Parental responses to child experiences of trauma following presentation at emergency departments: a qualitative study

Parent-Child Communication About Potentially Traumatic Events: A Systematic Review

Social support plays an important role in children's well-being after experiencing a potentially traumatic event (PTE). One such source of support is the parent-child relationship, specifically by discussing the event. However, current literature provides no consensus on whether parents and children communicate about PTEs, in what way they might communicate and how this affects the child. Hence the goal of the current study is threefold, to explore: (a) whether parents and children communicate about PTEs, (b) what this communication looks like, and (c) how this affects children's well-being. These questions are answered by means of a systematic literature review. Articles were eligible for inclusion if it was an empirical study on communication between parents and children about a PTE that the child (under 18 years) had experienced. Initial searches in electronic databases provided 31,233 articles, of which 26 were deemed eligible for inclusion. Results show that most parents and children have discussed PTEs, but that this may depend on cultural background. What the parent-child communication looks like depends on various factors such as, age of the child, tone, and child's initiation of discussion. Parental post-traumatic stress symptoms seem to negatively impact communication. The results of the impact of communication are less clear-cut, but it seems to have a predominantly positive effect on the child's well-being, depending on parental sensitivity. Clinicians should be watchful for parental symptoms of post-traumatic stress disorder and can focus on promoting parental sensitivity and responsiveness when discussing PTEs with their child or on creating a joint narrative within families.

'Life should go on': a qualitative inquiry of parental reactions, experiences, and perceived needs following adolescents' recent traumatic exposure

Background: Parents have a significant role in supporting children who have been exposed to traumatic events. Little is known about parental experiences and needs in the wake of traumatic exposure, which could help in designing tailored early interventions.Objective: This qualitative study explored experiences, perceived needs, and factors impacting those needs being met, in parents of adolescents aged 11-16 years who had been exposed in the past 3 months to a potentially traumatic event, in the city of Montpellier, France.Method: We purposively sampled 34 parents of 25 adolescents aged 11-16 years meeting the inclusion criteria and used semi-structured in-depth interviews. Thematic analysis was applied using a multistage recursive coding process.Results: Parents lacked trauma-informed explanations to make sense of their child's reduced functioning. They experienced stigma attached to the victim label and were reluctant to seek help. School avoidance and lack of collaboration with schools were major obstacles experienced by parents. Parents trying to navigate conflicting needs fell into two distinct categories. Those who experienced distressing levels of shame and guilt tended to avoid discussing the traumatic event with their child, pressuring them to resume life as it was before, despite this perpetuating conflictual interactions. Others adapted by revisiting their beliefs that life should go on as it was before and by trying to come up with new functional routines, which improved their relationship with their child and helped them to restore a sense of agency and hope, but at the cost of questioning their parental role.Conclusions: Key domains of parental experiences could provide potential early intervention targets, such as psychoeducation on traumatic stress, representations about recovery and the victim status, parent-child communication, and involvement of schools and primary caregivers. Further research is needed to validate the impact of these domains in early post-traumatic interventions.

Emergency department clinicians' views on implementing psychosocial care following acute paediatric injury: a qualitative study

Introduction: The early post-trauma period is a key time to provide psychological support to acutely injured children. This is often when they present to emergency departments (EDs) with their families. However, there is limited understanding of the feasibility of implementing psychological support for children and their families in EDs. The aim of this study was to explore UK and Irish ED clinicians' perspectives on developing and implementing psychosocial care which educates families on their children's post-trauma psychological recovery.Methods: Semi-structured individual and group interviews were conducted with 24 UK and Irish ED clinicians recruited via a paediatric emergency research network.Results: Clinicians expressed that there is value in offering psychological support for injured children and their families; however, there are barriers which can prevent this from being effectively implemented. Namely, the prioritisation of physical health, time constraints, understaffing, and a lack of training. Therefore, a potential intervention would need to be brief and accessible, and all staff should be empowered to deliver it to all families.Conclusion: Overall, participants' views are consistent with trauma-informed approaches where a psychosocial intervention should be able to be implemented into the existing ED system and culture. These findings can inform implementation strategies and intervention development to facilitate the development and delivery of an accessible digital intervention for acutely injured children and their families.

Mothers' satisfaction with emergency care when their child has an autism spectrum disorder

PURPOSE

This study aimed to examine factors identified by mothers as affecting their satisfaction with the care provided to their children in the Emergency Department (ED), among mothers of children with autistic spectrum disorder (ASD) in comparison to mothers of children without ASD.

