Contents lists available at ScienceDirect Child Abuse & Neglect journal homepage: www.elsevier.com/locate/chiabuneg Two-generational trauma-informed assessment improves documentation and service referral frequency in a child protection program Sarah Kottenstette b, *, Rachel Segal a , Victoria Roeder b , Hannah Rochford d , Eric Schnieders b , Levent Bayman c , Devin A. McKissic b , Greta J. Dahlberg b , Rebecca Krewer b , James Chambliss b,d , Jennifer L. Theurer e , Resmiye Oral a a Carver College of Medicine, Department of Pediatrics, University of Iowa, 100 Hawkins Drive, Iowa City, IA, 52242, USA b Carver College of Medicine, University of Iowa, 375 Newton Road, Iowa City, IA, 52242, USA c College of Public Health, Clinical Trials Statistical & Data Management Center, University of Iowa, 2400 University Capital Centre, Iowa City, IA, 52242, USA d College of Public Health, Department of Health Management and Policy, University of Iowa, 145 N. Riverside Dr., Iowa City, IA, 52242, USA e Stead Family Children’s Hospital, Child Protection Program, University of Iowa, 100 Hawkins Drive, Iowa City, IA, 52242, USA ARTICLE INFO Keywords: Adverse childhood experiences Trauma Child abuse Child neglect Trauma-informed care Trauma-informed assessment ABSTRACT Background: Two-generational trauma-informed assessment (TIA) helps providers conduct hol- istic family well-being assessment (FWbA). This tool makes it possible to use families’ trauma history in the case-finding process. Objective: This study compares the documentation and frequency of adverse childhood experi- ences (ACEs) and service referral rates for index children and their caretakers in two groups of families evaluated in a child abuse clinic (CAC). Participants and setting: The sample consisted of 364 children stratified into two groups: Group 1 - children seen in the CAC after implementation of FWbA in years 2014, 2015, 2016 and Group 2 - children seen in the CAC prior to implementation of FWbA in years 2011, 2012, 2013. Methods: Researchers utilized retrospective chart review method and analyzed data regarding ACEs and service referrals for patients and their caregivers. Results: Documentation of ACEs was higher in Group 1 for children (77.7 % vs 26.6 %,p < 0.0001) and caretakers (60.7 % vs 7.3 % p < 0.0001). Caretakers in Group 1 had a higher rate of four or more ACEs (47.0 % vs 5.1 % p < 0.001) while the increase for children was not statistically significant (61.4 % vs 51.1 %, p = 0.110). Both children and caretakers were re- ferred to more services in Group 1 (2.7 + 1.5 vs 1.5 + 1.3, and 3.0 + 1.9 vs 1.2 + 1.2, respectively, p < 0.0001). Conclusions: In families evaluated for child abuse and neglect, conducting TIA in addition to https://doi.org/10.1016/j.chiabu.2019.104327 Received 12 July 2019; Received in revised form 21 November 2019; Accepted 10 December 2019 ⁎ Corresponding author. E-mail addresses: sarah-kottenstette@uiowa.edu (S. Kottenstette), rachel-segal@uiowa.edu (R. Segal), vstinson@phoenixchildrens.com (V. Roeder), hannah-rochford@uiowa.edu (H. Rochford), eric-schnieders@uiowa.edu (E. Schnieders), levent-bayman@uiowa.edu (L. Bayman), devin-mckissic@uiowa.edu (D.A. McKissic), greta-dahlberg@uiowa.edu (G.J. Dahlberg), rebecca-krewer@uiowa.edu (R. Krewer), james-chambliss@uiowa.edu (J. Chambliss), jennifer-theurer@uiowa.edu (J.L. Theurer), resmiye-oral@uiowa.edu (R. Oral). Child Abuse & Neglect 101 (2020) 104327 0145-2134/ © 2019 Elsevier Ltd. All rights reserved. T