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Griffin BR, Harvey L, Dimanopoulos TA, Curtis KA, Gillen T, Kimble RM. Examining the impact of a paediatric trauma family support service on the quality of life of injured children: A longitudinal cohort study. J Pediatr Nurs 2024; 77:e356-e365. [PMID: 38735803 DOI: 10.1016/j.pedn.2024.04.052] [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: 11/01/2023] [Revised: 04/21/2024] [Accepted: 04/28/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE We describe and evaluate the introduction of a trauma family support service (TFSS) in an Australian tertiary paediatric hospital. DESIGN AND METHODS A longitudinal mixed-methods cohort study evaluated the effectiveness of the TFSS on quality of life. PedsQL4.0 and EuroQol 5D-Y scores were collected at 6 and 12 months at intervention and non-intervention sites and outcomes were compared using a two-sample t-test. Qualitative data from field notes collected during the administration of the quality-of-life measures were analysed using inductive content analysis. Data were integrated during the interpretation of results to expand and strengthen findings. RESULTS Data from 192 children were collected (intervention site: 104, control site: 88). Significant increases were seen in the PedsQL and EQ-5D-Y scores at the intervention site compared to the control site at both timepoints, indicating an increase in overall health related quality of life. Two main categories were generated from the qualitative analysis: "Psychosocial impact of trauma" and "Access to psychosocial services." CONCLUSIONS The introduction of a dedicated family support service after paediatric injury improved well-being up to 12 months post injury. PRACTICE IMPLICATIONS Healthcare providers should emphasise dedicated family support services for paediatric trauma patients, focusing on their psychosocial needs and ensuring access to suitable resources. Paediatric nurses are a major part of this service and should contribute to future research, co-designing and implementing these improved family support services to better serve families affected by paediatric trauma.
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Affiliation(s)
- Bronwyn R Griffin
- School of Nursing and Midwifery, Griffith University, Level 7, 62 Graham Street, South Brisbane 4101, Queensland, Australia; Queensland Children's Hospital, 501 Stanley Street, South Brisbane 4101, Queensland, Australia.
| | - Lauren Harvey
- Queensland Children's Hospital, 501 Stanley Street, South Brisbane 4101, Queensland, Australia.
| | - Tanesha A Dimanopoulos
- School of Nursing and Midwifery, Griffith University, Level 7, 62 Graham Street, South Brisbane 4101, Queensland, Australia; Queensland Children's Hospital, 501 Stanley Street, South Brisbane 4101, Queensland, Australia.
| | - Kate A Curtis
- Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Loftus Street, Wollongong 2500, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Susan Wakil School of Nursing and Midwifery, Camperdown 2006, New South Wales, Australia.
| | - Tona Gillen
- Queensland Children's Hospital, 501 Stanley Street, South Brisbane 4101, Queensland, Australia.
| | - Roy M Kimble
- Queensland Children's Hospital, 501 Stanley Street, South Brisbane 4101, Queensland, Australia.
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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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3
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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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Skandsen A, Sand L, Teicher MH, Heradstveit O, Bøe T. Exposure to potentially traumatic events and PTSD symptomatology in Norwegian 11-13-year-olds: results from the Bergen Child Study. Child Adolesc Psychiatry Ment Health 2023; 17:32. [PMID: 36870995 PMCID: PMC9985863 DOI: 10.1186/s13034-023-00578-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Exposure to potentially traumatic experiences (PTEs) is common among children and adolescents, but relatively little is known about the epidemiology of trauma and trauma-related psychopathology in children and youth. The present cross- sectional epidemiological study aimed to explore factors that is associated with posttraumatic stress symptoms (PTSS) in children. METHOD Data stem from the Bergen Child Study, a series of cross-sectional multi-phase surveys of children born between 1993 and 1995 in Bergen, Norway. The sample used is from the second wave of the Bergen Child Study (BCS) conducted in 2006, a two-phase study. The study entailed a detailed psychiatric evaluation using the Development and well-being assessment (DAWBA). The DAWBA was administered to parents or caregivers and covered diagnostic areas, child and family background, and child strengths. A total of 2043 parents participated. RESULTS Out of the total sample, parents reported that 4.8% children had experienced PTEs at some point in their lives. The findings revealed current PTSS in 30.9% of children exposed to PTE, which was 1.5% of the total sample. None of the parents reported PTSS in their children over the threshold for diagnosing posttraumatic stress disorder (PTSD). The most common PTSS cluster was arousal reactivity (90.0%), followed by negative cognitions and mood (80%). The least frequent symptom cluster was intrusions (63.3%) and avoidance (60%). Children with PTSS were reported to live in families with significantly more family stressors (p = 0.001, d = 0.8) and had utilized significantly more sources for help relative to those without PTSS (p = 0.001, d = 0.75). CONCLUSION The present population study on children revealed a lower prevalence rate of PTEs and PTSD than previous studies. It provided findings in the field of trauma on parent- reported PTSS and PTSD symptom clusters not restricted to the clinical level of PTSD. Lastly, it highlighted how family-life stressors and support differed between those who had PTSS and those with no PTSS.
