UCLA PTSD Reaction Index for DSM 5

Transcription

1 UCLA PTSD Reaction Index for DSM 5 Child/Adolescent, Parent/Caregiver, and 6 and Younger Versions Alan M. Steinberg, Ph.D. Associate Director National Center for Child Traumatic Stress University of California, Los Angeles Cameo Stanick, Ph.D. Vice President of Clinical Practice, Training, Research & Evaluation Hathaway Sycamores Child and Family Services

2 DSM-5 Diagnostic Criteria for PTSD Criterion A A) Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: 1) Directly experiencing the traumatic event. 2) Witnessing, in person, the event as it occurred to others. 3) Learning that the traumatic event occurred to a close family member or friend. In cases of actual or threatened death of a family member or friend, the event must have been violent or accidental. 4) Experiencing repeated or extreme exposure to aversive details of the traumatic event (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related

3 DSM-5 Diagnostic Criteria for PTSD Cluster B Presence of 1 of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: Recurrent, involuntary, & intrusive distressing memories of the event. *Repetitive play w/ trauma themes Recurrent distressing dreams related to the event. *May have frightening dreams w/o recognizable content Dissociative reactions (e.g., flashbacks) in which the individual feels/acts as if the event were recurring. *Trauma-specific reenactment may occur in play Psychological distress at cues resembling event. Physiological reactions to cues resembling the event.

4 DSM-5 Diagnostic Criteria for PTSD Cluster C Persistent avoidance of stimuli associated w/ the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by 1 of the following: Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event.

5 DSM-5 Diagnostic Criteria for PTSD Cluster D Negative alterations in cognitions & mood associated w/ the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by 2 of the following: Inability to remember an important aspect of the event (not due to head injury or substance use). Persistent & exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., I am bad, No one can be trusted ). Persistent, distorted cognitions about the cause or consequences of the event that lead the individual to blame himself/herself or others. Persistent negative emotional state (e.g., fear, anger, guilt, or shame). Markedly diminished interest or participation in significant activities. Feelings of detachment or estrangement from others. Persistent inability to experience positive emotions.

6 DSM-5 Diagnostic Criteria for PTSD Cluster E Marked alterations in arousal & reactivity associated w/ the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by 2 of the following: Irritable behavior & angry outbursts (w/ little or no provocation) typically expressed as verbal or physical aggression. Reckless or self-destructive behavior. Hypervigilance. Exaggerated startle response. Problems w/ concentration. Sleep disturbance

7 DSM-5 Diagnostic Criteria for PTSD F) Duration of the disturbance (Criteria B, C, D, & E) is > 1 month. G) The disturbance causes clinically significant distress or impairment important areas of functioning. H) The disturbance is not attributable to the physiological effects of a substance or other medical condition.

8 DSM-5 Diagnostic Criteria for PTSD Dissociative Subtype Specify whether the individual s symptoms meet criteria for PTSD, and in addition, the individual experiences persistent or recurrent symptoms of either of the following: Depersonalization: experiences of feeling detached from, and as if one were an outside observer of, one s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly). Derealization: experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted).

9 The UCLA PTSD Reaction Index for DSM-5 includes six sections:» Trauma History Profile» Trauma Details» PTSD Symptom Scale» Frequency Rating Sheet» Distress and Impairment in Functioning» PTSD Reaction Index Score Sheet The Trauma History Profile section is used to assess history of exposure to a wide range of traumatic events. For each trauma marked Yes on the Trauma History Profile section, the Trauma Details section is used to gather additional information about specific details of the traumatic experience, whether the child/adolescent was a victim, witness or learned about the trauma, and the age(s) over which the trauma occurred. The PTSD Symptom Scale and the Frequency Rating Sheet are used to rate the number of days in the past month that the child/adolescent experienced each PTSD symptom. The Distress and Impairment in Functioning section is used to rate whether the PTSD symptoms are related to significant distress and problems in relationships at home, in school, with peers, and in development. The PTSD Reaction Index Score Sheet provides a method for calculating whether DSM-5 criteria are met for PTSD symptoms, significant distress and impairment, and whether full diagnostic criteria are met for PTSD and Dissociative Subtype. 2015: Robert S Pynoos & Alan M Steinberg All Rights Reserved

10 Trauma History Profile Clinician-administered trauma exposure screen Prompts clinician to assess age and features of exposure Utilizes all available sources of information (e.g., self-report, DCFS reports, caregiver reports, other informants) Completed at intake and updated over course of treatment

