The challenge of evaluating rehabilitative activity holidays for burn-injured children: qualitative and quantitative outcome data from a Burns Camp over a five-year period

Psychosocial Interventions for Children and Young People With Visible Differences Resulting From Appearance-Altering Conditions, Injury, or Treatment Effects: An Updated Systematic Review

OBJECTIVE

Children and young people with visible differences can experience psychosocial difficulties, such as anxiety and teasing by others. Interventions targeting difficulties have previously been reviewed by Jenkinson et al. This review aimed to identify and critically assess recent studies evaluating the effectiveness of psychosocial interventions for children and young people with visible differences on psychosocial wellbeing, self-esteem, and social experiences and compare the findings with Jenkinson et al. using a replacement review process.

METHODS

Inclusion criteria are as follows: studies with participants aged 0-18 years with visible differences; investigating a psychosocial intervention; including comparison with an alternative intervention, control group, or pre- and post-intervention; and including a quantitative measure assessed pre- and post-intervention. Exclusion criteria are as follows: participants with body dysmorphic disorder or appearance changes due to eating disorders or obesity and studies not written in English. MEDLINE, AMED, and PsycInfo were searched and grey literature was included. Results were reviewed against eligibility criteria, data were extracted, and studies were evaluated using the Cochrane Risk of Bias 2 tool.

RESULTS

Using Jenkinson et al. as one source of studies, 24 studies were included evaluating a range of interventions such as social interaction skills training, residential social camps, and cognitive behavioral therapy. Risk of bias was high in 20 studies and of some concern in four studies.

CONCLUSION

There is some evidence of the effectiveness of hypnotherapy, a relaxation response resiliency program, integrative body-mind-spirit group, and therapeutic patient education, but more rigorous research is needed to confirm their impact on psychosocial outcomes.

The role of burn camp in the recovery of young people from burn injury: A qualitative study using long-term follow-up interviews with parents and participants

BACKGROUND

Children and adolescents recovering from burn injury are at heightened risk of psychosocial problems. An integrative form of psychosocial intervention is burn camp. However, evidence about burn camp effectiveness is equivocal.

OBJECTIVES

This study examined the role of therapeutic camp experiences in the recovery journeys of children and adolescents who had experienced burn injury and been treated in a tertiary pediatric hospital in Brisbane, Australia.

METHODS

Retrospective semi-structured interviews were conducted with youths and parents. Inductive reflexive thematic analysis was used with pooled interview data.

RESULTS

The participants were eight youths who attended at least one burns camp (between 2009 and 2019) and 15 parents of youth campers. An overwhelming majority (96%) reported a positive experience of camp, that they would return, and that they recommended the camp to other youth with burns. The four strengths of the camp experience were fun, adventurous activities; social relatedness (friendships, socializing); camp setting and experience; and acceptance. The four impacts of the camp on youth campers were normalizing ("I'm not the only one", shared experience); social support (making new friendships, social confidence, mentoring others); psychological recovery (happier, mentally stronger, more resilient, independence building); and confidence (increased self-confidence, increased social confidence, leadership development).

CONCLUSIONS

Although this is the first known research about burn camp in Australia, the findings are similar to a handful of other qualitative studies about burn camp experiences and impacts. Recommendations include future research on aspects of camp experiences that contribute to targeted outcomes, the role of staff and previous camp participants as mentors, and comparisons with other psychosocial interventions for youth burn survivors.

Pediatric Burn Care: How Burn Camps Survived and Thrived During the Coronavirus Pandemic

Burn camps play a vital role in the recovery of burn survivors by allowing them to develop the confidence and skill sets needed to reintegrate back into society. During the COVID-19 pandemic, burn camps across the United States and Canada could not hold any in-person activities. They had to either pause burn camps or quickly adapt to a virtual online platform. A 37-item electronic survey was developed and emailed to burn camp directors in the United States and Canada to determine what adaptations were necessary during the pandemic. This survey allowed directors to provide details on many facets such as camp format, successes observed, and challenges encountered. Twenty-one of 34 (62%) burn camp organizations completed the survey. Thirteen of the 21 (62%) respondents held virtual burn camps in 2020 while everyone else canceled their camps in 2020. The mean number of camps offered per organization decreased from 6.3 in 2019 to 4.7 in 2020. The average number of burn survivors and family members participating also dropped in that same period (2019 aggregate mean = 229.2 vs 2020 aggregate mean = 151.4). Components of virtual camp included video conferencing platforms, "camp-in-a-box" activities, and some prerecorded sessions. Most camp directors believed that their campers were satisfied with the virtual format. Factors allowing for a successful virtual camp included an effective online platform, scheduling adequate duration of programs, and appropriate staffing levels. Most common barriers to an effective virtual camp were participant engagement, special needs/accessibility concerns, and staff effectiveness in this format. While challenging, burn camps can be held in a virtual format successfully with proper planning, staff training, and support of campers and their families.