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Affiliation(s)
- Annika Skandsen
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway. .,Stavanger University Hospital, Gerd Ragna Bloch Thorsens Gate 25, Stavanger, Norway.
| | - Liv Sand
- Stavanger University Hospital, Gerd Ragna Bloch Thorsens Gate 25, Stavanger, Norway
| | - Martin H Teicher
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Developmental Biopsychiatry Research Program, McLean Hospital, Belmont, MA, USA
| | - Ove Heradstveit
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway.,Alcohol & Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Tormod Bøe
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway.,Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
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5
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Agoston AM. Expanding Neuroprotective Care: A Trauma-Informed Approach to Delivery of Services within Pediatric Inpatient Units. Clin Pediatr (Phila) 2023; 62:234-240. [PMID: 36039787 DOI: 10.1177/00099228221120290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Children with a history of trauma or adverse childhood experiences may be at higher risk for poor psychological and physical responses to medical experiences aimed at enhancing their well-being. Health care institutions are aware of the need for integration of trauma-informed care (TIC) practices yet struggle to find frameworks that promote resiliency to medical stress. An approach called neuroprotective care buffers the effects of toxic stress negatively affecting child health and well-being. Although often used in neonatal and cardiac intensive care units, the development and broad implementation of universal neuroprotective care measures across age groups and hospital settings has not been previously explored. An expanded neuroprotective care protocol takes a prevention approach to TIC. It fits a TIC framework, accounts for children's ecological, biological, and developmental needs, protects them against medical traumatic stress and retraumatization, and provides a tailored, measurable approach that systematically preserves child well-being within hospital settings.
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Affiliation(s)
- A Monica Agoston
- Children's Healthcare of Atlanta, Atlanta, GA, USA.,Division of Pediatric Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
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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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7
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Burgess A, Wilcoxon L, Rushworth I, Meiser‐Stedman R. Meta-analysis found high rates of post-traumatic stress disorder and associated risk factors in parents following paediatric medical events. Acta Paediatr 2021; 110:3227-3236. [PMID: 34534369 DOI: 10.1111/apa.16113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/24/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022]
Abstract
AIM This meta-analysis identified how prevalent parental post-traumatic stress disorder (PTSD) was after their children's medical events and evaluated the risk factors that increased the likelihood of PTSD. METHODS The MEDLINE, PsycINFO and PTSDpubs databases were searched for papers published in English from 1980 to June 2018. The prevalence of parental PTSD was pooled across the studies and risk factors were extracted whether PTSD symptoms were correlated with other research variables or when the authors had conducted between group analyses of PTSD. We also explored the effects of the assessment method, parental gender and medical events and the risk of bias. RESULTS The 54 studies that were identified had a pooled PTSD prevalence rate of 30.3% (95% confidence interval 25.3%-35.5%). Childhood cancer cases yielded the highest rates of parental PTSD. A total of 33 potential risk factors were identified. The risk factors with medium to large effects were: comorbid parental psychological responses and functioning, acute stress responses, child behavioural functioning, uncertainty about the child's illness and negative coping strategies. The findings are discussed within the context of high heterogeneity. CONCLUSION The prevalence of parental PTSD after paediatric medical events was relatively high, and 33 risk factors were identified.
