Systematic, large-scale screening of children for trauma-related symptoms and behavioral problems offers both critical opportunities and significant challenges. Screening has played a critical role in public health over the years and in many cases has become a routine part of standard medical care. Children who would benefit from early detection and intervention are1:
- Children who are known to have been abused and neglected (most of whom currently receive little or no interventions for the trauma);
- Children in foster care (of whom 70-80% are placed because of abuse or neglect to them or their siblings);
- Children who witness domestic violence or the violent death of a parent, sibling or friend;
- Children who are victims of catastrophic accidents or mass casualty events associated with school violence, forms of terrorism, or natural disasters;
- Children in the juvenile justice system;
- Refugee children from countries with major armed conflict and civil disturbances; and
- Children who require psychiatric hospitalization for certain symptoms or behavioral problems (e.g., attempted or thoughts of suicide, running away).
One way in which false positive risks can be minimized (false determinations of abuse) is by the use of multiple evaluation measures administered serially which tends to increase the specificity of the screen because of a positive series is more likely to represent a true disorder.
1 “Mobilizing Trauma Resources for Children,” January 8, 2004, William W. Harris, Ph.D., Children’s Research and Education Institute, Belmont, MA; Frank Putnam, M.D., Mayerson Center for Safe & Healthy Children, Children’s Hospital Medical Center, Cincinnati, OH; John A. Fairbank, Ph.D., UCLA-Duke University National Center for Child Traumatic Stress, Duke University Medical Center, Durham, NC