As a doctor or nurse practicing trauma informed care, you've likely incorporated, or want to start incorporating,  a screening assessment with all your patients to determine their level of distress. Once you assess your patient's distress level, how do you know if, or when, your patient needs a mental health referral?  

Initial distress among pediatric patients and families is common, expected, and understandable in response to injury or illness. Many patients and families cope well, with support and with time. However, some may develop persistent traumatic stress reactions, which can impede health and psychosocial functioning. To determine which patients may need additional support, first start by asking your patients (and their parents) about reactions and coping, either by using the DEF Protocol or another screening tool. Make sure to listen for ongoing or severe traumatic stress symptoms. You should consider a referral for a more thorough evaluation with a mental health professional if your patient expresses:

  • Traumatic stress reactions are severe or prolonged (more than a month).
  • Traumatic stress reactions interfere with recovery or with returning to normal activities.
  • Consider: Is the child participating in daily activities to the extent possible given their medical condition? Are stress reactions interfering with treatment adherence? Are new fears or worries troubling the child or parent?



The majority of your patients will benefit from psychoeducation, comfort, and basic assistance. Only a small number of patient and families with acute distress may need to be monitored and require interventions that focus on reducing symptoms of traumatic stress or promoting adjustment or adherence to medical treatment.  An even smaller minority of patients and families will experience distress severe enough to impede active medical treatment. These families may require intensified psychosocial services and/or mental health treatment. Should you determine a mental health referral is necessary for one of your patients, make sure to follow the recommended steps and include the patient and family in each part of the process.