151
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Supporting Development During Military Deployment and After April 2018. J Dev Behav Pediatr 2018; 39:447-449. [PMID: 29794889 DOI: 10.1097/dbp.0000000000000584] [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: 10/16/2022]
Abstract
Ryan is a 6-year-old child new to your primary care practice after relocating from out of state with his father and younger sister. Ryan's grandmother recently expressed concerns about Ryan's social skills and behavior. He was subsequently diagnosed by a developmental and behavioral pediatrician with autism spectrum disorder, global developmental delay, and attention deficit hyperactivity disorder. At your first visit with Ryan, his father provides the following history: When Ryan was 3 years old, he was living with his mother and infant sister while his father was serving his fourth tour of duty with the marines in Afghanistan. One night, while Ryan was sleeping in bed with his mother, she died suddenly from a pulmonary embolism. Ryan's father was then called home from Afghanistan to take care of the children.Ryan's father explains that this was his first time serving as a primary caregiver for any prolonged period. He felt overwhelmed and unprepared, both cognitively and emotionally, to return from a combat zone and assume full-time, single-parent responsibilities. Ryan's father admitted knowing little about child development and had not had sustained interactions with his own children because of frequent deployments. He did not appreciate the delays and atypicalities in Ryan's development until he moved back home with his own mother and she expressed concerns. Ryan's father had his own psychological, emotional, and physical challenges from participating in active combat, including chronic pain in his shoulder from multiple gunshot wounds. Despite moving back home to be close to his family, Ryan's father admits feeling isolated and reports that "no one knows what it feels like."How would you provide unique support to Ryan and his family? What treatment modalities are particularly important to emphasize?
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152
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Jacob G, van den Heuvel M, Jama N, Moore AM, Ford-Jones L, Wong PD. Adverse childhood experiences: Basics for the paediatrician. Paediatr Child Health 2018; 24:30-37. [PMID: 30792598 DOI: 10.1093/pch/pxy043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In 1998, the Centers for Disease Control and Prevention Adverse Childhood Experiences study established the profound effects of early childhood adversity on life course health. The burden of cumulative adversities can affect gene expression, immune system development and condition stress response. A scientific framework provides explanation for numerous childhood and adult health problems and high-risk behaviours that originate in early life. In our review, we discuss adverse childhood experiences, toxic stress, the neurobiological basis and multigenerational and epigenetic transmission of trauma and recognized health implications. Further, we outline building resilience, screening in the clinical setting, primary care interventions, applying trauma-informed care and future directions. We foresee that enhancing knowledge of the far-reaching effects of adverse childhood events will facilitate mitigation of toxic stress, promote child and family resilience and optimize life course health trajectories.
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Affiliation(s)
| | - Meta van den Heuvel
- Department of Paediatrics, Hospital for Sick Children.,Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto
| | - Nimo Jama
- Department of Paediatrics, Hospital for Sick Children
| | - Aideen M Moore
- Department of Paediatrics, Hospital for Sick Children.,Division of Neonatology, Department of Paediatrics, Faculty of Medicine, University of Toronto
| | - Lee Ford-Jones
- Department of Paediatrics, Hospital for Sick Children.,Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto.,Social Paediatrics, Hospital for Sick Children
| | - Peter D Wong
- Department of Paediatrics, Hospital for Sick Children.,Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto.,SickKids Research Institute
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153
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Hoysted C, Babl FE, Kassam-Adams N, Landolt MA, Jobson L, Van Der Westhuizen C, Curtis S, Kharbanda AB, Lyttle MD, Parri N, Stanley R, Alisic E. Knowledge and training in paediatric medical traumatic stress and trauma-informed care among emergency medical professionals in low- and middle-income countries. Eur J Psychotraumatol 2018; 9:1468703. [PMID: 29760867 PMCID: PMC5944367 DOI: 10.1080/20008198.2018.1468703] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/26/2018] [Indexed: 11/23/2022] Open
Abstract
Background: Provision of psychosocial care, in particular trauma-informed care, in the immediate aftermath of paediatric injury is a recommended strategy to minimize the risk of paediatric medical traumatic stress. Objective: To examine the knowledge of paediatric medical traumatic stress and perspectives on providing trauma-informed care among emergency staff working in low- and middle-income countries (LMICs). Method: Training status, knowledge of paediatric medical traumatic stress, attitudes towards incorporating psychosocial care and barriers experienced were assessed using an online self-report questionnaire. Respondents included 320 emergency staff from 58 LMICs. Data analyses included descriptive statistics, t-tests and multiple regression. Results: Participating emergency staff working in LMICs had a low level of knowledge of paediatric medical traumatic stress. Ninety-one percent of respondents had not received any training or education in paediatric medical traumatic stress, or trauma-informed care for injured children, while 94% of respondents indicated they wanted training in this area. Conclusions: There appears to be a need for training and education of emergency staff in LMICs regarding paediatric medical traumatic stress and trauma-informed care, in particular among staff working in comparatively lower income countries.