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Affiliation(s)
- Aaron Burgess
- Department of Clinical Psychology and Psychological Therapies Norwich Medical School University of East AngliaNorwich Research Park Norwich UK
| | - Lucy Wilcoxon
- Department of Clinical Psychology and Psychological Therapies Norwich Medical School University of East AngliaNorwich Research Park Norwich UK
| | - Imogen Rushworth
- Department of Clinical Psychology and Psychological Therapies Norwich Medical School University of East AngliaNorwich Research Park Norwich UK
| | - Richard Meiser‐Stedman
- Department of Clinical Psychology and Psychological Therapies Norwich Medical School University of East AngliaNorwich Research Park Norwich UK
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8
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Parental Internalizing Psychopathology and PTSD in Offspring after the 2012 Earthquake in Italy. CHILDREN-BASEL 2021; 8:children8100930. [PMID: 34682196 PMCID: PMC8535087 DOI: 10.3390/children8100930] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022]
Abstract
Post-traumatic stress disorder (PTSD) is common in youths after earthquakes, with parental psychopathology among the most significant predictors. This study investigated the contribution and the interactional effects of parental internalizing psychopathology, the severity of exposure to the earthquake, and past traumatic events to predict PTSD in offspring, also testing the reverse pattern. Two years after the 2012 earthquake in Italy, 843 children and adolescents (9-15 years) living in two differently affected areas were administered a questionnaire on traumatic exposure and the UCLA PTSD Reaction Index. Anxiety, depression, and somatization were assessed in 1162 parents through the SCL-90-R. General linear model showed that, for offspring in the high-impact area, predictors of PTSD were earthquake exposure, past trauma, and parental internalizing symptoms, taken individually. An interaction between earthquake exposure and parental depression or anxiety (not somatization) was also found. In the low-impact area, youth PTSD was only predicted by earthquake exposure. The reverse pattern was significant, with parental psychopathology explained by offspring PTSD. Overall, findings support the association between parental and offspring psychopathology after natural disasters, emphasizing the importance of environmental factors in this relationship. Although further research is needed, these results should be carefully considered when developing mental health interventions.
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9
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Sadeh Y, Dekel R, Brezner A, Landa J, Silberg T. Child and Family Factors Associated With Posttraumatic Stress Responses Following a Traumatic Medical Event: The Role of Medical Team Support. J Pediatr Psychol 2021; 45:1063-1073. [PMID: 32968802 DOI: 10.1093/jpepsy/jsaa070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/13/2020] [Accepted: 07/23/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study examined the contribution of pretrauma psychosocial factors (child emotional functioning, family resources, family functioning, and social support) and environmental factors (mother's posttraumatic stress symptoms [PTSSs], medical team support [MTS]) to PTSSs of injured or seriously ill children within a pediatric rehabilitation setting. It was hypothesized that psychosocial variables would be strongly associated with child's PTSS; that mother's PTSS and MTS would mediate the association between psychosocial factors and child's PTSS; that mother's report on child's PTSS would mediate the association between mother's PTSS and child's PTSS. METHODS Participants were 196 children hospitalized following an injury/illness and assessed M = 47.7 days postevent. Children completed measures of PTSS, mothers completed measures of their own PTSS, child's PTSS, and pretrauma psychosocial factors. Family's therapist completed a MTS measure. Structural equation modeling was employed to evaluate the study hypotheses. RESULTS Pretrauma family structure and resources were associated with child's self-reported PTSS; each pretrauma variable and mother's report of child's PTSS was significantly associated. Although mother's PTSS was not directly associated with child's PTSS, this relationship was mediated by mother's report of child's PTSS. MTS mediated the relationship between pretrauma social support and mother's PTSS. CONCLUSION This study further explicates the utility of a biopsychosocial framework in predicting childhood PTSS. Findings confirm the role of pretrauma factors and environmental factors at the peritrauma period in the development of PTSS following a pediatric injury/illness. Mother's PTSS and MTS may be appropriate targets for prevention and early intervention.
