Two-generational trauma-informed assessment improves documentation and service referral frequency in a child protection program

Abstract

Background: Two-generational trauma-informed assessment (TIA) helps providers conduct holistic family well-being assessment (FWbA). This tool makes it possible to use families' trauma history in the case-finding process.

Objective: This study compares the documentation and frequency of adverse childhood experiences (ACEs) and service referral rates for index children and their caretakers in two groups of families evaluated in a child abuse clinic (CAC).

Participants and setting: The sample consisted of 364 children stratified into two groups: Group 1 - children seen in the CAC after implementation of FWbA in years 2014, 2015, 2016 and Group 2 - children seen in the CAC prior to implementation of FWbA in years 2011, 2012, 2013.

Methods: Researchers utilized retrospective chart review method and analyzed data regarding ACEs and service referrals for patients and their caregivers.

Results: Documentation of ACEs was higher in Group 1 for children (77.7 % vs 26.6 %,p < 0.0001) and caretakers (60.7 % vs 7.3 % p < 0.0001). Caretakers in Group 1 had a higher rate of four or more ACEs (47.0 % vs 5.1 % p < 0.001) while the increase for children was not statistically significant (61.4 % vs 51.1 %, p = 0.110). Both children and caretakers were referred to more services in Group 1 (2.7 + 1.5 vs 1.5 + 1.3, and 3.0 + 1.9 vs 1.2 + 1.2, respectively, p < 0.0001).

Conclusions: In families evaluated for child abuse and neglect, conducting TIA in addition to conventional psychosocial evaluation increased documentation regarding trauma history, which led to increased referral rates.

Keywords: Adverse childhood experiences; Child abuse; Child neglect; Trauma; Trauma-informed assessment; Trauma-informed care.