The STRESS is a 10- to 15-minute assessment designed to assess (1) lifetime exposure to several domains of potentially traumatic events and other adverse experiences and (2) clinical symptoms of posttraumatic stress disorder (PTSD) and impairment as defined by the Diagnostic and Statistical Manual for Mental Disorders 5 th Edition (DSM-5). The STRESS has been tested in various youth and adult populations and has shown good psychometric properties. Symptom items have shown excellent fit with the DSM-5 four-factor symptom structure.
The STRESS differs from other trauma assessments in several ways including: (a) assessing DSM-5 based PTSD symptoms of intrusion, avoidance, negative alterations in cognition and mood, arousal/reactivity, and dissociation; (b) not limiting symptom questions to one index traumatic event, but allowing symptom questions to pertain to any one or more events; (c) using a relatively brief retroactive reporting period to reduce reporting bias (i.e., past week); (d) assessing other adverse experiences that often co-occur with trauma and inform case conceptualization and planning; (e) yielding a measure of cumulative trauma or poly-victimization for estimating risk; (f) obtaining age of exposure for each event for estimating risk; (g) carefully designed for administration and interpretation by both clinicians, as well as non-clinically trained professionals; and (h) being available for web- based administration with options for reading items aloud, scoring, and generating reports.
Psychometric Publications
- Grasso, D.J., Felton, J.W.J.W., Reid-Quiñones, K., 2015. The structured trauma-related experiences and symptoms screener (Stress): Development and preliminary psychometrics. Child Maltreat. 20, 214–220.
- Grasso, D.J., Ford, J.D., Greene, C.A., 2019. Preliminary psychometrics of the Structured Trauma-Related Experiences and Symptoms Screener for Adults (STRESS-A) in an urban prenatal healthcare clinic. Psychol. Trauma 11.
- McGuire, A., Beebe, R., Stover, C., Clough, M., DiVietro, S., & Grasso, D. J. (2021). Structured Trauma-Related Experiences and Symptoms Screener for Adults (STRESS-A): Validation in a child welfare sample of mothers and fathers with active domestic violence. Psychological trauma: theory, research, practice, and policy.
- Weinberger, E. C., Cruise, K. R., Auguste, E. E., & Samuels, J. K. (2023). The Structured Trauma-Related Experiences and Symptoms Screener (STRESS): Assessing factor structure and clinical utility in a juvenile justice sample. Psychological Trauma: Theory, Research, Practice, and Policy, 15(Suppl 1), S143–S153.
Other Relevant Publications
- Diestel, A. J., Price, M., Hidalgo, J. E., Contractor, A. A., & Grasso, D. J. (2023). Linkages between childhood maltreatment, intimate partner violence, and posttraumatic stress disorder symptoms in pregnant Hispanic women: a network analysis. Child maltreatment, 28(2), 243-253.
- Ford, J. D., Cruise, K. R., Grasso, D. J., & Holloway, E. (2018). A study of the impact of screening for poly-victimization in juvenile justice: The rocky road to a successful investigation in the real world. Journal of interpersonal violence, 33(5), 810-831.
- Goldstein, B. L., Briggs-Gowan, M. J., & Grasso, D. J. (2021). The effects of intimate partner violence and a history of childhood abuse on mental health and stress during pregnancy. Journal of family violence, 36, 337-346.
- Grasso, D. J., Doyle, C., & Koon, R. (2019). Two rapid screens for detecting probable post-traumatic stress disorder and interpersonal violence exposure: Predictive utility in a juvenile justice sample. Child maltreatment, 24(1), 113-120.
- Grasso, D. J., Drury, S., Briggs-Gowan, M., Johnson, A., Ford, J., Lapidus, G., ... & Covault, J. (2020). Adverse childhood experiences, posttraumatic stress, and FKBP5 methylation patterns in postpartum women and their newborn infants. Psychoneuroendocrinology, 114, 104604.
- Greene, C. A., McCoach, D. B., Briggs-Gowan, M. J., & Grasso, D. J. (2021). Associations among childhood threat and deprivation experiences, emotion dysregulation, and mental health in pregnant women. Psychological trauma: theory, research, practice, and policy, 13(4), 446.
- Hashweh, N., Johnson, F., Chrusciel, T., & Barnes, A. (2023). Effect of trauma-informed supervision in youth detention center: A retrospective study. Journal of Family Trauma, Child Custody & Child Development, 1-14.
- Jouriles, E. N., Johnson, E., Rancher, C., Johnson, J. L., Cook, K., & McDonald, R. (2022). Adolescents who have been sexually abused: trauma symptoms and self-blame while waiting for treatment. Journal of Clinical Child & Adolescent Psychology, 1-10.