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Affiliation(s)
- Claire Hoysted
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neuroscience, Monash University, Melbourne, Australia
| | - Franz E Babl
- Emergency Department, Royal Children's Hospital, Melbourne, Australia.,Emergency Research, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia, on behalf of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) and the Pediatric Emergency Research Networks (PERN)
| | - Nancy Kassam-Adams
- Centre for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
| | - Markus A Landolt
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Laura Jobson
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neuroscience, Monash University, Melbourne, Australia
| | - Claire Van Der Westhuizen
- Department of Psychiatry and Mental Health University of Cape Town, Alan J. Flisher Centre for Public Mental Health, Cape Town, South Africa
| | - Sarah Curtis
- Departments of Pediatrics & Emergency Medicine & Women and Children's Health Research Institute, University of Alberta, Edmonton, Canada, on behalf of the Pediatric Emergency Research Canada (PERC)
| | - Anupam B Kharbanda
- Department of Pediatric Emergency Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, USA, on behalf of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics (PEMCRC)
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, UK, on behalf of the Paediatric Emergency Research in the UK and Ireland (PERUKI).,Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Niccolò Parri
- Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy, on behalf of the Research in European Pediatric Emergency Medicine (REPEM)
| | - Rachel Stanley
- Department of Emergency Medicine, University of Michigan, Ann Arbor, USA, on behalf of the Pediatric Emergency Care Applied Research Network (PECARN)
| | - Eva Alisic
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland.,Monash University Accident Research Centre, Monash University, Melbourne, Australia
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154
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Meneses V, Cruz N. A trauma-informed approach supports health and development in children and youth with spina bifida. J Pediatr Rehabil Med 2017; 10:195-199. [PMID: 29125518 DOI: 10.3233/prm-170457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Children with developmental disabilities may be at greater risk for experiencing maltreatment and traumatic events, threats to their physical and psychological safety and well-being. Young children and youth with spina bifida benefit from being considered in light of this risk, and may be especially vulnerable given the complexity of their neurodevelopmental condition. A trauma-informed approach brings together evidence from the neurosciences, epidemiology and psychology to promote improved developmental, behavioral, physical and mental health status. Incorporating a trauma-informed approach strengthens a longitudinal, interdisciplinary and developmentally-oriented care model for children and youth with spina bifida. A case example further illustrates how using a trauma-informed approach and evidence-based interventions can foster the development and well-being of youth with spina bifida who have been impacted by a traumatic event.
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Affiliation(s)
- Veronica Meneses
- Pediatric Developmental Disabilities, Texas Scottish Rite Hospital for Children, Dallas, TX, USA.,Division of Developmental-Behavioral Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Natalie Cruz
- University of Southern California, University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles, Los Angeles, CA, USA
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155
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Stolbach BC, Anam S. Racial and Ethnic Health Disparities and Trauma-Informed Care for Children Exposed to Community Violence. Pediatr Ann 2017; 46:e377-e381. [PMID: 29019632 DOI: 10.3928/19382359-20170920-01] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Racial and ethnic disparities in health outcomes and access have been consistently documented for a wide variety of physical and behavioral health conditions. Health inequities are most pronounced in areas with high levels of racial and ethnic segregation, where children and adolescents are also more likely to face economic inequality, which places them at high risk for exposure to neighborhood violence and traumatic loss. Community violence exposure (CVE) has been increasingly recognized as a prominent contributor to negative physical and mental health outcomes. CVE has been linked to children's risk for negative psychological outcomes, such as posttraumatic stress disorder, externalizing behavior, and internalizing symptoms, as well as obesity, asthma, and health-risk behaviors. Providers of pediatric care have opportunities to address CVE and related health disparities by developing trauma-informed systems that routinely screen for CVE, provide basic support for affected families, and link those in need to trauma-focused intervention. [Pediatr Ann. 2017;46(10):e377-e381.].
