Tests and measures used in trauma-informed evaluations
The range of possible posttraumatic outcomes requires both broad and specific measures. Briere and Spinazzola (2005) recommend at least two broadband screening measures, such as the MMPI-2 and the Personality Assessment Inventory (PAI), and at least one measure for general trauma-related problems. If a trauma-related disorder, such as PTSD or Acute Stress Disorder (ASD), is suspected based on the general trauma measure, a specific diagnostic test or structured interview for those conditions is also required. In addition, if other trauma-linked problems are noted, relevant measures should be included, such as those assessing dissociation, suicidality, and/or cognitive ability. In forensic settings in particular, malingering or exaggerated symptoms should also be assessed, and this may be accomplished by the careful selection of measures that include validity scales or with measures designed for that purpose.
Although there are many measures that assess trauma-related problems and disorders, some are more widely used due to their higher reliability and validity, and not all have been updated for DSM-5. To determine the presence of general trauma-related problems, the Trauma Symptom Inventory 2 (TSI-2; Briere, 2011) is a 100-item questionnaire that includes ten clinical scales and three validity scales, has adaptations for children and adolescents, and is updated for DSM-5. The TSI-2 is particularly useful in forensic evaluations due to the presence of validity scales that assist in identifying malingering (Christiansen & Vincent, 2012). For the specific assessment of PTSD and ASD, the combination of a screening measure combined with a structured clinical interview is recommended (Ford, Grasso, & Elhai, 2015). Screening measures, such as the Life Events Checklist for DSM-5 (LEC-5; Weathers et al., 2013a), the PTSD Check List for DSM-5 (PCL-5; Weathers, Litz et al., 2013), and the Stressful Life Events Screening Questionnaire (SLESQ; Goodman, Corcoran, Turner, Yuan, & Green, 1998), allow a clinician to quickly assess an individual’s past exposure to trauma and identify traumatic events that meet criteria for those specific disorders. If a qualifying traumatic event is identified, the screening is followed by a detailed structured interview. For example, the LEC-5 is typically combined with the Clinician-Administered PTSD Scale (CAPS-5; Weathers et al., 2013b), a comprehensive and widely used PTSD interview that can evaluate current and lifetime PTSD. The CAPS-5 has been referred to as “the gold standard” for interview assessment of PTSD due to its level of detail, precise prompts, and impressive evidence of reliability and validity, and thus is often preferred in forensic contexts (Evans & Hass, 2018; Young, 2017). The CAPS-5 has several advantages, including the use of behaviorally based anchors for all ratings, which may improve assessment across cultures and ethnic groups.
Overall, the goals of a trauma-informed psychological evaluation are to obtain the most reliable and valid information about an individual’s past exposure to trauma and current symptomatology, and to determine how their past traumatic experiences may be linked to their present health and functioning and intertwined with symptoms of other psychiatric or medical conditions. Trauma-informed evaluations can be a valuable resource for attorneys and courts working to provide fair, effective representation for clients with a history of suffering.
Interested in talking about if a Trauma-Informed Psychological Evaluation is right for your client or case? Contact Dr. Ludlam: firstname.lastname@example.org or call 919-493-1975.
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