NRNP 6654 Week 5 Trauma-Informed Assessment Example

Trauma-Informed Assessment: A Shelter Clinic Intake Rewritten to Open on Control, With Three Questions Removed and Each Change Tied to a Principle

Student Name

College of Nursing, Walden University

NRNP 6654: Psychiatric Mental Health Advanced Practice Nursing Care of Vulnerable/Special Populations

Instructor Name

Month Day, Year

Trauma-Informed Assessment: A Shelter Clinic Intake Rewritten to Open on Control, With Three Questions Removed and Each Change Tied to a Principle

What This Document Is

Part one is the rewritten intake for a psychiatric clinic held in a homeless shelter. Part two is the rationale. No one has answered these questions, and no responses appear here. The original intake was a standard outpatient form: demographics, reason for referral, full psychiatric history, a trauma checklist with details, legal history, substance use, then current symptoms and risk.

Part One: The Instrument

Opening, read aloud before any question: "You can skip any question, stop at any time, or ask to finish another day. Nothing you skip will affect whether you can be seen here or keep your bed. I will tell you before I write anything down, and you can see what I write. Would you like to sit where you can see the door?"

Section A, today: What would you like help with today? Is there anything you need right now, such as food, water, or a bathroom, before we start? Is there somewhere you need to be later today?

Section B, how you have been: In the past two weeks, how has your sleep been? Your mood? Your appetite? Is anything making it hard to get through the day?

Section C, a practice stop: "We have done a few questions. Would you like to keep going, take a break, or stop here for today?" The answer is recorded and followed.

Section D, safety now: Do you feel safe where you are staying? Have you had thoughts of hurting yourself or ending your life? Of hurting someone else?

Section E, substances, asked without judgment: Do you use alcohol or other drugs? Would you like help with that, now or later?

Section F, past experiences, in general terms: "Many people who come here have been through hard or frightening things, now or in the past. You do not need to tell me what happened. Has something like that happened to you? Does it still affect you now?" Yes or no is enough.

Closing: What went well about this conversation, and what should I do differently next time?

Part Two: Control Before History

The original form opened with history. The rewrite opens on what the person can decline, pause, or postpone, and connects it to the thing that matters most in a shelter: keeping a bed. SAMHSA's guidance names empowerment, voice, and choice, together with safety and trustworthiness and transparency, among six principles of a trauma-informed approach (Substance Abuse and Mental Health Services Administration, 2014). The opening puts those three into practice before a single clinical question is asked. The practice stop in Section C matters more than its length suggests: by the time the questions about safety and the past arrive, the person has already chosen once to stop or continue and seen the choice respected. Without that experience, the permission to skip at the top is a promise; after it, it is something they have seen kept.

Three Items Removed, With Reasons

First removed: "Describe any physical or sexual abuse you have experienced, including who, when, and how often." It gathered a detailed trauma history at a first contact. The information that matters for today's plan, whether past trauma affects him now, is gathered by Section F with a yes or no; the detail can wait until he chooses to give it, if ever. Asking for it now risks the retraumatization SAMHSA's guidance asks services to avoid (Substance Abuse and Mental Health Services Administration, 2014).

Second removed: "Have you ever been arrested? What for?" It gathered legal history, which a shelter resident may reasonably fear will be passed on. It is not needed for today's plan, and when it matters, for example for housing applications, it can be asked with its purpose explained.

Third removed: "Why did you become homeless?" It gathered a cause, but it places the explanation inside the person, and in a shelter it is the question asked at every door. Its useful content, current stressors, is covered by Sections A and B.

Principles Cited to Their Sources

The reordering follows the principles in the SAMHSA guidance, which asks services to realize how widespread trauma is, recognize its signs, respond by building that knowledge into practice, and actively resist retraumatization (Substance Abuse and Mental Health Services Administration, 2014). Hopper et al. (2010), reviewing trauma-informed care in homelessness services, describe it as a strengths-based framework grounded in responsiveness to trauma's impact, with an emphasis on physical, psychological, and emotional safety and on chances for survivors to rebuild a sense of control. That emphasis on control is what moved the opening. The general question in Section F assumes that past adversity is common: in the Adverse Childhood Experiences study, more than half of respondents reported at least one category of childhood exposure, and those with four or more had substantially higher risks of alcoholism, drug use, depression, and suicide attempts (Felitti et al., 1998).

What the Rewrite Costs

The rewrite gathers less on the first day. Diagnosis of post-traumatic stress disorder will take longer, since the detail it needs is deferred. The practice stop adds minutes to a short visit, and some people will choose to stop before the safety questions, which then have to be asked at the next contact or, if there is concern, asked directly anyway. These costs are real and are accepted for a specific reason: in a clinic where many people do not return, an intake that feels safe is more likely to produce a second visit, and the second visit is where the missing detail can be gathered.

References

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258. https://doi.org/10.1016/S0749-3797(98)00017-8

Hopper, E. K., Bassuk, E. L., & Olivet, J. (2010). Shelter from the storm: Trauma-informed care in homelessness services settings. The Open Health Services and Policy Journal, 3, 80-100. https://doi.org/10.2174/1874924001003020080

Substance Abuse and Mental Health Services Administration. (2014). SAMHSA's concept of trauma and guidance for a trauma-informed approach (HHS Publication No. SMA 14-4884). https://library.samhsa.gov/product/samhsas-concept-trauma-and-guidance-trauma-informed-approach/sma14-4884