The Structured Trauma-Related Experiences and Symptoms Screener (STRESS): Assessing factor structure and clinical utility in a juvenile justice sample.

Abstract

Objective: High prevalence of traumatic event exposure and posttraumatic stress disorder (PTSD) among justice-involved adolescents has necessitated the use of trauma screening in juvenile justice settings. The present study explored the psychometric properties, factor structure, and construct validity of a trauma screen, the Structured Trauma-Related Experiences and Symptoms Screener (STRESS), in a detained adolescent sample. Prior to the current study, psychometric characteristics of the STRESS were evaluated only in a child welfare sample (Grasso et al., 2015). Method: The sample consisted of 132 adolescents in secure detention facilities in a southeastern state. Participants were included in the study if they engaged in the mental health screening process at intake and a follow-up assessment process with facility staff psychologists. Data consisted of de-identified, archival records. Results: The STRESS total symptom and 4 criterion symptom count scores demonstrated high internal consistency. Confirmatory factor analysis revealed that the STRESS had excellent fit with the DSM-5 four-factor PTSD model. Equally strong evidence was found for a higher order PTSD model, thus reinforcing the use of both STRESS PTSD total and criterion symptom count scores with justice-involved adolescents. Additionally, preliminary evidence of convergent and discriminant validity was supported. Conclusions: Findings support the STRESS as a reliable and valid trauma screen for use with detained adolescents. Results suggest that both STRESS total symptom and criterion symptom count scores have clinical utility for intake-level mental health decisions in juvenile detention settings. Implications for expanding use of the STRESS to inform appropriate interventions for justice-involved adolescents are discussed. Clinical Impact StatementThis is the first known study to investigate the psychometric properties, factor structure, and construct validity of the STRESS in a juvenile justice sample of detained adolescents. Screening for trauma symptoms has become standard practice in the juvenile justice system. However, no one widely accepted, empirically supported tool exists. Establishing psychometric characteristics is critical to increase confidence in the screening process and to provide recommendations for how a screen can be used to appropriately identify adolescents in need of services. The present findings suggest that the STRESS has clinical utility for intake-level mental health decisions in secure juvenile detention settings.