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 abu se, This study was designed to assess how a trauma history obtained th rough mandated inquiry is recorded and how it is used in diagnostic fo rmulation and treatment planning. Methods: Histories of physical and s exual abuse and other trauma were reviewed in the charts of 180 outpat ients receiving psychotherapy at an urban teaching hospital clinic, Th e extent and variety of traumatic experiences and the quality of clini cians' assessment of trauma histories were measured by a rating instru ment developed for the study. Results: Mandated inquiry led to the det ection of histories of traumatic experiences for 72 patients (40 perce nt), 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 i ncorporated the trauma history as a factor in the patient's presentati on for treatment. Conclusions: Although mandated inquiry led to the de tection of substantial abuse and trauma, this information was rarely u sed in assessment and treatment planning, Implementation of mandated i nquiry should be accompanied by relevant education and supervision to ensure that clinicians understand the diagnostic and treatment implica tions of past trauma.