Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Natalie Murphy, Ph.D., APRN, FNP-BC


Julie Bertram, Ph.D., APRN, PMHCS-BC

Judy McCaul, MSN, CPNP-PC


Introduction: Exposure to adverse childhood events (ACEs) is common in foster children. Primary care providers are ideally positioned to advocate for foster care children through early identification and treatment of trauma-related symptoms and diagnoses during routine well-child assessments.

Purpose: This quality improvement project sought to institute a standardized trauma assessment instrument, the Childhood Behavioral Checklist (CBCL), to determine if there was an increase in the identification of trauma-related symptoms and diagnoses along with an increase in the rate of referral to mental health care (MHC).

Method: This quality improvement project used a descriptive, observational design to complete retrospective and prospective record reviews to measure the number of trauma-related symptoms, diagnoses, and the rate of referral to mental health care before and after implementation of the tool.

Results: The average number of trauma-related symptoms identified was higher with the institution of the CBCL (32.2 vs. 3.67 number of symptoms) with a significant difference in the mean rank and distribution of symptoms. There was no change in the number of identified diagnoses or rates of referral to MHC.

Implications: The use of a standardized trauma assessment tool increases the identification of trauma-related symptoms in foster care children in the primary care setting. Subsequently, use of the tool may improve documentation of trauma-related symptoms and improve reimbursement for trauma-related diagnoses. More detailed medical records for foster children may also offer greater continuity of care as they are transferred from home to home and provider to provider on interdisciplinary teams.