Assessment Guide  |   Dec 12, 2024  |   6 minute read

UCLA PTSD RI | UCLA PTSD Reaction Index

UCLA PTSD Reaction Index (UCLA PTSD RI) Assessment Guide

Recommended Frequency: Every 4-6 weeks

UCLA PTSD Reaction Index Summary

The UCLA PTSD Reaction Index for DSM-5 (UCLA PTSD RI) is a widely used evidence-based tool designed to assess trauma exposure and posttraumatic stress disorder (PTSD) symptoms in children and adolescents. The tool evaluates trauma history, PTSD symptoms, and associated behavioral, functional, and developmental impairment, providing insights that can be used for diagnosis, treatment planning, monitoring treatment progress, and documenting clinically significant treatment outcome. Based on the DSM-5 diagnostic criteria, it has been extensively validated through research and cited in over 300 scholarly articles.

The Index is available in multiple versions, including self-report and caregiver-report formats, and is suitable for various age groups, including children as young as six and up to 18 years old. It is primarily used for clinical assessment, although it is also effective as a progress monitoring tool throughout treatment. This combination of diagnostic and monitoring functions makes it a unique tool compared to other PTSD measures.

About the UCLA PTSD Reaction Index

The UCLA PTSD RI was developed in response to the evolving understanding of PTSD and has gone through several updates, corresponding with changes in the DSM (from DSM-III to DSM-5). It includes versions for both child and adolescent self-report, as well as formats for parent/caregiver report.

Psychometric Properties

The assessment is psychometrically robust, with demonstrated reliability and validity across diverse populations and trauma types. Studies have shown the Index is sensitive to clinical change, making it effective for measuring clinical outcomes throughout treatment.

Comparison to Other Assessments

The UCLA PTSD Reaction Index stands out because it not only measures PTSD symptoms but also includes trauma history and distress/impairment measures. It offers a comprehensive view of a child’s history of trauma experiences (including trauma-specific details and age(s) of occurrence of the trauma) and the impact of PTSD, unlike many other tools that focus solely on symptomatology.

Formats and Versions

The Index is available in several formats:

  • Child/Adolescent Self-Report
  • Parent/Caregiver Report
  • Parent/Caregiver Report for Children Aged 6 and Younger
  • UCLA Brief Screen for Child/Adolescent Trauma and PTSD
  • UCLA Brief COVID-19 Screen for Child/Adolescent PTSD

 

These versions allow for flexibility in how the measure is administered dependent on the child’s age and nature of trauma.

Who is the UCLA PTSD Reaction Index For?

The Index is appropriate for use with children, adolescents and young adults aged 7-21 who have been exposed to traumatic events, including but not limited to physical and sexual abuse, community violence, natural disasters, and serious accidents. There is also a separate tool for children aged 6 and younger. The tool is often used in clinical settings such as mental health clinics, child welfare and juvenile justice programs, school mental health services, and pediatrics.

Use the following criteria to assess whether the UCLA PTSD RI is appropriate for your client:

  1. Has the child experienced trauma that involved actual or threatened death, serious injury, or sexual violence?
  2. Is the child showing symptoms of PTSD, such as intrusive memories, avoidance, negative mood changes, or hyper-arousal?
  3. Is there a need to assess PTSD symptom severity and its impact on daily functioning?

 

The UCLA PTSD RI can also be used for evaluating other stress-related disorders and is particularly effective in trauma-focused therapy contexts.

The UCLA PTSD Reaction Index Scale

The UCLA PTSD RI uses a Likert scale to measure symptom frequency. Clients are asked to reflect on their trauma and rate how often they have experienced specific symptoms in the past month, using a scale from 0 (none of the time) to 4 (most of the time). The Index also includes questions on functional impairment, assessing how PTSD symptoms affect the client’s relationships at home and with peers, school performance, and overall developmental progression.

Time to Complete: Approximately 15-30 minutes.

Completion Method: Self-report for older children and adolescents, caregiver report for younger children or children with limited ability to self-report.

Administering the PTSD Reaction Index

Trauma/Loss History Section

This section of the UCLA PTSD Reaction Index collects information about the various types of traumas or losses that a child or adolescent may have experienced. For each type of trauma, the clinician checks the corresponding box if the event has occurred. The Index evaluates 25 different types of traumas.

Tip: During your interview, you might introduce this section by saying “Sometimes, people experience frightening or violent events where someone could have been seriously hurt or killed. I’m going to ask if any of these types of challenging experiences have ever happened to you.” 

PTSD Reaction Index Graphics 2

PTSD Reaction Index Graphics 3

Trauma Details and Time Period

This section allows you to gather more specific information on each trauma uncovered in the Trauma/Loss History Section. It records whether the child or adolescent was a direct victim, a witness, or learned about the trauma, and captures the age(s) during which the trauma occurred. This section can be updated as treatment progresses if additional details about past traumas are disclosed or if new traumatic events occur.