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156
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Wissow LS, Brown JD, Hilt RJ, Sarvet BD. Evaluating Integrated Mental Health Care Programs for Children and Youth. Child Adolesc Psychiatr Clin N Am 2017; 26:795-814. [PMID: 28916015 DOI: 10.1016/j.chc.2017.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Evaluations of integrated care programs share many characteristics of evaluations of other complex health system interventions. However, evaluating integrated care for child and adolescent mental health poses special challenges that stem from the broad range of social, emotional, and developmental problems that need to be addressed; the need to integrate care for other family members; and the lack of evidence-based interventions already adapted for primary care settings. Integrated care programs for children's mental health need to adapt and learn on the fly, so that evaluations may best be viewed through the lens of continuous quality improvement rather than evaluations of fixed programs.
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Affiliation(s)
- Lawrence S Wissow
- Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, 550 North Broadway, Room 949, Baltimore, MD 21205, USA.
| | - Jonathan D Brown
- Mathematica Policy Research, 1100 1st Street, NE 12th Floor, Washington, DC 20024-2512, USA
| | - Robert J Hilt
- Department of Psychiatry and Behavioral Sciences, University of Washington, M/S CPH, PO Box 5371, Seattle, WA 98105, USA
| | - Barry D Sarvet
- Department of Psychiatry, University of Massachusetts, Medical School at Baystate, 759 Chestnut Street, WG703, Springfield, MA 01199, USA
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157
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Abstract
PURPOSE OF REVIEW This review examines the recent literature on biological factors that influence sex differences in posttraumatic stress disorder (PTSD) during childhood and adolescence, focusing on neurobiological, hormonal, and genetic factors that may increase risk in girls. RECENT FINDINGS More than 60% of children and adolescents are exposed to traumatic events, and many develop PTSD. There is increasing recognition of gender differences in PTSD, with women having double the rates of the disorder compared to men. These gender differences in symptoms and their underlying neurobiology appear to emerge during adolescence, although it is still unclear which biological mechanisms may play key roles in the development of sex difference. The literature on gender effects in children and adolescents is still in the early stages, and more prospective and longitudinal work is needed; however, estrogen appears to play a key role in increasing risk for PTSD in girls, which emerges in adolescence.
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Affiliation(s)
- Kristie Garza
- Neuroscience Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, USA
| | - Tanja Jovanovic
- Neuroscience Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, USA.
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 49 Jesse Hill Jr Dr NE, Suite 331, Atlanta, GA, 30303, USA.
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158
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Vu C, Rothman E, Kistin CJ, Barton K, Bulman B, Budzak-Garza A, Olson-Dorff D, Bair-Merritt MH. Adapting the Patient-Centered Medical Home to Address Psychosocial Adversity: Results of a Qualitative Study. Acad Pediatr 2017; 17:S115-S122. [PMID: 28865642 DOI: 10.1016/j.acap.2017.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 01/04/2017] [Accepted: 01/21/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The patient-centered medical home (PCMH) seeks to improve population health. However, PCMH models often focus on improving treatment of chronic diseases rather than on addressing psychosocial adversity. We sought to gather key stakeholder input about how PCMHs might feasibly and sustainably address psychosocial adversity within their patient populations. METHODS We conducted 25 semistructured interviews with key stakeholders, such as physicians, nurses, medical assistants, and patients. The audiorecorded interviews focused on participants' perceptions of the best ways to modify the PCMH to address patients' psychosocial adversity. To facilitate information gathering, a fictional patient case was presented. Analyses were conducted using a 3-stage content-analysis process. RESULTS Participants identified provider-related and systems-level changes necessary for addressing these psychosocial adversities effectively. On the provider level, participants thought that practitioners should foster trusting relationships with patients and should be emotionally present as patients describe their life experiences. Participants also emphasized that providers need to have sensitive conversations about adversity and resilience. On a systems level, participants discussed that documentation must balance privacy and include relevant information in the medical record. In addition, care should be delivered not by a single provider but by a team that has a longitudinal relationship with the patient; this care team should include behavioral health support. CONCLUSIONS Participants provided practical strategies and highlighted provider and systems level changes to adequately address patients' prior psychosocial adversity. Future studies need to assess the degree to which such a trauma-informed approach improves patient access, outcomes, and care quality, and reduces cost.
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Affiliation(s)
- Cecilia Vu
- Boston University School of Public Health, Boston, Mass
| | - Emily Rothman
- Boston University School of Public Health, Boston, Mass
| | - Caroline J Kistin
- Division of General Pediatrics, Boston University School of Medicine, Boston, Mass
| | | | | | | | | | - Megan H Bair-Merritt
- Division of General Pediatrics, Boston University School of Medicine, Boston, Mass.
