Racial Trauma

Self-Assessment

This worksheet is designed to help you reflect on how racial trauma may have impacted you. It is NOT a diagnostic tool but a guide for awareness and healing.

Instructions:
On a ruled sheet of paper, number the lines 1–20. This will serve as your answer sheet.
Read each statement below and rate your experience using the following scale:

0 = Never

1 = Rarely

2 = Sometimes

3 = Often

4 = Almost Always

Write your chosen number on the corresponding line of your answer sheet. For example, your answer to Question 1 goes on line 1, your answer to Question 2 goes on line 2, and so on. Total the scores on you answer sheet at the bottom of the ruled sheet of paper.

Section 1 – Experiences of Racism (Exposure)

1. I have been treated unfairly because of my race (at work, school, or in public).

2. I have been followed, harassed, or suspected of wrongdoing because of my race.

3. I have been ignored, overlooked, or dismissed in conversations because of my

race.

4. I have been told I “don’t belong” or asked “where I am really from.”

5. I have been called racial names, slurs, or subjected to racist jokes.

6. I have witnessed someone of my race being mistreated because of race.

7. I have been denied opportunities (jobs, housing, education) due to race.

Section 2 – Emotional & Physical Reactions

8. Thinking about racist experiences makes me feel angry or enraged.

9. Thinking about racist experiences makes me feel sad or hopeless.

10. I avoid certain people, places, or situations to prevent racist treatment.

11. I experience intrusive thoughts, flashbacks, or nightmares about racism.

12. My body reacts (tight chest, stomach upset, headaches) when I remember

racism.

13. I feel numb, shut down, or disconnected after racial incidents.

14. I feel fear or hypervigilance in spaces where I may be targeted.

Section 3 – Impact on Self & Relationships

15. Racism has affected how I see myself or my self-worth.

16. Racism has made it harder to trust people outside my racial group.

17. Racism has affected how safe I feel in my community.

18. I feel isolated or alienated because of my racial experiences.

19. Racism has strained my family, friendships, or community ties.

20. I feel pressure to hide or change parts of my racial or cultural identity.

Interpreting Your Responses

0–15 (Mild Impact):

Racism affects you but may not feel overwhelming.

16–40 (Moderate Impact):

Racism regularly affects your emotions, body, or relationships.

41–60 (High Impact):

You may be experiencing significant racial trauma. Consider supportive spaces.

61–80 (Severe Impact):

The impact of racism may be deeply traumatic. Professional, trauma-informed support is strongly recommended.

Reflection Questions

Which items did you score the highest on?
How have these experiences shaped the way you see yourself and others?
What coping strategies do you use to manage the impact?
Where do you notice racial trauma most strongly, in your body, thoughts, or relationships?

Journaling Prompt

We invite you to begin journaling your journey with the following prompt:

“Today, I acknowledge the ways racism has impacted me, and I honor my ability to overcome by …”

Acknowledgment of Sources
The Racial Trauma Self-Assessment Worksheet was created as an adaptation of two established self-report tools. It combines and modifies elements for the specific purpose of raising awareness about the effects of racial trauma. This worksheet is not a diagnostic instrument but a reflective guide for personal and communal healing.

The two primary sources that informed this worksheet are:

1. Race-Based Traumatic Stress Symptom Scale (RBTSSS) – Developed by Dr. Robert T. Carter and colleagues, Teachers College, Columbia University. This validated scale assesses symptoms related to race-based traumatic stress.
   Reference: Carter, R. T., & Forsyth, J. (2010). Reactions to Racial Discrimination: Emotional Stress and Help-Seeking Behaviors. Psychological Trauma: Theory, Research, Practice, and Policy, 2(3), 183–191.

2. Trauma Symptom Checklist & Related Self-Assessment Tools – Instruments commonly used in clinical and psychoeducational contexts to help individuals reflect on the emotional, cognitive, and somatic impact of trauma.
   Reference: Briere, J. (1996). Trauma Symptom Checklist for Children (TSCC): Professional Manual. Odessa, FL: Psychological Assessment Resources.

By merging elements of these approaches, the worksheet seeks to provide an accessible, culturally responsive tool that centers the lived experiences of race-based harm while encouraging pathways toward awareness, resilience, and healing.