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Sloover M, Stoltz SEM, van Ee E. Parent-Child Communication About Potentially Traumatic Events: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:2115-2127. [PMID: 37946404 PMCID: PMC11155229 DOI: 10.1177/15248380231207906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
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.
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Affiliation(s)
| | | | - Elisa van Ee
- Radboud University Nijmegen, The Netherlands
- Psychotraumacentrum Zuid Nederland, Reinier van Arkel, s-Hertogenbosch, The Netherlands
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Kerbage H, Elbejjani M, El-Hage W, Purper-Ouakil D. 'Life should go on': a qualitative inquiry of parental reactions, experiences, and perceived needs following adolescents' recent traumatic exposure. Eur J Psychotraumatol 2024; 15:2299660. [PMID: 38285906 PMCID: PMC10826792 DOI: 10.1080/20008066.2023.2299660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/19/2023] [Indexed: 01/31/2024] Open
Abstract
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.
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Affiliation(s)
- Hala Kerbage
- Department of Child and Adolescent Psychiatry, Saint-Eloi University Hospital, Montpellier, France
- Center for Epidemiology and Population Health (CESP) INSERM U1018, Developmental Psychiatry Team, Paris-Saclay University, Paris, France
| | - Martine Elbejjani
- Clinical Research Institute, Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Wissam El-Hage
- UMR 1253, iBrain, University of Tours, INSERM, Tours, France
| | - Diane Purper-Ouakil
- Department of Child and Adolescent Psychiatry, Saint-Eloi University Hospital, Montpellier, France
- Center for Epidemiology and Population Health (CESP) INSERM U1018, Developmental Psychiatry Team, Paris-Saclay University, Paris, France
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3
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Afzal N, Lyttle MD, Rajabi M, Rushton-Smith F, Varghese R, Trickey D, Halligan SL. Emergency department clinicians' views on implementing psychosocial care following acute paediatric injury: a qualitative study. Eur J Psychotraumatol 2024; 15:2300586. [PMID: 38197257 PMCID: PMC10783840 DOI: 10.1080/20008066.2023.2300586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024] Open
Abstract
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.
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Affiliation(s)
- Nimrah Afzal
- Department of Psychology, University of Bath, Bath, UK
| | - Mark D. Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK
| | - Mohsen Rajabi
- Department of Psychology, University of Bath, Bath, UK
| | | | - Rhea Varghese
- Department of Psychology, University of Bath, Bath, UK
| | | | | | - on behalf of the Paediatric Emergency Research in the UK and Ireland (PERUKI)
- Department of Psychology, University of Bath, Bath, UK
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK
- Anna Freud Centre, UK Trauma Council, London, UK
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Ben Natan M, Igbarin H, Watted A. Mothers' satisfaction with emergency care when their child has an autism spectrum disorder. J Pediatr Nurs 2024; 74:35-40. [PMID: 37992479 DOI: 10.1016/j.pedn.2023.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/05/2023] [Accepted: 11/05/2023] [Indexed: 11/24/2023]
Abstract
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.
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Affiliation(s)
- Merav Ben Natan
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel.
| | - Heba Igbarin
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel
| | - Arwa Watted
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel
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Brinckman B, Alfaro E, Wooten W, Herringa R. The promise of compassion-based therapy as a novel intervention for adolescent PTSD. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2024; 15:100694. [PMID: 38283688 PMCID: PMC10817702 DOI: 10.1016/j.jadr.2023.100694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024] Open
Abstract
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.
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Affiliation(s)
- Bridget Brinckman
- University of Wisconsin-Madison, BRAVE Research Lab, 6001 Research Park Blvd., Madison, WI 53719-1176, United States
| | - Elena Alfaro
- University of Wisconsin-Madison, BRAVE Research Lab, 6001 Research Park Blvd., Madison, WI 53719-1176, United States
| | - William Wooten
- University of Wisconsin-Madison, BRAVE Research Lab, 6001 Research Park Blvd., Madison, WI 53719-1176, United States
| | - Ryan Herringa
- University of Wisconsin-Madison, BRAVE Research Lab, 6001 Research Park Blvd., Madison, WI 53719-1176, United States
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A systematic literature review of the relationship between parenting responses and child post-traumatic stress symptoms. Eur J Psychotraumatol 2023; 14:2156053. [PMID: 37052099 PMCID: PMC9788707 DOI: 10.1080/20008066.2022.2156053] [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: 12/24/2022] Open
Abstract
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.