11 YES TRAUMA HISTORY PROFILE 1) Serious Accidental Injury: Has your child ever been in a bad accident, like a serious car, bus, train or bicycle accident where he/she or someone else was or could have been badly hurt or killed? Did your child ever have a serious dog bite, near drowning experience, a really bad burn or a bad fall? Has your child ever seen a bad accident where someone was badly hurt or killed? 2) Illness/Medical Trauma: Has your child ever been so sick that you or other people taking care of him/her were scared that he/she might die? Did your child have a medical treatment that was very scary or painful? Did your child ever see a loved one get so sick that your child was very frightened, including things like a heart attack or stroke? 3) Community Violence: Did your child ever see a bad fight or shooting in your neighborhood, like between gangs? Was he/she badly hurt or could have been badly hurt or killed? Has your child seen someone mugged, robbed, stabbed or killed in your neighborhood? 4) Domestic Violence: Has your child ever seen adults that he/she lives with getting physically attacked or in a bad fight with each other, where someone got punched, kicked or hit with some object? Have adults he/she lives with threatened to hurt each other? Has your child ever seen an adult he/she lives with forced to do something sexual by another adult in the home? Has your child heard screams of adults who were threatened or hurt at home? 5) School Violence/School Emergency: Was your child ever at day care, pre school or school when something really scary happened, like a shooting, a stabbing, a fire, a bomb scare, or where he/she or someone got badly beaten up or where he/she saw a person die or saw a dead body? 6) Physical Assault: Has your child ever been badly physically hurt (punched, kicked, stabbed, shaken) by someone outside of your family or who was not taking care of him/her, like someone in your neighborhood or a stranger?

12 7) Disaster: Has your child ever been in a natural disaster, like a hurricane, tornado, earthquake, flood or wildfire where he/she was hurt or could have been hurt or killed? Has your child been in a natural disaster where he/she saw someone badly hurt or killed? Has he/she been in a place where there was a chemical spill or explosion? 8) Sexual Abuse: Did someone who was taking care of your child, a sibling or close relative, ever do something sexual with him/her? Did your child ever witness a sibling, relative or playmate being forced to do something sexual? Did someone who was taking care of your child, a sibling or close relative ever force your child to watch pornography? 9) Physical Abuse: Has your child ever been badly physically hurt (punched, kicked, stabbed, shaken) by someone who is in your family or was taking care of him/her? Has your child seen another child in your family being badly physically hurt by a parent, caregiver or legal guardian? 10) Neglect: Has there ever been a time when someone who should have been taking care of your child didn t, like they didn t take him/her to a doctor when he/she was really sick? Has a caregiver ever left your child alone in a house or car or left your child unsupervised for a long time? Did a caregiver ever regularly neglect the basic care of your child, like food, clothing or bathing? Did a caregiver not do their best to keep your child healthy and safe? 11) Psychological Maltreatment/Emotional Abuse: Did anyone in your family ever keep telling your child that he/she was no good, keep yelling at him/her or keep threatening to leave him/her or send him/her away? Was your child often punished at home in ways that were very extreme or seemed to you to be unfair? 12) Interference with Caregiving: Was there ever a time when someone who was supposed to take care of your child couldn t because of a serious physical illness, mental health condition, drug or alcohol problem or for some other reason? 13) Sexual Assault: Did someone outside your family ever do something sexual with your child? Did your child ever see someone being forced to do something sexual? 14) Kidnapping/Abduction: Has your child ever been kidnapped (taken somewhere against his/her will) by someone without permission of a parent or legal guardian?

13 15) Terrorism: Was your child ever there when a terrorist attack happened, like a bombing, shooting, chemical attack or where people were taken hostage? 16) Bereavement: Has someone your child really cared about ever died? 17) Separation: Was your child ever separated for a long time from someone he/she depended on due to a parent being hospitalized or going to jail? Was your child separated from a parent or caregiver by being placed in foster care? Has your child ever had a lengthy separation from someone close to him/her due to divorce or military deployment? Was your child ever separated for a long time from someone he/she depended on due to refugee or immigration circumstances? 18) War/Political Violence: Has your child lived in a country where a war or armed conflict was happening (like soldiers or armed groups were fighting)? Did he/she see people who had been badly hurt or killed in a war or armed conflict? 19) Forced Displacement: Has your child ever been forced to move out of his/her house due to war, armed conflict or disaster, like having to move to a trailer or refugee camp? 20) Trafficking/Sexual Exploitation: Has your child ever been used for pornography? Has a caregiver ever been paid, including given drugs, to have your child do something sexual? 21) Bullying: Has another child, adolescent or a student at his/her school ever bullied him/her, like with repeated name calling, teasing or taunting? Has he/she been repeatedly pushed around or hit by a bigger child or targeted for taking things from him/her? Has he/she been repeatedly excluded socially from being or doing things with other children? 22) Witnessed Suicide: Has your child ever seen someone during or after he/she attempted or committed suicide?