DESIGN AND METHODS

In this correlational quantitative study, 128 Israeli mothers - 59 (46%) mothers of children with ASD and 69 (54%) of children without ASD - completed an online survey based on a Ministry of Health national survey of patient experience.

RESULTS

Mothers of children with ASD expressed lower satisfaction with the care provided. The difference was particularly evident concerning waiting times for examination of the child by nurses and physicians in the ED, whether the nurses were attentive and responsive to the mother's questions and concerns, whether the ED staff demonstrated coordination and cooperation with regard to medical care of the child, and whether work in the ED was conducted in an orderly and organized manner. The presence of communication difficulties in children predicted mothers' satisfaction with care.

CONCLUSIONS

These findings suggest that certain needs of mothers and/or their children with ASD do not receive an appropriate response in the ED.

PRACTICE IMPLICATIONS

It is important to raise the awareness of healthcare providers in EDs regarding the needs of children with ASD and their parents, especially children with communication difficulties. Strategies should be implemented to improve the experience of children with ASD and their parents in the ED.

The promise of compassion-based therapy as a novel intervention for adolescent PTSD

In this review, we summarize current evidence for compassion-based approaches for PTSD and the potential for their application to the adolescent PTSD population. Exposure to traumatic events is common in adolescence and PTSD remains a public health crisis. Accessibility, willingness, and engagement are significant barriers to established treatments for PTSD, with attrition rates as high as 50 %. Compassion-based therapies provide potential solutions to treatment obstacles by providing a non-threatening, transdiagnostic option unburdened by aspects of current trauma treatment which may be associated with treatment resistance (e.g., exposure, trauma narrative, induction of fear). Compassion-based approaches are intuitive for trauma treatment, as compassion activates the self-soothing system, thereby disarming the fear system and promoting affect regulation. Compassion-based treatments demonstrate reductions across a substantial range of PTSD symptoms in adults, however, in adolescents extant literature is sparse, with cross-sectional studies suggesting self-compassion is inversely associated with trauma-related psychopathology. Understanding the impact of compassion-based approaches on adolescent PTSD is warranted as the adolescent developmental period may be a particularly opportune time for this approach. Evaluation of the impact of compassion-based treatment on adolescent PTSD in clinical populations via randomized-controlled studies and comparison of its relative efficacy to current evidence-based practices is warranted.

A systematic literature review of the relationship between parenting responses and child post-traumatic stress symptoms

Background: Parents are a key source of support for children exposed to single-incident/acute traumas and can thereby play a potentially significant role in children's post-trauma psychological adjustment. However, the evidence base examining parental responses to child trauma and child posttraumatic stress symptoms (PTSS) has yielded mixed findings.Objective: We conducted a systematic review examining domains of parental responding in relation to child PTSS outcomes.Method: Studies were included if they (1) assessed children (6-19 years) exposed to a potentially traumatic event, (2) assessed parental responses to a child's trauma, and (3) quantitatively assessed the relationship between parental responses and child PTSS outcomes. A systematic search of three databases (APAPsycNet, PTSDpubs, and Web of Science) yielded 27 manuscripts.Results: Parental overprotection, trauma communication, avoidance of trauma discussion and of trauma reminders, and distraction were consistently related to child PTSS. There was more limited evidence of a role for trauma-related appraisals, harsh parenting, and positive parenting in influencing child outcomes. Significant limitations to the evidence base were identified, including limited longitudinal evidence, single informant bias and small effect sizes.Conclusion: We conclude that key domains of parental responses could be potential intervention targets, but further research must validate the relationship between these parental responses and child PTSS outcomes.

Leveraging the developmental neuroscience of caregiving to promote resilience among youth exposed to adversity

Early adversity is a major risk factor for the emergence of psychopathology across development. Identifying mechanisms that support resilience, or favorable mental health outcomes despite exposure to adversity, is critical for informing clinical intervention and guiding policy to promote youth mental health. Here we propose that caregivers play a central role in fostering resilience among children exposed to adversity via caregiving influences on children's corticolimbic circuitry and emotional functioning. We first delineate the numerous ways that caregivers support youth emotional learning and regulation and describe how early attachment lays the foundation for optimal caregiver support of youth emotional functioning in a developmental stage-specific manner. Second, we outline neural mechanisms by which caregivers foster resilience-namely, by modulating offspring corticolimbic circuitry to support emotion regulation and buffer stress reactivity. Next, we highlight the importance of developmental timing and sensitive periods in understanding caregiving-related mechanisms of resilience. Finally, we discuss clinical implications of this line of research and how findings can be translated to guide policy that promotes the well-being of youth and families.