PTSD Reaction Index Graphics 4

PTSD Symptom Scale

In this section, the child or adolescent is asked to focus on the traumatic event that is currently most distressing. For each PTSD symptom, such as re-experiencing, avoidance, or hyperarousal, they are instructed to select a number between 0 and 4, representing how often the symptom occurred in the past month. The scale ranges from 0 (none of the time) to 4 (most of the time). This scale helps clinicians determine whether the individual meets the diagnostic criteria for PTSD and/or Dissociative Subtype, which is essential for monitoring symptom progression over time.

Frequency Rating Sheet

The Frequency Rating Sheet is used to assess how often the child or adolescent has experienced specific PTSD symptoms within the past month. For each symptom, the individual selects a number to indicate the frequency, ranging from 0 to 4, where 0 represents no occurrence and 4 indicates the symptom was present most of the time. The clinician introduces the rating by asking the child to think about the traumatic event that bothers them most, and then select how often each symptom has occurred in the past 30 days. This tool supports the accurate measurement of symptom frequency and severity.

PTSD Reaction Index Graphics 5

Distress and Impairment

This section evaluates the impact of PTSD symptoms on the child or adolescent’s daily functioning, behavior and development. It asks how frequently the PTSD symptoms have caused significant distress or impaired functioning in various areas, such as home life, peer relationships, school performance, or developmental progression. The Frequency Rating Sheet is again used to measure how often these issues have arisen over the past month. This information is crucial for understanding how PTSD symptoms are affecting the individual’s overall functioning and to inform treatment decisions.

PTSD Reaction Index Graphics 1

Scoring the UCLA PTSD Reaction Index

The UCLA PTSD RI includes subscale scores that correspond to DSM-5 PTSD criteria, including:

  • Category B: Intrusion
  • Category C: Avoidance
  • Category D: Negative Cognitions/Mood
  • Category E: Arousal and Reactivity

 

Cut-off scores help determine whether the child meets the criteria for PTSD or Dissociative Subtype. The scoring system also supports tracking symptom changes over time, which is crucial for monitoring treatment progress.

Cut Scores

A total score of 35 has the greatest sensitivity and specificity for detecting whether DSM-5 diagnostic criteria for PTSD are met. Individuals who score below 35 may still have significant distress and impairment related to their symptoms that may require clinical treatment. 

The tool also evaluates distress and impairment, offering insight into how PTSD affects daily life and functioning.

Watch: UCLA PTSD RI Scoring 

For more details on the measure and how to score it, watch the training video below developed by Behavioral Health Innovations:

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Copyright Information & Disclaimer
This assessment is copyrighted to the UCLA developers and the Regents of the University of California.

Frequently Asked Questions
What are the benefits of using the UCLA PTSD Reaction Index in trauma-focused treatment?

The Index provides a comprehensive evaluation of PTSD symptoms and associated impairment, helping clinicians tailor their interventions. It is also highly sensitive to symptom change, making it ideal for monitoring progress and documenting treatment outcome. Unlike many PTSD measures, the UCLA PTSD RI can be used both for diagnosis and for monitoring treatment progress. 

How should I introduce the UCLA PTSD RI to my clients?

It’s important that clients understand the purpose and value of this assessment prior to being asked to complete it. Ensuring your clients understand the value of the measurement process is the best way to ensure they regularly complete measures, deepen their engagement in treatment and improve both therapeutic alliance and clinical outcomes. For inspiration, here is an example of how you might introduce this measure to clients:

“Just like you have your blood pressure taken when you go to the doctor, this assessment is my way of measuring your mental well-being. The measure will help us understand how the trauma you experienced may be affecting you today. It’s not a test with right or wrong answers, it’s just a way for us both to understand your feelings and experiences right now, and how they might change over time as we continue to work together. The results we get throughout the course of your treatment will be our way of checking in on your progress, so we can better understand what’s working and what might need to change, talk more deeply about your symptoms and experiences, and work together to set goals in treatment. This way we both know that we’re working towards what matters to you and that our time together is addressing the challenges you’re experiencing.”

How should I respond to changes in a client's UCLA PTSD RI scores?

Significant changes in scores may indicate a shift in symptom severity or functioning. If scores increase, consider whether additional interventions are needed. Decreases in scores are a positive sign of treatment progress, though monitoring should continue to prevent relapse. If the scores contradict what a client is sharing in session, you can use them as a tool to help both you and your client understand their experience and challenges. 

Watch the videos below featuring Dr. Amber Childs and Dr. Jessica Barber from the Yale Measurement-Based Care Collaborative to see an example of how contradiction in scores or client feedback might be addressed in session. The first video offers a live clinical example of reviewing assessment scores where contradiction exists, and the second video explains how these contradictions can be leveraged to uncover useful information to guide treatment:

For more clinical examples and skill building exercises, visit our ‘Clinicians Guide to Practicing MBC Featuring the Yale MBCC’.

What is the most important thing to note when administering the UCLA PTSD RI?

Ensure the child or caregiver understands the Frequency Rating Scale, the intention of the questions being asked and offer support during administration, especially if the trauma is recent or severe, as answering the questions can be distressing for some clients.