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Affiliation(s)
- Yaara Sadeh
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University.,Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center
| | - Rachel Dekel
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University
| | - Amichai Brezner
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center
| | - Jana Landa
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center.,Sackler Faculty of Medicine, Tel-Aviv University
| | - Tamar Silberg
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center.,Holland Bloorview Kids Rehabilitation Hospital.,Department of Psychology, Bar-Ilan University
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10
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Paniccia M, Ippolito C, McFarland S, Murphy J, Reed N. Health-Related Quality of Life in Non-Concussed Children: A Normative Study to Inform Concussion Management. Dev Neurorehabil 2020; 23:534-541. [PMID: 32156189 DOI: 10.1080/17518423.2020.1736683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: There has been a shift to consider pediatric concussion recovery beyond symptom management by considering how health-related quality of life (HRQoL) affects recovery. This study investigated normative ranges of HRQoL in children and explored its relationship with common pediatric concussion variables. Methods: A cross-sectional study of 1,722 non-concussed children 8-12 years old (M = 10.52 ± 1.23 years; 1,335 males, 387 females) was conducted by secondary analysis of clinical baseline concussion data. Demographic information, concussion-like symptoms (PCSI-C), and HRQoL (KIDSCREEN-10 Index) were self-reported. Results: The most reported concussion-like symptoms were common stress symptoms and were significantly negatively correlated with HRQoL. Premorbid histories of attention deficit hyperactivity disorder, mental health challenges, headaches/migraines, and concussion significantly lowered HRQoL. The number of diagnosed concussions and PCSI-C scores were significantly negatively correlated with HRQoL. Conclusions: The normative ranges and model can indicate HRQoL levels to inform clinicians how children may respond to concussion and streamline care beyond traditional assessment models.
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Affiliation(s)
- M Paniccia
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - C Ippolito
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - S McFarland
- Early Concussion Care Program, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - J Murphy
- Early Concussion Care Program, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - N Reed
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto , Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto , Toronto, Canada
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A Pilot and Feasibility Randomized Controlled Trial of Dyadic Exposure Therapy and Dyadic Client-Centered Therapy for Posttraumatic Preschool Children and Their Caregivers. Int J Cogn Ther 2020. [DOI: 10.1007/s41811-020-00084-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Graves JM, Moore M, Kehoe L, Li M, Chan A, Conrick K, Williams-Gilbert W, Vavilala MS. Family Hardship Following Youth Concussion: Beyond the Medical Bills. J Pediatr Nurs 2020; 51:15-20. [PMID: 31838221 PMCID: PMC7430715 DOI: 10.1016/j.pedn.2019.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 11/20/2019] [Accepted: 11/27/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE The costs facing families after pediatric concussion are not limited to medical expenses for treatment and rehabilitation care. The objective of this research was to examine the economic hardship facing families following concussion. DESIGN AND METHODS Eighteen youth (10-18 years old) with a diagnosed concussion injury and sixteen parents (13 parent/youth dyads) answered open-ended questions regarding experiences associated with concussion care and recovery, specifically as they related to cost. Participants were recruited from a concussion clinic, social media, and via snowball sampling. Interviews were audio recorded, transcribed verbatim, and coded using deductive qualitative content analysis. RESULTS In addition to direct health care expenses (e.g. copays and deductibles), families of youth with concussion faced indirect costs associated with tutoring and transportation to medical appointments, in some cases over long distances. Financial cost-sharing for concussion care varied widely across participants. CONCLUSIONS Lost productivity included parents missing work to care for their child and for travel to appointments. Research that describes costs of care using claims or survey data lack the experiential perspective of the economic burden on families following concussion. PRACTICE IMPLICATIONS To fully understand the impact of concussion on patients and families, healthcare providers must consider non-monetary costs, such as opportunity costs, transportation required to obtain healthcare, or the productivity cost associated with missed work and school.