Brief emotion-focused family therapy: A 12-month follow-up study

This study provides a 12-month follow-up evaluation of caregivers after participating in a 2-day Emotion-focused family therapy (EFFT) intensive, a brief intervention for caregivers of youth struggling with mental health difficulties. Caregivers (N = 498) of children (N = 337) completed measures of caregiver self-efficacy and child mental health difficulties 1 week before the intervention, immediately after the intervention, and at 4, 8, and 12-month follow-ups. Piecewise latent trajectory models revealed that parental self-efficacy showed a large immediate increase following the intervention, β = 1.61 (1.32, 2.14), and although this effect was attenuated by 4 months, β = -0.77 (-1.31, -0.52), it did not change further by 12 months. Reductions in child mental health difficulties were observed by 4 months, β = -0.54 (-0.77, -0.37), and remained stable through the 12-month follow-up. Caregivers reporting more increases in self-efficacy also reported greater reductions in their children's symptoms at 4 and 12 months.

The magnitude of parental stress is highly variable following pediatric concussion: using the transactional model of stress to understand parent experiences

OBJECTIVES

To use the Transactional Model of Stress to understand variations in parental stress following pediatric concussion.

METHODS

Mixed-methods design. 49 children with concussion (13.8 ± 2.3 years, n_females = 27) and their parent (n_females = 40) were recruited from a specialty clinic. Quantitative data were collected via surveys at the child's initial clinic visit. Qualitative data were collected through an eleven-question, semi-structured interview with 12 parents. Interview questions focused on post-concussion stressors and data were analyzed using thematic analysis. Multivariable linear regression analyzed predictors of parental stress .

RESULTS

Ten of the parents interviewed (83%) described the concussion as having a negative overall effect on their stress, while two parents described the overall experience as positive. Coping abilities and other life stressors were described as reasons for varying stress levels. Neurotic and conscientious personality factors and the child's quality of life total score accounted for 45% of the variance in parental stress (R² = 0.451, F_(3,33) = 9.03, p < 0.001).

CONCLUSIONS

Parental stress following pediatric concussion is highly variable. The Transactional Model of Stress appears useful to understand this phenomenon. Future studies should investigate interventions to reduce stress for parents experiencing high levels following their child's concussion.

Developing a conceptual framework to identify and classify sources of parental stress following pediatric concussion

OBJECTIVES

To create a conceptual framework that classifies the various stresses parents experience following their child's concussion.

METHODS

Twelve parents of children with concussion completed a semi-structured interview with the lead author. Questions broadly focused on post-concussion stress, with specific probes for caregiving responsibilities, concussion knowledge, and athletic participation. Data were analyzed using thematic analysis.

RESULTS

Ten mothers and 2 fathers participated. Five themes stemmed from our analysis: 1) Concussion Knowledge (central theme): stressors related to sources of concussion information; 2) Child Health Factors: stressors related to injury and illness, including concussion; 3) Activity Factors: stressors related to academic and athletic performance; 4) Parent-Injured Child Relationship Factors: stressors related to providing care to the child; and 5) Personal Factors: stressors unrelated to the concussion (e.g. family, social, career, etc.). Child Health Factors was most frequently identified as the primary stressor (n = 9).

CONCLUSIONS

Sources of parental stress were varied following pediatric concussion. Issues relating to the child's post-injury dysfunction and the uncertain recovery from concussion were key stressors identified by parents. Moving forward, this framework can be used to ground the development of specific parental stress screening tools and interventions, which may benefit the parent's mental health and the child's clinical recovery.

Psychological and psychosocial aspects of major trauma care in the United Kingdom: A scoping review of primary research

Introduction

More people are surviving major trauma, often with life changing injuries. Alongside physical injury, many survivors of major trauma experience psychological and psychosocial impacts. Presently, there is little guidance at the UK national level for psychological and psychosocial aspects of major trauma care. Set in the context of the regional model of major trauma care implemented in the UK in 2012, the purpose of this review was to identify and bring together primary research about psychological and psychosocial aspects of major trauma care in the UK to produce an overview of the field to date, identify knowledge gaps and set research priorities.

