51
|
Kadoura B, Toulany A. Self-management for adolescents with fluctuating chronic disease: time for a more holistic approach. Arch Dis Child 2022; 107:625-626. [PMID: 35365500 DOI: 10.1136/archdischild-2021-323722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Basil Kadoura
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Temerty Faculty of Medicine, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Alène Toulany
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada .,Temerty Faculty of Medicine, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| |
Collapse
|
52
|
Christou-Ergos M, Wiley KE, Leask J, Shapiro GK. Traumatic Events and Vaccination Decisions: A Systematic Review. Vaccines (Basel) 2022; 10:vaccines10060911. [PMID: 35746519 PMCID: PMC9230365 DOI: 10.3390/vaccines10060911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023] Open
Abstract
Despite the apparent relationship between past experiences and subsequent vaccination decisions, the role of traumatic events has been overlooked when understanding vaccination intention and behaviour. We conducted a systematic review to synthesize what is known about the relationship between traumatic events and subsequent vaccination decisions. MEDLINE, PsycINFO and CINHAL electronic databases were searched, and 1551 articles were screened for eligibility. Of the 52 articles included in full-text assessment, five met the eligibility criteria. Findings suggest that the experience of trauma is associated with individual vaccination decisions. Social and practical factors related to both trauma and vaccination may mediate this relationship. As this is a relatively new field of inquiry, future research may help to clarify the nuances of the relationship. This review finds that the experience of psychological trauma is associated with vaccination intention and behaviour and points to the potential importance of a trauma-informed approach to vaccination interventions during the current global effort to achieve high COVID-19 vaccine coverage.
Collapse
Affiliation(s)
- Maria Christou-Ergos
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown 2006, Australia;
- Correspondence:
| | - Kerrie E. Wiley
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown 2006, Australia;
- Sydney Institute for Infectious Diseases, Westmead Hospital, Westmead 2145, Australia
| | - Julie Leask
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown 2006, Australia;
- Sydney Institute for Infectious Diseases, Westmead Hospital, Westmead 2145, Australia
| | - Gilla K. Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada;
| |
Collapse
|
53
|
Shonkoff JP, Boyce WT, Bush NR, Gunnar MR, Hensch TK, Levitt P, Meaney MJ, Nelson CA, Slopen N, Williams DR, Silveira PP. Translating the Biology of Adversity and Resilience Into New Measures for Pediatric Practice. Pediatrics 2022; 149:187008. [PMID: 35535547 DOI: 10.1542/peds.2021-054493] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
As the science of adversity and resilience advances, and public awareness of the health consequences of stress grows, primary care providers are being increasingly asked to address the effects of adverse experiences on child wellbeing. Given limited tools for assessing these effects early in life, the authors explore how enhanced capacity to measure stress activation directly in young children could transform the role and scope of pediatric practice. When employed within a trusted relationship between caregivers and clinicians, selective use of biological measures of stress responses would help address the documented limitations of rating scales of adverse childhood experiences as a primary indicator of individual risk and strengthen the ability to focus on variation in intervention needs, assess their effectiveness, and guide ongoing management. The authors provide an overview of the potential benefits and risks of such expanded measurement capacity, as well as an introduction to candidate indicators that might be employed in an office setting. The ultimate value of such measures for both pediatricians and parents will require vigilant attention to the ethical responsibilities of assuring their correct interpretation and minimizing the harm of inappropriate labeling, especially for children and families experiencing the hardships and threats of racism, poverty, and other structural inequities. Whereas much work remains to be done to advance measurement development and ensure its equitable use, the potential of validated markers of stress activation and resilience to strengthen the impact of primary health care on the lives of young children facing significant adversity demands increased attention.
Collapse
Affiliation(s)
- Jack P Shonkoff
- Center on the Developing Child.,Harvard Graduate School of Education.,Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.,Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - W Thomas Boyce
- University of California, San Francisco, San Francisco, California
| | - Nicole R Bush
- Departments of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences.,Department of Pediatrics, Division of Developmental Medicine, University of California, San Francisco, San Francisco, California
| | - Megan R Gunnar
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota
| | - Takao K Hensch
- Center on the Developing Child.,Conte Center for Basic Mental Health Research.,Center for Brain Science, Harvard University, Cambridge, Massachusetts.,Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Pat Levitt
- Developmental Neuroscience and Neurogenetics Program, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Michael J Meaney
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Hospital Research Center, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Brenner Centre for Molecular Medicine, Singapore, Republic of Singapore
| | - Charles A Nelson
- Center on the Developing Child.,Harvard Graduate School of Education.,Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Natalie Slopen
- Center on the Developing Child.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - David R Williams
- Center on the Developing Child.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Patricia Pelufo Silveira
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Hospital Research Center, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
54
|
Lanphier E, Anani UE. Trauma Informed Ethics Consultation. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:45-57. [PMID: 33684027 DOI: 10.1080/15265161.2021.1887963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We argue for the addition of trauma informed awareness, training, and skill in clinical ethics consultation by proposing a novel framework for Trauma Informed Ethics Consultation (TIEC). This approach expands on the American Society for Bioethics and Humanities (ASBH) framework for, and key insights from feminist approaches to, ethics consultation, and the literature on trauma informed care (TIC). TIEC keeps ethics consultation in line with the provision of TIC in other clinical settings. Most crucially, TIEC (like TIC) is systematically sensitive to culture, history, difference, power, social exclusion, oppression, and marginalization. By engaging a neonatal intensive care ethics consult example, we define our TIEC approach and illustrate its application. Through TIEC we argue it is the role of ethics consultants to not only hold open moral spaces, but to furnish them in morally habitable ways for all stakeholders involved in the ethics consultation process, including patients, surrogates, and practitioners.
Collapse
Affiliation(s)
- Elizabeth Lanphier
- Cincinnati Children's Hospital Medical Center
- University of Cincinnati College of Medicine
| | | |
Collapse
|
55
|
Masalha B, Ben-David S, Benarroch F, Ben-ari A. Intercultural Differences in the Development of Pediatric Medical Traumatic Stress (PMTS) in Children Following Surgical Hospitalization. CHILDREN 2022; 9:children9040526. [PMID: 35455570 PMCID: PMC9032594 DOI: 10.3390/children9040526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/16/2022]
Abstract
Background: Illness, surgery and surgical hospitalization are significant stressors for children. Some children who experience such a medical event may develop Pediatric Medical Traumatic Stress (PMTS). PMTS affects physical recovery, and many areas and functions in children’s lives, both short- and long-term. The aim of the study is to examine the difference in the rate of PMTS between the Arab and Jewish populations and the difference in risk factors for the development of this syndrome. Method: The study involved 252 parents of children aged 1–6 who were hospitalized in the surgical ward of Hadassah Medical Center. During hospitalization, parents completed questionnaires to identify risk factors for the development of PMTS. At 3 months from the time of discharge, the children’s level of PMTS was measured. Results: The rate of children diagnosed with PMTS among Arab children was significantly higher than the rate in the Jewish population. The affiliation to an ethnic group affected different socioeconomic, demographic, social, linguistic and cultural background variables, which in turn affected the emergence of PMTS. Conclusion: The study emphasizes the nature of PMTS at the intercultural level, which can be an important source for theoretically understanding both the disorder and culture, as well as for clinical implications in developing population-sensitive treatment.
Collapse
Affiliation(s)
- Bushra Masalha
- Herman Dana Division of Child and Adolescent Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem 91240, Israel; (B.M.); (S.B.-D.); (F.B.)
- Department of Psychology, Hebrew University, Jerusalem 9190501, Israel
| | - Shiri Ben-David
- Herman Dana Division of Child and Adolescent Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem 91240, Israel; (B.M.); (S.B.-D.); (F.B.)
- Department of Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem 91240, Israel
| | - Fortu Benarroch
- Herman Dana Division of Child and Adolescent Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem 91240, Israel; (B.M.); (S.B.-D.); (F.B.)
| | - Amichai Ben-ari
- Herman Dana Division of Child and Adolescent Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem 91240, Israel; (B.M.); (S.B.-D.); (F.B.)
- Department of Behavioral Sciences, Ariel University, Ariel 9318659, Israel
- Correspondence: ; Tel.: +972-29978901; Fax: +972-2-5324844
| |
Collapse
|
56
|
Hubbard DK, Davis P, Willis T, Raza F, Carter BS, Lantos JD. Trauma-informed care and ethics consultation in the NICU. Semin Perinatol 2022; 46:151527. [PMID: 34895926 DOI: 10.1016/j.semperi.2021.151527] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Trauma-informed care responds to our current understanding of the ways in which people's traumatic life experiences influence both their health and their interactions with the health care system. Many ethics consults arise because those past traumatic life experiences are not recognized and addressed. In this paper, we present a NICU case that led to an ethics consultation about end-of-life decisions for a dying baby. We illustrate the ways in which a trauma-informed approach helped doctors, nurses and ethics consultants to better understand and care for the mother and baby.
Collapse
Affiliation(s)
- Dena K Hubbard
- Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas City.
| | - Patricia Davis
- Division of Psychosocial Services, Department of Social Work, Child and Family Therapy, Children's Mercy-Kansas City
| | - Tiffany Willis
- Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas City; Division of Developmental and Behavioral Medicine, Department of Pediatrics, Children's Mercy-Kansas City
| | - Fajar Raza
- Pediatric Bioethics Center, Children's Mercy-Kansas City
| | - Brian S Carter
- Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas City; Pediatric Bioethics Center, Children's Mercy-Kansas City
| | - John D Lantos
- Pediatric Bioethics Center, Children's Mercy-Kansas City
| |
Collapse
|
57
|
Drake SA, Burton C. Trauma-Informed Approaches to Medicolegal Death Investigation: A Forensic Nursing Perspective. JOURNAL OF FORENSIC NURSING 2022; 18:85-90. [PMID: 35143439 DOI: 10.1097/jfn.0000000000000359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Forensic nurses engaged in medicolegal death investigations experience trauma-induced responses in responding to, investigating, and documenting sudden unexpected deaths. The trauma of these repeated experiences often results in diminished performance, job dissatisfaction, and burnout. The principles of trauma-informed care are not new but have not been incorporated into death investigation practices. When coupled with medicolegal death investigation procedures, application of these principles can help to alleviate distress for forensic nurses, colleagues, and decedents of concerned families. This case series illustrates how the principles of trauma-informed care can be implemented to enhance communication, deescalate emotional or threatening situations, and prevent retraumatization in the context of medicolegal death investigations.
