A collaboration between researchers at Pitt Public Health and the University of Pittsburgh Department of Psychiatry is challenging how trauma is measured, arguing that traditional assessment tools often fail to capture the experiences of people with minoritized identities.
Published in June in the Journal of Traumatic Stress, the review grew out of a symposium at the 2025 International Society for Traumatic Stress Studies (ISTSS) annual meeting, where researchers recognized a shared interest in improving trauma assessment for historically underrepresented populations.
Phillip W. Schnarrs, PhD, professor in the Department of Behavioral and Community Health Sciences and co-director of the Center for LGBT Health Research at Pitt Public Health, collaborated with Krithika Prakash, PhD, a postdoctoral scholar in the Developmental Alcohol Research Training Program in the University of Pittsburgh Department of Psychiatry.
“Diagnoses and treatment decisions often rely on trauma assessments, yet the field has not done a great job of adapting these for people with minoritized identities,” said Prakash.
The review provides practical recommendations for developing and adapting trauma assessments that better reflect the experiences of Black, Indigenous and other people of color, as well as sexual and gender minority populations. Among the recommendations are incorporating community-engaged research, participatory and human-centered methods, and using behaviorally specific language to improve trauma disclosure and evaluating assessment tools for measurement bias before they are widely implemented.
“Collectively, our research encourages a broader understanding of trauma and how it affects people’s lives,” said Schnarrs. “It also reflects a public health approach, which emphasizes community engagement, challenges the status quo when it isn’t serving people well and recognizes that many minoritized populations historically have not had a voice in science, medicine or health research, and in particular development of measures and clinical assessments that assess aspects of their lived experiences.”
Traditional trauma assessments are often evaluated by testing whether items or questions are clear and practical to administer. Schnarrs and Prakash argue that those steps alone are not enough.
“Researchers need to understand the experiences of minoritized populations and ensure those experiences shape the measures themselves,” Schnarrs said. “Beyond simply asking for feedback, measures should be co-designed with communities so they accurately reflect people’s lived experiences as well as are acceptable and feasible in practice.”
The researchers also encourage involving community members throughout the research process—not only when developing assessment tools but also when interpreting and sharing study findings.
“Community involvement shouldn’t stop once a study is complete,” Prakash said. “Communities should also be part of interpreting and disseminating research findings.”
Schnarrs said his team has already begun applying these principles to new projects. Building on previous work developing the Sexual and Gender Minority Adverse Childhood Experiences (SGM-ACE) Scale. In collaboration with Dr. Virgina Brown at the Hastings Center for Bioethics, his team received funding last year from the Patient-Centered Outcomes Research Institute to develop a measure of organizational trustworthiness in community-academic partnerships, and have successful revised and implemented the TRUST TEAM participatory method for scale development and are now testing this new measure.
“Our goal is to continue refining and adapting our TRUST TEAM method to ensure that lived experiences and community expertise are central to the development and testing of measures and clinical assessments, whether focused on trauma, health, or community engaged research,” said Schnarrs.
Additional co-authors include Selime R. Salim, a postdoctoral fellow at Stanford University; Colin T. Mahoney, PhD, assistant professor of psychology at University of New Mexico; and Antonio A. Morgan-López, PhD, senior fellow in quantitative psychology at RTI International.
-Ava Dzurenda