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Demers LA, Wright NM, Kopstick AJ, Niehaus CE, Hall TA, Williams CN, Riley AR. Is Pediatric Intensive Care Trauma-Informed? A Review of Principles and Evidence. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101575. [PMID: 36291511 PMCID: PMC9600460 DOI: 10.3390/children9101575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022]
Abstract
Pediatric critical illness and injury, along with the experience of recovering from critical illness are among the most potentially traumatic experiences for children and their families. Additionally, children often come to the Pediatric Intensive Care Unit (PICU) with pre-existing trauma that may sensitize them to PICU-related distress. Trauma-informed care (TIC) in the PICU, while under-examined, has the potential to enhance quality of care, mitigate trauma-related symptoms, encourage positive coping, and provide anticipatory guidance for the recovery process. This narrative review paper first describes the need for TIC in the PICU and then introduces the principles of TIC as outlined by the American Academy of Pediatrics: awareness, readiness, detection and assessment, management, and integration. Current clinical practices within PICU settings are reviewed according to each TIC principle. Discussion about opportunities for further development of TIC programs to improve patient care and advance knowledge is also included.
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Affiliation(s)
- Lauren A. Demers
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Naomi M. Wright
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Psychology, University of Denver, Denver, CO 80208, USA
| | - Avi J. Kopstick
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Texas Tech University Health Science Center El Paso, El Paso, TX 97705, USA
| | - Claire E. Niehaus
- Division of Psychology and Psychiatry, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Trevor A. Hall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Correspondence: ; Tel.: +1-503-418-2134
| | - Cydni N. Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Andrew R. Riley
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
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Morris KA, Glover S, Neff S. Interprofessional Collaboration to Optimize Trauma-Informed Care in Pediatric Forensics. JOURNAL OF FORENSIC NURSING 2022; 18:247-253. [PMID: 35437298 DOI: 10.1097/jfn.0000000000000395] [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
There are many challenges in providing trauma-informed healthcare to pediatric victims of sexual abuse and their families. We address this through collaborative interprofessional efforts within our hospital facility, located in a Midwestern adult Level 1 and pediatric trauma center. Our sexual assault nurse examiner team is composed of eight nurses and provides 24/7 coverage. The child abuse team located in our hospital includes one board-certified child abuse pediatrician, one certified pediatric nurse practitioner, and a licensed clinical social worker. The application of trauma-informed care using case scenarios involving both teams is described in this article.
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Affiliation(s)
| | - Stephanie Glover
- Center of Hope Forensics, Peyton Manning Children's Hospital at Ascension St. Vincent Hospital
| | - Samantha Neff
- Center of Hope Forensics, Peyton Manning Children's Hospital at Ascension St. Vincent Hospital
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53
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Back to Basics: Lifestyle Interventions for Adolescent Depression. Harv Rev Psychiatry 2022; 30:283-302. [PMID: 36103683 DOI: 10.1097/hrp.0000000000000343] [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] [Indexed: 01/10/2023]
Abstract
LEARNING OBJECTIVES After completing this activity, practitioners will be better able to:• Discuss and better understand the recently adopted screening standards for adolescents with depression and the potential advantages of using "lifestyle medicine"• Set up a process for providing effective interventions for the increased number of patients with adolescent depression• Design or update their toolbox of treatment options for adolescents with depression based on the new literature and increased demand. ABSTRACT Recently adopted quality standards recommend that pediatricians screen adolescents for depression and that they document follow-up plans for those who screen positive. As a result of these new recommendations, pediatricians and other pediatric providers, as well as psychiatrists and other mental health professionals, may face an increasing number of referrals and a growing need for effective interventions for adolescent depression. Given the widely acknowledged scarcity of traditional mental health resources, the current study reviewed the rapidly expanding array of evidence-based, but nontraditional, interventions applicable to outpatient pediatric and mental health care settings. Many of these interventions come from a lifestyle medicine framework. Lifestyle medicine interventions are congruent with the cultures of pediatrics and outpatient psychiatry, and offer additional evidence-based tools for providers managing adolescent depression. These interventions can be implemented individually or within group or community settings, and may be used in conjunction with more common interventions such as psychotherapy or psychotropic medications.