Collapse
Affiliation(s)
- Stacy A Drake
- Author Affiliations:Texas A&M University College of Nursing
| | | |
Collapse
|
58
|
Ogihara H. Development and validation of the Distracting Ingenuity Promotion Scale for paediatric nurses to support the psychological outcomes of paediatric patients and their families: A survey-based cross-sectional cohort study. Nurs Open 2022; 9:1653-1666. [PMID: 35274821 PMCID: PMC8994938 DOI: 10.1002/nop2.1190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 12/24/2021] [Accepted: 01/30/2022] [Indexed: 11/24/2022] Open
Abstract
Aim To develop and validate the Distracting Ingenuity Promotion Scale (DIPS) for paediatric nurses. Design Cross‐sectional study using anonymized self‐administered questionnaires. Methods From July–November 2013, paediatric nurses working in the wards or outpatient departments in 39 medical institutions in Japan were enrolled in the survey. Data were analysed using the Student's t‐test, Mann–Whitney U test and analysis of variance test. Exploratory and confirmatory factor analyses were performed to validate the factors in the DIPS. Cronbach's α was used to calculate the reliability of the DIPS. Results The DIPS included five subscales comprising 21 items. The goodness‐of‐fit indices for confirmatory factor analysis had a Comparative Fit Index of 0.923 and a Root Mean Square Error of Approximation of 0.059 and fulfilled the standard external validity criteria. Cronbach's α was 0.707–0.826 for each subscale and 0.895 for the overall scale.
Collapse
Affiliation(s)
- Hiroyuki Ogihara
- Pediatric Nursing, Faculty of Nursing, Ashikaga University, Ashikaga, Tochigi, Japan.,Graduate School of Science and Technology, Gunma University, Kiryu, Gunma, Japan
| |
Collapse
|
59
|
Steen M, Raynor J, Baldwin CD, Jee SH. Child Adversity and Trauma-Informed Care Teaching Interventions: A Systematic Review. Pediatrics 2022; 149:184788. [PMID: 35165742 DOI: 10.1542/peds.2021-051174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Health professionals need training to provide trauma-informed care (TIC) for children with adverse childhood experiences (ACEs), which can affect short- and long-term health. We summarize and evaluate published curricula for health professionals on ACEs and TIC. METHODS We searched PubMed, Embase, Web of Science, CINAHL, Cochrane Central Register of Controlled Trials, PsychInfo, and MedEdPORTAL through January 2021. Studies meeting the following criteria were included: Described teaching interventions on ACEs, TIC, and child abuse and maltreatment; included health care providers or trainees as learners; were written in English; included an abstract; and described a curriculum and evaluation. We reviewed 2264 abstracts, abstracted data from 79 studies, and selected 51 studies for qualitative synthesis. RESULTS Studies focused on ACEs/TIC (27), child abuse (14), domestic/intimate partner violence (6), and child maltreatment/parental physical punishment (4). Among these 51 studies, 43 were published since 2010. Learners included a mix of health professionals (34) and students (17). Duration, content, and quality of the 51 curricula were highly variable. An analysis of 10 exemplar curricula on ACEs and/or TIC revealed high and very high quality for methods and moderate to very high quality for curriculum evaluation, suggesting that they may be good models for other educational programs. Four of the 10 exemplars used randomized controlled trials to evaluate efficacy. Studies were limited to English language and subject to publication bias. CONCLUSIONS ACEs and TIC are increasingly relevant to teaching health professionals, especially pediatricians, and related teaching curricula offer good examples for other programs.
Collapse
Affiliation(s)
| | - Jennifer Raynor
- Edward G. Miner Library, University of Rochester Medical Center, Rochester, New York
| | | | - Sandra H Jee
- Division of General Pediatrics, Department of Pediatrics.,Center for Community Health and Prevention, Rochester, New York
| |
Collapse
|
60
|
Ladin K, Flescher AM, Reese PP. Vaccine Mandates for Transplant Patients: Caring for Patients Versus Turning Them Away. AMERICAN JOURNAL OF KIDNEY DISEASES 2022; 79:774-777. [PMID: 35257815 PMCID: PMC8894499 DOI: 10.1053/j.ajkd.2022.01.421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/30/2022] [Indexed: 12/14/2022]
|
61
|
Varghese L, Emerson A. Trauma-informed care in the primary care setting: An evolutionary analysis. J Am Assoc Nurse Pract 2022; 34:465-473. [PMID: 34618717 DOI: 10.1097/jxx.0000000000000663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The high prevalence of trauma in the United States and its adverse effects on patient wellbeing has led to the adoption of trauma-informed care (TIC) in some specialized health care services. However, the implementation of TIC in primary care, where many nurse practitioners (NPs) provide services, is relatively uncommon and the concept not well-defined. Trauma includes physically and emotionally devastating experiences that have a lasting impact on individuals. OBJECTIVES To synthesize a definition of TIC in the primary care setting for NPs to guide future practice and research. DATA SOURCES We searched CINAHL, PsycINFO, Social Work Abstracts, Scopus, and PubMed for articles published 2010-2020 that described the use of TIC in primary care. Rodgers' evolutionary method and the framework method of analysis were used to identify attributes and contexts of TIC in primary care and synthesize a definition. Thirty-one articles from nursing, medical, and social work sources were selected, including data-based studies ( n = 15) and thought pieces ( n = 16). Attributes, antecedents, and consequences were combined to provide a definition grounded in the literature. CONCLUSION Trauma-informed care in primary care is a strengths-based approach in which trained, trauma-aware health care professionals provide services that prioritize safety, empowerment, and support, resulting in improved patient satisfaction and health care engagement in individuals who have experienced trauma. IMPLICATIONS FOR PRACTICE A clearly defined concept provides a starting point for developing strategies to help NPs recognize and respond more effectively to the needs of patients who have experienced trauma.
Collapse
Affiliation(s)
- Latha Varghese
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri
| | | |
Collapse
|
62
|
Gannon BS, Gregg A, Wang H, Marshall ME, Yerby LG, Jenkins C, Parton JM. A medical home for children in foster care reduces expenditures. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2039146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Brian S. Gannon
- College of Community Health Sciences, Pediatrics, The University of Alabama, Tuscaloosa, AL, USA
| | - Abbey Gregg
- College of Community Health Sciences, Institute for Rural Health Research, The University of Alabama, Tuscaloosa, AL, USA
| | - Hui Wang
- College of Community Health Sciences, Institute for Rural Health Research, The University of Alabama, Tuscaloosa, AL, USA
| | | | - Lea G. Yerby
- College of Community Health Sciences, Institute for Rural Health Research, The University of Alabama, Tuscaloosa, AL, USA
| | - Caroline Jenkins
- Institute of Data and Analytics, The University of Alabama, Tuscaloosa, AL, USA
| | - Jason M. Parton
- Institute of Data and Analytics, The University of Alabama, Tuscaloosa, AL, USA
| |
Collapse
|
63
|
Schwoebel A, Quigley E, Deeley A, DeLuca J, Hollister S, Ruggiero J. A Quality Improvement Project to Reduce Events of Visitor Escalation in the Intensive Care Nursery. Adv Neonatal Care 2022; 22:69-78. [PMID: 33756499 DOI: 10.1097/anc.0000000000000852] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Escalating and aggressive visitor behaviors have become increasingly common in healthcare settings nationally, negatively impacting staff and patients alike. Most healthcare providers do not innately possess the specific skills to manage such behaviors. Management of escalating and aggressive behaviors presents a particularly bedeviling challenge when staff safety must be balanced with the needs of parent-neonate bonding. PURPOSE In the Intensive Care Nursery (ICN), the frequency of aggressive and hostile incidents from visitors increased such that the staff felt frustrated by and uneasy about their work environment. METHODS The ICN convened an interprofessional team to strategize interventions aimed at consistently managing aggressive behavior and supporting the staff after aggressive and/or hostile visitor encounters. FINDINGS Following staff education and training, the unit launched a de-escalation management algorithm in July 2018 that assisted in identifying high-risk families at admission and drove consistent action and management of all visitor behaviors. In the 12 months following the intervention, the frequency of behavioral escalation decreased by 75% and staff perception of safety increased by 25%. IMPLICATIONS FOR PRACTICE Collaborating with staff to design consistent strategies to manage aggressive and escalating visitor behavior can improve safety and improve employee satisfaction in the ICN. IMPLICATIONS FOR RESEARCH Additional research on the effectiveness of the algorithm in other ICNs and alternative areas of practice is needed. Furthermore, validation of a staff perception survey measuring the impact of escalating visitor behaviors on employees would be an important next step in this research.Video abstract available athttps://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=43.