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159
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Weiss D, Kassam-Adams N, Murray C, Kohser KL, Fein JA, Winston FK, Marsac ML. Application of a Framework to Implement Trauma-Informed Care Throughout a Pediatric Health Care Network. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2017; 37:55-60. [PMID: 28252468 DOI: 10.1097/ceh.0000000000000140] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION To evaluate the initial application of a recently published three-step framework for implementing trauma-informed care (TIC) in a pediatric health care network by applying Framework for Spread. METHODS In steps 1 and 2 of the framework, we established commitment from the health care network leadership and initial interest in TIC among clinical providers (step 1), set evidence-based training goals and created the associated TIC training content (step 2). In step 3, 440 health care professionals (from 27 health care teams) participated in single-session, 1-hour training that covered the psychological impact of injury- and illness-related trauma, identification of traumatic stress symptoms, and how to respond to children exposed to potentially traumatic events. A concomitant quality improvement project allowed us to assess potential changes in training participants' favorable attitudes toward the integration of TIC and confidence in delivering TIC. RESULTS Compared with pretraining, participants demonstrated increases in attitude toward TIC, t(293) = 5.8, P < .001, Cohen's d = 0.32, and confidence in delivering TIC, t(293) = 20.9, P < .001, Cohen's d = 1.09. DISCUSSION Trainings were effective in achieving proximal goals targeting attitudes and confidence, thereby demonstrating the feasibility and clinical relevance of TIC training when implemented according to the three-step framework. Future research should examine methods of training to reach wide audiences to promote systematic change and evaluate changes in patient outcomes associated with providers' implementation of TIC.
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Affiliation(s)
- Danielle Weiss
- Ms. Weiss: Research Assistant, Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA. Dr. Kassam-Adams: Research Associate Professor of Clinical Psychology in Pediatrics, Perelman School of Medicine, University of Pennsylvania, Associate Director for Behavioral Research, Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA, and Director of the Center for Pediatric Traumatic Stress; Past President, International Society for Traumatic Stress Studies. Ms. Murray: Training Manager, Violence Prevention Initiative, Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA. Ms. Kohser: Research Coordinator, Center for Injury Research and Prevention; Project Coordinator, Center for Pediatric Traumatic Stress, The Children's Hospital of Philadelphia, Philadelphia, PA. Dr. Fein: Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Director, Violence Prevention Initiative, The Children's Hospital of Philadelphia, and Director of Advocacy & Health Policy, The Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA. Dr. Winston: Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Attending Physician, Founder and Scientific Director, Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA, and Director of the National Science Foundation Industry, University Cooperative Research Center, the Center for Child Injury Prevention Studies. Dr. Marsac: Assistant Professor of Pediatrics, College of Medicine, Kentucky University, and Kentucky Children's Hospital, Lexington, KY
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160
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Altimier L, Phillips R. The Neonatal Integrative Developmental Care Model: Advanced Clinical Applications of the Seven Core Measures for Neuroprotective Family-centered Developmental Care. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.nainr.2016.09.030] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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161
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Kassam-Adams N, Marsac ML. Brief Practical Screeners in English and Spanish for Acute Posttraumatic Stress Symptoms in Children. J Trauma Stress 2016; 29:483-490. [PMID: 27923266 DOI: 10.1002/jts.22141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 08/25/2016] [Accepted: 08/25/2016] [Indexed: 11/10/2022]
Abstract
With millions of children experiencing acute traumatic events, validated screening tools are needed in both research and service contexts. We aimed to identify and evaluate short forms of the Acute Stress Checklist for Children in English (ASC-Kids) and Spanish (Cuestionario de Estrés Agudo-Niños [CEA-N]), using data from 4 samples (Ns of 254, 225, 176, and 80) of children with recent acute trauma. Confirmatory factor analyses of the full checklist in the largest sample guided item selection for 6-item and 3-item short forms. Across samples, both short forms (ASC-6/ASC-3 in English; CEA-6/CEA-3 in Spanish) were correlated with acute stress disorder (ASD) symptom severity on the full checklist (r = .79 to .92), and on an interview measure (r = .52 to .62). Receiver operating curve analyses for each short form detecting current ASD status showed high areas under the curve (.76 to .95). Cutoff scores identified based on Sample 1 provided acceptable sensitivity (.59 to 1.00) and specificity (.57 to .86) across samples. Children scoring above the cutoff on each screener reported greater concurrent impairment from ASD symptoms and more severe posttraumatic stress 3 months later. These very brief measures could expand clinicians' and researchers' ability to screen for acute posttraumatic stress in children.
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Affiliation(s)
- Nancy Kassam-Adams
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Division of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Meghan L Marsac
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Child and Adolescent Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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162
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Ash J, Williams ME. Policies and Systems Support for Infant Mental Health in the Care of Fragile Infants and Their Families. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.nainr.2016.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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