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54
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Cibralic S, Alam M, Mendoza Diaz A, Woolfenden S, Katz I, Tzioumi D, Murphy E, Deering A, McNamara L, Raman S, Eapen V. Utility of screening for adverse childhood experiences (ACE) in children and young people attending clinical and healthcare settings: a systematic review. BMJ Open 2022; 12:e060395. [PMID: 36008078 PMCID: PMC9422820 DOI: 10.1136/bmjopen-2021-060395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine and synthesise the literature on adverse childhood experience (ACE) screening in clinical and healthcare settings servicing children (0-11) and young people (12-25). DESIGN A systematic review of literature was undertaken. DATA SOURCE PsycInfo, Web of Science, Embase, PubMed and CINAHL were searched through June 2021. Additional searches were also undertaken. ELIGIBILITY CRITERIA English language studies were included if they reported results of an ACE tool being used in a clinical or healthcare setting, participants were aged between 0 and 25 years and the ACE tool was completed by children/young people or by parents/caregivers/clinicians on behalf of the child/young person. Studies assessing clinicians' views on ACE screening in children/young people attending health settings were also included. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed for risk of bias using the Mixed Methods Appraisal Tool. Results were synthesised qualitatively. RESULTS Initial searches identified 5231 articles, of which 36 were included in the final review. Findings showed that the most commonly used tool for assessing ACE was the ACE questionnaire; administering ACE tools was found to be feasible and acceptable; there were limited studies looking at the utility, feasibility and acceptability of assessing for ACE in First Nations people; and while four studies provided information on actions taken following ACE screening, no follow-up data were collected to determine whether participants accessed services and/or the impact of accessing services. CONCLUSION As the evidence stands, widespread ACE screening is not recommended for routine clinical use. More research is needed on how and what specific ACE to screen for and the impact of screening on well-being. PROSPERO REGISTRATION NUMBER University of York Centre for Reviews and Dissemination (CRD42021260420).
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Affiliation(s)
- Sara Cibralic
- Ingham Institute, Liverpool, New South Wales, Australia
| | - Mafruha Alam
- Ingham Institute, Liverpool, New South Wales, Australia
| | - Antonio Mendoza Diaz
- Department of Psychiatry, University of South Wales, Sydney, New South Wales, Australia
| | - Susan Woolfenden
- Sydney Local Health District, Camperdown, New South Wales, Australia
- Department of Paediatrics, University of New South Wales, Sydney, New South Wales, Australia
| | - Ilan Katz
- Department of Social Policy Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Dimitra Tzioumi
- University of New South Wales, Sydney, New South Wales, Australia
- New South Wales Ministry of Health, St Leonards, New South Wales, Australia
| | - Elisabeth Murphy
- New South Wales Ministry of Health, St Leonards, New South Wales, Australia
| | - April Deering
- New South Wales Ministry of Health, St Leonards, New South Wales, Australia
| | - Lorna McNamara
- New South Wales Ministry of Health, St Leonards, New South Wales, Australia
| | - Shanti Raman
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Valsamma Eapen
- Department of Psychiatry, University of South Wales, Sydney, New South Wales, Australia
- ICAMHS, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
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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.
