CPM
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Child Traumatic Stress Care Process Model
Child Traumatic Stress Care Process Model
As a part of the CPM, children between the ages of 6 and 18 are screened for symptoms of traumatic stress. For children between the ages of 6 and 10, the caregiver will complete the screening tool. Youth between the ages of 10 and 18 will complete the screening tool themselves. The tool consists of a series of 13 questions which aim to identify concerns for issues surrounding sleep, hypervigilance, intrusive thoughts, avoidance, negative mood and suicidal ideation. If the youth endorses any suicidal ideation, he/she will be given the Columbia Suicide Severity Rating Scale (CSSR-S) to further assess their risk.
Based on the outcome of the screening tool, the youth may be monitored by their primary care provider, referred to evidence-based trauma therapeutic services, or referred for an urgent mental health assessment. A safety plan may also be developed with the youth and their caregiver. All youth will receive an in-office intervention, providing them with a coping strategy they can use to address symptoms of traumatic stress, particularly before starting therapeutic services.
In order to best meet the needs of youth who have experienced one or multiple traumatic events, it is important that we screen them for childhood traumatic stress, provide a compassionate response, and refer to the appropriate services and support. No clinical training or expertise is needed to implement this screening.
At-a-Glance: Children 6-18 Years of Age
For children 6 – 18 years who report a potentially traumatic experience on the Pediatric Traumatic Stress Screening Tool (more information on this screening tool available in full CPM), the process of responding effectively to child traumatic stress involves three steps:
Report if required. If the potentially traumatizing event does not involve alleged child abuse or family violence, reporting to law enforcement or child protection services is unnecessary. If abuse or family violence is the source of the potential trauma, determine if the event needs to be reported to appropriate investigative authorities. In Minnesota, reports can be made to Child Protective Services (CPS) in the county in which the family resides. You may also contact Law Enforcement in the jurisdiction in which the crime occurred. Per MN state statute, CPS and LE are required to cross-report. If the event has already been reported, there is no need to do it a second time.
Respond to suicide risk. The Pediatric Traumatic Stress Screening Tool includes an item assessing recent suicidal ideation. If the parent or youth endorses any suicidal ideation, providers must complete the Columbia Suicide Severity Rating Scale (C-SSRS) to assess patient safety and determine response protocols, referring to local emergency medical services when needed.
Stratify treatment approach. Results from the Pediatric Traumatic Stress Screening Tool are stratified into three levels. The mild range scores (0 – 10) identify a child / teen for whom it would be appropriate to use a “protective approach” with ongoing primary care monitoring and supportive guidance building on strengths. The moderate range (11 – 20) indicates a “resilient approach” is appropriate with a brief in-office intervention and a referral to a child therapist. Scores in the severe range (21 or higher) indicate a “restorative approach” is needed, which includes a brief in-office intervention and a referral to a therapist with specialized trauma evidence-based treatments (EBT) training (in addition to safety planning, when indicated).
Brief In-Office Intervention
Based on screening tool results, a brief in-office intervention targeting their most prominent symptom(s) has been shown to make a big difference for many children. In addition to teaching them a useful coping skill, the child often feels an increased sense of support from parent(s) / guardian(s) who can help them practice the skill at home and remind them to use it when needed. For many children, belly breathing or mindfulness training (teens) will be able to slow down a racing heart or mind at bedtime to fall asleep easier or reduce the intensity of anxious / fearful or angry feelings. Children in the severe and moderate traumatic stress symptom range will typically benefit from an intervention based on their symptoms, but clinicians may also choose to use a brief intervention with those in the low symptom range.
Follow Up at Regular Intervals
You may chose to follow-up with the youth or the caregiver to check in and make sure they have successfully accessed services. This is not required and can be decided on an individual basis depending on the needs of the youth.
Why Focus on Trauma in Children
Why Focus on Trauma in Children
Childhood traumatic stress is the intense fear and stress response occurring when children are exposed to potentially traumatic experiences that overwhelm their ability to cope with what they have experienced. Traumatic stress needs to be addressed for the following reasons:
High prevalence. Up to 80 % of children experience at least one significant traumatic experience in childhood.
Poor mental health outcomes. Some children and adolescents develop adverse traumatic stress responses.
Poor health outcomes and lower life expectancy. The ACE studies link child maltreatment to early death and other poor health outcome.
High cost. Children can experience exacerbated symptoms and poorer outcomes resulting in elevated costs.
Often under-diagnosed and misdiagnosed.
Early identification and integrated care using evidence-based treatments can increase positive outcomes.
Key Points
Key Points
Screen for child traumatic stress. Then make 3 key decisions.
Report if required. If abuse or family violence is the source of the potential trauma, determine if the event needs to be reported to appropriate investigative authorities.
Respond to suicide risk.
Stratify treatment approach.
Mild range scores (0 – 10) “protective approach”
Moderate range (11 – 20) “resilient approach”
Severe range (21 or higher) “restorative approach”
* This CPM presents a model of best care based on the best available scientific evidence at the time of publication. It is not a prescription for every physician or every patient, nor does it replace clinical judgment. All statements, protocols, and recommendations herein are viewed as transitory and iterative. Although physicians are encouraged to follow the CPM to help focus on and measure quality, deviations are a means for discovering improvements in patient care and expanding the knowledge base.
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