Collapse
|
64
|
Shapiro MH, Goodman DM, Rodriguez VA. The Perfect Discharge: A Framework for High-Quality Hospital Discharges. Hosp Pediatr 2022; 12:108-117. [PMID: 34961884 DOI: 10.1542/hpeds.2021-006100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Matthew H Shapiro
- Department of Pediatrics, School of Medicine, University of California, Irvine, Irvine, California.,Children's Hospital of Orange County, Orange, California
| | - Denise M Goodman
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Victoria A Rodriguez
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| |
Collapse
|
65
|
Sadeh Y, Dekel R, Brezner A, Landa J, Silberg T. Families following pediatric traumatic medical events: identifying psychosocial risk profiles using latent profile analysis. Eur J Psychotraumatol 2022; 13:2116825. [PMID: 36186160 PMCID: PMC9518403 DOI: 10.1080/20008066.2022.2116825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Post-traumatic stress symptoms (PTSS) are often experienced by children and family members after pediatric traumatic medical events (PTMEs). Assessing families' psychosocial risk factors is a crucial part of trauma-informed practice as it helps identify risk for PTSS in the aftermath of PTME. OBJECTIVES Using the Psychosocial Assessment Tool 2.0 (PAT2.0), this study describes the psychosocial risk of families following PTMEs in two ways: 1. Describing the psychosocial risk defined by the PAT2.0 based on three-tiered risk levels; 2. Using latent profile analysis (LPA); identifying psychosocial risk profiles and examining how child- and injury-related factors can affect profile membership. METHODS Caregivers of 374 children following PTMEs admitted to a pediatric rehabilitation department in Israel completed the PAT2.0. Total PAT2.0 score and the seven PAT2.0 subscales (family structure/resources, social support, child problems, sibling problems, family problems, caregiver stress reactions, and family beliefs) were included in the first analysis. Mean PAT2.0 scores of three risk categories (universal, targeted, clinical) were calculated; LPA, which allows for cross-sectional latent variable mixture models to identify heterogeneity within a population, and multinomial logistic regressions using six out of the seven PAT2.0 subscales, were used to determine distinct profile differences and predictors of profile membership. RESULTS The three-tiered risk levels revealed were relatively high, as compared to levels in families of children with other clinical diagnoses. LPA yielded a three-profile solution: low family risk (63.53%); high caregiver stress, above-average levels of family risk (22.5%); and sibling problems, above-average levels of family risk (13.94%). Ethnicity and type of injury predicted group membership. CONCLUSION Families of children following PTMEs are at increased psychosocial risk. A clinically useful approach to identifying and preventing PTSS may be to evaluate specific domain patterns rather than just the total PAT2.0 risk level alone, based on the PAT2.0 subscales.
Collapse
Affiliation(s)
- Yaara Sadeh
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel.,Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel.,Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rachel Dekel
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Amichai Brezner
- Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel
| | - Jana Landa
- Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-aviv, Israel
| | - Tamar Silberg
- Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel.,Department of Psychology, Bar Ilan University, Ramat Gan, Israel
| |
Collapse
|
66
|
Beaulieu-Jones BR, Bingham S, Rhynhart KK, Croitoru DP, Singleton MN, Rutman MS, Baertschiger RM. Incorporating a Trauma-Informed Care Protocol Into Pediatric Trauma Evaluation: The Pediatric PAUSE Does Not Delay Imaging or Disposition. Pediatr Emerg Care 2022; 38:e52-e58. [PMID: 33181796 DOI: 10.1097/pec.0000000000002278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Trauma evaluation in the emergency department (ED) can be a stressful event for children. With the goal of minimizing pain, anxiety, and unneeded interventions in stable patients, we implemented the Pediatric PAUSE at our level 1 adult/level 2 pediatric trauma center. The Pediatric PAUSE is a brief protocol performed after the primary survey, which addresses Pain/Privacy, Anxiety/IV Access, Urinary Catheter/Rectal exam/Genital exam, Support from family or staff, and Explain to patient/Engage with PICU team. The aim was to assess whether performing the PAUSE interfered with timeliness of emergent imaging in pediatric patients and their disposition. METHODS We identified all patients aged 0 to 18 years evaluated as trauma activations at our institution after the Pediatric PAUSE was implemented (October 1, 2016-March 31, 2017) as well as 2 analogous 6-month pre-PAUSE periods. Patient demographics, time to imaging studies, and time to ED disposition were analyzed. RESULTS One hundred seventy-two patients met the study criteria, with a mean age of 10.9 years and mean injury severity score of 10.6. One hundred fifteen participants (68.5%) were transferred from other hospitals, and 101 (87.8%) had ≥1 imaging study performed before arrival. The Pediatric PAUSE was performed for 41 (25%) of 163 study participants. There was no difference in time to first imaging study in participants for whom the PAUSE was performed (18.4 vs 15.0 minutes, P = 0.09). CONCLUSIONS The PAUSE is a practice intervention designed to address the psychosocial needs of pediatric trauma patients and their families to help prevent posttraumatic stress symptoms. Implementation did not interfere with the timeliness of first imaging in pediatric trauma patients.
Collapse
Affiliation(s)
| | - Sarah Bingham
- Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock
| | - Kurt K Rhynhart
- Section of Trauma and Acute Care Surgery, Department of Surgery, Dartmouth-Hitchcock
| | | | - Marcy N Singleton
- Pediatric Intensive Care, Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock
| | - Maia S Rutman
- Section of Emergency Medicine, Department of Medicine/Pediatrics, Dartmouth-Hitchcock, Lebanon, NH
| | | |
Collapse
|
67
|
Communicating With and Supporting Youth Diagnosed With COVID-19: A Trauma-Informed Care Approach. J Adolesc Health 2022; 70:7-9. [PMID: 34930572 PMCID: PMC8678103 DOI: 10.1016/j.jadohealth.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 11/29/2022]
|
68
|
Bethell CD, Garner AS, Gombojav N, Blackwell C, Heller L, Mendelson T. Social and Relational Health Risks and Common Mental Health Problems Among US Children: The Mitigating Role of Family Resilience and Connection to Promote Positive Socioemotional and School-Related Outcomes. Child Adolesc Psychiatr Clin N Am 2022; 31:45-70. [PMID: 34801155 DOI: 10.1016/j.chc.2021.08.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Nearly 70% (67.6%) of US children with mental, emotional, and behavioral problems (MEB) experienced significant social health risks (SHR) and/or relational health risks (RHR). Shifts are needed in child mental health promotion, prevention, diagnosis, and treatment to address both RHR and SHR. Public health approaches are needed that engage families, youth, and the range of child-serving professionals in collaborative efforts to prevent and mitigate RHR and SHR and promote positive mental health at a community level. Building strong family resilience and connection may improve SR and, in turn, academic and social outcomes among all US children with or without MEB.
Collapse
Affiliation(s)
- Christina D Bethell
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Andrew S Garner
- Partners in Pediatrics and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Narangerel Gombojav
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Courtney Blackwell
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Laurence Heller
- NeuroAffective Relational Model Training Institute, Inc, Littleton, CO, USA
| | - Tamar Mendelson
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
69
|
Nelson S, Agoston M, Kovar-Gough I, Cunningham N. A Scoping Review and Proposed Framework for Coping in Youth With a History of Psychological Trauma and Chronic Pain. J Pediatr Psychol 2021; 47:469-482. [PMID: 34939115 DOI: 10.1093/jpepsy/jsab127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Psychological trauma (e.g., abuse, neglect) and posttraumatic stress symptoms (PTSS) commonly occur in pediatric pain populations and may be related to various maladaptive coping strategies, which may in turn affect short- and long-term pain-related outcomes in youth. Accordingly, the current scoping review and conceptual framework seeks to identify important gaps in the field's current understanding of how coping impacts outcomes in youth who have experienced trauma/PTSS and pediatric chronic pain and explores avenues for future investigation. METHODS A scoping review of the literature was performed in Medline, Embase, Cochrane Library, PsycInfo, and Sociological Abstracts. Eligibility criteria included pediatric populations experiencing chronic pain, trauma, adverse childhood events, and/or PTSS and associated coping mechanisms. Nine research papers were selected and used to support the conceptual framework. The framework builds upon the work of Compas et al.'s' model of control-based coping (Compas et al., 2006; Compas & Harding Thomsen, 1999) and outlines the potential effects of trauma and/or PTSS and pain on coping and pain-related outcomes (e.g., pain chronicity, functional outcomes) in pediatric chronic pain populations. RESULTS A history of chronic pain and psychological trauma and/or PTSS in youth may contribute to increased risk for maladaptive coping and in turn, poorer pain-related and psychosocial outcomes long-term. CONCLUSIONS Findings from the current scoping review and proposed conceptual framework will guide future research and treatment efforts for youths experiencing pain and trauma and/or PTSS and thereby enhance long-term outcomes.
Collapse
Affiliation(s)
- Sarah Nelson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, USA.,Department of Psychiatry, Harvard Medical School, USA
| | | | | | | |
Collapse
|
70
|
McEvoy MJ, Scott MJ, Sawyer KE. Requests for Accommodation in Brain Death Cases: Emerging Role for Pediatric Palliative Care. J Pain Symptom Manage 2021; 62:1319-1324. [PMID: 33933614 DOI: 10.1016/j.jpainsymman.2021.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
Death by neurologic criteria is a diagnosis that has presented complexities since its inception and pediatric cases are no exception. While rare, families may request accommodation to deviate from the traditionally defined diagnostic pathway based on their beliefs, mistrust of the diagnosis, or other complex reasons. Palliative care consultation offers a unique clinical perspective to complement the work of intensivists to support families through the diagnosis and possible resolution around accommodation requests. With misinformation and high-profile cases widely visible to the public through the media, these requests require a thoughtful and informed clinical approach by all members of the interdisciplinary clinical team. Common themes in many of these cases are trauma, bias and their impact on caregivers. We use a case-based approach to explore these complexities and clinical tools.