Methods

A scoping review was undertaken. Seven electronic databases (MEDLINE, Cochrane Library, CINAHL, Embase, PsycINFO, SocINDEX with Full Text and PROSPERO) were searched alongside a targeted grey literature search. Data from included studies were extracted using a predefined extraction form and underwent bibliometric analysis. Included studies were then grouped by type of research, summarised, and synthesised to produce a descriptive summary and overview of the field.

Results

The searches identified 5,975 articles. Following screening, 43 primary research studies were included in the scoping review. The scoping review, along with previous research, illustrates that psychological and psychosocial impacts are to be expected following major trauma. However, it also found that these aspects of care are commonly underserved and that there are inherent inequities across major trauma care pathways in the UK.

Conclusion

Though the scoping review identified a growing body of research investigating psychological and psychosocial aspects of major trauma care pathways in the UK, significant gaps in the evidence base remain. Research is needed to establish clinically effective psychological and psychosocial assessment tools, corresponding interventions, and patient-centred outcome measures so that survivors of major trauma (and family members or carers) receive the most appropriate care and intervention.

Caregiver maltreatment history and treatment response following an intensive Emotion Focused Family Therapy workshop

This single-arm, repeated measures study investigated the impact caregiver trauma history may have on treatment response following an intensive, 2-day Emotion Focused Family Therapy (EFFT) caregiver workshop. Caregivers (n = 243) completed questionnaires regarding their child's emotion regulation and clinical symptoms, as well as their own childhood trauma history (i.e., exposure to various forms of child maltreatment), caregiver self-efficacy and caregiver blocks (e.g., fears) to support their child's treatment and recovery. Questionnaires were administered prior to and immediately following the workshop and again 4, 8 and 12 months later. At baseline, caregivers who reported experiences of childhood maltreatment demonstrated more blocks compared with caregivers who did not (B = 6.35, SE = 2.62, p < 0.05). Results indicated that caregivers with and without maltreatment histories reported similar, significant gains in their child's total difficulties (B = 0.64, SE = 0.41, p = 0.12) and emotional negativity and lability (B = 0.51, SE = 0.48, p = 0.29) at 12-month post-workshop. Caregivers with maltreatment histories reported greater improvements in caregiver blocks (B = 5.15, SE = 1.34, p < 0.001) and child emotion regulation (B = 0.90, SE = 0.18, p < 0.001) than caregivers without maltreatment histories. They also report less, but still significant, improvement in parental self-efficacy (B = -0.68, SE = 0.26, p < 0.01) when compared with caregivers without maltreatment histories. Findings suggest that EFFT workshops may be an acceptable and effective trans-diagnostic intervention for families presenting with complex histories, including caregiver exposure to childhood maltreatment.

Higher parental stress is significantly related to longer clinical recovery times in concussed children: A mixed-methods study

OBJECTIVES

Parental stress and anxiety negatively influences a child's recovery following traumatic brain injury, but these relationships are largely unexplored in a concussion-specific sample. We hypothesized that children with parents experiencing high stress or with pre-existing anxiety would take significantly longer to recover from concussion.

DESIGN

Mixed-methods.

METHODS

Forty-nine concussed children (13.8 ± 2.3 years, n_females = 27) and their parents were recruited. Quantitative data were collected using the Perceived Stress Scale (10-item). Qualitative data (n = 12) were collected through a semi-structured interview with the parent. Kaplan-Meier curves and Cox proportional hazard models analyzed the effect of parental stress and anxiety on time in clinic (days between clinic presentation and discharge) and recovery time (days between concussion and clinic discharge). Thematic analysis was used to analyze interview data.

RESULTS

Parental anxiety was not significantly related to either the child's time in clinic (P = 0.27) or recovery time (P = 0.41). Conversely, higher perceived parental stress was related to longer recovery time (Hazard Ratio: 2.162, 95% CI: 1.075, 4.348; p = 0.03) for the injured child, with similar results for time in clinic (Hazard Ratio: 1.883, 95% CI: 0.966, 3.668, p = 0.06). During the interview, parents expressed their stress was directly tied to their child's symptoms and overall functioning and varied throughout recovery.

CONCLUSIONS

Recovery time is significantly longer in concussed children whose parents are experiencing higher levels of stress, but not pre-existing anxiety, following injury. Parental stress varies throughout recovery, with stress generally higher in the acute post-injury period. Clinicians should monitor parental stress post-concussion when possible.