Supporting children and young people with an acquired brain injury (ABI) and their siblings: The experience of a camp for families with a child with an ABI

Paediatric acquired brain injury (ABI) is associated with long-term negative sequelae, and families must continually adapt to meet the needs of the child with ABI and family members. Condition-specific camps may support families in this process. This study explored the experience of camps for children with ABI and their families from the perspective of children and young people with ABI and their siblings. Semi-structured interviews were conducted with 10 people with ABI (M_age = 23.93, SD = 16.52 years) and 19 siblings of people with ABI (M_age = 14.53, SD = 5.73 years). Using reflexive thematic analysis, the central theme identified was "My safe space," supported by three further themes: "Having fun and relaxing," "Making friends," and "Enjoying choices." Camp was a space where the shared understanding and acceptance of ABI created a sense of safety. This was facilitated by enjoying activities, developing friendships with peers who shared the experience of ABI, and having a sense of control through choice availability. Thus, camps appear to offer opportunities to enjoy typical childhood experiences while restoring a sense of security, increasing understanding of ABI and validating attendees' experiences. Camps may, therefore, offer low-cost interventions to support children with ABI and their families.

Psychosocial Interventions Targeting Recovery in Child and Adolescent Burns: A Systematic Review

Children post-burn injury experience a range of psychosocial sequelae that benefit from early provision of psychosocial support. However, no systematic review exists evaluating the full range of psychological interventions.

OBJECTIVE

To critically evaluate psychosocial interventions for children (<18 years old) with burn injuries in improving psychosocial recovery.

STUDY DESIGN

All-language studies were identified from inception to March 2018 in six electronic databases and appraised according to PRISMA checklist and Cochrane Risk of Bias Tool for quality. Studies were stratified into three groups: distraction (virtual reality, child life therapy, imagery-based therapy, hypnosis), burn camps, and other (social skills, cognitive behavioral therapy, parent group counseling).

RESULTS

Out of a total of 5,456 articles identified, 297 underwent full review resulting in 27 included articles published between 1986 and 2018. Sample sizes ranged from 9 to 266, comprising child and adult participants. A range of interventions and psychosocial outcome measures were found. Several studies (n = 21) reported statistically significant improvements in outcome; the majority were distraction interventions to reduce pain and anxiety. A limited number of studies showing effect was found for cognitive behavioral therapy and parent counseling. Risk of bias was high in studies of burn camps and mixed for all other interventions.

CONCLUSIONS

A range of psychosocial interventions and outcome tools exist in pediatric burns. Distraction interventions prior to and/or during dressing changes or physical therapy were shown to effectively reduce pain and anxiety for a wide range of pediatric ages.

Burn camps for burns survivors-Realising the benefits for early adjustment: A systematic review

OBJECTIVES

Child and adolescent burn survivors benefit from skills to cope with the physical and mental challenges associated with their injuries. Burn camps can offer an opportunity to build these skills. In this study, we systematically review the best available evidence on burn camps in order to better assess their impact on burn survivors.

METHOD

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A total of 815 articles on recreational therapeutic camps for burn survivors were retrieved from PubMed, PsycINFO, CINAHL and Scopus restricted to the English language and published before or by May 2018. Critical Appraisal Skills Programme (CASP) for Qualitative Studies Checklist and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for non-randomized experimental studies were used to assess the methodological rigour of the quantitative studies.

RESULTS

Quantitative data did not support any long-lasting impacts on psychosocial wellbeing. Qualitative data showed children, parents and staff all perceived benefits from camp attendance, including companionship and belonging.