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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
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56
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Duffee J. Trauma-Informed Ethics and Relational Health. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:62-65. [PMID: 35475954 DOI: 10.1080/15265161.2022.2055217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- James Duffee
- Wright State University Boonshoft School of Medicine
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57
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Healy M, Tuohy B. Trauma and Community: Trauma-Informed Ethics Consultation Grounded in Community-Engaged Principles. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:71-73. [PMID: 35475966 DOI: 10.1080/15265161.2022.2055211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Megan Healy
- Lewis Katz School of Medicine at Temple University
| | - Brian Tuohy
- Lewis Katz School of Medicine at Temple University
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58
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Chambers R, Greenbaum J, Cox J, Galvan T. Trauma Informed Care: Trafficking Out-Comes (TIC TOC Study). J Prim Care Community Health 2022; 13:21501319221093119. [PMID: 35438596 PMCID: PMC9021523 DOI: 10.1177/21501319221093119] [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] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Little is known about the impact of trauma-informed primary healthcare on recovery from human trafficking, or individual characteristics associated with successful participation in community services. OBJECTIVE To evaluate the efficacy of a trauma-informed family medicine clinic, the Medical Safe Haven ("MSH"), in facilitating success in a community-based anti-trafficking victim service program, Community Against Sexual Harm ("CASH"), and to identify participant characteristics associated with successful CASH completion. METHODS Retrospective analysis of data from 57 adult females participating in the CASH program, 37 of whom received care at MSH. We examined differences in descriptive statistics between those who completed the CASH program and those who did not; then conducted logistic and linear regressions testing the association between MSH care and CASH program outcomes. Survival analysis models examined the time to CASH program drop-out (program incompletion). RESULTS Odds of successful CASH completion increased by a factor of 5.37 for MSH patients compared to other participants. This association strengthened with increases in the duration of MSH care and degree of patient engagement. The positive association of MSH care on program completion was mediated by the length of program participation. The extended length of participation among MSH patients was even stronger when those patients were in a stable and independent housing situation. The risk of program incompletion was 68% lower for MSH patients compared to other participants. CONCLUSIONS Adults who experience human trafficking and receive healthcare at MSH are significantly more likely to successfully complete the CASH program than those who do not receive healthcare or who use alternative health systems. Study findings argue for the importance of consistent, trauma-informed longitudinal healthcare for trafficked persons.
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Affiliation(s)
- Ronald Chambers
- Commonspirit Health, Dignity Health, Sacramento, CA, USA,Ronald Chambers, Dignity Health, 7601 Hospital Drive #207, Sacramento, CA 94107-1773, USA.
| | - Jordan Greenbaum
- International Centre for Missing and Exploited Children, Alexandria, VA, USA
| | - Jennifer Cox
- Commonspirit Health, Dignity Health, Sacramento, CA, USA
| | - Terri Galvan
- Community Against Sexual Harm, Sacramento, CA, USA
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Angelo F, Veenstra D, Knerr S, Devine B. Prevalence and prediction of medical distrust in a diverse medical genomic research sample. Genet Med 2022; 24:1459-1467. [PMID: 35384843 DOI: 10.1016/j.gim.2022.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Medical distrust has been identified as a persistent barrier to medical care, affecting preventative screening, treatment uptake, and treatment adherence. Despite this, little research to date has examined medical distrust in a genomic medicine context. The goal of this work was to assess the prevalence of medical distrust in a genomic medicine research study and examine patient-level demographic, access-related, and health-status characteristics that predict medical distrust. METHODS We assessed medical distrust in a research sample of adults (N = 967) receiving genomic sequencing to screen for hereditary risk of cancer syndromes in the United States. We used multiple predictive variable selection models to determine predictors of medical distrust followed by marginal mean analyses to characterize the relationships. RESULTS The prevalence of medical distrust was 32%. The final model indicated that Black and African American race/ethnicity; trans, nonbinary, or nonidentifying gender identity; high education; low income; low access to health care; and poor Short Form 12 mental health composite scores predict medical distrust. CONCLUSION Medical distrust may pose similar challenges to genomic sequencing, as it does in other medical contexts. The pattern of variables that predict distrust suggest that increasing access and accommodation for stigmatized and underserved communities may help overcome the negative effects of medical distrust.