Collapse
Affiliation(s)
| | - Maya J Scott
- Seattle Children's Hospital, Seattle, Washington, USA
| | | |
Collapse
|
71
|
Affiliation(s)
- Lauren M Yagiela
- Critical Care Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit
- Critical Care Medicine, Department of Pediatrics, Central Michigan University, Mount Pleasant
| | - Mary E Hartman
- Critical Care Medicine, Department of Pediatrics, St Louis Children's Hospital, Washington University in St Louis, St Louis, Missouri
| |
Collapse
|
72
|
Jackson JE, Do-Nguyen A, Ewbank C, Anderson C, Newton C, Schreiber M. Feasibility of PTSD risk identification in pediatric trauma patients using PsySTART: A pilot study. J Pediatr Surg 2021; 56:2348-2353. [PMID: 33836845 DOI: 10.1016/j.jpedsurg.2021.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/01/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Trauma patients undergo a standardized history and physical, however identification of mental health risk factors is not typically included. We aimed to assess the feasibility of using a modified version of Psychological Simple Triage and Rapid Treatment (PsySTART) to identify post-traumatic stress disorder (PTSD) risk factors in pediatric trauma patients. We hypothesized that PsySTART could identify risk factors and be integrated into the electronic medical record (EMR). METHODS Trauma patients 10-17 years old at a level II pediatric trauma center from 2014 to 2015 were screened. PsySTART was used on a pilot cohort to determine if risk factors were present. PsySTART was then integrated into an automated EMR workflow and completion rates were evaluated. RESULTS PsySTART was completed in a pilot cohort of 63 patients with the following findings: 33.3% (n = 21) with 1 risk factor, 22.2% (n = 14) with 2 risk factors, and 19.1% (n = 12) with ≥3 risk factors. The most commonly identified risk factor was, "felt or expressed extreme fear or panic" (n = 27, 43.0%). After EMR integration, PsySTART was successfully completed with automatic consults in 156 of 198 patients (78.8%). CONCLUSIONS PsySTART identified risk factors in pediatric trauma patients. EMR integration was feasible and led to proactive psychological management and intervention. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Jordan E Jackson
- Department of Surgery, University of California, San Francisco East Bay, Oakland, CA USA.
| | - Amy Do-Nguyen
- Department of Pediatrics, Lundquist Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Clifton Ewbank
- Department of Surgery, University of California, San Francisco East Bay, Oakland, CA USA
| | - Craig Anderson
- Department of Emergency Medicine, University of California Irvine, Irvine, CA USA
| | - Christopher Newton
- Department of Surgery, University of California San Francisco Benioff Children's Hospital Oakland, Oakland, CA USA
| | - Merritt Schreiber
- Department of Pediatrics, Lundquist Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| |
Collapse
|
73
|
Vasan A, Mitchell HK, Fein JA, Buckler DG, Wiebe DJ, South EC. Association of Neighborhood Gun Violence With Mental Health-Related Pediatric Emergency Department Utilization. JAMA Pediatr 2021; 175:1244-1251. [PMID: 34542562 PMCID: PMC8453357 DOI: 10.1001/jamapediatrics.2021.3512] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Many children and adolescents in the United States are exposed to neighborhood gun violence. Associations between violence exposure and children's short-term mental health are not well understood. OBJECTIVE To examine the association between neighborhood gun violence and subsequent mental health-related pediatric emergency department (ED) utilization. DESIGN, SETTING, AND PARTICIPANTS This location-based cross-sectional study included 128 683 ED encounters for children aged 0 to 19 years living in 12 zip codes in Philadelphia, Pennsylvania, who presented to an urban academic pediatric ED from January 1, 2014, to December 31, 2018. Children were included if they (1) had 1 or more ED visits in the 60 days before or after a neighborhood shooting and (2) lived within a quarter-mile radius of the location where this shooting occurred. Analysis began August 2020 and ended May 2021. EXPOSURE Neighborhood violence exposure, as measured by whether a patient resided near 1 or more episodes of police-reported gun violence. MAIN OUTCOMES AND MEASURES ED encounters for a mental health-related chief complaint or primary diagnosis. RESULTS A total of 2629 people were shot in the study area between 2014 and 2018, and 54 341 children living nearby had 1 or more ED visits within 60 days of a shooting. The majority of these children were Black (45 946 [84.5%]) and were insured by Medicaid (42 480 [78.1%]). After adjusting for age, sex, race and ethnicity, median household income by zip code, and insurance, children residing within one-eighth of a mile (2-3 blocks) of a shooting had greater odds of mental health-related ED presentations in the subsequent 14 days (adjusted odds ratio, 1.86 [95% CI, 1.20-2.88]), 30 days (adjusted odds ratio, 1.49 [95% CI, 1.11-2.03]), and 60 days (adjusted odds ratio, 1.35 [95% CI, 1.06-1.72]). CONCLUSIONS AND RELEVANCE Exposure to neighborhood gun violence is associated with an increase in children's acute mental health symptoms. City health departments and pediatric health care systems should work together to provide community-based support for children and families exposed to violence and trauma-informed care for the subset of these children who subsequently present to the ED. Policies aimed at reducing children's exposure to neighborhood gun violence and mitigating the mental symptoms associated with gun violence exposure must be a public health priority.
Collapse
Affiliation(s)
- Aditi Vasan
- National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Hannah K. Mitchell
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joel A. Fein
- Division of Emergency Medicine, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Center for Violence Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David G. Buckler
- The Urban Health Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Douglas J. Wiebe
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Eugenia C. South
- The Urban Health Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| |
Collapse
|
74
|
Lynch BP, Brokamp KM, Scheerer CR, Bishop M, Stauble L, Hagedorn B, Endres L. Outcomes of Occupational Therapy in Trauma-Informed Care. JOURNAL OF OCCUPATIONAL THERAPY, SCHOOLS, & EARLY INTERVENTION 2021. [DOI: 10.1080/19411243.2021.2003733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Kristen M. Brokamp
- Department of Physical Therapy and Occupational Therapy, The Christ Hospital, Cincinnati, Ohio, USA
| | - Carol R. Scheerer
- Department of Occupational Therapy, Xavier University, Cincinnati, Ohio, USA
| | - Mackenzie Bishop
- Department of Rehabilitation Services Premier Health Network, Middletown, Ohio, USA
| | - Lauryn Stauble
- Department of Rehabilitation University of Cincinnati Hospital, West Chester, Ohio, USA
| | - Becky Hagedorn
- Department of Therapy, Hillandale Communities Advanced Therapy Center, Cincinnati, Ohio USA
| | - Lauren Endres
- Department of Therapy, Hillandale Communities Advanced Therapy Center, Cincinnati, Ohio USA
| |
Collapse
|
75
|
Understanding the meaning of trauma-informed care for burns health care professionals in a pediatric hospital: A qualitative study using interpretive phenomenological analysis. Burns 2021; 48:1462-1471. [PMID: 34922784 DOI: 10.1016/j.burns.2021.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/02/2021] [Accepted: 10/26/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Trauma-informed care includes a range of practices that build a culture of safety, empowerment, and healing. Limited information is available regarding the lived experience of trauma-informed care by healthcare professionals treating burns in a multidisciplinary setting. OBJECTIVE The primary aim of this study was to understand what 'trauma-informed care' means to staff and students working in burns at a tertiary pediatric hospital. METHODS Semi-structured interviews and focus group were conducted with healthcare professionals (medical, nursing, allied health, pre-graduate students) working in paediatric burn care (or their line manager). Analysis of the dataset was undertaken using qualitative methods (interpretive phenomenological approach and qualitative content analysis). RESULTS Eleven interviews and one focus group were completed and transcribed verbatim. Three superordinate themes were applicable across the five cohorts: 'what does trauma-informed care mean?', 'being able to deliver trauma-informed care' (agency) and 'impact of the setting'. Eleven components of trauma-informed care practice (for example, everyday interactions with patients and colleagues, screening and assessment) and service-level approaches (for example, service provider training) were described by participants. CONCLUSIONS Healthcare professionals' experiences of delivering trauma-informed care in a burns centre highlighted the need to clarify the concept of 'trauma-informed care' as a first step. Enabling the workforce to understand trauma-informed care and apply it in everyday interactions with patients and colleagues, and a strategic commitment to practice change needs to be actioned more systematically to support implementation of a trauma-informed care approach in pediatric health services.
Collapse
|
76
|
Koch A, Kozhumam A. Addressing Adultification of Black Pediatric Patients in the Emergency Department: A Framework to Decrease Disparities. Health Promot Pract 2021; 23:555-559. [PMID: 34693783 DOI: 10.1177/15248399211049207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Systematic racism and structural discrimination in the United States are factors that have negatively affected the health of Black individuals and families. One form of racism that often goes unrecognized and yet has a profound negative impact on the health and safety of Black children is adultification. Adultification occurs when children are perceived, or treated, as being older than they are. We implemented the Racism as a Root Cause framework to identify ways health care providers and health care systems can work to dismantle inequities and address the adultification of Black children in the emergency department (ED). A shift to change policies, systems, and environments in the ED begins with recognition of blind spots through training, communication, and reflection. Utilizing methods to identify adultification and racism, such as the ICD-10-CM Diagnosis Code Z60.5 Target of (perceived) adverse discrimination and persecution, can assist providers in recognizing the prevalence of racism and discrimination. To reduce the harms of inequities, injustice, and impacts of racism on Black children in the ED, it is essential to use trauma-informed care in all interactions. It is crucial for all employees of the ED to understand that adultification is extremely prevalent, hard to recognize, and causes harm to the health of Black children and their families. Without conscious efforts to decrease the pervasiveness and detriment of adultification bias, the repercussions of such racism will continue to perpetuate medical mistrust and negative health care experiences for Black children and families.
Collapse
|
77
|
Bargeman M, Smith S, Wekerle C. Trauma-informed care as a rights-based "standard of care": A critical review. CHILD ABUSE & NEGLECT 2021; 119:104762. [PMID: 33046264 DOI: 10.1016/j.chiabu.2020.104762] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/23/2020] [Accepted: 09/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND A growing body of literature on the concept of trauma-informed care (TIC) has emerged in response to greater recognition of the prevalence of childhood trauma. Currently, no review has examined the conceptualization of TIC in various child-serving systems, specifically TIC as a standard of care, the outcomes examined relevant to care, and whether child rights are part of the TIC discourse. METHOD A systematic search of 12 health and non-health databases, reviewed for relevance to children and youth specifically, was conducted to form a critical review of the literature. RESULTS Forty-nine documents were selected, which included articles from child welfare (n = 16), education (n = 15), juvenile justice (n = 8), health (n = 7), and multiple sectors (n = 3). A common theme across all sectors was a lack of clear understanding regarding what is TIC and how to implement it. While trauma symptoms are seemingly a good-fit outcome and reflective of a right to rehabilitative health, validated assessment tools were not commonly used. Few studies explicitly included a child rights perspective within TIC. CONCLUSION Emerging evidence encourages systematic inquiry into the operationalization of TIC to better assess whether it is an established model with consistent measurement. Empirical studies need to embrace established intervention methodology (e.g., improvement from baseline, control groups). From this expanded rigor, the issue as to whether TIC can evolve to a rights-based standard of care can be addressed.
