Assessment and interventions for child trauma and abuse

Children who present to primary health practitioners may have a history of trauma that is a significant, but perhaps undetected, factor in their physical health presentation. Traumatic events may range from a single incident experienced by a child who has had an otherwise uneventful childhood, such as an accident or natural disaster, to chronic abuse and neglect. In the latter case, a growing body of research has emerged internationally that clearly demonstrates many types of abuse and violence witnessed and experienced by children are not unique or singular experiences (Saunders 2003). It is not uncommon for children to have experienced a number of forms of abuse or violence on multiple occasions (Finkelhor er al. 2005). In addition, whether having experienced a single incident of trauma or multiple abuse and violence, some children may demonstrate resilience whereas others exhibit long-lasting effects. For these children, referral for treatment is imperative. To ensure best outcomes for this most vulnerable population, health care practitioners need to (1) be aware of the range of trauma presentations in children; (2) make or refer for assessments of trauma and abuse history, current risk and treatment needs; (3) refer for evidence-based treatment targeted to specific identified concerns; (4) monitor treatment progress and outcomes. This chapter aims to support this process for primary health care practitioners by providing information and guidelines, including working with parents, caregivers and therapists.