The impact of injury: The experiences of children and families after a child's traumatic injury

Objective:

To explore the experiences of children and families after a child’s traumatic injury (Injury Severity Score >8).

Design:

Qualitative interview study.

Setting:

Two children’s major trauma centres in England.

Participants:

32 participants: 13 children with traumatic injuries, their parents/guardians (n = 14) and five parents whose injured child did not participate.

Methods:

Semi-structured interviews exploring the emotional, social, practical and physical impacts of children’s injuries, analysed by thematic analysis.

Results:

Interviews were conducted a median of 8.5 months (IQR 9.3) post-injury. Injuries affected the head, chest, abdomen, spine, limbs or multiple body parts. Injured children struggled with changes to their appearance, physical activity restrictions and late onset physical symptoms, which developed after hospital discharge when activity levels increased. Social participation was affected by activity restrictions, concerns about their appearance and interruptions to friendships. Psychological impacts, particularly post-traumatic stress type symptoms often affected both children and parents. Parents’ responsibilities suddenly increased, which affected family relationships and roles, their ability to work and carry out daily tasks. Rapid hospital discharge was wanted, but participants often felt vulnerable on return home. They valued continued contact with a healthcare professional and practical supports from family and friends, which enabled resumption of their usual lives.

Conclusions:

Injured children experience changes to their appearance, friendships, physical activity levels and develop new physical and mental health symptoms after hospital discharge. Such challenges can be addressed by the provision of advice about potential symptoms, alternative activities during recovery, strategies to build resilience and how to access services after hospital discharge.

Qualitative study of the needs of injured children and their families after a child's traumatic injury

OBJECTIVE

To explore the needs of children and their families after a child's traumatic injury.

DESIGN

Semi-structured qualitative interviews with purposeful sampling for different types of injuries and a theoretical thematic analysis.

PARTICIPANTS

32 participants; 13 children living at home after a traumatic injury, their parents/guardians (n=14) and five parents whose injured child did not participate.

SETTING

Two Children's Major Trauma Centres (hospitals) in England.

RESULTS

Interviews were conducted a median 8.5 months (IQR 9.3) postinjury. Injuries affected the limbs, head, chest, abdomen, spine or multiple body parts. Participants highlighted needs throughout their recovery (during and after the hospital stay). Education and training were needed to help children and families understand and manage the injury, and prepare for discharge. Information delivery needed to be timely, clear, consistent and complete, include the injured child, but take into account individuals' capacity to absorb detail. Similarly, throughout recovery, services needed to be timely and easily accessible, with flexible protocols and eligibility criteria to include injured children. Treatment (particularly therapy) needed to be structured, goal directed and of sufficient frequency to return injured children to their full function. A central point of contact is required after hospital discharge for advice, reassurance and to coordinate ongoing care. Positive partnerships with professionals helped injured children and their families maintain a sense of hope and participate in joint decision making about their care.

CONCLUSION

Throughout the full trajectory of recovery injured children and their families need family centred, accessible, flexible, coordinated health services, with more effective harmonious, communication between professionals, the child and their family. There is a requirement for support from a single point of contact and a system that monitors the needs of the injured child and their family after hospital discharge.

Parental Experiences of Supporting Children with Clinically Significant Post-Traumatic Distress: a Qualitative Study of Families Accessing Psychological Services

The aim of this study was to investigate the experiences of parents in providing support to their child following trauma exposure in cases where children are experiencing clinically significant levels of post-traumatic distress. Qualitative interviews were conducted with parents whose child was exposed to a trauma and referred for psychological treatment. Parents reported considerable anxiety in coping with their child's post-traumatic distress. Avoidance of trauma-related discussions was encouraged due to concerns that non-avoidant approaches may worsen children's post-trauma difficulties. Nonetheless, parents were often sensitive to their child's distress and offered reassurance and other forms of support. Many barriers existed to accessing psychological treatment, and perceptions of inadequate guidance from therapists on supporting child adjustment contributed to parental distress. The results illustrate the strategies used by parents in supporting their child post-trauma and may assist mental health professionals in providing acceptable guidance to parents following child trauma.