Collapse
Affiliation(s)
- M Bargeman
- Department of Health Research Methods Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario, Canada
| | - S Smith
- Department of Pediatrics, McMaster University, 1280 Main St. West, Hamilton, Ontario, Canada.
| | - C Wekerle
- Department of Pediatrics, McMaster University, 1280 Main St. West, Hamilton, Ontario, Canada
| |
Collapse
|
78
|
Jordan A, Carter B, Vasileiou K. “Pain talk”: A triadic collaboration in which nurses promote opportunities for engaging children and their parents about managing children’s pain. PAEDIATRIC AND NEONATAL PAIN 2021; 3:123-133. [PMID: 35547948 PMCID: PMC8975224 DOI: 10.1002/pne2.12061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/23/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022]
Abstract
Effective communication with children about pain is important and has the potential to mediate the short‐ and longer‐term effects of pain on children. Most communication studies relating to children's pain have focused on language children use to describe everyday pain experiences. However, little is known regarding how health professionals, particularly nurses, communicate with children in healthcare settings about pain. This study aimed to explore how nurses talk to children and their parents about pain and what factors influence nurses’ use of language and non‐verbal communication. A cross‐sectional mixed‐methods (predominantly qualitative) survey (“pain talk”) was conducted, comprising qualitative items about pain communication and four vignettes portraying hypothetical cases of children representing typical child pain scenarios. Participants were recruited via email, social media, newsletters, established networks, and personal contacts. A total of 141 registered (68.1%) or in‐training nurses across 11 countries with experience of managing children's pain completed the survey. Textual survey responses were analyzed using conventional qualitative content analysis. Qualitative content analysis generated a meta‐theme “Being confident and knowing how to do ‘pain talk’” and four main themes that described the functions, purpose, and delivery of “pain talk”: (a) “contextualizing and assessing,” (b) “empowering, explaining, and educating,” (c) “supporting, affirming, and confirming,” and (d) “protecting, distracting, and restoring.” “Pain talk” was a triadic collaborative communication process that required nurses to feel confident about their role and skills. This process involved nurses talking to children and parents about pain and creating engagement opportunities for children and parents. “Pain talk” aimed to promote the agency of the child and parent and their engagement in discussions and decision‐making, using information, support, and comfort. Nurses shaped their “pain talk” to the specific context of the child's pain, previous experiences, and current concerns to minimize potential distress and adverse effects and to promote optimal pain management.
Collapse
Affiliation(s)
- Abbie Jordan
- Centre for Pain Research and Department of Psychology University of Bath Bath UK
| | - Bernie Carter
- Faculty of Health, Social Care and Medicine Edge Hill University Ormskirk UK
| | - Konstantina Vasileiou
- Department of Psychology University of Bath Bath UK
- University of West Attica Athens Greece
| |
Collapse
|
79
|
Abstract
Most children will experience some type of trauma during childhood, and many children suffer from significant adversities. Research in genetics, neuroscience, and epidemiology all provide evidence that these experiences have effects at the molecular, cellular, and organ level, with consequences on physical, emotional, developmental, and behavioral health across the life span. Trauma-informed care translates that science to inform and improve pediatric care and outcomes. To practically address trauma and promote resilience, pediatric clinicians need tools to assess childhood trauma and adversity experiences as well as practical guidance, resources, and interventions. In this clinical report, we summarize current, practical advice for rendering trauma-informed care across varied medical settings.
Collapse
Affiliation(s)
- Heather Forkey
- Department of Pediatrics, University of Massachusetts, Worcester, Massachusetts
| | - Moira Szilagyi
- Divisions of General and Developmental-Behavioral Pediatrics, Department of Pediatrics, University of California, Los Angeles, Los Angeles, California
| | - Erin T Kelly
- Ambulatory Health Services, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | | | | |
Collapse
|
80
|
Duffee J, Szilagyi M, Forkey H, Kelly ET. Trauma-Informed Care in Child Health Systems. Pediatrics 2021; 148:peds.2021-052579. [PMID: 34312294 DOI: 10.1542/peds.2021-052579] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- James Duffee
- Departments of Pediatrics and Psychiatry, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Moira Szilagyi
- Divisions of General and Developmental-Behavioral Pediatrics, Department of Pediatrics, University of California, Los Angeles, Los Angeles, California
| | - Heather Forkey
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | | |
Collapse
|
81
|
McAleese T, Brent L, O'Toole P, Synnott K, Quinn N, Deasy C, Sheehan E. Paediatric major trauma in the setting of the Irish trauma network. Injury 2021; 52:2233-2243. [PMID: 34083024 DOI: 10.1016/j.injury.2021.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/10/2021] [Accepted: 05/16/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The construction of a new tertiary children's hospital and reconfiguration of its two satellite centres will become the Irish epicentre for all paediatric care including paediatric trauma. Ireland is also currently establishing a national trauma network although further planning of how to manage paediatric trauma in the context of this system is required. This research defines the unknown epidemiology of paediatric major trauma in Ireland to assist strategic planning of a future paediatric major trauma network. METHODS Data from 1068 paediatric trauma cases was extracted from a longitudinal series of annual cross-sectional studies collected by the Trauma Audit and Research Network (TARN). All paediatric patients between the ages of 0-16 suffering AIS ≥2 injuries in Ireland between 2014-2018 were included. Demographics, injury patterns, hospital care processes and outcomes were analysed. RESULTS Children were most commonly injured at home (45.1%) or in public places/roads (40.1%). The most frequent mechanisms of trauma were falls <2 m (36.8%) followed by RTAs (24.3%). Limb injuries followed by head injuries were the most often injured body parts. The proportion of head injuries in those aged <1 year is double that of any other age group. Only 21% of patients present directly to a children's hospital and 46% require transfer. Consultant-led emergency care is currently delivered to 41.5% of paediatric major trauma patients, there were 555 (48.2%) patients who required operative intervention and 22.8% who required critical care admission. A significant number of children in Ireland aged 1-5 years die from asphyxia/drowning. The overall mortality rate was 3.8% and was significantly associated with the presence of head injuries (p < 0.001). CONCLUSION Paediatric Trauma represents a significant childhood burden of mortality and morbidity in Ireland. There are currently several sub-optimal elements of paediatric trauma service delivery that will benefit from the establishment of a trauma network. This research will help guide prevention strategy, policy-making and workforce planning during the establishment of an Irish paediatric trauma network and will act as a benchmark for future comparison studies after the network is implemented.
Collapse
Affiliation(s)
- Timothy McAleese
- National University of Ireland, Galway, Ireland; Department of Trauma and Orthopaedics, Midland Regional Hospital Tullamore, Ireland.
| | - Louise Brent
- Major Trauma Audit, National Office of Clinical Audit, Ireland
| | - Patrick O'Toole
- Department of Trauma and Orthopaedics, CHI at Crumlin, Dublin, Ireland
| | - Keith Synnott
- National Clinical Lead for Trauma services, Dublin, Ireland
| | - Nuala Quinn
- Department of Paediatric Emergency Medicine, CHI at Temple Street
| | - Conor Deasy
- Major Trauma Audit Clinical Lead, National Office of Clinical Audit, Ireland
| | - Eoin Sheehan
- Department of Trauma and Orthopaedics, Midland Regional Hospital Tullamore, Ireland
| |
Collapse
|
82
|
Garner A, Yogman M. Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health. Pediatrics 2021; 148:peds.2021-052582. [PMID: 34312296 DOI: 10.1542/peds.2021-052582] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
By focusing on the safe, stable, and nurturing relationships (SSNRs) that buffer adversity and build resilience, pediatric care is on the cusp of a paradigm shift that could reprioritize clinical activities, rewrite research agendas, and realign our collective advocacy. Driving this transformation are advances in developmental sciences as they inform a deeper understanding of how early life experiences, both nurturing and adverse, are biologically embedded and influence outcomes in health, education, and economic stability across the life span. This revised policy statement on childhood toxic stress acknowledges a spectrum of potential adversities and reaffirms the benefits of an ecobiodevelopmental model for understanding the childhood origins of adult-manifested disease and wellness. It also endorses a paradigm shift toward relational health because SSNRs not only buffer childhood adversity when it occurs but also promote the capacities needed to be resilient in the future. To translate this relational health framework into clinical practice, generative research, and public policy, the entire pediatric community needs to adopt a public health approach that builds relational health by partnering with families and communities. This public health approach to relational health needs to be integrated both vertically (by including primary, secondary, and tertiary preventions) and horizontally (by including public service sectors beyond health care). The American Academy of Pediatrics asserts that SSNRs are biological necessities for all children because they mitigate childhood toxic stress responses and proactively build resilience by fostering the adaptive skills needed to cope with future adversity in a healthy manner.