14 Trauma Type Trauma Details Role in Event Life Threatening Medical Illness Serious Accident School Violence Disaster Terrorism Kidnapping Sexual Assault/Rape Type Motor Vehicle Dog Bite Hospitalized Other Shooting Bullying Suicide Assault Other Earthquake Fire Flood Hurricane Tornado Toxic Substance Other Lost Home Injured Conventional Weapon Biological Chemical Radiological Other Stranger Relative Acquaintance Other Weapon Used Stranger Date Rape Prosecution Self Family Friend Victim Witness Learned about Victim Witness Learned about Victim Witness Learned about Victim Witness Learned about Victim Witness Learned about Victim Witness Learned about Age(s) Experienced Interpersonal Violence Bereavement Robbery Assault Homicide Suicide Suicide Attempt Other Parent Sibling Friend Other Relative Other Sudden Death Cause of Death: Illness Victim Witness Learned about Witness Learned about (exclude death due to natural causes)

15 Trauma Type Trauma Details Role in Event Age(s) Experienced Separation Divorce Foster Care Parent/Sibling Incarcerated Parent Hospitalized Immigration/Refugee Proceeding Separation from relatives/ friends in country of origin Other Impaired Caregiving Biological Mother Biological Father Other Relative Other Adult Impairment Due to: Drug use/abuse/addiction Mental Health

16 Trauma History Profile Age In Years Trauma Information Sexual Maltreatment/Abuse Sexual Assault/Rape Physical Maltreatment/Abuse Physical Assault Emotional Abuse Neglect Domestic Violence War/Terrorism/Political Violence (US) War/Terrorism/Political Violence (non-us) Illness/Medical Serious Injury/Accident Natural Disaster Kidnapping Trauma Loss or Bereavement Forced Displacement Impaired Caregiver Extreme Interpersonal Violence Community Violence School Violence

17 Trauma History Profile Age In Years Trauma Information Sexual Maltreatment/Abuse Sexual Assault/Rape Physical Maltreatment/Abuse Physical Assault Emotional Abuse Neglect Domestic Violence War/Terrorism/Political Violence (US) War/Terrorism/Political Violence (non-us) Illness/Medical Serious Injury/Accident Natural Disaster Kidnapping Trauma Loss or Bereavement Forced Displacement Impaired Caregiver Extreme Interpersonal Violence Community Violence School Violence

18 Trauma History Timeline Age In Years Trauma Information Unk Sexual Maltreatment/Abuse Sexual Assault/Rape Physical Maltreatment/Abuse Physical Assault Emotional Abuse/Psychological Maltreatment Neglect Domestic Violence War/Terrorism/Political Violence Inside U.S. War/Terrorism/Political Violence Outside U.S. Illness/Medical Serious Injury/Accident Natural Disaster Kidnapping Bereavement Forced Displacement Impaired Caregiver Extreme Interpersonal Violence (not reported elsewhere) Community Violence (not reported elsewhere) School Violence (not reported elsewhere) Other Trauma (not reported elsewhere)

19 Modeling the Developmental Epidemiology by Age of Onset of Trauma Overview

20 Research Limitations of Adult Studies Retrospective Inclusion of History of Child Trauma The typical child trauma history instruments used retrospectively in adult studies: Consider trauma types as interchangeable, for example physical and sexual abuse Have little to no specified developmental parameters (age of onset, etc.) Use Yes/No endorsement without any characterization of age of onset, duration or co-occurrence Are unable to judge severity of exposure in relation to known trauma detail risk factors

21 Two Clinical Advantages 1) In cases where a single-event trauma or loss may be the focus of referral or treatment, THP findings encourage the clinician to consider other more chronic or repeated elements of a trauma history profile that may be significantly related to the clinical profile and course of recovery. 2) In cases for which typically chronic trauma types serve as the reason for referral, THP findings similarly encourage the clinician to consider circumscribed events (e.g., a traffic accident in which an older sibling was killed) that may also significantly contribute to the clinical profile and course of recovery.