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Affiliation(s)
- Janessa M Graves
- Washington State University College of Nursing Spokane, Spokane, WA, United States of America; Harborview Injury Prevention and Research Center, WA, United States of America.
| | - Megan Moore
- School of Social Work, University of Washington (UW), WA, United States of America; Harborview Injury Prevention and Research Center, WA, United States of America.
| | - Leanne Kehoe
- Department of Biology, Boston University, MA, United States of America; Harborview Injury Prevention and Research Center, WA, United States of America.
| | - Matthew Li
- Department of Anesthesiology and Pain Medicine, School of Medicine, UW, Harborview Injury Prevention and Research Center, WA, United States of America; Harborview Injury Prevention and Research Center, WA, United States of America.
| | - Anissa Chan
- University of Southern California, Dana and David Dornsife College of Letters, Arts and Sciences, Harborview Injury Prevention and Research Center, WA, United States America; Harborview Injury Prevention and Research Center, WA, United States of America
| | - Kelsey Conrick
- Harborview Injury Prevention and Research Center, WA, United States of America.
| | | | - Monica S Vavilala
- Department of Anesthesiology and Pain Medicine, School of Medicine, UW, Harborview Injury Prevention and Research Center, WA, United States of America; Harborview Injury Prevention and Research Center, WA, United States of America.
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13
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Canga M, Malagnino I, Malagnino G, Malagnino VA. Evaluating different stressors among parents with hospitalized children. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2020; 9:9. [PMID: 32154304 PMCID: PMC7032031 DOI: 10.4103/jehp.jehp_529_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/02/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The pediatric hospital is an environment with a high level of stress for most parents. Parents experience high levels of stress if their children are hospitalized due to the fear for the loss of their child's life. OBJECTIVE The objective of this study was to evaluate stress factors in parents of hospitalized children. MATERIALS AND METHODS This study was conducted from January to July 2019 at the General Pediatrics Department of Fieri Regional Hospital. The study sample was composed of 200 parents, of which 86 (43.3%) were males and 114 (56.7%) were females. The parents chosen as our sample had their children hospitalized for at least 5 days. RESULTS Our results showed that 80% of the sample was stressed out by waiting at the hospital, whereas 42% of them felt stressed also by their child's oral problems. Parents of hospitalized children (83%) felt stressed about the painful techniques applied to their children. Nearly 65% of them were stressed out by the hospital environment; child's sleep bruxism was considered another stressor by 39% of the sample. CONCLUSION This study claims that parents of hospitalized children experience stress from different stressors such as dental visits, waiting for the diagnosis, and sleep bruxism. There are other factors which do not influence parental stress including residence, divorced parents, and hospital conditions.
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Affiliation(s)
- Mimoza Canga
- Department of Nursing, Faculty of Public Health, University “Ismail Qemali,” Vlora, Albania
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14
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Ranney M, Karb R, Ehrlich P, Bromwich K, Cunningham R, Beidas RS. What are the long-term consequences of youth exposure to firearm injury, and how do we prevent them? A scoping review. J Behav Med 2019; 42:724-740. [PMID: 31367937 PMCID: PMC8321509 DOI: 10.1007/s10865-019-00035-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/23/2019] [Indexed: 12/14/2022]
Abstract
The long-term consequences of exposure to firearm injury-including suicide, assault, and mass shootings-on children's mental and physical health is unknown. Using PRISMA-ScR guidelines, we conducted a scoping review of four databases (PubMed, Scopus, PsychINFO, and CJ abstract) between January 1, 1985 and April 2, 2018 for articles describing long-term outcomes of child or adolescent firearm injury exposure (n = 3582). Among included studies (n = 31), most used retrospective cohorts or cross-sectional studies to describe the correlation between firearm injury and post-traumatic stress. A disproportionate number of studies examined the effect of mass shootings, although few of these studies were conducted in the United States and none described the impact of social media. Despite methodologic limitations, youth firearm injury exposure is clearly linked to high rates of post-traumatic stress symptoms and high rates of future injury. Evidence is lacking on best practices for prevention of mental health and behavioral sequelae among youth exposed to firearm injury. Future research should use rigorous methods to identify prevalence, correlates, and intervention strategies for these at-risk youth.
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Affiliation(s)
- Megan Ranney
- Department of Emergency Medicine, Alpert Medical School, Brown University, 593 Eddy Street, Claverick 2, Providence, RI, 02903, USA.
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, 121 South Main Street, Providence, RI, 02903, USA.