A mixed-methods investigation of parent-child posttrauma discussion and the effects of encouraging engagement

Recent developments in the child trauma field include preventative interventions that focus on augmenting parental support. However, we have limited knowledge of how parents experience trauma conversations with children. We examined how parents and children experienced both spontaneous trauma conversations and a structured task in which they generated a joint trauma narrative, following the child's experience of an acute trauma. Parent and child ratings of distress during the structured narrative were low for all 127 families that took part, with child ratings of distress being lower overall than parent ratings. Task-related distress was positively associated with parent and child PTSD symptoms. Thematic analysis of semi-structured interviews conducted with a subset of twenty parents identified both facilitators of (e.g. open and honest relationship with child) and barriers to (e.g. parent/child avoidance of discussion) spontaneous trauma-related conversations with their child. Additionally, parents described the structured trauma narrative task as an opportunity to start the conversation with their child, to understand their child's feelings, and for the child to process the trauma. However, the task was also uncomfortable or upsetting for some parents/children, and resulted in parents becoming more overprotective. The findings can inform development of low-dose interventions that encourage families to engage in trauma-related conversations following child experiences of trauma.

A longitudinal investigation of the role of parental responses in predicting children's post-traumatic distress

BACKGROUND

While parental post-trauma support is considered theoretically important for child adjustment, empirical evidence concerning the specific aspects of parental responding that influence child post-traumatic distress, or the processes via which any such impacts occur, is extremely limited. We conducted a longitudinal examination of whether parental post-trauma appraisals, trauma-specific support style and general parenting style predicted child post-traumatic stress symptom severity (PTSS) following trauma; and whether such influences operated via the child's own appraisals and coping style.

METHOD

We recruited 132 parent-child pairs following children's experience of acute trauma. We examined whether parental responses assessed at 1-month post-trauma, predicted child PTSS at 6-month follow-up. Parental trauma-specific appraisals and responses, and general parenting style, were assessed via both self-report and direct observations. Child-report questionnaires were used to assess PTSS and potential mediators.

RESULTS

Initial parent negative appraisals and encouragement of avoidant coping were associated with higher child-reported PTSS at 6-month follow-up. Predictive effects were maintained even when controlling for initial child symptom levels. Observational assessments broadly supported conclusions from self-report. There was evidence that parental influences may operate, in part, by influencing the child's own appraisals and coping responses. In contrast, there was no evidence for an influence of more "adaptive" support or general parenting style on child PTSS.

CONCLUSIONS

Findings provide important insight into how elements of social support may influence child post-trauma outcomes.

The Parent Trauma Response Questionnaire (PTRQ): development and preliminary validation

Background: Following a child's experience of trauma, parental response is thought to play an important role in either facilitating or hindering their psychological adjustment. However, the ability to investigate the role of parenting responses in the post-trauma period has been hampered by a lack of valid and reliable measures. Objectives: The aim of this study was to design, and provide a preliminary validation of, the Parent Trauma Response Questionnaire (PTRQ), a self-report measure of parental appraisals and support for children's coping, in the aftermath of child trauma. Methods: We administered an initial set of 78 items to 365 parents whose children, aged 2-19 years, had experienced a traumatic event. We conducted principal axis factoring and then assessed the validity of the reduced measure against a standardized general measure of parental overprotection and via the measure's association with child post-trauma mental health. Results: Factor analysis generated three factors assessing parental maladaptive appraisals: (i) permanent change/damage, (ii) preoccupation with child's vulnerability, and (iii) self-blame. In addition, five factors were identified that assess parental support for child coping: (i) behavioural avoidance, (ii) cognitive avoidance, (iii) overprotection, (iv) maintaining pre-trauma routines, and (v) approach coping. Good validity was evidenced against the measure of parental overprotection and child post-traumatic stress symptoms. Good test-retest reliability of the measure was also demonstrated. Conclusions: The PTRQ is a valid and reliable self-report assessment of parenting cognitions and coping in the aftermath of child trauma.

Acute burns management: placement reflections of a children's nursing student

Reflection can help nurses make sense of their clinical surroundings and understand risks, challenges and opportunities. Learning the art required for reflective practice begins as a student when critical reflection is particularly important during practice placements. A suitable reflective framework is provided by Rolfe et al ( 2011 ). Adopting this framework, this article draws on the placement experiences of a second-year undergraduate children's nursing student in an acute setting, caring for a toddler with 13% partial and full-thickness burns. The decisions made about assessing and monitoring homeostasis, overall fluid and pain management, infection prevention and potential safeguarding concerns are explored. Reflecting on clinical experience provides students with invaluable transferable skills.

Caregiver experiences of public services following child trauma exposure: a qualitative study

Background

Many children in low and middle income countries (LMIC) are exposed to trauma. Contact with public services are a potential influence on parent–child reactions and coping post-trauma. Little is known about how caregivers perceive these interactions.

