School-Counselor Interventions: Assessment
Throughout the assessment process, you must consider contextual factors, such as the student's age, cognitive functioning, ability to identify or label emotions, capacity to express thoughts clearly, cultural background, gender, social skills, and family and social support. 20 Constructing genograms, schematic drawings of family members, allows the counselor and student to view, graphically, complex information about the student's family, its patterns, and their relationships to one another. 21 In the following demonstration, Beverly James, a social-work child-trauma therapist, illustrates the process of constructing a genogram with a child.
It is important, whenever possible, to gather a detailed profile of the student before, during, and after the trauma through interviews with the student, teacher, parents, or caretakers. In this way you can obtain a comprehensive assessment that will inform and guide your treatment plan. Keep in mind that you should always inquire about trauma histories in students who complain of depression, anxiety, or substance abuse since these often coexist with PTSD. 7
When a student is referred to you, your first step is to determine whether
- the student was directly or indirectly exposed to a perceived or real traumatic event
- the symptoms include reexperiencing the traumatic event, avoidance, emotional numbing, and increased arousal. Review Course 1, Part 1: Impact
- the symptoms are interfering with the student's functioning
- there is evidence of suicidality (thoughts, threats, actions) 19
Among school-age children, adolescents are at highest risk for suicide. However, studies have shown that even very young children can be suicidal. 22 Thus, it is imperative that when students, no matter their age, express any form of suicidality, they be taken seriously. All school personnel should be advised that they are required to refer such students to you immediately for a comprehensive suicide assessment.
When trauma symptoms are intense and persist for over one month without improvement, experts recommend psychotherapy to reduce the risk of chronic symptoms. When a student is unresponsive to therapy, it is important to explore the possibility of substance abuse or other comorbid disorders such as depression. 23 Once these disorders are ruled out, we recommend that you consult a psychopharmacologist about the possibility that medication is indicated. Because of the important role of psychopharmacology in treatment of severe PTSD, it is essential that you have access to a psychopharmacologist who can do a thorough medication assessment of children and adolescents.
In addition to face-to-face interviews, there are a variety of measures that have been recommended for assessing behavior, trauma symptoms, and PTSD in children and adolescents. 11