Conducting a Quick Screen for Trauma - Parent Interview

many clinicians can have a lot of uncertainty about the best way to ask about and screen for a childhood traumas or adverse childhood experiences and so this video models how a clinician can ask about these things in a structured and evidence-based way even in the context of a routine clinical appointment that might have real time constraints the screening questionnaire being used is called the ace or the adverse childhood experiences question it's a 10 item validated tool that asks about childhood experiences such as sexual physical or verbal abuse physical neglect and also emotional deprivation it also asks if a child has had an experience of loss of a parent either due to incarceration or uh divorce it inquires about a parent having a major mental illness or a substance use disorder and also about whether there's been any domestic violence in the home and for each item that a child or a parent endorses the child gets one point and the total of those points is called their Ace score so the reason to screen for these Aces is that we now have a large body of literature which really links these adverse childhood events with a whole host of long-term serious physical and mental health outcomes we know that these adverse childhood experiences are not only significant for health but that they're prevalent a recent study showed that 75 % of adult respondents in a population sample endorsed an a score of at least one and we also have evidence that says that the higher your a score is the more likely you are to have really serious physical and mental illnesses for example respondents with an a score of four or more were at a six to tenfold increased risk of things like cardiovascular disease stroke and diabetes also mental illnesses such as depression substance use disorders and even suicide respondents with an a score of six or higher had a mortality that was 20 years sooner than those with an a score of zero so this following clinical scenario models how a clinician can ask about these traumas in a sensitive and evidence-based way which is also timely we see that Dr Lawson is meeting with 10-year-old Sam and his mom Dana and Dr Lawson's just completed a routine physical checkup and she has no health concerns for Sam she's is about to wrap up the appointment when Sam's mom raises questions about Sam's Behavior at school and also mentions that there have been some stresses in the home so Dr Lawson decides to do this brief screen so Sam's healthy other than some seasonal allergies and everything else okay then actually not quite I don't know what's been happening but between last school year and this year all of a sudden I'm getting these phone calls from his teacher saying that he's not paying attention in class they think he has ADHD all of a sudden I mean I don't know where this is coming from but this is not the same kid I had a year ago okay so sounds like there's a little bit more going on that and some more worries that you wanted to talk about so perhaps I make sense that that we take a few minutes and then I chat with you and then I'll spend a few minutes with Sam sure that'd be great okay Sam do you want to go and hang out in the waiting room for a bit and I'll come find you in a few minutes go ahead honey so tell me about Sam and the issues that he's having at school well he's like a totally different kid and not in a good way all of a sudden this year I've been getting calls three four times a week from his teacher the principal they're saying things like he's acting out in class he's having little kind of angry spurts all of a sudden he's not doing his homework which is completely news to me his grades are slipping I mean he used to be like 7s ' 80s 90s kid now he's getting 60s so this feels like a real diversion from last year real change from last year oh totally like night and day okay so it sounds like there's been some problems at home so I'm going to ask you some screening questions that I ask all the parents some of them might fit for you and some of them might not probably take about five minutes and we'll just go through them together sure let's do it so why don't we start with how you're doing I'm honestly I'm getting by I mean I think you know Daryl and I got divorced last year he's somewhere out in BC who only knows where so is Sam seeing them at all or I think they Skype maybe once every couple months but he's really not been in contact and he's not been sending the money that he promised he would so really not thrilled with him right now so has that meant that finances have been tight or is yeah I mean I was kind of counting on the child support to come in you know things are tight with a three people household and then and for almost since long darl's been gone my mother's also moved in with me she you know as you get older she's starting to get a little bit more dementia some people just stick their parents in a home but I was the good daughter and I decided to take her to mine so lots of changes lots of things going on yeah and how do you feel like you're managing with all of that I mean some days are obviously better or worse than others it's been a lot of changes like you said I mean I'm I'm not getting enough sleep I'm things are tight financially emotionally how have you been doing then and managing things are you know sometimes very stressful like if my mother has an episode or when I get called from school but like I don't think I'm really like depressed or anything it just it's kind of day-to-day thing yeah so are there ever any times that you're not managing well like you're you're not get able to get out of bed or do the things that you need to do in a day there's a couple mornings that I sleep in but it's really like I still kind of get by I get everything done I need to like I know it's kind of a tough time right now but I don't feel like it's going to be hopeless forever hopefully so some struggles but yeah okay do you ever cope with um using drugs or alcohol no I mean my mother used to drink but I tried to be verely aware of not using that as crutch so then no drinking at all at home yeah no drinking and I definitely don't want drugs in the house for the kids so none of be what about making sure that Sam and your little one have what they need in terms of winter coats or food or or um those sorts of things I I'm doing the best I can you know like we haven't got a chance to go winter coat shopping yet his from last year still kind of fits it's not great but it's solution for now always wearing his coat from last year yeah do you have a sense about is that hard because of finances or are there other reasons mostly finances but I mean kind of time too like to get everybody out the door to go grocery shopping or go clothes shopping it's a big ordeal right I mean I know we didn't pick up everything he wanted for back to school this year either it it'd be easier if I had a few extra dollars and a few extra hours right so Sam's not always having the things that he needs right now then I guess not exactly no yeah and what about you know food are you do there food in the fridge is are you able to put food on the table of course I mean we have a bulk food store membership so when we do get out I let Sam pick out things he likes to make you know macaroni stuff for sandwiches cereals that way you know sometimes He makes himself breakfast in the morning before school or dinners there's there's always something for them to eat right and what kinds of things does does Sam have for dinner like I said like he'll do macaroni you know sometimes