Methods

The aim of this study was to explore caregivers’ experiences of accessing and interacting with public services post-trauma and perceptions of needed improvements to public services in a LMIC context. Qualitative interviews were conducted with 20 female caregivers from a high-risk settlement in South Africa after child trauma exposure.

Results

Three themes and seven sub-themes were identified regarding caregivers’ perceptions of interactions with public services post-trauma. The key themes identified related to (1) communication and exchanges with law enforcement, (2) consequences of an under-resourced justice system and (3) importance of communication and empathy in the healthcare system. Interactions with police were often positive. However, caregivers explained that police-family communication post-trauma could be improved and may help to lessen caregiver anxiety and concerns for the child’s safety post-trauma. Caregivers perceived the judicial system to be under-resourced as contact with the judicial system was often protracted and caused child anxiety and distress. Medical treatment was reportedly rushed, with extensive waiting times and little information provided to caregivers regarding the child’s injuries or treatment. Some medical staff were perceived as unsympathetic during the child’s treatment which was found to exacerbate caregiver and child distress post-trauma.

Conclusions

This study provides insight into caregiver experiences of accessing public services following child trauma exposure in a high-risk LMIC context. Public services were perceived as oversubscribed and under-resourced and negative interactions often influenced caregiver responses and appraisals of child safety. Given the impact of poor interactions with public services on families post-trauma, additional research is needed to investigate feasible improvements to public services in LMIC.

Electronic supplementary material

The online version of this article (10.1186/s13033-018-0190-6) contains supplementary material, which is available to authorized users.

Post-trauma coping in the context of significant adversity: a qualitative study of young people living in an urban township in South Africa

OBJECTIVE

Compared with knowledge of the post-trauma needs of young people living in developed countries, little is known about the needs of those in low-middle-income countries. Such information is crucial, particularly as young people in these environments can be at increased risk of experiencing trauma, coupled with less available resources for formal support. The aim of this study was to explore post-trauma coping and support-seeking of young people living in a high-adversity settlement in South Africa.

DESIGN

Semistructured qualitative interviews analysed using thematic analysis.

SETTING

An urban settlement ('township') in Cape Town, South Africa.

PARTICIPANTS

25 young people, aged 13-17 years, who had experienced trauma. Events included serious car accidents, hearing of a friend's violent death, and rape, and all reported having experienced multiple traumatic events. All participants identified as black South African and spoke Xhosa as their first language.

RESULTS

Social support was considered key to coping after trauma, although the focus of the support differed depending on the source. Parents would most commonly provide practical support, particularly around safety. Peers often provided an avenue to discuss the event and young person's emotional well-being more openly. Outside of social support another key theme was that there were numerous community-level barriers to participants receiving support following trauma. Many young people continued to be exposed to the perpetrator of the event, while there was also the realistic concern around future traumas and safety, community stigma and a perceived lack of justice.

CONCLUSION

This study provides insight into how young people cope and seek support following trauma when they are living in a context of significant adversity and risk. Overall, most young people identified helpful sources of support and thought talking about the event was a useful strategy, but concerns around safety and trust could impede this process.

Caregiver Responses to Child Posttraumatic Distress: A Qualitative Study in a High-Risk Context in South Africa

Many low- and middle-income countries (LMIC) have high rates of child trauma exposure and limited access to psychological services. Caregivers are often a child's key source of support following trauma in such contexts. The aim of this study was to explore the experiences of primary caregivers in supporting their child posttrauma. Qualitative interviews were conducted with 20 female caregivers from a high-risk settlement in Cape Town following child trauma exposure. Children were exposed to significant traumatic events, including gang violence, assault, and fatalities of close relatives. The data were analyzed using thematic analysis; several key themes emerged. First, caregivers were typically aware of child distress posttrauma, based primarily on manifest behaviors. Second, caregivers identified varied ways of providing support, including being warm and responsive; seeking to ensure physical safety by encouraging the child's perceptions of the community as dangerous; and encouraging forgetting as a way of coping, with limited discussions of the event. Third, many barriers existed to accessing psychological treatment, and caregivers had low involvement in any interventions. Finally, caregivers also experienced significant distress that could impact their responses to their child. The results illustrate the challenges faced by caregivers in supporting children following trauma in LMIC contexts and the need for accessible psychological interventions.