Collapse
Affiliation(s)
- Andrew Garner
- Partners in Pediatrics, Westlake, Ohio.,School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | | | | |
Collapse
|
83
|
Augustine EF, Adams HR, de Los Reyes E, Drago K, Frazier M, Guelbert N, Laine M, Levin T, Mink JW, Nickel M, Peifer D, Schulz A, Simonati A, Topcu M, Turunen JA, Williams R, Wirrell EC, King S. Management of CLN1 Disease: International Clinical Consensus. Pediatr Neurol 2021; 120:38-51. [PMID: 34000449 DOI: 10.1016/j.pediatrneurol.2021.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 04/01/2021] [Accepted: 04/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND CLN1 disease (neuronal ceroid lipofuscinosis type 1) is a rare, genetic, neurodegenerative lysosomal storage disorder caused by palmitoyl-protein thioesterase 1 (PPT1) enzyme deficiency. Clinical features include developmental delay, psychomotor regression, seizures, ataxia, movement disorders, visual impairment, and early death. In general, the later the age at symptom onset, the more protracted the disease course. We sought to evaluate current evidence and to develop expert practice consensus to support clinicians who have not previously encountered patients with this rare disease. METHODS We searched the literature for guidelines and evidence to support clinical practice recommendations. We surveyed CLN1 disease experts and caregivers regarding their experiences and recommendations, and a meeting of experts was conducted to ascertain points of consensus and clinical practice differences. RESULTS We found a limited evidence base for treatment and no clinical management guidelines specific to CLN1 disease. Fifteen CLN1 disease experts and 39 caregivers responded to the surveys, and 14 experts met to develop consensus-based recommendations. The resulting management recommendations are uniquely informed by family perspectives, due to the inclusion of caregiver and advocate perspectives. A family-centered approach is supported, and individualized, multidisciplinary care is emphasized in the recommendations. Ascertainment of the specific CLN1 disease phenotype (infantile-, late infantile-, juvenile-, or adult-onset) is of key importance in informing the anticipated clinical course, prognosis, and care needs. Goals and strategies should be periodically reevaluated and adapted to patients' current needs, with a primary aim of optimizing patient and family quality of life.
Collapse
Affiliation(s)
- Erika F Augustine
- Department of Neurology and Neurogenetics, Kennedy Krieger Institute, Baltimore, Maryland; Departments of Neurology and Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York.
| | - Heather R Adams
- Departments of Neurology and Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Emily de Los Reyes
- Department of Pediatrics and Neurology, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | | | | | - Norberto Guelbert
- Metabolic Diseases Section, Children's Hospital of Cordoba, Cordoba, Argentina
| | - Minna Laine
- Department of Pediatric Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tanya Levin
- Medical Writing Consultant, Atlanta, Georgia
| | - Jonathan W Mink
- Departments of Neurology, Neuroscience, and Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Miriam Nickel
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Angela Schulz
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandro Simonati
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona School of Medicine, Verona, Italy
| | - Meral Topcu
- Professor Emeritus, Department of Pediatric Neurology, Hacettepe University, Ankara, Turkey
| | - Joni A Turunen
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ruth Williams
- Children's Neurosciences Centre, Evelina London Children's Hospital, London, United Kingdom
| | - Elaine C Wirrell
- Divisions of Epilepsy and Child and Adolescent Neurology, Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | |
Collapse
|
84
|
Brown T, Mehta PK, Berman S, McDaniel K, Radford C, Lewis-O'Connor A, Grossman S, Potter J, Hirsh DA, Woo B, Krieger D. A Trauma-Informed Approach to the Medical History: Teaching Trauma-Informed Communication Skills to First-Year Medical and Dental Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11160. [PMID: 34150993 PMCID: PMC8180538 DOI: 10.15766/mep_2374-8265.11160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Trauma is ubiquitous and associated with negative effects on physical and mental health. Trauma-informed care (TIC) is a framework for mitigating these health effects and improving patients' engagement with medical care. Despite these clinical benefits, TIC is not routinely taught in undergraduate medical education. METHODS We designed a session for first-year medical and dental students to introduce TIC principles and their application in patient care. The session focused on screening for and inquiring about trauma and responding to disclosures of trauma. Using live patient interviews, small-group discussions, and case-based role-plays, the session offered expert instruction and hands-on practice. Students completed pre- and postsession surveys and a 5-month follow-up survey. Students reported their comfort with screening for trauma and responding to disclosures of trauma before and after the session and at 5 months following the session. RESULTS Of the 164 student participants, 76% completed surveys during the session, and 50% completed the follow-up survey. More than one-third (34%) of respondents reported having received at least one disclosure of trauma from a patient within the first 5 months of medical school. Students' comfort with screening for trauma increased from 30% to 56%, and their comfort with responding to disclosure of trauma increased from 35% to 55%. These improvements persisted on reevaluation at 5 months. DISCUSSION We present a model for teaching trauma-informed communication skills to first-year medical and dental students. The intervention significantly increased students' comfort level and self-reported clinical skills, and benefits persisted at 5 months.
Collapse
Affiliation(s)
- Taylor Brown
- Fourth-Year Medical Student, Harvard Medical School
- Corresponding author:
| | - Pooja K. Mehta
- Second-Year Resident, Department of Medicine, Brigham and Women's Hospital
| | - Sarah Berman
- First-Year Resident, Department of Psychiatry, Cambridge Health Alliance
| | | | | | - Annie Lewis-O'Connor
- Nurse Practitioner, Department of Medicine, Division of Women's Health, Brigham and Women's Hospital; Instructor, Harvard Medical School
| | - Samara Grossman
- Social Worker, Department of Psychiatry, Brigham and Women's Hospital
| | - Jennifer Potter
- Professor, Department of Medicine, Harvard Medical School; Physician, Department of General Internal Medicine, Beth Israel Deaconess Medical Center
| | - David A. Hirsh
- The George E. Thibault Academy Associate Professor, Harvard Medical School; Physician, Department of Internal Medicine, Cambridge Health Alliance
| | - Beverly Woo
- Associate Professor of Medicine, Harvard Medical School; Senior Physician, Department of Medicine, Brigham and Women's Hospital
| | - David Krieger
- Clinical Instructor in Medicine, Harvard Medical School; Physician, Atrius Health
| |
Collapse
|
85
|
Marcynyszyn LA, McCarty CA, Rivara FP, Johnson AM, Wang J, Zatzick DF. Parent Traumatic Events and Adolescent Internalizing Symptoms: The Mediating Role of Parental Depression Among Youth with Persistent Post-concussive Symptoms. J Pediatr Psychol 2021; 46:547-556. [PMID: 33411915 DOI: 10.1093/jpepsy/jsaa128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/07/2020] [Accepted: 12/13/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Research has demonstrated associations between parental depression (PD) and negative psychological outcomes among their children. However, little is known about the pathways through which lifetime parent traumatic events (PTEs) influence their adolescents' internalizing symptoms. Our study examined whether PD mediates the association between PTE and adolescent depressive and anxious symptoms among youth with persistent postconcussive symptoms (PPCS). METHODS We used baseline data from a randomized effectiveness trial of collaborative care for treatment of persistent postconcussive symptoms among sports-injured adolescents aged 11-18 years. Parent-adolescent dyads were recruited from pediatric clinics throughout western Washington. Eligible adolescents had three or more PPCS that lasted for at least 1 month but <9 months and spoke English. Of 1,870 potentially eligible adolescents, 1,480 (79%) were excluded for not meeting the inclusion criteria. Of the eligible 390 adolescents, 189 (49%) declined to participate/consent. Participants included 200 parent-adolescent dyads (adolescent Mage = 14.7 years, SD = 1.7). Parent respondents were mostly female (83%) and mothers (81%). Adolescents reported on their depressive (Patient Health Questionnaire-9; PHQ-9) and anxious symptoms (Revised Child Anxiety and Depression Scale-Short Version [anxiety subscale]) and parents reported on their depressive symptoms (M = 3.7, SD = 3.7; PHQ-9). RESULTS Mediation analyses revealed two (out of four) significant indirect effects of PTE on both adolescent and parent report of depressive symptoms, but not anxiety. CONCLUSIONS This study elucidates one pathway (PD) through which PTE history influences adolescent depressive symptoms, supporting a two-generation approach to pediatric patient care for youth experiencing PPCS.
Collapse
Affiliation(s)
- Lyscha A Marcynyszyn
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute
| | - Carolyn A McCarty
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute.,Department of Pediatrics, University of Washington
| | - Frederick P Rivara
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute.,Department of Pediatrics, University of Washington.,Harborview Injury Prevention and Research Center, University of Washington
| | - Ashleigh M Johnson
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute
| | - Jin Wang
- Department of Pediatrics, University of Washington.,Harborview Injury Prevention and Research Center, University of Washington
| | - Douglas F Zatzick
- Harborview Injury Prevention and Research Center, University of Washington.,Psychiatry and Behavioral Sciences, University of Washington
| |
Collapse
|
86
|
Berger E, Jamshidi N, Reupert A, Jobson L, Miko A. Review: The mental health implications for children and adolescents impacted by infectious outbreaks - a systematic review. Child Adolesc Ment Health 2021; 26:157-166. [PMID: 33733620 DOI: 10.1111/camh.12453] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND This systematic review synthesized available research on the psychological implications for children and adolescents who either were directly or indirectly exposed to an infectious outbreak. On this basis, the current paper aims to provide recommendations for future research, practice and policy regarding children during pandemics. METHOD A total of 2195 records were retrieved from the PsycINFO, SCOPUS and MEDLINE databases, and three from Google Scholar. RESULTS Including only those papers that focused on children or adolescent's mental health in association with respiratory infectious outbreaks, 11 articles were identified. The majority of research utilized qualitative or retrospective hospital record data. Children and adolescents reported fear and anxiety, as well as disruptions to their day to day routines as a result of outbreaks. However, children were also able to demonstrate resilience during outbreaks with the right support. CONCLUSIONS Children's psychological response to the outbreak appeared to be largely attributed to how their parents, healthcare providers and the media communicated the event. Recommendations for policy, practitioners and researchers concerning the current COVID-19 outbreak concludes the paper.
Collapse
Affiliation(s)
- Emily Berger
- Faculty of Education, Monash University, Melbourne, Vic, Australia
| | - Negar Jamshidi
- School of Health and Biomedical Sciences, College of Science, Engineering and Health, RMIT University, Melbourne, Vic, Australia
| | - Andrea Reupert
- Faculty of Education, Monash University, Melbourne, Vic, Australia
| | - Laura Jobson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
| | - Amy Miko
- Faculty of Education, Monash University, Melbourne, Vic, Australia
| |
Collapse
|
87
|
Lang JM, Connell CM, Macary S. Validating the Child Trauma Screen Among a Cross-Sectional Sample of Youth and Caregivers in Pediatric Primary Care. Clin Pediatr (Phila) 2021; 60:252-258. [PMID: 33853370 DOI: 10.1177/00099228211005302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pediatric primary care providers have an important role in addressing the health effects of trauma, yet routine screening is rare. This study evaluated whether the 10-item Child Trauma Screen (CTS) could identify youth experiencing posttraumatic stress disorder (PTSD) symptoms. Participants were 107 caregiver-youth pairs aged 7 to 17 years old, 55.8% male, and 76.4% Hispanic who were recruited at an urban pediatric primary care clinic. Youth and caregivers separately completed the CTS and the UCLA PTSD Reaction Index for DSM-5 (RI-5) prior to their medical visit. Half of youth experienced at least one type of trauma, and one sixth reported elevated PTSD symptoms. The CTS was highly correlated with the RI-5 on PTSD symptom severity, and correctly classified 85% of youth based on likely PTSD diagnosis. The brief CTS can accurately identify youth suffering from PTSD symptoms, and may be particularly feasible to implement in busy primary care practices.