- Consider the optimal timing for administration
- Establish good working rapport, but remain non-judgmental
- Ensure that the respondent is in a private place and comfortable
- Introduce the STRESS and specify the amount of time it will take and general instructions
- Establish the degree of assistance needed to complete the assessment
- Encourage respondents to ask questions if any come up during the assessment
- Know that respondents may become uncomfortable or distress when completing questions, and this is okay. Be mindful of respondents’ reactions and ensure that support is available should the respondent need it. Make explicit the option to talk to and seek report from you and/or another professional during or after completion.
- Explain how assessment results will be used to plan services and how results will not be used
- Be clear about any limits to confidentiality
- Share results of the assessment with the respondent
- Allow the respondent to elaborate on aspects of the assessment if s/he chooses to
- Be mindful of child or elder abuse reporting laws
Results will include:
- Trauma-related experiences: a list of all endorsed trauma exposures followed by how old the respondent said s/he was when the trauma occurred or started to occur
- PTSD Symptom Clusters: Severity and whether diagnostic criteria are met
- Intrusive Symptoms (Criterion B): Recurrent intrusive thoughts and memories, nightmares, intense emotional and physical distress in response to trauma reminders
- Avoidance Symptoms (Criterion C): Purposeful or involuntary avoidance of people, places, activities, or situations that serve as reminders of the trauma
- Negative Cognitions and Mood Symptoms (Criterion D): Negative thoughts and mood including intense emotions, reduced interest in activities, detachment from others, and distorted thoughts that “I am unworthy, others are untrustworthy, and the world is dangerous”
- Arousal/Reactivity Symptoms (Criterion E): Irritability, aggression, hyperarousal, difficulty concentrating, problems with sleep
- Dissociative symptoms (diagnostic specifier): Reduced awareness of self/surroundings, experiencing things as not real or dreamlike
- Whether symptoms were present for the past month
- Functional Impairment Indicators
- Whether full or partial diagnosis of PTSD is likely
Sample Reports:
This screening tool is designed to be administered and interpreted by professionals qualified to do so. This may include psychologists, psychiatrists, mental health care providers, social workers, pediatricians, nurse practitioners, school counselors, and others trained in the use and interpretation of mental health screens. Use of this tool by non-qualified individuals do so at their own risk. We are not responsible for misuse of these tools, nor use and interpretation by non-qualified individuals.
The Trauma-Related Symptoms and Impairment Rapid Screen (TSIRS) is a very brief screening tool designed to detect traumatic stress symptoms and flag when probable posttraumatic stress disorder (PTSD) is likely. The rapid screen was developed to address the demand for efficient, effective, and user-friendly tools for use in settings where universal screening of trauma and related symptoms is recommended, but training and expertise in clinical assessment is generally lacking or absent. The TSIRS is comprised of 10 yes-or- no questions and takes less than one minute to complete. The TSIRS does not screen for exposure to trauma, but acknowledges in the instructions that most people experience one or more traumatic or violent events in their lifetime, with some developing problems or impairment. Respondents are instructed to indicate how much each statement is true for them by choosing “yes” or “no.” Items refer to problems with emotions or behavior that they may have had in the past month because of exposure to trauma or violence. Because base-rates of trauma exposure are high in the general population, and higher still in high-risk settings, screening for trauma exposure does not add predictive value, and omitting these items can save time. The first five TSIRS items map on to the 4 DSM-5 PTSD symptom clusters, with Criterion E (alterations in arousal and reactivity) represented twice (e.g., “I act angry or aggressive towards others,” “I react to situations in unhealthy or harmful ways”). These items were constructed to capture these criteria in the most concise format possible. The last five items assess aspects of functional impairment (e.g., “I do poorly at work or school,” “I do not get along with my family, friends, or other people”). The TSIRS has been tested in a juvenile population with evidence of good predictive utility for probable PTSD (sensitivity = .93, specificity = .54, PPV = .49, NPV = .94). Additional research is underway.
Relevant Publications
- Grasso, D.J., Doyle, C., Koon, R., 2019. Two Rapid Screens for Detecting Probable Post-Traumatic Stress Disorder and Interpersonal Violence Exposure: Predictive Utility in a Juvenile Justice Sample. Child Maltreat. 24, 113–120. https://doi.org/10.1177/1077559518808584
Administration Guidelines
- Consider the optimal timing for administration
- Establish good working rapport, but remain non-judgmental
- Ensure that the respondent is in a private place and comfortable
- Introduce the TSIRS and specify the amount of time it will take and general instructions
- Establish the degree of assistance needed to complete the assessment
- Encourage respondents to ask questions if any come up during the assessment
- Know that respondents may become uncomfortable or distress when completing questions, and this is okay. Be mindful of respondents’ reactions and ensure that support is available should the respondent need it. Make explicit the option to talk to and seek report from you and/or another professional during or after completion.