it's not great but he'll do like the Fruit by the Foot or you know sometimes some snack food sometimes more comprehensive meals I guess so when you say he does it is is he cooking or or are you cooking or both I guess kind of a mix of both to be honest like I can usually get dinner together a couple nights a week or if we have more money coming in you know sometimes We'll order pizza but I just I just don't have time to cook right so with all the stress in the house has there been any times that um people have kind of gotten really upset with Sam or yelled at him or said mean or hurtful things to him not really I mean like my mother's not ever really been a very nice person and now she's gotten kind of more and more scile she gets kind of more and more mouthy sometimes so she'll sort of go off on him but I mean I do the best I can to let him know that he's still Lov that it's you know not his fault things like that and what about how is discipline handled in your house has anybody ever um spanked or hit or physically hurt um samon anyway no never I mean I used to give him timeouts when he was younger but I know it sounds awful but like I don't actually have time to discipline them now okay and what about sexual abuse is anyone touch Sam in a sexual way or an inappropriate way excuse me yeah that's a hard question to hear for lots of people but I ask everybody that question so no no never I I would never let that happen to my child okay so so he's been safe from sexual abuse or from sexual appropriate touch okay so how do you think Sam's doing in his close family relationships do you think Sam's feeling loved and supported I mean I know I guess I haven't really been around for him as much as I'd like to be obviously I do the best to let him know you know how much I care for him sometimes we have a little bit of more money I will get him something nice that he wants you know I've heard him kind of he's kind of mouthed off and said oh you you love the baby more than you love me but that's that's obviously not true I love both my kids so what do you think he would say if he was here and I asked you if he felt loved I I'd hope he'd say do okay have some doubt I mean like I said like I'm I know I'm doing the best I can but I guess sometimes I'm not doing enough for him I don't know you mentioned that there were some Sometimes some difficulties with your mom can you tell me a little bit more about what's happening with your mom in the home well she's lived with us for the past year or so she was diagnosed with dementia so she has days where she remembers everything and days where she's starting to slip more and more and she just she's very judgmental very opinionated she has the way she likes things and has there been any time that your mom has become physically aggressive in the home no never yeah and what about her relationship with you how is she managing or how are you managing together with her in the home some days are definitely better than others she like I guess you could say I kind of try to check her behavior when she's getting a little bit too mouthy I guess that's probably the best way to say it has it ever come to physical blows between the two of you no no just arguments here and there and when you mean arguments how how intense are those arguments getting like we raise our voices I mean it's I'm doing the best I can here MH and has it ever it's never come to physical blows no never that I'd have to take some other action if that happened and that that that intensity is it kind of like arguing or is it like yelling and screaming and doors slamming or people throwing objects I I guess you could say we've gotten pretty loud I mean she'll go and kind of Slam things in her room you know I'm I obviously I wouldn't let ever let her hurt the kids and where are Sam and the baby when these things are happening Sam will usually go and hide in his room maybe turn his music up you know Le sometimes napping in the crib in the play pen I guess to be totally honest I do lose my patience and scream more than I'd like to but so it sounds like there's kind of a lot of tension and and and and arguing in that relationship how often would you say that that's happening that it comes to the you know kind of arguing and and yelling place I guess like a few times a week and kind of one sort of last question what has anyone in your family been in in prison or in jail no never okay so thank you very much for sharing all of that I'm just going to recap sounds like there's been a lot of stressors and lots of change over the last year yeah Sam's data has moved away which has kind of created some changes in finances which have led to maybe not always having the the food or the clothing that you've needed or that Sam has needed you've got your mom who's moved in and there's some stress and tension and arguing that's happening in that and you've also told me that maybe all of these stressors and stuff have contributed to Sam not feeling as loved um or as cared for on the other hand it sounds like you're managing emotionally and that you're not using any drugs or alcohol you have told me that there are no concerns regarding physical emotional or sexual abuse for Sam in his life and that nobody in your family um or in Sam's life has gone to prison so I think you're right there is likely a connection between kind of what's happening for Sam in school and the difficulties that he's starting to have with all of these stresses and changes at home so I'm going to book a follow-up appointment for you and Sam to come in and at that time we'll talk about some of the ways in which I might be able to help or develop a plan together sounds sounds good thank you okay all right so make sure you make an appointment on your way out to to come back in as soon as you can okay and you said you wanted to see Sam for a bit as well yeah I'm gonna see Sam right now um and then um when when I'm done just make sure on the way out that you talk to reception about making another appointment okay all right thanks Dr Lawson all right okay thanks based on the information that Dr Lawson gathered in her interview with Sam's mother Sam's a score would be three as she reports that Sam's experienced loss of a parent due to divorce some physical neglect and also a sense of emotional deprivation it's even possible that Sam's a score might be higher as Dr Lawson might further investigate whether the conflicts between Sam's mother and grandmother were sufficiently intense to constitute domestic violence and also whether the conflict between Sam's grandmother and himself was sufficiently intense or frequent as to constitute verb abuse if Sam or his mother had reported that Sam experienced physical or sexual or emotional abuse or serious physical neglect that put him at risk of harm then Dr Lawson would have to report that immediately to Child Protective Services but we know from the literature that even without those reportable experiences of abuse with an ace score of three Sam is still at a much elevated risk for a host of physical and mental health outcomes beginning in adolescence and laugh lasting throughout his life so this brief screen is an effective first step to assess for childhood trauma and develop a treatment plan the ace screening questionnaire can be a 10-minute investment of time that clinicians make to develop an effective and evidence-based plan of care

Channel: CAMH Professionals Videos

Views: 308,644

Keywords: trauma, children and trauma, screening, ACE, childhood trauma

Id: bxbSsK5D_PY

Length: 16min 20sec (980 seconds)

Published: Wed Mar 15 2017