- American Foundation for Firearm Injury Reduction in Medicine, PO Box 503, Williamstown, MA, 01267, USA.
| | - Rebecca Karb
- Department of Emergency Medicine, Alpert Medical School, Brown University, 593 Eddy Street, Claverick 2, Providence, RI, 02903, USA
| | - Peter Ehrlich
- Department of Surgery, Section of Pediatric Surgery, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Kira Bromwich
- Department of Emergency Medicine, Alpert Medical School, Brown University, 593 Eddy Street, Claverick 2, Providence, RI, 02903, USA
| | - Rebecca Cunningham
- Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk #210, Philadelphia, PA, 19104, USA
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15
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Hahn H, Putnam K, Epstein C, Marans S, Putnam F. Child and family traumatic stress intervention (CFTSI) reduces parental posttraumatic stress symptoms: A multi-site meta-analysis (MSMA). CHILD ABUSE & NEGLECT 2019; 92:106-115. [PMID: 30947101 DOI: 10.1016/j.chiabu.2019.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/06/2019] [Accepted: 03/04/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Following traumatization, caregiver support is a crucial factor contributing to children's successful management of posttraumatic reactions and their recovery. Caregivers who have been traumatically impacted themselves, however, may be compromised in this posttraumatic caregiving role. Although there are a number of evidence-based child trauma treatments that are effective in reducing children's trauma symptoms, the impact of child treatment on participating caregiver's posttraumatic symptoms (PTS) has received less attention. OBJECTIVE Explore PTS reduction caregivers experience through participation in their child's evidence-based trauma-focused mental health treatment. PARTICIPANTS AND SETTING 640 Child-Caregiver dyads referred for the Child and Family Traumatic Stress Intervention (CFTSI) following formal disclosure of abuse in a Child Advocacy Center (CAC). METHODS Data were collected from 10 community treatment sites trained in CFTSI. A multi-site meta-analytic approach was used to evaluate pooled and site-specific therapeutic effect sizes for caregivers and children. RESULTS CFTSI was associated with significant changes (Hedge's g = 1.17, Child-rated; g = 0.66, caregiver-rated) in children's PTS and with clinically meaningful improvements in PTS for 62% of participating caregivers who had started CFTSI with clinical levels of PTS as measured by the Post Traumatic Checklist-Civilian Version (PCL-C). The overall mean PCL-C change (9.31, SD = 12.9) in paired, pre-post PCL-C scores is close to a clinically meaningful change of 10 or higher. There was a robust moderate pooled effect size (g = 0.70, N = 640, p < 0.0001). CONCLUSION The value of a reduction in caregiver PTS as a secondary outcome of children's trauma-focused treatment is discussed.
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Affiliation(s)
- Hilary Hahn
- Yale School of Medicine Child Study Center, 230 South Frontage Road, New Haven, CT 06520, United States.
| | - Karen Putnam
- Department of Psychiatry, University of North Carolina at Chapel Hill, Campus Box 7160, 387 Medical School, Wing D, Chapel Hill, NC 27516, United States
| | - Carrie Epstein
- Yale School of Medicine Child Study Center, 230 South Frontage Road, New Haven, CT 06520, United States
| | - Steven Marans
- Yale School of Medicine Child Study Center, 230 South Frontage Road, New Haven, CT 06520, United States
| | - Frank Putnam
- Department of Psychiatry, University of North Carolina at Chapel Hill, Campus Box 7160, 387 Medical School, Wing D, Chapel Hill, NC 27516, United States
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16
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Mangelsdorf SN, Mehl MR, Qiu J, Alisic E. How Do Mothers and Fathers Interact With Their Children After An Injury? Exploring the Role of Parental Acute Stress, Optimism, and Self-Efficacy. J Pediatr Psychol 2019; 44:311-322. [DOI: 10.1093/jpepsy/jsy107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 11/28/2018] [Accepted: 12/05/2018] [Indexed: 01/23/2023] Open
Affiliation(s)
- Shaminka N Mangelsdorf
- School of Psychological Sciences, Monash University
- Monash University Accident Research Centre, Monash University
| | | | - Jianrong Qiu
- Monash University Accident Research Centre, Monash University
| | - Eva Alisic
- Murdoch Children’s Research Institute
- Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, The University of Melbourne
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