Recognize Trauma

What is Trauma?

Trauma can mean different things to different people. Children and adolescents may experience trauma from an event, repeated events, or set of circumstances that are physically or emotionally harmful. Traumatic stress has a negative impact on a child’s mental, social, or emotional well-being and can have lasting adverse effects.

The National Child Traumatic Stress Network (NCTSN) has identified 13 different kinds of traumatic stress children may be exposed to. Although this is not an exhaustive list of the types of events than can cause trauma to a child, it gives you an idea of the most common types of traumatic events. The trauma is determined by the child's experience and interpretation of the event or conditions.

Types of Traumatic Stress

Do You Know Your ACE Score?

The Centers for Disease Control and Prevention and Kaiser Permanente have been collaborating for several decades to conduct research on the impact of adverse childhood experiences, or ACEs, on a person’s life. To find out your ACE score, or to see how adverse childhood experiences may affect a child you know, take the 10-question test.

Take the 10-question ACE test now

How Do You Know?

Children suffering from traumatic stress symptoms generally have difficulty regulating their behaviors and emotions. They may be clingy and fearful of new situations, easily frightened, difficult to console, and/or aggressive and impulsive. They may also have difficulty sleeping, lose recently acquired developmental skills, and show regression in functioning and behavior.

Generally these reactions fall into three main categories: cognitive, behavioral and physiological.


  • Demonstrate poor verbal skills or setbacks in speech development
  • Exhibit memory problems
  • Have difficulties focusing or learning in school
  • Develop learning disabilities
  • Show poor skill development


  • Display excessive temper
  • Demand attention through both positive and negative behaviors
  • Exhibit rage or aggressive behaviors
  • Act out in social situations
  • Scream or cry excessively
  • Are verbally abusive
  • Exhibit regressive behaviors
  • Exhibit helplessness
  • Imitate or re-enact the abusive/traumatic event
  • Startle easily
  • Are unable to trust others or make friends
  • Believe they are to blame for the traumatic experience
  • Fear adults who remind them of the traumatic event
  • Clinginess or fear of being separated from parent/caregiver
  • Are anxious and fearful and avoidant
  • Shows irritability or restlessness
  • Shows fearfulness or anxiety
  • Exhibits sadness or depression
  • Act withdrawn from family and friends
  • Lack self-confidence
  • Drug use


  • Have a poor appetite, low weight, and/or digestive problems
  • Experience stomachaches and headaches
  • Have poor sleep habits
  • Experience nightmares or sleep difficulties
  • Wet the bed or self after being toilet trained or exhibit other regressive behaviors

What Can I Do?

When you’re trying to offer help to a child who experienced a traumatic experience, it’s not always easy to know the right thing to do. Here are some steps you can take to support children by opening communication, and offering emotional support.

  1. Let children know they are safe and that trustworthy people are in control.
  2. Encourage children to talk about the trauma and their feelings as much as they want.
  3. Let children know you understand the seriousness of their experience.
  4. Listen patiently, without criticism or judgment.
  5. Answer children’s questions about the traumatic event in words they can understand.
  6. When children are reminded of the trauma, let them know you want to help them.
  7. If they experience guilt, reassure children that the event was not their fault.
  1. Spend extra time with children and return to normal routines as quickly as possible.
  2. Set and adhere to routines and schedules.
  3. Engage in age-appropriate activities that stimulate the mind and body.
  4. Find ways to have fun and relax together.
  5. Honor family traditions that bring children close to the people they love.
  6. If parents have difficulty dealing with a traumatic event, they should explain to their children that they are reacting to a memory and the children are not to blame.

Is it time to get help?

If a child’s response to trauma becomes worse, instead of improving over time, it may be time to seek a referral to a trained and qualified mental health professional.

  • Withdrawal from friends or family
  • Lack of participation in family activities
  • Refusal to go to school for weeks or months
  • Inability to concentrate, resulting in lower grades than usual
  • Talking and thinking only about fear, grief or guilt
  • Fear of leaving the house or doing usual activities
  • Dropping out of activities previously enjoyed

Sources: National Child Traumatic Stress Network (, American Psychological Association

Free Trauma Informed Care Consultation

The Trauma Informed Care Clinical Group is a subcommittee of the COACT Colorado System of Care, an initiative funded by the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services. The initiative is housed within the Colorado Department of Human Services, Office of Behavioral Health, in partnership with the Office of Children, Youth and Families. The Trauma Informed Care Clinical Group is comprised of licensed mental health professionals with extensive experience serving at-risk children and families. The group provides free consultation to organizations serving children and families who have experienced trauma.

Listen to Dr. Jerry Yager, Clinical Psychologist, talk about what educators and counselors should know about traumatic stress in children.

As part of the State’s effort to support an ongoing development of a trauma-Informed, integrated system of care to improve mental health and child welfare outcomes, the clinical group, which meets the third Tuesday of every month, is offering the following services free of charge:

  • Individual case consultations
  • Organizational consultations to create and implement Trauma Informed Care policies

To request consultation from this group, please contact Dr. Ashley Brock-Baca at or Dr. Jerry Yager at

The Trauma Informed Care Clinical Group is led by Dr. Jerry Yager, a clinical psychologist with more than 25 years of experience in the assessment and treatment of traumatized children and adolescents. He specializes in working with adolescents who exhibit self-destructive behavior and have severe mental illness such as clinical depression, bipolar mood disorder, post-traumatic distress disorder, and psychosis. Jerry is currently the Director of Programs at the Denver Children’s Advocacy Center. Prior to this, Jerry was the Executive Director of the Denver Children's Home, which shares a mission with DCAC to provide high quality mental health care for low-income children whose problems would otherwise go undiagnosed and untreated.


For a mental health evaluation that includes a trauma assessment, you can refer a child to a local mental health provider in their community. If you need assistance finding a mental health provider, use the COACT Colorado Community Resource Directory. Be sure to mention your concerns about trauma when making the referral.

Call 1-844-493-8255 (1-844-493-TALK) to reach the statewide 24/7 hotline with trained crisis clinicians and peer support specialists. You can also contact the Denver Children's Advocacy Center at 303.825.3850 or the Kempe Center at 303.864.5300.

If you or someone you know needs immediate help, go to Get Help Now. For information on Trauma Informed Care training for your agency, please contact Ashley Brock-Baca, PhD at the Office of Behavioral Health.

Title IV-E Waiver Trauma Screening Information

Mental health providers: click here to register for access to a Google form to enter your trauma screening data. Contact Patty Montoya for assistance with Google forms at

Click here to see the slides from the webinar on the Title IV-E Waiver screening, assessment, and treatment.

Click here for the Title IV-E Waiver screening, assessment, and treatment flow chart.

Trauma Assessment Tools for Mental Health Providers

See the flow chart for ages and instructions. Contact Claudia Zundel at if you need the Trauma Symptom Checklist for Young Children.

Child PTSD Symptom Scale, Parent Version

Child PTSD Symptom Scale, Youth Version

Child PTSD Symptom Scale Scoring

Adult/Caregiver PTSD Checklist

Young Child PTSD Checklist

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COACT Colorado is a cooperative initiative between the Colorado Department of Human Services and other state, local, and federal partners