Clinical Social Work Practice Decisions: Standardized Assessment Domains As Predictors of Prescription of Trauma-Focused Treatment

Background/Purpose:

Social workers who practice in child welfare and behavioral health work with youth who have traumatic experiences, yet the associated effects on youth emotional and behavioral wellbeing may be unrecognized, overlooked, or untreated. An assessment to identify youth needs is vital as an initial step to receiving needed treatment. Standardized assessments in particular can serve as an effective starting point in addressing the needs of youth with traumatic experiences. The purpose of this presentation is to explore if standardized assessment domains were associated with a prescribed treatment. More specifically, this cross-sectional study examined if domains of the Child and Adolescent Needs and Strengths (CANS) assessment were associated with a prescribed trauma-focused treatment.

Methods:

The sample consisted of children in out-of-home care in one southern state who were administered a standardized functional assessment. The sampling frame consisted of all children who entered out-of-home care during the study time period, were administered a functional assessment, and were five years of age or older on the date of their initial functional assessment (N=2342). The primary independent variables for this study were domains from the CANS assessment including (1) life domain functioning, (2) acculturation, (3) child strengths, (4) child emotional/behavioral needs, (5) child risk behaviors, and (6) caregiver needs/strengths. The CANS assessment is a communimetric, not psychometric, tool interpreted at the item level. Increased scores suggest greater problems. The dependent variable in this study was a dichotomous prescribed treatment variable of trauma-focused treatment. Covariates of age, race, and gender were included. Bivariate ANOVA, chi-square, and multivariate binary logistic regression analyses were employed.

Results:

Over half of the sample was assessed to have trauma symptoms, and one-fourth of the sample was prescribed a trauma-focused treatment. Younger youth, girls, and youth who identify as African American or as a race in the Other/Multiple race category had greater odds of being prescribed a trauma-focused treatment. As CANS ‘life domain functioning’ scores increased, the odds of being prescribed a trauma-focused treatment decreased. As ‘emotional behavioral needs’, and ‘caregiver/ needs and strengths’ scores increased, so too did the odds of being prescribed a trauma-focused treatment.

Conclusions and Implications:

Findings have training and supervision implications for social workers practicing in child welfare and behavioral health, and can aid in understanding the characteristics and needs of the youth served. Child welfare and behavioral health systems can be better calibrated to meet children’s needs if standardized instruments are used. There was a sizeable portion of youth in the study with identified trauma-related symptoms who were not prescribed a trauma-focused treatment; which is consistent with prior research and suggests traumatized youth in out-of-home care are undertreated. There is a need to investigate those youth who were assessed to have trauma-related symptoms, yet were not prescribed a trauma-focused treatment. Using similar language from standardized assessments allow child welfare and behavioral health workers to better communicate and collaborate to serve youth. Findings from this study promote evidence-informed practice in child welfare and behavioral health so that social workers can better serve children and families.