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Gee DG, Cohodes EM. Leveraging the developmental neuroscience of caregiving to promote resilience among youth exposed to adversity. Dev Psychopathol 2023; 35:2168-2185. [PMID: 37929292 PMCID: PMC10872788 DOI: 10.1017/s0954579423001128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
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.
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Foroughe M, Browne DT, Thambipillai P, Cordeiro K, Muller RT. Brief emotion-focused family therapy: A 12-month follow-up study. JOURNAL OF MARITAL AND FAMILY THERAPY 2023; 49:394-410. [PMID: 36682069 DOI: 10.1111/jmft.12628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/06/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
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.
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Affiliation(s)
- Mirisse Foroughe
- Emotion Transformation Lab, Family Psychology Centre, Toronto, Ontario, Canada
| | - Dillon T Browne
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | | | | | - Robert T Muller
- Department of Psychology, York University, Toronto, Ontario, Canada
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Teel EF, Caron JG, Gagnon IJ. The magnitude of parental stress is highly variable following pediatric concussion: using the transactional model of stress to understand parent experiences. Brain Inj 2022; 36:1025-1032. [PMID: 35950296 DOI: 10.1080/02699052.2022.2110282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
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, nfemales = 27) and their parent (nfemales = 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.
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Affiliation(s)
- Elizabeth F Teel
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Jeffrey G Caron
- School of Kinesiology and Physical Activity Sciences, Université de Montréal, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
| | - Isabelle J Gagnon
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
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10
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Teel EF, Caron JG, Gagnon IJ. Developing a conceptual framework to identify and classify sources of parental stress following pediatric concussion. Brain Inj 2022; 36:1149-1157. [PMID: 35946143 DOI: 10.1080/02699052.2022.2110283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
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.
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Affiliation(s)
- Elizabeth F Teel
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Jeffrey G Caron
- School of Kinesiology and Physical Activity Sciences, Université de Montréal, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
| | - Isabelle J Gagnon
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
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11
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Olive P, Hives L, Wilson N, Ashton A, O’Brien MC, Mercer G, Jassat R, Harris C. Psychological and psychosocial aspects of major trauma care in the United Kingdom: A scoping review of primary research. TRAUMA-ENGLAND 2022. [DOI: 10.1177/14604086221104934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Philippa Olive
- School of Nursing, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Lucy Hives
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Neil Wilson
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Amy Ashton
- Clinical Health Psychology Service, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Marie Claire O’Brien
- Neuropsychology Department, Kings College Hospital NHS Foundation Trust, London, UK
| | - Gemma Mercer
- Acute Rehabilitation Trauma Unit, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Raeesa Jassat
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Catherine Harris
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Applied Health Research Hub, University of Central Lancashire, Preston, UK
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12
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Cordeiro K, Wyers C, Oliver M, Foroughe M, Muller RT. Caregiver maltreatment history and treatment response following an intensive Emotion Focused Family Therapy workshop. Clin Psychol Psychother 2022; 29:1728-1741. [PMID: 35373406 DOI: 10.1002/cpp.2739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Kristina Cordeiro
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Cassandra Wyers
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Meghan Oliver
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
| | | | - Robert T Muller
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
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Teel EF, Caron JG, Gagnon IJ. Higher parental stress is significantly related to longer clinical recovery times in concussed children: A mixed-methods study. J Sci Med Sport 2021; 25:108-114. [PMID: 34518082 DOI: 10.1016/j.jsams.2021.08.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
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, nfemales = 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.
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Affiliation(s)
- Elizabeth F Teel
- School of Physical and Occupational Therapy, McGill University, Canada.
| | - Jeffrey G Caron
- School of Kinesiology and Physical Activity Sciences, Université de Montréal, Canada; Center for Interdisciplinary Research in Rehabilitation, Canada.
| | - Isabelle J Gagnon
- School of Physical and Occupational Therapy, McGill University, Canada; Trauma Center, Montreal Children's Hospital, McGill University Health Center, Canada.
