Trauma Informed Care: Assessment Susan Sturges, MA, MPA Mental Health Coordinator Brooklyn Treatment Court

Brooklyn Treatment Court (BTC) Full-time problem-solving court  Adult Drug Court  DUI Court  Veterans Court  Co-Occurring Court Currently 300+ active cases 78% graduation rate Estimated 20% of participants have current mental health diagnosis

Mental Health and Trauma Services at BTC Specialized screening and assessment:  Post Traumatic Checklist (PCL)  Beck Depression Inventory  Level of Service Inventory Revised  Trauma Symptom Inventory – 2  Comprehensive Psychiatric Evaluation Specialized services:  Assigned to a dedicated case manager  Receive treatment for both substance abuse and mental health needs  Peer support

Why Assess Trauma? High rates of trauma among justice involved individuals. Underreported by trauma survivors. Trauma-related symptoms often not evaluated and go unrecognized and untreated. Symptoms of trauma can be mistaken for symptoms of psychotic or affective disorders Allows for the development of trauma- informed responses:  Increase safety  Reduce recidivism  Promote recovery

Trauma Screening vs. Assessment Screening is brief and focused on specific traumatic events.  Example: Post Traumatic Checklist (PCL) Assessment is an in-depth exploration of the nature and severity of the traumatic events, the consequences of those events, and current trauma-related symptoms.  Example: Trauma Symptom Inventory-2 (TSI-2 )

Universal Trauma Screening It is recommended that all participants be screened for trauma as part of the initial intake or assessment process:  To determine appropriate follow-up and referral  To identify imminent danger requiring urgent response  To identify need for trauma-specific services

Guidelines for Trauma Screening and Assessment: Maximize participant choice and control as much as possible Explain directly and clearly the reasons for the screen and offer explicit options of not answering questions Give option of taking breaks Give option of Self-administering the questionnaire De-brief with a discussion of its implications for service planning, and for any necessary immediate intervention.

Assessment: Trauma Symptom Inventory (TSI-2) 136 item self-report measure Assesses impact of traumatic events over the past six months – Rated 0 (never) to 3 (often) Relevant for various types of trauma Scoring – Four overall factors – 12 clinical scales – 2 validity scales

TSI-2 Factors Self-Disturbance Post-Traumatic Stress Externalization Somatization

TSI-2 Clinical Scales Anxious Arousal Depression Anger Intrusive Experience Defensive Avoidance Dissociation Somatic Preoccupations Sexual Disturbance Suicidality Insecure Attachment Impaired Self-Reference Tension-Reduction Behavior

TSI-2 Scoring Clinical Cutoffs Raw scores are converted to t-scores T-scores have a mean of 50 and a standard deviation of 10 T-score of 65+ indicates further assessment is recommended 6.7% of respondents will score 65+ (1.5 s.d. above the mean) Percentile Scores Percentiles will range from 0-100% No published clinical cutoff

Participants Data were collected from 22 drug court participants  15 (68.2%) were women  Average age: 42.8 Mental health diagnoses included:  PTSD  Depression  Bi-polar Disorder Substances used included:  Crack (36.4%)  Heroin (27.3%)  Polysubstance (9%)

Findings – Clinical Scales 19/22 (86.4%) of participants had a t-score of 65+ on at least one TSI scale On average, participants had clinically significant scores on 2.13 scales (range 0-9) The most common scales with clinically significant scores were: – Defensive Avoidance (12 participants) – Intrusive Experience (8 participants) – Tension-Reduction Behavior (6 participants)

Average % Score by Scale

Findings - Validity 8 participants had scores on the validity scale that were above the cutoff (t-score 65+) Using the 90 th percentile as the cutoff, 9 participants had scores on the validity scale that were above the cutoff The tendency to exaggerate symptoms must be taken into account when using the TSI-2

Practical Implications: Specialized treatment planning Trauma-informed responses:  Orientation  Waiting-room policy  Toxicology screening process  Sanctions/Incentives Peer Support Treatment