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Affiliation(s)
- Frank Angelo
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - David Veenstra
- The Comparative Health Outcomes, Policy & Economics (CHOICE) Institute and Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA
| | - Sarah Knerr
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA
| | - Beth Devine
- The Comparative Health Outcomes, Policy & Economics (CHOICE) Institute and Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA
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Buysse CA, Bentley B, Baer LG, Feldman HM. Community ECHO (Extension for Community Healthcare Outcomes) Project Promotes Cross-Sector Collaboration and Evidence-Based Trauma-Informed Care. Matern Child Health J 2022; 26:461-468. [PMID: 35013885 PMCID: PMC8747847 DOI: 10.1007/s10995-021-03328-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Adverse Childhood Experiences (ACEs) are traumatic events that occur before 18 years. ACEs, associated with increased health-risk behaviors and chronic health disorders, disproportionately impact people from marginalized communities. Evidence shows that toxic stress from ACEs and adverse social determinants of health can be prevented and treated with trauma-informed care (TIC). The purpose of this educational program was to train a maternal and child health workforce to bring evidence-based trauma-informed care to all impacted people. METHODS Participants were professionals recruited from Federally Qualified Health Centers, community behavioral health organizations, educational institutions, and agencies serving low-income children and families. 100 unique participants representing 3 counties and 54 agencies joined sessions. Twelve virtual educational sessions were convened over 6 months using the Project ECHO® model via Zoom technology. Sessions consisted of didactic lectures and case-based discussions. RESULTS After completion of the series, participants reported high satisfaction and increased knowledge and confidence in using TIC best practice skills. After participation, a significant number of participants voluntarily completed an additional online training about the specific TIC best practices that had been taught in the ECHO. Participants rated the opportunity for interprofessional collaboration and peer support for vicarious trauma as program strengths. DISCUSSION This project demonstrated feasibility and effectiveness in delivery of a curriculum on trauma-informed care to cross-sector, multi-agency maternal and child health workforce professionals using the Project ECHO® model. Robust interprofessional collaboration and participants' request for more sessions demonstrate the potential for this model to effect change at a local systems level.
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Affiliation(s)
- Christina A Buysse
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA.
| | - Barbara Bentley
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA, 94304, USA
| | - Linda G Baer
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Heidi M Feldman
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
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Sonagra M, Jones J, McGill M, Gmuca S. Exploring the intersection of adverse childhood experiences, pediatric chronic pain, and rheumatic disease. Pediatr Rheumatol Online J 2022; 20:14. [PMID: 35164793 PMCID: PMC8842822 DOI: 10.1186/s12969-022-00674-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/30/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND While the general relationship between ACEs and the development of chronic pain has become increasingly clear, how ACEs may shape a child's clinical presentation with regards to chronic pain has yet to be fully expounded. We aimed to determine the association between ACEs and clinical manifestations of pediatric chronic pain and explore the interaction of ACEs and pediatric rheumatic disease among youth with chronic pain on health-related outcomes. METHODS We conducted a cross-sectional cohort study of patients aged ≤18 years with chronic pain seen in a pediatric rheumatology amplified pain clinic between August 2018 and July 2020. We stratified subjects into three groups: no ACEs, one ACE, and ≥ 2 ACEs. We assessed clinical signs and symptoms associated with the presence of ACEs using Chi-square or Wilcoxon-rank test. The association between ACEs as well as other variables of interest with functional impairment was tested using simple and multivariable linear regression. RESULTS Of the 412 patients included, more than 75% of patients reported at least one ACE. Most frequent included history of mental illness in a first degree relative (56%) and parental divorce or separation (20%). Those with ≥2 ACEs had more somatic symptoms, worse functional disability, and a higher proportion of mental health conditions. There appeared to be a dose dependent interaction between ACEs and functional disability from co-morbid rheumatologic disease. In multivariable regression, higher verbal pain score, symptom severity score (SSS), and presence of autonomic changes were associated with estimated average increase in FDI score (β = 1.05, 1.95 and 4.76 respectively; all p < 0.01). CONCLUSION Children with chronic pain and/or rheumatologic diseases who are exposed to ACEs are at increased risk of greater symptomatology, functional disability, and somatization of symptoms. Our findings indicate an ongoing need for systemic evaluation of ACEs in children with chronic pain and/or rheumatic disease and incorporation of trauma-based care.