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14
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Berger E, Samuel S. A qualitative analysis of the experiences, training, and support needs of school mental health workers regarding student trauma. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1111/ap.12452] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Emily Berger
- Faculty of Education, Monash University, Clayton, Victoria, Australia,
| | - Sarah Samuel
- Faculty of Education, Monash University, Clayton, Victoria, Australia,
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Jones S, Tyson S, Yorke J, Davis N. The impact of injury: The experiences of children and families after a child's traumatic injury. Clin Rehabil 2020; 35:614-625. [PMID: 33283528 PMCID: PMC8027929 DOI: 10.1177/0269215520975127] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
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.
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Affiliation(s)
- Samantha Jones
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Department of Trauma and Orthopaedics, Royal Manchester Children's Hospital, Manchester Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK
| | - Sarah Tyson
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK
| | - Janelle Yorke
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK
| | - Naomi Davis
- Department of Trauma and Orthopaedics, Royal Manchester Children's Hospital, Manchester Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK
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16
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Jones S, Tyson S, Davis N, Yorke J. Qualitative study of the needs of injured children and their families after a child's traumatic injury. BMJ Open 2020; 10:e036682. [PMID: 33257479 PMCID: PMC7705499 DOI: 10.1136/bmjopen-2019-036682] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
- Samantha Jones
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Paediatric Trauma & Orthopaedics, Manchester University NHS Foundation Trust, Royal Manchester Children's Hospital, Manchester, UK
- Manchester Academic Health Science Centre Manchester, Manchester, UK
| | - Sarah Tyson
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre Manchester, Manchester, UK
| | - Naomi Davis
- Department of Paediatric Trauma & Orthopaedics, Manchester University NHS Foundation Trust, Royal Manchester Children's Hospital, Manchester, UK
- Manchester Academic Health Science Centre Manchester, Manchester, UK
| | - Janelle Yorke
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre Manchester, Manchester, UK
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17
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The impact of spine sarcoma on mental health and well-being. Spine J 2019; 19:1603-1605. [PMID: 31125690 DOI: 10.1016/j.spinee.2019.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 02/03/2023]
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18
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Williamson V, Creswell C, Butler I, Christie H, Halligan SL. Parental Experiences of Supporting Children with Clinically Significant Post-Traumatic Distress: a Qualitative Study of Families Accessing Psychological Services. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2019; 12:61-72. [PMID: 32318180 PMCID: PMC7163877 DOI: 10.1007/s40653-017-0158-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
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.
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Affiliation(s)
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6UA UK
| | - Ian Butler
- Department of Humanities and Social Sciences, University of Bath, Bath, BA2 7AY UK
| | - Hope Christie
- Department of Psychology, University of Bath, Bath, BA2 7AY UK
| | - Sarah L. Halligan
- Department of Psychology, University of Bath, Bath, BA2 7AY UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, 7700 South Africa
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19
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McGuire R, Hiller RM, Cobham V, Haag K, Halligan SL. A mixed-methods investigation of parent-child posttrauma discussion and the effects of encouraging engagement. Eur J Psychotraumatol 2019; 10:1644127. [PMID: 31489132 PMCID: PMC6711190 DOI: 10.1080/20008198.2019.1644127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/14/2019] [Accepted: 06/23/2019] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Vanessa Cobham
- School of Psychology, The University of Queensland, Brisbane, Australia.,Children's Health QLD, Child and Youth Mental Health Service, Brisbane, Australia
| | | | - Sarah L Halligan
- Department of Psychology, University of Bath, UK.,Department of Psychiatry, University of Cape Town, Rondebosch, South Africa
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20
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Hiller RM, Meiser‐Stedman R, Lobo S, Creswell C, Fearon P, Ehlers A, Murray L, Halligan SL. A longitudinal investigation of the role of parental responses in predicting children's post-traumatic distress. J Child Psychol Psychiatry 2018; 59:781-789. [PMID: 29197098 PMCID: PMC6849512 DOI: 10.1111/jcpp.12846] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 01/14/2023]
Abstract
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.
