Development of a Pediatric Screening Tool for Trauma Exposure & Developmental Milestones: Enhancing Early Identification of Childhood Trauma to Facilitate Occupational Therapy Intervention

Background: Exposure to traumatic events during early childhood can have lasting effects on the typical development of a child, impacting their occupational performance. Despite growing research highlighting the impact of childhood trauma on various developmental domains, early recognition is often challenging in primary care settings due to a lack of appropriate resources or time limitations to routinely administer screening tools. There continues to be a need for accessible, trauma-informed resources to support pediatricians in identifying children and families who may benefit from occupational therapy services. Objective: To develop a trauma-informed pediatric screening tool and accompanying educational resource for caregivers to enhance early recognition of developmental and behavioral concerns potentially related to trauma exposure and facilitate referrals for further occupational therapy intervention. ACOTE Area: Primary: Program Development; Secondary: Advocacy and Education Methods: This capstone project followed a program development design throughout 14 weeks. The pediatric screening tool and a caregiver educational resource were developed in collaboration with Cincinnati-based occupational therapists and co-founders of Holding Space Collaborative, Breanna Lynch and Kristen Brokamp. The screening tool was designed as a checklist-style caregiver report and includes sections on child and family history, developmental milestones and skills, and previous relevant experiences of the child and family. The educational flyer informs caregivers about the impact of trauma on child development and the role of occupational therapy in addressing these concerns. Feedback on content, format, clarity, and usability was gathered from the site mentors throughout the development process. The project focused on tool development and refinement, so no human subjects were recruited, and no outcome measures were collected. Results: The Childhood Development & Support Screener gathers essential information about the child from caregivers, including demographic information, developmental and behavioral checklists rooted in trauma-informed principles, and a history of potentially traumatic experiences. The structure is concise, using accessible language for application in primary care or pediatric settings. The caregiver educational flyer accompanies the screening tool to enhance understanding of occupational therapy’s role in addressing trauma-related concerns in children and families. Through the iterative feedback process, preserving clinical flexibility in interpreting the results of the screening tool was an important aspect. Therefore, no scoring rubric or rigid referral threshold was incorporated. Site mentor feedback determined that the final deliverables reflected best practices of trauma-informed care, were clinically relevant and were practical for pediatric primary care settings. Conclusions and Relevance: The capstone project deliverables contribute vital resources for advancing interdisciplinary collaboration and trauma-informed care in pediatric settings. By enhancing early identification of trauma-related developmental concerns and providing caregivers with education on occupational therapy, the tools developed from the capstone project may facilitate a pathway for referrals and increase caregiver engagement. Future directions include pilot testing the tools in primary care settings and collecting feedback from healthcare providers and caregivers to guide further refinement and validation.