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Abstract

Purpose: The purpose of the study was to identify major symptom domain variables common to child trauma and create a prototype short trauma symptom screening tool (STST) intended for use in pediatric medical settings.

Methods: This manuscript describes the first two phases of an on-going prospective mixed-method instrument development study. Phase 1 exploratory factor analysis was conducted with an archived LONGSCAN CBCL dataset to: (1) identify behavioral symptoms endorsed by children with known trauma exposure; and (2) generate a preliminary STST item pool. During Phase 2, researchers convened an expert panel (N = 10) and conducted Content Validity Index (CVI) procedures with the 20-item preliminary STST item pool, to further inform item retention, elimination and modification for an updated prototype STST.

Findings: Expert quantitative scores yielded a CVI of 0.90 for the overall preliminary STST. The first two phases of this study assisted researchers with identifying 12 items that represent nine child trauma symptom domain variables, which include: (1) aggression/anger; (2) anxiety/fear; (3) sexual concerns; (4) elimination concerns; (5) somatic concerns; (6) depression; (7) dissociation; (8) physical acting out; and (9) dysregulation.

Conclusions: The first two phases of STST development resulted in development of a brief, empirically-derived prototype screening tool that features 12 items operationalizing nine domains of child trauma symptoms. Developers can now advance to the next phase of STST development; feasibility assessment and psychometric testing.

Key Take Away Points

  • Nearly 70% of children seen in pediatric health care settings have experienced exposure to traumatic events.
  • Child trauma symptoms are often missed, or overlooked, by pediatric providers.
  • Few tools are available to assist pediatric providers with identifying child trauma symptoms, and tools that do exist were not intended for use in pediatric medical outpatient settings.
  • This study describes steps taken toward developing a short trauma screening tool (STST) that can be comfortably administered in pediatric settings to rapidly identify patients demonstrating symptoms in need of referral for specialized mental health care.

Author Biography

Dr. Maguire, RN MS PhD, an advanced practice forensic nurse, is an Associate Professor of Nursing at the University of Massachusetts Graduate School of Nursing. Dr. Maguire is interested in conducting family-focused research. Dr. Maguire presently holds the position of Forensic Nurse Specialist with the University of Massachusetts Memorial Healthcare Child Protection Program. Ms. Hirsh, BA, is a 3rd year medical student at the University of Massachusetts Medical School. Ms. Hirsh completed a summer research internship with the University of Massachusetts Memorial Health Care Child Protection Program. Dr. Allison, MS MD, is Professor and Vice Chair of the Department of Quantitative Health Sciences at the University of Massachusetts Medical School, where he also serves as Associate Vice Provost for Health Disparities Research. Dr. Allison’s research focuses on quality measurement, implementation science, and statistical methodology, with an emphasis on eliminating racial/ethnic disparities in medical care and health outcomes. Dr. Allison is board certified in Internal Medicine and received a Masters’ degree in Epidemiology from the Harvard school of Public Health. Dr. Forkey, MD, is an Associate Professor of Pediatrics at the University of Massachusetts Medical School, and was recently named The Joy McCann Professor for Women in Medicine. In her institutional roles as Division Director for the Child Protection Program and as Director of the Foster Children Evaluation Service (FaCES) of the UMass Memorial Children’s Medical Center, Dr. Forkey leads programs to address the needs of children who are victims of abuse, neglect and emotional trauma. She received her undergraduate degree from Cornell University and medical degree from the State University of New York at Buffalo School of Medicine and Biomedical Sciences. She completed her pediatric residency and chief residency at Children’s Hospital of Philadelphia.

Acknowledgements

Authors’ Note: This study was partially funded by a University of Massachusetts Medical School Faculty Scholar Award. Laura Maguire (LM), Estelle Hirsh (EH), Jeroan Allison (JA) and Heather Forkey (HF) all participated in developing and writing this manuscript. The authors wish to express their deepest gratitude to the panel of experts who participated in this study. We also wish to acknowledge and thank Philip Picard-Frasier (PPF), BS, a 2nd year medical student at the University of Massachusetts Medical School for his diligence and thoughtful determination with cleaning, coding, categorizing, and managing study data.

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