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Affiliation(s)
| | | | - Sarah Lobo
- Department of PsychologyUniversity of BathBathUK
| | - Cathy Creswell
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - Pasco Fearon
- Department of Clinical, Educational and Health PsychologyUniversity College LondonLondonUK
| | - Anke Ehlers
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
| | - Lynne Murray
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK,Department of PsychiatryUniversity of Cape TownCape TownSouth Africa
| | - Sarah L. Halligan
- Department of PsychologyUniversity of BathBathUK,Department of PsychiatryUniversity of Cape TownCape TownSouth Africa
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21
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Williamson V, Hiller RM, Meiser-Stedman R, Creswell C, Dalgleish T, Fearon P, Goodall B, McKinnon A, Smith P, Wright I, Halligan SL. The Parent Trauma Response Questionnaire (PTRQ): development and preliminary validation. Eur J Psychotraumatol 2018; 9:1478583. [PMID: 29938010 PMCID: PMC6008584 DOI: 10.1080/20008198.2018.1478583] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 05/08/2018] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Victoria Williamson
- Department of Psychology, University of Bath, Bath, UK
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | | | | | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit and Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Pasco Fearon
- Department of Clinical, Education and Health Psychology, University College London, London, UK
| | - Ben Goodall
- Medical Research Council Cognition and Brain Sciences Unit and Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Anna McKinnon
- Medical Research Council Cognition and Brain Sciences Unit and Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Patrick Smith
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
| | - Isobel Wright
- Medical Research Council Cognition and Brain Sciences Unit and Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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22
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Smith S, Hunt J. Acute burns management: placement reflections of a children's nursing student. Nurs Child Young People 2018. [PMID: 29512962 DOI: 10.7748/ncyp.2018.e1009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- Sara Smith
- Salisbury District Hospital, Wiltshire, England
| | - Jane Hunt
- Children and young people's nursing, Faculty of Health and Social Sciences, Bournemouth University, Dorset, England
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23
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Caregiver experiences of public services following child trauma exposure: a qualitative study. Int J Ment Health Syst 2018; 12:15. [PMID: 29651301 PMCID: PMC5894141 DOI: 10.1186/s13033-018-0190-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/22/2018] [Indexed: 11/23/2022] Open
Abstract
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.
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Hiller RM, Halligan SL, Tomlinson M, Stewart J, Skeen S, Christie H. Post-trauma coping in the context of significant adversity: a qualitative study of young people living in an urban township in South Africa. BMJ Open 2017; 7:e016560. [PMID: 28988171 PMCID: PMC5640056 DOI: 10.1136/bmjopen-2017-016560] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Jackie Stewart
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Sarah Skeen
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Hope Christie
- Department of Psychology, University of Bath, Bath, UK
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25
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Williamson V, Butler I, Tomlinson M, Skeen S, Christie H, Stewart J, Halligan SL. Caregiver Responses to Child Posttraumatic Distress: A Qualitative Study in a High-Risk Context in South Africa. J Trauma Stress 2017; 30:482-490. [PMID: 29077999 PMCID: PMC5698750 DOI: 10.1002/jts.22215] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 03/28/2017] [Accepted: 04/21/2017] [Indexed: 01/20/2023]
Abstract
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.
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Affiliation(s)
| | - Ian Butler
- Department of Humanities and Social SciencesUniversity of BathBathUnited Kingdom
| | - Mark Tomlinson
- Department of PsychologyStellenbosch UniversityStellenboschSouth Africa
| | - Sarah Skeen
- Department of PsychologyStellenbosch UniversityStellenboschSouth Africa
| | - Hope Christie
- Department of PsychologyUniversity of BathBathUnited Kingdom
| | - Jackie Stewart
- Department of PsychologyStellenbosch UniversityStellenboschSouth Africa
| | - Sarah L Halligan
- Department of PsychologyUniversity of BathBathUnited Kingdom
- Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
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26
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Williamson V, Creswell C, Fearon P, Hiller RM, Walker J, Halligan SL. The role of parenting behaviors in childhood post-traumatic stress disorder: A meta-analytic review. Clin Psychol Rev 2017; 53:1-13. [DOI: 10.1016/j.cpr.2017.01.005] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 01/05/2017] [Accepted: 01/16/2017] [Indexed: 12/01/2022]
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