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Affiliation(s)
- Maitry Sonagra
- grid.239552.a0000 0001 0680 8770Division of Rheumatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, Roberts Center for Pediatric Research, Philadelphia, PA USA ,grid.239552.a0000 0001 0680 8770PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA USA ,grid.239552.a0000 0001 0680 8770Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA USA ,grid.240741.40000 0000 9026 4165Heart Center, Center for Integrative Brain Research, Seattle Children’s Hospital, Seattle, WA USA
| | - Jeremy Jones
- grid.25879.310000 0004 1936 8972Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA ,grid.239552.a0000 0001 0680 8770Division of General Pediatrics, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Mackenzie McGill
- Division of Rheumatology, Department of Pediatrics, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Roberts Center for Pediatric Research, Philadelphia, PA, USA. .,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Sabrina Gmuca
- grid.239552.a0000 0001 0680 8770Division of Rheumatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, Roberts Center for Pediatric Research, Philadelphia, PA USA ,grid.239552.a0000 0001 0680 8770PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA USA ,grid.239552.a0000 0001 0680 8770Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA USA ,grid.25879.310000 0004 1936 8972Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
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Schwartz L, Nakonechna M, Campbell G, Brunner D, Stadler C, Schmid M, Fegert JM, Bürgin D. Addressing the mental health needs and burdens of children fleeing war: a field update from ongoing mental health and psychosocial support efforts at the Ukrainian border. Eur J Psychotraumatol 2022; 13:2101759. [PMID: 36212118 PMCID: PMC9543048 DOI: 10.1080/20008198.2022.2101759] [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: 12/02/2022] Open
Abstract
UNLABELLED Background: The ongoing horrors of the war in Ukraine have led to enormous consequences: loss of life, severe injuries, and mass movements of civilians. Exposure to war, living in conflict zones, and forced displacement increase the risk of experiencing a broad spectrum of direct and indirect burdens towards physical and mental health, in particular among children. Objective: This letter to the editor aims to provide multiple clinical and 'mental health and psychosocial support' (MHPSS) systems' perspectives by experts working in ongoing aid efforts to bridge and disseminate their current observations towards child and adolescent mental health services involved in the mental health response to the current war in Ukraine. Results and Discussion: The diverse perspectives from three mental health professionals involved in the MHPSS response highlight the different burdens and needs of children being confronted with situations of an existential nature. Children live through transformed social situations, deteriorated life conditions, general uncertainty, and encounter numerous losses. As such, war is the ultimate non-normative and existential stressor. The four perspectives highlight the need to: (1) adjust help toward the needs of the beneficiary, (2) understand help efforts as intersubjective human encounters and enable parents and caregivers in these encounters, (3) recognise losses and embrace finding ways to facilitate grief, and (4) continue to address these needs in a coordinated way that follows inter-agency guidelines. Conclusion: Better understanding the needs of refugee children underlines the importance of investing in their future by providing resources for humanitarian aid and psychosocial interventions during sustained emergencies. The perspectives presented in this letter emphasise that psychosocial care is deeply rooted in intersubjective help-encounters and, therefore, a professionalisation of interventions should co-occur with their humanisation and be adapted to subjective needs, varying sociocultural backgrounds, and the individuals themselves with the goal of reducing suffering and fostering well-being. HIGHLIGHTS The three expert humanitarian aid perspectives highlight the need to: adjust help toward the needs of the beneficiary,understand help efforts as intersubjective human encounters and enable parents and caregivers in these encounters,recognise losses and embrace finding ways to facilitate grief, andcontinue to address these needs in a coordinated way that follows inter-agency guidelines.
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Affiliation(s)
- Lyla Schwartz
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland.,Peace of Mind Afghanistan Global (PoMA Global), Longmeadow, MA, USA
| | - Mariia Nakonechna
- Department of General and Applied Psychology, Nizhyn Gogol State University, Nizhyn, Ukraine.,Unitatem Foundation ("Poland Welcomes"), Jarosław, Poland
| | | | - Donja Brunner
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Christina Stadler
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Marc Schmid
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Jörg M Fegert
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - David Bürgin
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland.,Department for Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
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Bürgin D, Anagnostopoulos D, Vitiello B, Sukale T, Schmid M, Fegert JM. Impact of war and forced displacement on children's mental health-multilevel, needs-oriented, and trauma-informed approaches. Eur Child Adolesc Psychiatry 2022; 31:845-853. [PMID: 35286450 PMCID: PMC9209349 DOI: 10.1007/s00787-022-01974-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The infliction of war and military aggression upon children must be considered a violation of their basic human rights and can have a persistent impact on their physical and mental health and well-being, with long-term consequences for their development. Given the recent events in Ukraine with millions on the flight, this scoping policy editorial aims to help guide mental health support for young victims of war through an overview of the direct and indirect burden of war on child mental health. We highlight multilevel, need-oriented, and trauma-informed approaches to regaining and sustaining outer and inner security after exposure to the trauma of war. The impact of war on children is tremendous and pervasive, with multiple implications, including immediate stress-responses, increased risk for specific mental disorders, distress from forced separation from parents, and fear for personal and family's safety. Thus, the experiences that children have to endure during and as consequence of war are in harsh contrast to their developmental needs and their right to grow up in a physically and emotionally safe and predictable environment. Mental health and psychosocial interventions for war-affected children should be multileveled, specifically targeted towards the child's needs, trauma-informed, and strength- and resilience-oriented. Immediate supportive interventions should focus on providing basic physical and emotional resources and care to children to help them regain both external safety and inner security. Screening and assessment of the child's mental health burden and resources are indicated to inform targeted interventions. A growing body of research demonstrates the efficacy and effectiveness of evidence-based interventions, from lower-threshold and short-term group-based interventions to individualized evidence-based psychotherapy. Obviously, supporting children also entails enabling and supporting parents in the care for their children, as well as providing post-migration infrastructures and social environments that foster mental health. Health systems in Europe should undertake a concerted effort to meet the increased mental health needs of refugee children directly exposed and traumatized by the recent war in Ukraine as well as to those indirectly affected by these events. The current crisis necessitates political action and collective engagement, together with guidelines by mental health professionals on how to reduce harm in children either directly or indirectly exposed to war and its consequences.
