Understanding the Impact of Racism

UConn Racial/Ethnic Stress & Trauma Scale (UnRESTS)

We have developed a semi-structured interview called the University of Connecticut Racial/Ethnic Stress & Trauma Scale (UnRESTS). This measure is offered in both English and Spanish, and provides a more comprehensive assessment of race-based trauma relative to existing measures. Because it is an interview, it can facilitate the conversation between the client and clinician regarding the client’s experiences with racism and help the clinician build rapport with the client. This may be particularly helpful for clinicians who are unsure how or what to ask about racially-charged topics. The format of the UnRESTS is modeled after the DSM-5 Cultural Formulation Interview (APA, 2013). Unfortunately, neither the CFI nor its supplementary modules examine racism or discrimination despite that assessment is intended as a cultural assessment. Therefore, it is important for clinicians to also have access to an interview specifically for the assessment of discrimination and its impact.

Frequently Asked Questions about the UnRESTS

1. What background or qualifications does the interviewer need? Should the person be a clinical psychologist, social worker, or share a formal education in clinical practice?

The UnRESTS is designed so that it can be administered by any mental health clinician. The interviewer does not need any other specific qualifications to administer the UnRESTS, other than their discipline-specific formal training in mental health assessment. Interviewers should practice administering the UnRESTS at least twice to someone else (not a client) and should also practice at least once in the role of a client.

Those without mental health training and students who wish to administer the interview should be properly supervised by a licensed clinician.

2. Is any special training needed from the developers in order to administer the measure?

The UnRESTS is designed so that it can be administered by any mental health clinician without formal training or supervision from those who developed the measure (i.e., Dr. Monnica Williams and colleagues). Reading literature associated with the UnRESTS is very important prior to administering it (see papers below). Cultural humility is perhaps the most important skill needed to administer the UnRESTS. A well-informed perspective of the history that has led to the current cultural and sociopolitical situation for people of color paired with empathy for their experiences are vitally important when assessing for racial trauma.

Formal training in administering the UnRESTS can be helpful, as there is some multicultural nuance inherently associated with the interview. Dr. Williams has done trainings for health systems in administering the UnRESTS. Contact the lab if you would like to arrange this.

3. How is the measure scored?

The main purpose of the UnRESTS is to help therapists and clinicians better understand the client’s experience of racism, so no scoring is necessary.

That being said, the UnRESTS does include a quantitative assessment of Ethnic/Racial Identity at the beginning, as well as a racism and discrimination-oriented checklist (Section G) at the end. The Ethnic/Racial Identity items are scored by simply summing the six items. Section G is scored by checking the items that are true and following the directions to see if there are enough items in each of the PTSD symptom areas to qualify for a DSM-5 PTSD diagnosis. These are simply DSM-5 items, but applied specifically to racism, which ultimately informs the clinician of whether a final diagnosis of PTSD as a result of racism is warranted.

Aside from these two “scored” sections, most of the UnRESTS relies upon the qualitative responses provided to the clinician based upon the subjective lived experience of the patient which provide clinical insight and are kept in mind during the final assessment.

4. Should Section G be given, even if there is no criterion A event?

Yes, Section G should be given as it will help inform a formal DSM-5 diagnosis. Even if the client does not meet criteria for PTSD as per the DSM-5, if the symptoms are clinically significant, they will likely meet criteria for another DSM-5 Trauma-Related Stressor Disorder or for PSTD under ICD-9 criteria.

Tips: For Section G, the clinician should NOT read the anchors. Items should be checked off based on the interviewer’s clinical judgement, which should include everything the client has said over the course of the interview. If a client provides an answer to an item in Section G that is incongruent with previous statements or the client’s affect, the interviewer should probe further to arrive at a final decision.

5. Who is the UnRESTS for? Can it be administered to White people?

The UnRESTS was designed for people who have experienced minoritzation due to race and/or ethnicity. In the United States, where the measure was developed, White people generally have not experienced this. However, sometimes White Americans have lived in other countries where they may have experienced stigma due to their race or ethnicity, and in these situations it would be appropriate to administer the UnRESTS.