Psychometrics of a Brief Trauma Symptom Screen for Youth in Residential Care

Abstract

Trauma screening is an important element for providing trauma-informed services to youth in residential care. Unfortunately, lack of time and resources may deter clinicians from conducting trauma screening at intake. This study tested the psychometric properties of the Brief Trauma Symptom Screen for Youth (BTSSY), which could be used during intake into residential care. Participants included 572 youth, ages 10-18 years (M = 14.28 years, SD = 2.31), of whom 58.9% were boys, 78.7% were Caucasian, 51.7% were youth receiving services in residential care, 15.6% were youth with clinical needs, and 32.7% were typically developing youth from the local community. Participants completed the BTSSY; other questionnaires of psychopathology, childhood maltreatment, and symptomology of posttraumatic stress disorder (PTSD); and diagnostic interviews, which were conducted by licensed psychiatrists. The total BTSSY score had a good composite reliability (CR) of .80 and was valid based on a significant positive correlation, r = .64, with the UCLA PTSD-Reaction Index. The BTSSY score was also fair, area under the curve = .75, at detecting a diagnosis of PTSD from a psychiatrist. Significant group differences in the BTSSY scores were found between youth with a diagnosis of PTSD and the other two groups, with moderate-to-large effect sizes, ds = 0.73-1.22. Preliminary results indicated the BTSSY may be a useful screening tool for identifying youth at residential care intake who may need additional assessment for PTSD. Limitations and implications for future research and practice are discussed.

Semantic adaptation of the Global Psychotrauma Screen for children and adolescents in the United States

“… No No No No No No No No GPS-T: Other stressful events, social support, childhood trauma, history of mental illness, resilience. Functioning 1 item No No 7 items 5 items No No 6 items 21 items for caregivers GPS-T: 1 item Validation Kassam-Adams et al, 2013 , Kassam-Adams & Marsac, 2016 ) Tyler et al, 2019 Dow, Kenardy, Le Brocque, & Long, 2012 ; Dyregrov, Kuterovac, & Barath, 1996 ; Perrin, Meiser-Stedman, & Smith, 2005 Foa et al, 2018 Sachser et al, 2017 , 2018 Lang & Connell, 2017 ; 2018 Kenardy et al, 2006 Grasso et al, 2015 Doric et al, 2019 ; Kaplow et al, 2020 Planned. Languages English & Spanish English CRIES-8 in 27 languages; CRIES-13 in 26 languages.…”

“…The review of the selected instruments shows that most of them do not differentiate between the child and adolescent age groups. The various starting and ending age points from 6, 7, or 8 years to 16, 17, or 18 years and a wide age range in these instruments (Dyregrov & Yule, 1995 ; Foa, Asnaani, Zang, Capaldi, & Yeh, 2018 ; Kassam-Adams, 2006 ; Kenardy, Spence, & Macleod, 2006 ; Lang & Connell, 2017 ; Sachser et al, 2017 ; Tyler et al, 2019 ) do not account enough for differences in comprehension between children and adolescents. Although the authors of the instruments sought providers’ feedback when developing or adapting the instruments, they did not report collecting data from children and adolescents on how to better articulate the screening items for them.…”

“…Some of the reviewed instruments were newly developed for children and adolescents (Grasso, Felton, & Reid-Quiñones, 2015 ; Kassam-Adams, 2006 ; Lang & Connell, 2017 ; Sachser et al, 2017 ) and then adapted for adults (Grasso, Ford, & Greene, 2019 ), whereas others were adapted from the adult to child and adolescent versions (Dyregrov & Yule, 1995 ; Foa et al, 2018 ; Kenardy et al, 2006 ; Tyler et al, 2019 ). Developing a new screening instrument requires more time and resources, whereas, adapting an adult version for children involves careful consideration of not only developmentally appropriate language, but also, an item and response structure (Yes-No versus Likert-type) and a form of expression (first or second person), among other details.…”

“…The shorter timeframes were from seven days in the Children’s Revised Impact of Event Scale (CRIES; Dyregrov & Yule, 1995 ) to 14 days in the CATS (Sachser et al, 2017 ). The longest period for symptoms was six months in the Brief Trauma Symptom Screen for Youth (BTSSY; Tyler et al, 2019 ). The open and perhaps more accurate timeframe was ‘since the accident’ in the Child Trauma Screening Questionnaire (CTSQ-10; Kenardy et al, 2006 ).…”

“…A child self-report is considered a more accurate measure of traumatic stress symptoms than a parental or caregiver report (Kassam-Adams et al, 2013 ; Sachser et al, 2017 ). However, the use of first-person statements, as in the UCLA Child/Adolescent PTSD Reaction Index for DSM‐5 (Rolon-Arroyo et al, 2020 ) or the BTSSY (Tyler et al, 2019 ), may appear suggestive and inadvertently lead children and adolescents to ‘agree’ with such statements. Formulating second-person questions as in the CRIES (Dyregrov & Yule, 1995 ), the CTSQ-10 (Kenardy et al, 2006 ), or the Structured Trauma-Related Experiences and Symptoms Screener (STRESS; Grasso et al, 2015 ) allows a more direct self-appraisal of child’s symptoms.…”