3. The Toolbox - Implementation & Tactical Resources

3.6. Triage vs Screening vs Assessment in Disasters or Mass Casualty Incidents (MCIs)

In a disaster surge, it is essential to understand the rationale, and the practical and clinical differences amongst triage, screening, and assessment. Time required to complete the task is often a critical factor, and patient surge can be overwhelming. As such, it is important to quickly, efficiently, and accurately sort and clarify which patients need what level of support, and who needs further evaluation and treatment. This appendix sheet was developed to clarify the differences between these three processes (triage, screening, & assessment) and inform providers and planners about what timing and conditions are most appropriate for each.

TRIAGE (e.g., PsySTART, ASC-Kids)22,82
What it is / What it does Rapid identification of risk that is exposure-based and non-symptom focused.
When you use it Often brief (less than 2 mins) and used in first hours to up to 45 days post-impact to identify new individual PTSD risk, and to allocate broader population care priorities based on objective risk factors.
Other Considerations High sensitivity for predicting future pathology, primarily PTSD and depression, and can be conducted by trained, non-licensed staff or others.
SCREENING (e.g., CPSS-583 or CAT584 )
What it is / What it does Standardized measures of current symptoms or risk indicators suggesting a diagnosis and used in secondary evaluation.
When you use it Brief (5-15 mins) and ideally used 40 days+ post-event for further stratification of an affected population.
Other Considerations Screening instruments are often related to a specific diagnosis and are designed to pick up currently expressed symptoms such as a “depression screener”, a “suicide screener”, or a “PTSD screener.” They are less useful in the first 30-40 days post event because they pick up normative distress and likely miss those who are numb and avoidant. Suicide screeners are the exception and can be used any time there is a safety concern or may be used for all children starting at a certain age threshold in acute care settings. These are usually administered by a clinician.
ASSESSMENT (e.g., UCLA PTSD-RI85 , structured diagnostic interview)
What it is / What it does Comprehensive clinical evaluation to establish diagnoses, degree of functional impairment, and treatment planning in later stages of care.
When you use it Often takes 30 mins to several hours; Can be conducted any time 40 days+ post event.
Other Considerations Requires a licensed clinical professional or psychometrist under supervision.

Key things to know regarding patient surge that can impact planning for population level evaluation of behavioral health needs in a community:

  • Behavioral Health surge following a large-scale event can occur across phases of recovery from impact to rebuilding / resilience
    • Impacts will likely be apparent immediately after the event, but also weeks to months later in the disaster cycle, when resources are further reduced and providers are exhausted86 .
  • Disasters generate large population impacts with variable exposure levels.
    • Not all of those impacted will need formal behavioral health care, but many may benefit from additional basic support.
    • Longitudinal studies show multiple typical symptom trajectories. These include the following:
      • resilient/recovery(may experience distress but recover quickly to baseline)
      • chronic (symptoms of distress and impact on function persist over time.
      • delayed  (initial recovery from distress symptoms and then re-appearance)
    • A tiered approach is essential to effectively orient care resources to the right families and individuals. Identification of a variety of risks, and subsequent support and intervention should be considered within a comprehensive and “tiered” approach87,88
  • Evidence supports population-based triage approaches that stratify individuals into risk categories to guide proportional intervention as soon as possible following the impact from an event.
    • Research demonstrates that exposure characteristics, prior trauma history, loss, perceived life threat, and caregiver distress are more predictive of PTSD development than acute distress alone89,90
    • Consequently, contemporary models prioritize exposure-based risk indicators91-94 ; 
  • Screening may need to be repeated
    • Because some children worsen after the acute phase (typically from 30-45 day post-impact), a one-time screen can miss later-emerging cases — scheduled re-screening (for example at 1, 3, and 6 months) is recommended as part of triage pathways82 .

Triage, Screening and Assessment should be planned for and may be delivered in “tiered” approach that includes resource-based universal support as outlined below. 