Collapse
Affiliation(s)
- Jason M Lang
- Child Health and Development Institute, Farmington, CT, USA.,Yale University, New Haven, CT, USA.,UCONN Health, Farmington, CT, USA
| | | | - Susan Macary
- Child Health and Development Institute, Farmington, CT, USA
| |
Collapse
|
88
|
Brown T, Berman S, McDaniel K, Radford C, Mehta P, Potter J, Hirsh DA. Trauma-Informed Medical Education (TIME): Advancing Curricular Content and Educational Context. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:661-667. [PMID: 32675789 DOI: 10.1097/acm.0000000000003587] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The majority of patients and medical students experience some form of psychological trauma or adversity across their life course. All forms of trauma can be associated with adverse health consequences and can negatively affect learning and professional development. Trauma-informed care (TIC) offers a framework to address and mitigate these consequences and promote safety and health. The Substance Abuse and Mental Health Services Administration describes 6 domains of TIC: safety; trust and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and cultural, historic, and gender issues. At present, TIC is not taught routinely in undergraduate medical education (UME)-a crucial educational gap given that UME grounds the development of key perspectives and practices that students use throughout their careers. Further, given the prevalence of preexisting trauma among learners and the likelihood of new traumatic exposures during training, medical schools' processes, practices, and learning environments may risk exacerbating or even causing trauma. To address this educational need and support students and their future patients, the authors propose a trauma-informed medical education (TIME) framework. TIME informs medical schools' curricular content and educational context. In UME, curricular content should address trauma epidemiology, physiology, and effects; trauma-informed clinical skills including sensitive communication and physical exam techniques; and trauma-informed self-care techniques including education on organizational resources, how to elicit supports, and personal self-care practices. A trauma-informed educational context encompasses curricular development, including student-faculty coproduction of educational content; curricular delivery, including faculty development on TIC principles; and learning environment, including trauma-informed educational practices, medical student advising, institutional policies, and recruitment. TIME offers practical strategies to support teaching, learning, educational administration, and professional development and aims to inspire new strategies for effective learner and faculty engagement. TIME aims to foster students' development of competency in TIC and promote student engagement, learning, health, and well-being.
Collapse
Affiliation(s)
- Taylor Brown
- T. Brown is a third-year medical student, Harvard Medical School, Boston, Massachusetts
| | - Sarah Berman
- S. Berman is a fourth-year medical student, Harvard Medical School, Boston, Massachusetts
| | - Katherine McDaniel
- K. McDaniel is a third-year medical student, Harvard Medical School, Boston, Massachusetts
| | - Caitlin Radford
- C. Radford is a third-year medical student, Harvard Medical School, Boston, Massachusetts
| | - Pooja Mehta
- P. Mehta is a first-year resident, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer Potter
- J. Potter is professor of medicine, Harvard Medical School, Boston, Massachusetts
| | - David A Hirsh
- D.A. Hirsh is the George E. Thibault Academy Associate Professor and director, HMS Academy, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
89
|
Expert Perspectives on Intimate Partner Violence Power and Control in Pediatric Healthcare Settings. Acad Pediatr 2021; 21:548-556. [PMID: 32097782 DOI: 10.1016/j.acap.2020.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/11/2020] [Accepted: 02/15/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Childhood exposure to intimate partner violence (IPV) is a pervasive public health epidemic with profound impact on child health. While past work has demonstrated how abusive partners exert control over IPV survivors in a variety of settings (eg workplace, courts, home), scant research has examined how IPV power and control behaviors manifest themselves in pediatric healthcare settings. In this study, we explore the perspectives of pediatric IPV experts about: (1) behaviors used by abusive partners to control IPV survivors in pediatric healthcare settings; (2) how controlling behaviors impact healthcare access and quality; and (3) recommendations for the pediatric healthcare team. METHODS Individual semi-structured interviews were conducted with pediatric IPV experts recruited through snowball sampling. Interviews were individually coded by two research team members and analyzed using thematic analysis. RESULTS Twenty-eight pediatric IPV experts participated. Participants described several types of controlling behaviors including limiting healthcare access, dominating conversations during medical visits, controlling medical decision making, and manipulating perceptions of the healthcare team. Participants acknowledged the challenges of recognizing controlling behaviors and provided several recommendations to addressing behaviors such as leveraging the expertise of multidisciplinary teams. CONCLUSIONS Participants described how abusive partners may attempt to control or discredit their partners in pediatric healthcare settings, using subtle behaviors that may be easily missed by the healthcare team. These results set the stage for further research and clinical practice innovation including triangulating the findings with IPV survivors, examining how frequently these behaviors occur, and developing multidisciplinary IPV training for the pediatric healthcare team.
Collapse
|
90
|
Abstract
American Indian and Alaska Native (AI/AN) populations have substantial health inequities, and most of their disease entities begin in childhood. In addition, AI/AN children and adolescents have excessive disease rates compared with the general pediatric population. Because of this, providers of pediatric care are in a unique position not only to attenuate disease incidence during childhood but also to improve the health status of this special population as a whole. This policy statement examines the inequitable disease burden observed in AI/AN youth, with a focus on toxic stress, mental health, and issues related to suicide and substance use disorder, risk of and exposure to injury and violence in childhood, obesity and obesity-related cardiovascular risk factors and disease, foster care, and the intersection of lesbian, gay, bisexual, transgender, queer, and Two-Spirit and AI/AN youth. Opportunities for advocacy in policy making also are presented.
Collapse
Affiliation(s)
- Shaquita Bell
- Departments of Pediatrics and
- Contributed equally as co-first authors
| | - Jason F Deen
- Departments of Pediatrics and
- Contributed equally as co-first authors
| | - Molly Fuentes
- Rehabilitation Medicine, School of Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington; and
| | - Kelly Moore
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| |
Collapse
|
91
|
Dealing with "Difficult" Patients and Families: Making a Case for Trauma-informed Care in the Intensive Care Unit. Ann Am Thorac Soc 2021; 17:541-544. [PMID: 31944818 DOI: 10.1513/annalsats.201909-700ip] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
|
92
|
Malhi P, Bharti B. Traumatic Stress or ADHD? Making a Case for Trauma Informed Care in Pediatric Practice. Indian J Pediatr 2021; 88:287. [PMID: 33095396 DOI: 10.1007/s12098-020-03545-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Prahbhjot Malhi
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
| | - Bhavneet Bharti
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| |
Collapse
|
93
|
Marsac ML, Wurth MA. Opportunities to support emotional health in school-age children with food allergy. Ann Allergy Asthma Immunol 2021; 126:728-729. [PMID: 33639263 DOI: 10.1016/j.anai.2021.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/19/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Meghan L Marsac
- Division of Pediatric Palliative Care, Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky.
| | - Mark A Wurth
- Division of Pulmonology, Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky
| |
Collapse
|
94
|
Sadeh Y, Dekel R, Brezner A, Landa J, Silberg T. Child and Family Factors Associated With Posttraumatic Stress Responses Following a Traumatic Medical Event: The Role of Medical Team Support. J Pediatr Psychol 2021; 45:1063-1073. [PMID: 32968802 DOI: 10.1093/jpepsy/jsaa070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/13/2020] [Accepted: 07/23/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study examined the contribution of pretrauma psychosocial factors (child emotional functioning, family resources, family functioning, and social support) and environmental factors (mother's posttraumatic stress symptoms [PTSSs], medical team support [MTS]) to PTSSs of injured or seriously ill children within a pediatric rehabilitation setting. It was hypothesized that psychosocial variables would be strongly associated with child's PTSS; that mother's PTSS and MTS would mediate the association between psychosocial factors and child's PTSS; that mother's report on child's PTSS would mediate the association between mother's PTSS and child's PTSS. METHODS Participants were 196 children hospitalized following an injury/illness and assessed M = 47.7 days postevent. Children completed measures of PTSS, mothers completed measures of their own PTSS, child's PTSS, and pretrauma psychosocial factors. Family's therapist completed a MTS measure. Structural equation modeling was employed to evaluate the study hypotheses. RESULTS Pretrauma family structure and resources were associated with child's self-reported PTSS; each pretrauma variable and mother's report of child's PTSS was significantly associated. Although mother's PTSS was not directly associated with child's PTSS, this relationship was mediated by mother's report of child's PTSS. MTS mediated the relationship between pretrauma social support and mother's PTSS. CONCLUSION This study further explicates the utility of a biopsychosocial framework in predicting childhood PTSS. Findings confirm the role of pretrauma factors and environmental factors at the peritrauma period in the development of PTSS following a pediatric injury/illness. Mother's PTSS and MTS may be appropriate targets for prevention and early intervention.