CONCLUSION

Further research is required to understand the lack on congruence between qualitative and quantitative data. Qualitative data suggests burn camps are beneficial for children with burn injuries.

An evaluation of the impact of a burn camp on children and young people's concerns about social situations, satisfaction with appearance and behaviour

INTRODUCTION

This evaluation aimed to assess the impact of a burn camp on children and young people's concerns about social situations, satisfaction with appearance and behaviour.

METHODS

Young people completed the Perceived Stigmatisation Questionnaire (PSQ), Social Comfort Questionnaire (SCQ) and Satisfaction with Appearance Scale (SWAP) one month before camp (n=23), on the last day of camp (n=21) and at a three-month follow-up (n=13). Parents completed the Strengths and Difficulties Questionnaire (SDQ) one month before camp (n = 22) and at follow-up (n=12). Parents and young people also completed open-ended questions before camp and at the follow-up.

RESULTS

Results in this evaluation were mixed. While parents' reported scores on the SDQ were poorer after camp, young people's reported outcomes on all three measures improved at the end of camp. PSQ and SWAP scores were maintained and improved, respectively, at the follow-up. Qualitative responses were generally consistent with these scores. Significant improvements were found between the scores before camp and at the three-month follow-up for both the SWAP and PSQ. These results indicate that the burn camp may help to improve young people's satisfaction with their appearance and concerns about social situations. However, there was no comparison group and there was a significant loss of participants at follow-up.

CONCLUSION

Burn camps may therefore offer a range of psychosocial benefits to young people with burn injuries. This was the first evaluation to demonstrate a positive impact of a burn camp on satisfaction with appearance and concerns about social situations using outcome measures validated with the burns population.

Systematic Review: Psychosocial Interventions for Children and Young People With Visible Differences Resulting From Appearance Altering Conditions, Injury, or Treatment Effects

OBJECTIVE

Evaluate critically the evidence of the effectiveness of psychosocial interventions for children/young people (<18 years old) with visible differences in improving self-esteem, social experiences, psychological well-being, and behavioral outcomes.

METHODS

Studies were systematically identified using electronic databases, appraised according to eligibility criteria and evaluated for risk of bias. Findings were reported using the PRISMA checklist.

RESULTS

Studies were identified that evaluated residential social camps, exercise with counseling, social skills training (SIST), behavioral therapy (BT), and cognitive behavioral therapy (CBT). Risk of bias within studies was high. Camp studies and exercise with counseling showed little or no effect postintervention on self-esteem, social experiences, and psychological well-being. The five studies evaluating SIST, CBT, and BT provided limited support for their effectiveness.

CONCLUSIONS

Evidence base is inconclusive. Further rigorous research using appropriate outcome measures to evaluate the effectiveness of interventions for young people with visible differences is required.

A systematic review of patient reported outcome measures (PROMs) used in child and adolescent burn research

INTRODUCTION

Patient reported outcome measures (PROMs) can identify important information about patient needs and therapeutic progress. The aim of this review was to identify the PROMs that are being used in child and adolescent burn care and to determine the quality of such scales.

METHODS

Computerised and manual bibliographic searches of Medline, Social Sciences Index, Cinahl, Psychinfo, Psycharticles, AMED, and HAPI, were used to identify English-language articles using English-language PROMs from January 2001 to March 2013. The psychometric quality of the PROMs was assessed.

RESULTS

23 studies met the entry criteria and identified 32 different PROMs (31 generic, 1 burns-specific). Overall, the psychometric quality of the PROMs was low; only two generic scales (the Perceived Stigmatisation Questionnaire and the Social Comfort Scale) and only one burns-specific scale (the Children Burn Outcomes Questionnaire for children aged 5-18) had psychometric evidence relevant to this population.

CONCLUSIONS

The majority of PROMs did not have psychometric evidence for their use with child or adolescent burn patients. To appropriately identify the needs and treatment progress of child and adolescent burn patients, new burns-specific PROMs need to be developed and validated to reflect issues that are of importance to this population.