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Affiliation(s)
- David Bürgin
- grid.410712.10000 0004 0473 882XDepartment of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Steinhövelstrasse 5, 89073 Ulm, Germany ,grid.6612.30000 0004 1937 0642Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | | | | | - Benedetto Vitiello
- grid.7605.40000 0001 2336 6580Division of Child Neurology and Psychiatry, Department of Public Health and Pediatric Sciences, Regina Margherita Pediatric Hospital, University of Turin, Turin, Italy
| | - Thorsten Sukale
- grid.410712.10000 0004 0473 882XDepartment of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Steinhövelstrasse 5, 89073 Ulm, Germany
| | - Marc Schmid
- grid.6612.30000 0004 1937 0642Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Jörg M. Fegert
- grid.410712.10000 0004 0473 882XDepartment of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Steinhövelstrasse 5, 89073 Ulm, Germany
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Kenney MK, Chanlongbutra A, Fanflick PL, Ferrero A, Kim S, Novoa C. Systems of care among children and youth with special health care needs with and without adverse childhood events: National Survey of Children's Health 2016-2017. Disabil Health J 2021; 15:101226. [PMID: 34772650 DOI: 10.1016/j.dhjo.2021.101226] [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] [Received: 05/06/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Knowledge of adverse childhood events (ACEs), the associated access to healthcare and unmet needs among children and youth with special health care needs (CYSHCN) is limited. OBJECTIVES Our objectives were to compare the likelihood of CYSHCN versus non-CYSHCN experiencing one or more ACEs and document differences in receipt of recommended and needed health care among CYSHCN with and without ACEs. METHODS We combined two years of data from the 2016 and 2017 National Survey of Children's Health (N = 71,181), providing a sample of 16,304 CYSHCN. Our primary outcome measures included eight adverse childhood events, compared to singular and aggregated ACEs among non-CYSHCN. We calculated associations between ACEs and secondary outcome measures for six components of well-functioning systems of care and unmet need for different types of health care using bivariate and multivariate analyses. RESULTS CYSHCN were more likely to have each of the ACEs measured and were likelier to experience aggregated levels of ACEs compared to non-CYSHCN. The likelihood of CYSHCN having a medical home with family-centered and coordinated care decreased with increased ACEs, while one or more ACES increased the likelihood of having unmet needs for mental health care. CONCLUSION The findings of the current study extend our understanding of the additional adverse event burden associated with special health care needs status, the accompanying limitations in access to family-centered and coordinated care in a medical home and unmet need for mental health care, indicating that much work remains in establishing appropriate care systems for this very vulnerable population.
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Affiliation(s)
- Mary Kay Kenney
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD, 20857, USA.
| | - Amy Chanlongbutra
- U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Office of Extramural Research, Education and Priority Populations, Rockville, MD, 20857, USA.
| | - Patricia L Fanflick
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD, 20857, USA.
| | - Ann Ferrero
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD, 20857, USA.
| | - Soohyun Kim
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD, 20857, USA.
| | - Cristina Novoa
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD, 20857, USA.
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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
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