22 Symptom Scale 27 items to assess PTSD symptoms 4 additional items (#s 28-31) to assess Dissociative Subtype Clinician administered or completed independently by adolescent When answering questions, the child/adolescent should think about the traumatic event that is most bothersome to him/her currently Child rates the frequency of symptoms as how many days in the past month

23 FREQUENCY RATING SHEET HOW MANY DAYS DURING THE PAST MONTH DID THE PROBLEM HAPPEN? NEVER TWO DAYS 1 2 DAYS 2 3 DAYS ALMOST EVERY A MONTH A WEEK A WEEK DAY S NONE LITTLE SOME MUCH MOST M T W H F S S M T W H F S S M T W H F S S M T W H F S S M T W H F S X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X

24 Introducing the PTSD-RI Frequency Rating Sheet Now I am going to ask you about some reactions people sometimes have after very bad things happen to them like [the trauma]. I m going to read you some statements, and then use the Frequency Rating Sheet to answer HOW MANY DAYS IN THE PAST MONTH you have had the reaction, that is since. Here are your choices to answer the next question [hand Frequency Rating Sheet to client and point to the calendar as you explain the rating choices]. 0 means that in the past month, you have not had the reaction at all. 1 means that you have had the reaction a LITTLE of the time, about once every other week. See the 2 X s on the calendar? 2 means that you have had the reaction SOME of the time, about 1 2 times each week. 3 means that you have had the reaction MUCH of the time, about 2 3 times each week. 4 means that you have had the reaction MOST of the time, almost every day. Let s do some practice questions to make sure you get how to use the calendar. If I read the statement, I have had a headache, point to the number on the calendar that tells how often in the past month, since, you have had a headache. What about the statement, I have had green hair? Point to the number on the calendar that tells how often in the past month you have had green hair.

25 Symptom Scale I am on the lookout for danger or things that I am afraid of (like looking 1 E3 over my shoulder even when nothing is there). 2 D2 I have thoughts like I am bad. 3 C2 I try to stay away from people, places, or things that remind me about what happened. 4 E1 I get upset easily or get into arguments or physical fights. I feel like I am back at the time when the bad thing happened, like it s 5 B3 happening all over again. 6 D4 I feel like what happened was sickening or gross. 7 D5 I don t feel like doing things with my family or friends or other things that I liked to do. 8 E5 I have trouble concentrating or paying attention. 9 D2 I have thoughts like, The world is really dangerous. 10 B2 I have bad dreams about what happened, or other bad dreams.

26 11 B4 When something reminds me of what happened I get very upset, afraid, or sad. 12 D7 I have trouble feeling happiness or love. 13 C1 I try not to think about or have feelings about what happened. When something reminds me of what happened, I have strong feelings in 14 my body like my heart beats fast, my head aches or my stomach aches. B5 I am mad with someone for making the bad thing happen, not doing more 15 to stop it, or to help after. D3 16 D2 I have thoughts like I will never be able to trust other people. 17 D6 I feel alone even when I am around other people. I have upsetting thoughts, pictures or sounds of what happened come into 18 my mind when I don t want them to. B1 19 D3 I feel that part of what happened was my fault. 20 E2 I hurt myself on purpose. 21 E6 I have trouble going to sleep, wake up often, or have trouble getting back to sleep. 22 D4 I feel ashamed or embarrassed over what happened.

27 23 D1 I have trouble remembering important parts of what happened. 24 E4 I feel jumpy or startle easily, like when I hear a loud noise or when something surprises me. 25 D4 I feel afraid or scared. 26 E2 I do risky or unsafe things that could really hurt me or someone else. 27 D4 I want to get back at someone for what happened. With Dissociative Symptoms (Dissociative Subtype) 28 A1 I feel like I am seeing myself or what I am doing from outside my body (like watching myself in a movie). 29 A1 I feel not connected to my body, like I m not really there inside. 30 A2 I feel like things around me look strange, different, or like I am in a fog. 31 A2 I feel like things around me are not real, like I am in a dream.