Summer camps for children with burn injuries: a literature review

The first summer camps for children with burn injuries started over 25 years ago, and as of 2008, there were 60 camps worldwide. This review examines the literature on summer pediatric burn camps. The authors describe common characteristics of burn camp structure, activities, and staffing and then examine the scientific evidence regarding the effect of burn camp programs on campers and camp staff volunteers. A search of Pubmed and Psychinfo databases from 1970 to 2008 for articles related to pediatric burn summer camps identified 17 articles, of which 13 fit the inclusion criteria. Existing literature consists primarily of qualitative studies, suggesting that burn camp can decrease camper isolation, improve self-esteem, and promote coping and social skills. Studies examining volunteer staff at burn camp have consistently found that there are both personal and professional benefits. Quantitative studies of self-esteem have yielded equivocal results. No studies have examined safety or the effect of burn camp on medical or rehabilitation outcomes. For the past 25 years, pediatric summer camps for children with burn injuries have played an important rehabilitation role and provided a strong community that benefits both campers and staff. Future research using more rigorous research methods and examining a broader range of outcomes (eg, safety and medical/rehabilitation outcomes) is recommended.

Treatments for common psychiatric conditions among children and adolescents during acute rehabilitation and reintegration phases of burn injury

Advances in critical care and surgical management during the last 20 years have decreased mortality rates among children with severe burn injuries. This improved survival rate has prompted researchers to study the psychological aspects of recovering from a burn injury. Initially research focused primarily on epidemiology, prevention and descriptions of the psychological phenomenon experienced by the children and adolescents. Whereas previously interventions were often utilized during the acute phases of burn injury without knowledge of the long-term effects, more recently, priorities have shifted to include long-term treatment outcome studies. The purpose of this paper is to review and discuss the current evidence-based techniques and their efficacy in the treatment of common psychological and psychiatric conditions among children and adolescents during the three major phases of burn injury.

The application of mixed methods designs to trauma research

Despite the use of quantitative and qualitative data in trauma research and therapy, mixed methods studies in this field have not been analyzed to help researchers designing investigations. This discussion begins by reviewing four core characteristics of mixed methods research in the social and human sciences. Combining these characteristics, the authors focus on four select mixed methods designs that are applicable in trauma research. These designs are defined and their essential elements noted. Applying these designs to trauma research, a search was conducted to locate mixed methods trauma studies. From this search, one sample study was selected, and its characteristics of mixed methods procedures noted. Finally, drawing on other mixed methods designs available, several follow-up mixed methods studies were described for this sample study, enabling trauma researchers to view design options for applying mixed methods research in trauma investigations.

A Pan-European evaluation of residential burns camps for children and young people

INTRODUCTION

Residential camps for children who have experienced a severe burn have existed for over 20 years. The idea stemmed from recognition that children with burns face additional challenges, both physical and psychological, and therefore need long-term psychosocial support away from the acute care setting. Whilst individual programmes have published positive evaluation findings, there have been no cross-regional evaluations undertaken to date.

METHODS

Five European burn camp programmes agreed to take part in a cross-regional study to assess the benefits as reported by participants. Shared objectives included: giving children the opportunity to experience success through overcoming challenging activities, enhancing self-esteem and confidence and enabling children to share their experiences of having a burn with peers and staff in a supportive environment. Each site collected qualitative feedback from children, parents and staff using a common framework. Simple Likert scale data were also collected. Each site coded responses into themes which were then collated at one site.

RESULTS

104 children, 57 parent/carers and 50 staff took part in the cross-regional evaluation. Children were aged between 5 and 18 years. 98% of children reported that they had enjoyed camp, in particular the activities and the sense of achievement they brought, along with the ability to gain support and friendship from peers and staff. A large proportion felt that they had benefitted from having the opportunity to share their experiences of having a burn with peers, leaving them feeling less isolated. In addition some comments related to boosting confidence and self-esteem and mastering new skills. Parent/carers again cited the increase in their child's confidence in self and appearance as key benefits of the camps. Staff reports also included the benefits for burn care teams by increasing awareness of patient needs and improving multidisciplinary team working.

DISCUSSION

The study highlighted the generic benefits of burn camps by collapsing themes across five different sites. Whilst this minimised the localised differences between camps, further research could be used to analyse these subtle differences in greater detail. Some consideration was made of the language barriers between sites which could have effected the interpretation of some of the individual themes. A multi-methodological approach could be used to reduce this effect in future.