Quality and use of trauma histories obtained from psychiatric outpatients through mandated inquiry

OBJECTIVE: A growing awareness of the sequelae of trauma has prompted clinical and administrative mandates that psychiatric assessments must include inquiry about whether patients have experienced trauma or abuse. This study was designed to assess how a trauma history obtained through mandated inquiry is recorded and how it is used in diagnostic formulation and treatment planning. METHODS: Histories of physical and sexual abuse and other trauma were reviewed in the charts of 180 outpatients receiving psychotherapy at an urban teaching hospital clinic. The extent and variety of traumatic experiences and the quality of clinicians' assessment of trauma histories were measured by a rating instrument developed for the study. RESULTS: Mandated inquiry led to the detection of histories of traumatic experiences for 72 patients (40 percent). The recognition of trauma did not trigger appropriate evaluation. Only 11 percent of clinicians mentioned posttraumatic stress disorder symptoms. Only one in ten charts of patients with histories of trauma contained diagnostic assessments or treatment plans that adequately incorporated the trauma history as a factor in the patient's presentation for treatment. CONCLUSIONS: Although mandated inquiry led to the detection of substantial abuse and trauma, this information was rarely used in assessment and treatment planning. Implementation of mandated inquiry should be accompanied by relevant education and supervision to ensure that clinicians understand the diagnostic and treatment implications of past trauma.