Step 1: Risk / Exposure Based Triage to determine individual and population needs 

  • Key Characteristics: Brief (less than 5 mins); Offered to all as resources allow, based on proximity to event and exposure to scenes of the event itself and can be conducted by a trained volunteer (does not require a medical professional).
  • Timing: Can be offered immediately after an event, and days to weeks following the event. 
  • Example(s): Risk exposure-driven systems such as PsySTART; specific behavioral health triage frameworks for emergency department settings such as the Australian Mental Health Triage Scale95 .

Step 2: Universal Support, Dependent on resource capacity

  • Key Characteristics: Brief (10-20 mins); Offered to all as resources allow, and appropriate for all; can be conducted by a trained volunteer (does not require a medical professional)
  • Timing: Can be offered immediately following an event, and hours to days following the event
  • Examples: Psychological First Aid96,97  

Step 3: Targeted Screening and Referral for Additional Assessment as Indicated

  • Key Characteristics: Brief (less than 20 mins) standardized measures or instruments; Offered to those who receive positive triage based on exposure, and / or those who are expressing symptoms more than 30+ days after an event.
  • Timing: Should be offered weeks to months after an event (30-45 days+).
  • Example(s):  The Child PTSD Symptom Scale for DSM-V (CPSS5), Child and Asolescent Trauma Screen (CATS-2)98,99
  • Use CPSS-5 for detailed, in-depth evaluation of PTSD symptom severity and functional impairment in children aged 8-18.
  • Use CATS-2 for a faster, broader screening tool that covers both DSM-5 and ICD-11 criteria.

Please note: Measures for Acute Stress Disorder (e.g., Acute Stress Checklist for Children) screen for distress in the immediate post-event100 . Symptoms of distress are normative after a negative event and typically resolve within 30-40 days. An acute stress disorder diagnosis is not predictive of later risk for PTSD. Significant symptoms of distress continuing past 40 days do not qualify as acute stress disorder but may be diagnostic for other mental health disorders.

Step 4: Comprehensive Assessment

  • Key Characteristics: Lengthy standardized measures or instruments to assist Diagnostic evaluation and individualized treatment planning101 Offered to those who receive positive screenings and / or those who are expressing symptoms more than 30+ days after an event.
  • Timing: Should be offered weeks to months after an event (30-45 days+).
  • Example(s): Diagnostic Interviews, Functional Impairment assessments (e.g., the Vineland BASC102)

The stepped model aligns with global mental health guidelines recommending proportional, tiered response systems in humanitarian emergencies103 .

Please see Table 1 for examples of risks indicators, their association with PTSD, and the accompanying supporting evidence-base.

Table 1. Pediatric PTSD Risk Factors Incorporated in Exposure-Based Triage Models

Risk Domain Specific Pediatric Risk Indicator Empirical Association With PTSD
Objective Trauma Exposure Physical injury to child Strong predictor of chronic PTSD86,89
  Witnessing death or severe injury Strong predictor86,89
  Perceived life threat Moderate–strong predictor86,90
  Home destruction/displacement Moderate predictor86,90
Interpersonal Factors Separation from caregiver during disaster Strong predictor (especially <12 yrs)90
  Caregiver acute distress/PTSD Strong predictor via modeling pathway89,104
Prior Vulnerability Previous trauma exposure Moderate predictor (cumulative risk effect)89,105
  Preexisting anxiety/depression Moderate predictor106
Contextual Stressors Ongoing displacement Moderate predictor of chronicity90,105
  Loss of social support Moderate predictor106

Table 2. Pediatric Outcomes Identified Through Exposure-Based Triage in Acute Care Settings

Pediatric Trauma ED Pilot
Age Range 10–17 years
Identified as High Risk Approximately 30–40%
Primary Outcome Triggered Automated mental health consult
Follow-Up Outcome Increased early specialty referral.
Disaster Shelter Screening (Superstorm Sandy Subset Youth Contacts)
Age Range Children & adolescents
Identified as High Risk Variable by exposure cluster
Primary Outcome Triggered Risk stratification for follow-up outreach
Follow-Up Outcome Geographic risk clustering independent of infrastructure damage.107
School-Based Disaster Implementation
Age Range 6–18 years
Identified as High Risk 15–35% elevated exposure risk
Primary Outcome Triggered Tier 2 intervention referral
Follow-Up Outcome Reduced persistent PTSD symptoms when early intervention was applied.90,108