Collapse
Affiliation(s)
- Yaara Sadeh
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University.,Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center
| | - Rachel Dekel
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University
| | - Amichai Brezner
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center
| | - Jana Landa
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center.,Sackler Faculty of Medicine, Tel-Aviv University
| | - Tamar Silberg
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center.,Holland Bloorview Kids Rehabilitation Hospital.,Department of Psychology, Bar-Ilan University
| |
Collapse
|
95
|
Brodie N, Perdomo JE, Silberholz EA. The dual pandemics of COVID-19 and racism: impact on early childhood development and implications for physicians. Curr Opin Pediatr 2021; 33:159-169. [PMID: 33394742 DOI: 10.1097/mop.0000000000000985] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The novel coronavirus (COVID-19) pandemic has highlighted healthcare and racial inequities. This article discusses recent literature documenting the impact of racism on early childhood development, disparities in access to developmental services and ways healthcare providers and health systems can promote physician well being during these difficult times. RECENT FINDINGS Exposure to racism begins prenatally, and early childhood experiences with racism are intimately tied to adverse physical and mental health outcomes. Early intervention is key to treating children with developmental delay, but disparities exist in accessing eligibility screening and in the provision of services. Paediatric providers are at risk of developing secondary traumatic stress and burnout, which may affect the care that they provide. SUMMARY New research has led to the development of resources that help paediatric providers address racism, access developmental resources in a novel manner and protect the paediatric workforce from trauma and burnout.
Collapse
Affiliation(s)
| | - Joanna E Perdomo
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth A Silberholz
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
96
|
Ong JE, Fassel M, Scieszinski L, Hosseini S, Galet C, Oral R, Wibbenmeyer L. The burden of adverse childhood experiences in children and those of their parents in a burn population. J Burn Care Res 2021; 42:944-952. [PMID: 33484246 DOI: 10.1093/jbcr/irab009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the prevalence, type, and associations of parental and child adverse childhood experiences (ACEs) in children presenting with burn injuries. METHODS Parents of burned children completed an ACE-18 survey, including questions on parent and child ACEs, needs, and resiliency. Demographics, burn injury, hospital course, and follow up data were collected. Family needs and burn outcomes of children with and without ACEs' exposure (NO ACE vs. 1-2 ACE vs ≥ 3 ACE) was analyzed. P < 0.05 was considered significant. RESULTS Seventy-five children were enrolled; 58.7% were male, 69.3% white. The average age was 6.0 ± 5.2 years. The average total burn surface area was 4.4 ± 5.7% (0.1 to 27%). Parent ACE exposure correlated with child ACE exposure (r = 0.57; p = 0.001) and this intensified by increasing child age (p = 0.004). Child ACE exposure showed a graded response to family needs, including food and housing insecurity and childcare needs. Stress and psychosocial distress of the parents was significantly associated with their children's ACE burden. CONCLUSIONS The ACE burden of parents of burned children can affect the ACE load of their children. Burned children with more ACEs tend to have significantly more needs and more family distress. Awareness of past trauma can help identify a vulnerable population to ensure successful burn recovery.
Collapse
Affiliation(s)
- Jia Ern Ong
- College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA
| | - Mikenzy Fassel
- Carver College of Medicine, University of Iowa, Iowa City, IA
| | | | | | - Colette Galet
- Department of Surgery, University of Iowa, Iowa City, IA
| | - Resmiye Oral
- Dartmouth Hitchcock Medical Center, Geisel School of Medicine, Lebanon, NH
| | | |
Collapse
|
97
|
Sala-Hamrick KJ, Isakson B, De Gonzalez SDC, Cooper A, Buchan J, Aceves J, Van Orton E, Holtz J, Waggoner DM. Trauma-Informed Pediatric Primary Care: Facilitators and Challenges to the Implementation Process. J Behav Health Serv Res 2021; 48:363-381. [DOI: 10.1007/s11414-020-09741-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
|
98
|
Jones MT, Kirkendall M, Grissim L, Daniels S, Boles JC. Exploration of the Relationship Between a Group Medical Play Intervention and Children's Preoperative Fear and Anxiety. J Pediatr Health Care 2021; 35:74-83. [PMID: 32928600 DOI: 10.1016/j.pedhc.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/30/2020] [Accepted: 08/01/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Surgical procedures place children of all ages at risk for pediatric medical traumatic stress. Although medical play has proven effective in pediatric care, little is known about the impacts of a group medical play intervention on children's preoperative fear and anxiety. Therefore, the purpose of this pre-post quasi-experimental study was to explore the relationship between a group medical play activity and children's preoperative fear and anxiety. METHOD Fifty children (aged 5-10 years) scheduled for a medical procedure participated in a group medical play session facilitated by a Certified Child Life Specialist. RESULTS Statistically significant decreases in anxiety and self-reported fear were observed after the intervention, suggesting that medical play may generate additional coping benefits when offered in group formats. DISCUSSION Providing children with the opportunity to explore and become familiar with medical equipment through group medical play can help to minimize preoperative anxiety and improve the patient experience for children and their families.
Collapse
|
99
|
McNamara M, Cane R, Hoffman Y, Reese C, Schwartz A, Stolbach B. Training Hospital Personnel in Trauma-Informed Care: Assessing an Interprofessional Workshop With Patients as Teachers. Acad Pediatr 2021; 21:158-164. [PMID: 32492574 DOI: 10.1016/j.acap.2020.05.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/08/2020] [Accepted: 05/16/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Trauma-informed care (TIC) and violence intervention programs (VIPs) facilitate psychosocial healing and reduce injury recidivism for children and families affected by community violence. To integrate a VIP into 2 Level 1 Pediatric Trauma Centers, an educational initiative was developed and co-taught by pediatricians and former patients. The primary aim was to increase provider-driven patient referrals to the VIP. A secondary aim was to improve all participants' comfort levels in 5 areas of TIC. METHODS Referrals to the VIP from 2014 to 2018 were tracked and analyzed. A curriculum based on Five Points of TIC was developed and offered to interprofessional groups of hospital employees. Pediatricians and former patients recovering from violent injury facilitated the workshops. Twenty-two workshops were attended by 318 providers and hospital staff members from 2015 to 2018. Pre- and postworkshop surveys asked participants to rate their comfort levels with 5 areas of TIC. RESULTS Provider-driven patient identification increased from 34.8% to 86.8% over the study period. For the entire cohort, participants' self-assessment of comfort levels with TIC improved by 21% (P < .001), with medical students' scores improving the most (24%). Residents were less likely to complete the workshop than fellows or attendings (P = .03). CONCLUSIONS This novel curriculum was associated with a change in practice patterns, as well as a closer relationship between the VIP and pediatric hospital systems. All professional groups experienced an improvement in comfort levels with the Five Points of TIC. Future study on information retention and other patient care-related outcomes is needed.
Collapse
Affiliation(s)
- Meredithe McNamara
- Division of Adolescent Medicine, Department of Pediatrics, University of Illinois - Chicago (M McNamara and A Schwartz).
| | - Rachel Cane
- Johns Hopkins University (R Cane), Baltimore, MD
| | - Yael Hoffman
- Department of Pediatrics, University of Chicago (Y Hoffman and B Stolbach), Chicago, Ill
| | - Carol Reese
- Department of Trauma and Burns, John H. Stroger Hospital of Cook County (C Reese), Chicago, Ill
| | - Alan Schwartz
- Division of Adolescent Medicine, Department of Pediatrics, University of Illinois - Chicago (M McNamara and A Schwartz)
| | - Bradley Stolbach
- Department of Pediatrics, University of Chicago (Y Hoffman and B Stolbach), Chicago, Ill
| |
Collapse
|
100
|
Chokshi B, Walsh K, Dooley D, Falusi O, Deyton L, Beers L. Teaching Trauma-Informed Care: A Symposium for Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:11061. [PMID: 33409358 PMCID: PMC7780743 DOI: 10.15766/mep_2374-8265.11061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/11/2020] [Indexed: 06/03/2023]
Abstract
INTRODUCTION A large body of evidence links exposure to childhood trauma with negative health outcomes. Training future physicians to recognize and respond to trauma is paramount, and engaging medical students in the preclinical years affords the opportunity to foster the development of a trauma-informed lens that can then be solidified during clinical clerkships. METHODS We developed and implemented a 4-hour trauma-informed care (TIC) symposium for 179 second-year medical students at the George Washington University School of Medicine and Health Sciences during the Patients, Populations, and Systems course. The symposium included three interactive didactic sessions focusing on the connection between trauma and health and TIC principles. A facilitated small-group discussion allowed students to apply TIC principles to a patient case, followed by reflection and evaluation. RESULTS The overall rating of the TIC symposium was 4 out of 5. Strengths included integration of a small-group case with discussion on application of TIC in practice, experience of the lecturers and small-group facilitators, and review of research relating adversity to specific health outcomes. Suggestions for improvement included incorporating role-play and standardized patients. Content analysis of student reflections mapped to the domains of physician competency. DISCUSSION A 4-hour symposium can affect student knowledge and understanding of TIC. Teaching TIC presents an opportunity to prepare medical students for a career in medicine through cultivation of required physician competencies. Next steps include enhanced opportunities to practice TIC and follow-up analysis of participants to determine behavior change during clinical years.
Collapse
Affiliation(s)
- Binny Chokshi
- Pediatrician and Co-Medical Director Healthy Generations, Children's National Hospital; Assistant Professor of Pediatrics, George Washington University School of Medicine and Health Sciences
| | - Kimberly Walsh
- Clinical Research Coordinator, Children's National Hospital
| | - Danielle Dooley
- Pediatrician and Medical Director of Community Affairs and Population Health, Child Health Advocacy Institute, Children's National Hospital; Assistant Professor of Pediatrics and Co-Course Director, Patients Populations and Systems, George Washington University School of Medicine and Health Sciences
| | - Olanrewaju Falusi
- Pediatrician and Medical Director Advocacy Education, Child Health Advocacy Institute, Children's National Hospital; Assistant Professor of Pediatrics, George Washington University School of Medicine and Health Sciences
| | - Lawrence Deyton
- Senior Associate Dean of Clinical Public Health, Murdock Head Professor of Medicine and Health Policy, and Professor of Medicine, George Washington University School of Medicine and Health Sciences
| | - Lee Beers
- Pediatrician and Medical Director for Municipal and Regional Affairs, Child Health Advocacy Institute, Children's National Hospital; Co-Director Early Childhood Innovation Network, Children's National Hospital; Associate Professor of Pediatrics, George Washington University School of Medicine and Health Sciences
| |
Collapse
|