28 Clinician: Ask the parent/caregiver whether the reactions above cause impaired relationships with parents, siblings, peers, and other caregivers. Relationship with Parents/Caregivers: (Check the box if parent/caregiver endorses any of #1 through #7 below.) Overall, do the reactions above get in the way of your child s relationship with you or another parent or caregiver? For example: 1 Does your child cling more or get more upset when separated from you or another parent/caregiver? Yes No Don t Know 2 Does your child refuse to sleep alone? Yes No Don t Know Does your child have more trouble being comforted by you or another parent/caregiver? 3 Does your child have a harder time listening to you or another parent/caregiver, for example, when told to stop doing something? Yes No Don t Know 4 Does your child wander off without checking with you or another parent/caregiver? Yes No Don t Know 5 Does your child have trouble trusting what you or another parent/caregiver says, for example, that a situation or place is safe? Yes No Don t Know 6 Is your child more aggressive or angry toward you or another parent/caregiver? Yes No Don t Know 7 Is your child less affectionate with you or another parent/caregiver? Yes No Don t Know

29 Clinician: Ask the parent/caregiver whether the reactions above cause behavior problems at school. School Behavior: (Check the box if parent/caregiver endorses #1 to #6 below.) Overall, have the reactions above affected your child s behavior at daycare, pre school or at school? For example: 1 Has your child been in fights and arguments at school? Yes No Don t Know 2 Has your child had trouble taking turns at school, waiting in line, sitting in a circle, sharing, or being helpful to other children? 3 Does your child repeatedly stay by him/herself during group activities at school? 4 Have you been told that your child has become extremely quiet at school and no longer asks questions or participates in class activities? 4 Have you been called to come to school on several occasions because of your child s behavior? 5 Have you been told that your child has trouble paying attention, taking instruction or that he/she seems to be spacing out during learning activities at school? 6 Has your child ever been expelled from pre school or school, or been refused further daycare because of his/her behavior? Yes No Don t Know Yes No Don t Know Yes No Don t Know Yes No Don t Know Yes No Don t Know 7 Have you been told that other parents complained about your child s Yes No Don t Know behavior at school? Has your child had more difficulty separating from you to be at school? Yes No Don t Know

30 Problems in Developmental Progression: (check the box if parent/caregiver endorses #1 to #7 below) Over all, have the above reactions led to a big change or caused problems in your child s development? For example: 1 Does your child act younger, like asking for more help doing things he/she used to do on their own? 2 Is your child not doing new things that you expected him/her to start to do or not doing things that other kids his/her age are doing? 3 Is your child more afraid of everyday situations, like being in the dark, being by themselves in the bathroom or going to sleep at night? Yes No Don t Know Yes No Don t Know Yes No Don t Know 4 Is your child more scared of new places or people? Yes No Don t Know 5 Does your child have new fears that get in the way of doing things or trying new experiences? 6 Does your child repeatedly go off on his/her own without concern in ways that worry you? 7 Is your child doing, including saying things, that are well beyond what you would expect at his/her age? Yes No Don t Know Yes No Don t Know Yes No Don t Know

31 UCLA PTSD Reaction Index for Children/Adolescents DSM-5 Score Sheet For Items 2, 9, and 16: indicate highest score only for DSM-5 Symptom D2; for Items 15 and19: indicate highest score only for DSM- 5 Symptom D3; for Items 6, 22, 25, and 27: indicate highest score only for DSM-5 Symptom D4; for Items 20 and 26: indicate highest score only for DSM-5 Symptom E2. Category B Total: Sum scores for symptoms B1-B5; Category C Total: Sum scores for symptoms C1 and C2; Category D Total: Sum scores for symptoms D1-D7; Category E Total: Sum scores for symptoms E1-E6; PTSD-RI Total Scale Score: Sum Category B, C, D, and E. Item # DSM-5 Symptom Score (0-4) 18 B1 10 B2 5 B3 11 B4 14 B5 SYMPTOM CATEGORY B SUMMATIVE SCORE: 13 C1 3 C2 SYMPTOM CATEGORY C SUMMATIVE SCORE: Item # DSM-5 Symptom Score (0-4) 23 D1 2* D2 9* D2 16* D2 15* D3 19* D3 6* D4 22* D4 25* D4 27* D4 7 D5 17 D6 12 D7 SYMPTOM CATEGORY D SUMMATIVE SCORE: DSM-5 Score Item # Symptom (0-4) 4 E1 20* E2 26* E2 1 E3 24 E4 8 E5 21 E6 SYMPTOM CATEGORY E SUMMATIVE SCORE Dissociative Symptoms 28. A1 29. A1 (Indicate highest score for A1) 30. A2 31. A2 (Indicate highest score for A2) PTSD-RI TOTAL SCALE SCORE DSM-5 PTSD DIAGNOSIS B: One or more Category B symptoms present: C: One or more Category C symptoms present: D: Two or more Category D symptoms present: E: Two or more Category E symptoms present: F: Symptom duration greater than one month: G: Symptoms cause clinically significant distress or impairment: Specify Dissociative Subtype: One or more dissociative symptoms present: Estimating Whether DSM-5 PTSD Category B, C, D, and E Symptom Criteria are Met If symptom score is 3 or 4, then score symptom as present. For question #4, #10, and #26; use a rating of 2 or more for symptom presence. Then determine whether one or more B symptoms are present; whether one or more C symptoms are present; whether two or more D symptoms are present; and whether two or more E symptoms are present. If one or more Dissociative Symptoms are present, then assign Dissociative Subtype.