Additional Reading

  • de Bildt, A., Kraijer, D., Sytema, S. et al. The Psychometric Properties of the Vineland Adaptive Behavior Scales in Children and Adolescents with Mental Retardation. J Autism Dev Disord 35, 53–62 (2005). https://doi.org/10.1007/s10803-004-1033-7
  • Dückers, Michel L.A. PhD; Stroebe, Margaret S. PhD; Baliatsas, Christos PhD; Spreeuwenberg, Peter MSc; Brüning, Annelie MSc; Stroebe, Katherine E. PhD. The Long-Term Mental Health Impact of Disasters: A Systematic Review and Multilevel Meta-Analysis of Longitudinal Epidemiological Studies. Harvard Review of Psychiatry 34(2):p 59-72, March/April 2026. | DOI: 10.1097/HRP.0000000000000450
  • Hoffmann, J. A., Denicolo, K., Cobb, P., Farley, K., Brown, M., Pergjika, A., Janssen, A., Cory, D., Alpern, E. R., Grupp-Phelan, J., & Foster, A. A. (2026). Interrater reliability in the triage of children with mental and behavioral health symptoms using two triage systems. Journal of Emergency Nursing. https://doi.org/10.1016/j.jen.2025.11.019 
  • Meiser-Stedman, R., McKinnon, A., Dixon, C., Boyle, A., Smith, P., & Dalgleish, T. (2017). Acute stress disorder and the transition to posttraumatic stress disorder in children and adolescents: Prevalence, course, prognosis, diagnostic suitability, and risk markers. Depression and Anxiety, 34(4), 348–355. https://doi.org/10.1002/da.22602
  • Newnham, E., et al (2022). Long term mental health trajectories after disasters and pandemics: A multilingual systematic review of prevalence, risk and protective factors. Clinical Psychology Review, Volume 97,102203,ISSN 0272-7358, https://doi.org/10.1016/j.cpr.2022.102203
  • Norris, F.H., Stevens, S.P., Pfefferbaum, B., Wyche, K.F. and Pfefferbaum, R.L. (2008), Community Resilience as a Metaphor, Theory, Set of Capacities, and Strategy for Disaster Readiness. American Journal of Community Psychology, 41: 127-150. https://doi.org/10.1007/s10464-007-9156-6
  • Perrin, S., Meiser-Stedman, R., & Smith, P. (2005). The Children’s Revised Impact of Event Scale (CRIES): Validity as a screening instrument for PTSD. Behavioural and Cognitive Psychotherapy, 33(4), 487–498. https://doi.org/10.1017/S1352465805002419
  • Pfefferbaum, B., Jacobs, A. K., & Schreiber, M. D. (2020). Stepped-care mental health triage, screening, and referral for children in shelters. Disaster Medicine and Public Health Preparedness, 14(3), 371–376. https://doi.org/10.1017/dmp.2019.107
  • Sachdev, N., et al. (2021). Child and Adolescent Trauma Screen (CATS): Psychometric review and clinical applications. European Journal of Psychotraumatology, 12(1). https://doi.org/10.1080/20008198.2021.1882988
  • Schreiber, M. D., Yin, R., Omaish, M., & Broderick, J. E. (2014). PsySTART rapid mental health triage following Superstorm Sandy. Disaster Medicine and Public Health Preparedness, 8(6), 493–498. https://doi.org/10.1017/dmp.2014.128
  • Steinberg, A. M., Brymer, M. J., Decker, K., & Pynoos, R. S. (2013). The UCLA PTSD Reaction Index for DSM-5. Current Psychiatry Reports, 15, Article 393. https://doi.org/10.1007/s11920-013-0393-3