom severity based on need for intervention | The UCLA Brief Screen used multilevel diagnostic likelihood ratios (DLRs) to identify scores associated with low (0–20), moderate (21–35), and high (36–44) risk for PTSD. In a primary care setting, children with milder symptoms of traumatic stress following a PTE may benefit from early identification, assessment, and intervention even in the absence of PTSD based on formal diagnostic criteria. Informed by cut points described in the initial validation study, we adapted the scoring system to classify children as none/mild (0–10), moderate (11–20) or severe (21–44) symptoms of traumatic stress. |
Trauma screening only | Trauma + suicide screening | We added a screening question for risk of suicide and/or self-harm (Question 9 from the PHQ-A). Positive responses prompted full screening with the Columbia Suicide Severity Rating Scale. |