32 Scoring Instructions Use PTSD-RI Score Sheet to tabulate symptom category scores and total scale score PTSD-RI Total Scale Score: Sum Category B, C, D, & E Count highest score only for alternatively worded items of the same symptom Example of scoring a symptom category: For Items 20 & 26, indicate highest score only for Symptom E2. Category E total: Sum scores for symptoms E1-E6 Item # DSM-5 Symptom 4 E1 20* E2 26* E2 1 E3 24 E4 8 E5 21 E6 Score (0-4) SYMPTOM CATEGORY E SUMMATIVE SCORE

33 Scoring Instructions Estimating whether DSM-5 PTSD category B, C, D, and E symptom criteria are met: If symptom score is 3 or 4, score symptoms as present For questions 4, 10, & 26; use a rating of 2 or more for symptom presence Then determine whether one or more B symptoms are present; whether one or more C symptoms are present; whether two or more D symptoms are present; and whether two or more E symptoms are present. Determine if symptoms duration has been greater than one month Determine if symptoms cause clinically significant distress/impairment If one or more Dissociative Symptoms are present, then assign Dissociative Subtype. DSM-5 PTSD DIAGNOSIS B: One or more Category B symptoms present: C: One or more Category C symptoms present: D: Two or more Category D symptoms present: E: Two or more Category E symptoms present: F: Symptom duration greater than one month: G: Symptoms cause clinically significant distress or impairment: Specify Dissociative Subtype: One or more dissociative symptoms present:

34

35 Clinician Benefits of Assessment Clinical Intuition vs. Standardized Measurement Objective documentation of client progress or negative change that informs strength-based treatment Develops clinical assessment skills (it gets easier!) Rapid identification of specific treatment issues Increases objectivity and clarity for case consultation and presentation

36 Consumer Benefits of Assessment Targeted treatment Helps clients identify difficult themes May be client s first opportunity to develop rapport and trust with you Repeating the measures helps to identify new issues

37 Use of the UCLA PTSD-RI Diagnostic Tool Unique to have diagnostic tool in survey form! Matching PTSD diagnosis with evidence base Trauma exposure info helps with targeting narrative Progress Monitoring Tool Variations in symptom criteria = variations in practice elements? Use of modular treatment approach Targets and goals relevant to individual symptom categories Routine visual tracking/monitoring of symptom scores

38 Symptom-level Targets and Goals Avoidance of Reminders Elevations (C2) Possible interventions: Personal Safety Skills Relaxation Exposure Diminished Interest (D5) Possible interventions: Self-Monitoring Activity Selection Cognitive

39 Training Options Background on childhood trauma, measure overview, and scoring Use of the measure as a diagnostic tool and establishing medical necessity Use of the measure as a progress monitoring tool Integration of tool into routine clinical applications Case examples/vignettes Electronic health record integration Linking symptom elevations with practice elements Use of the measure in integrated care (primary care version) Use of the measure with young children

40 Obtaining the UCLA PTSD-RI For information about obtaining the UCLA PTSD Reaction Index for DSM 5, go to reactionindex.com or contact Preston Finely at:

41 What Challenges or Questions Do You Have? Assessment? Data-based decision making? Trauma assessment? Administration or scoring? Clinical utility?