How should I approach asking PTSD symptom questions if a child or adolescent has indicated that they’ve experienced more than one trauma type?

Children and adolescents may have exposure to multiple types of trauma. If that is the case with a particular client, you should work to determine which trauma is having the most detrimental impact on your client and ask the PTSD symptom questions about that identified trauma. If a child or adolescent has two traumas that are equally bothersome, you may wish to ask symptom questions about each one. Completing the Trauma History Profile section will help you build a developmental map of a child or adolescent’s trauma and loss history to inform your care decisions.

What is the age range for administering the Child/Adolescent Self-Report version of the UCLA PTSD Reaction Index for DSM-5?

There are two assessment tools. There is a Child/Adolescent Self-Report–which is intended to be used for children, adolescents, and young adults ages 7-21–and a Parent/Caregiver Report for Children Aged 6 and Younger.

Interested in using the UCLA PTSD RI or other assessments in your clinic? Schedule a call with one of our implementation experts to learn how our MBC platform can help you streamline assessment delivery, track client progress, and enhance clinical outcomes. 

Are there any additional resources or further reading on the PTSD RI to support my learning?

Contractor, A. A., Layne, C. M., Steinberg, A. M., Ostrowski, S. A., Ford, J. D., Elhai, J. D. (2013). Do gender and age moderate the symptom structure of PTSD? Findings from a national clinical sample of children and adolescents. Psychiatry Research, 210(3), 1056–1064.

Elhai, J. D., Layne, C. M., Steinberg, A. S., Brymer, M. J., Briggs, M. J., Ostrowski, S. A., Pynoos, R. S. (2013). Psychometric properties of the UCLA PTSD reaction index. Part II: Investigating factor structure findings in a national clinic-referred youth sample. Journal of Traumatic Stress, 26, 10–18.

Igelman R, Taylor N, Gilbert A, Ryan B, Steinberg AM, Wilson C, Mann G: (2007) Creating more trauma-informed services for children using assessment-focused tools. Child Welfare Journal of Policy, Practice, and Programs, 86, 15-33.

Kaplow, JB, Rolon-Arroyo, B; Layne, CM; Oosterhoff, B; Hill, R; Steinberg, AM; Pynoos, RS. (2020) Validation of the UCLA PTSD Reaction Index for DSM-5: A Developmentally Informed Assessment Tool for Trauma-Exposed Youth. Journal of the American Academy of Child and Adolescent Psychiatry, 59(1), 186-194.

Roulon-Arroyo, B, Oosterhoff, B, Layne, CM, Steinberg, AM, Pynoos, RS, Kaplow, JB (2019) The UCLA PTSD Reaction Index for DSM-5 Brief Form: A Screening Tool for Trauma-Exposed Youth. Journal of the American Academy of Child and Adolescent Psychiatry, 59(3), 434-443.

Pynoos, R. S., Steinberg, A. M., Layne, C. M., Liang, L., Vivrette, R., Briggs, E. C., Kisiel, C., Habib, M., Belin, T., & Fairbank, J. A. (2014). Modeling constellations of trauma exposure in the National Child Traumatic Stress Network Core Data Set. Psychological Trauma: Theory, Research, Practice, and Policy, 6(Suppl 1), S9-S17.

Steinberg AM, Brymer MJ, Kim S, Ghosh C, Ostrowski SA, Gulley K, Briggs, EC, Pynoos RS: (2013) Psychometric properties of the UCLA PTSD Reaction Index: Part 1, Journal of Traumatic Stress, 26:1-9. T

Steinberg, A. M., Brymer, M., Decker, K., & Pynoos, R. S. (2004). The UCLA PTSD Reaction Index. Current Psychiatry Reports, 6, 96–100.

Steinberg, A. M., Brymer, M. J., Kim, S., Briggs, E. C., Ippen, C. G., Ostrowski, S. A., Pynoos, R. S. (2013). Psychometric properties of the UCLA PTSD Reaction Index: Part 1. Journal of Traumatic Stress, 26(1), 1–9.

Steinberg, A. M., Pynoos, R. S., Gerrity, E. T., Gerrity, E. T., Layne, C. M., Vivrette, R. L., Fairbank, J. A. (2014). The NCTSN core data set: Emerging findings, future directions, and implications for theory, research, practice, and policy. Psychological Trauma: Theory, Research, Practice and Policy, 6(Suppl 1), S50–S57.

Steinberg, AM, Layne, CM, Briggs, ED, Liang, L, Brymer, MJ, Belin, TR, Fairbank, JA, Pynoos, RS (2019): Benefits of Treatment Completion Over Premature Termination: Findings from the National Child Traumatic Stress Network, Psychiatry: Interpersonal and Biological Processes, 82, 113-127.

Doric, A, Stevanovic, et al., (2019) Psychometric evaluation of the UCLA PTSD reaction index for children and adolescents (PTSD-RI-5) sampled from communities in eleven different countries. European Journal of Psychotraumatology, 82, 113-127.

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