- Explain how assessment results will be used to plan services and how results will not be used
- Be clear about any limits to confidentiality
- Share results of the assessment with the respondent
- Allow the respondent to elaborate on aspects of the assessment if s/he chooses to
- Be mindful of child or elder abuse reporting laws
Interpreting Results
Results will include each item and whether the respondent endorsed the item. Results will indicate
whether probable PTSD is likely based on a cut-score of 2 or more endorsed criterion symptoms.
This screening tool is designed to be administered and interpreted by professionals qualified to do so. This may include psychologists, psychiatrists, mental health care providers, social workers, pediatricians, nurse practitioners, school counselors, and others trained in the use and interpretation of mental health screens. Use of this tool by non-qualified individuals do so at their own risk. We are not responsible for misuse of these tools, nor use and interpretation by non-qualified individuals.
The Dimensions of Violence Exposure Rapid Screen (DVERS) is a very brief screening tool designed to detect exposure to characteristics of trauma exposure conferring high risk for psychological impairment. The rapid screen was developed to address the demand for efficient, effective, and user- friendly tools for use in settings where universal screening of trauma and related symptoms is recommended, but training and expertise in clinical assessment is generally lacking or absent. The DVERS is comprised of 10 yes-or- no questions and takes less than one minute to complete. The DVERS acknowledges that many people experience violence at some point in their lives. It instructs respondents to choose yes or no to items that refer to aspects of interpersonal trauma exposure that have been shown to confer high risk for developing trauma-related impairment. These include violent experiences that: (1) caused significant harm or risk of death to the respondent or a loved one, (2) persisted over time, (3) occurred at early stages of development, (4) involved multiple forms, (5) involved sexual assault, (6) involved multiple perpetrators, and (7) was perpetrated by a caregiver or an intimate partner. The content of these items was derived from research focusing on risk associated with specific types of interpersonal trauma exposure, cumulative exposure, and poly- victimization. The DVERS is the first known screen that relies on characteristics of trauma exposure in the absence of symptom questions to detect probable impairment. There may be value in focusing on event information, which is more tangible than assessing one’s perception of emotional or behavioral problems; for example, when respondents are deemed poor informants. The DVERS has been tested in a juvenile population with evidence of good predictive utility for probable PTSD (sensitivity = .87, specificity = .59, PPV = .51, NPV = .90) and poly-victimization based on trauma events inventoried on the STRESS (sensitivity = .86, specificity = .63, PPV = .59, NPV = .88). Additional research is underway.
Relevant Publications
- Grasso, D.J., Doyle, C., Koon, R., 2019. Two Rapid Screens for Detecting Probable Post-Traumatic Stress Disorder and Interpersonal Violence Exposure: Predictive Utility in a Juvenile Justice Sample. Child Maltreat. 24, 113–120. https://doi.org/10.1177/1077559518808584
Administration Guidelines
- Consider the optimal timing for administration
- Establish good working rapport, but remain non-judgmental
- Ensure that the respondent is in a private place and comfortable
- Introduce the TSIRS and specify the amount of time it will take and general instructions
- Establish the degree of assistance needed to complete the assessment
- Encourage respondents to ask questions if any come up during the assessment
- Know that respondents may become uncomfortable or distress when completing questions, and this is okay. Be mindful of respondents’ reactions and ensure that support is available should the respondent need it. Make explicit the option to talk to and seek report from you and/or another professional during or after completion.
- Explain how assessment results will be used to plan services and how results will not be used
- Be clear about any limits to confidentiality
- Share results of the assessment with the respondent
- Allow the respondent to elaborate on aspects of the assessment if s/he chooses to
- Be mindful of child or elder abuse reporting laws
Interpreting Results
Results will include each item and whether the respondent endorsed the item. Results will indicate whether trauma-related psychological impairment is likely based on a cut-score of 3 or more endorsed items.
This screening tool is designed to be administered and interpreted by professionals qualified to do so. This may include psychologists, psychiatrists, mental health care providers, social workers, pediatricians, nurse practitioners, school counselors, and others trained in the use and interpretation of mental health screens. Use of this tool by non-qualified individuals do so at their own risk. We are not responsible for misuse of these tools, nor use and interpretation by non-qualified individuals.