Application of a Framework to Implement Trauma-Informed Care Throughout a Pediatric Health Care Network

Weiss, Danielle; Kassam‐Adams, Nancy; Murray, Carol; Kohser, Kristen L.; Fein, Joel A.; Winston, Flaura Koplin; Marsac, Meghan L.

doi:10.1097/ceh.0000000000000140

Cited by 54 publications

(63 citation statements)

References 22 publications

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“…Most children and families recover well after a child's injury or illness; however, about 30% develop posttraumatic stress symptoms (trauma symptoms) after an illness or injury (Price et al, 2015). This vulnerability is exacerbated in children and families who have been previously exposed to psychosocial traumas (Weiss et al, 2017).…”

Section: Trauma and Trauma-informed Carementioning

confidence: 99%

“…TIC care must become a routine part of pediatric health care. TIC aims to decrease the impact of emotional and psychological trauma on all participants within a system of care (Weiss et al, 2017). A comprehensive multilevel approach that changes the way organizations and individual practitioners' view and approach trauma must be initiated (Oral et al, 2016).…”

Section: Trauma and Trauma-informed Carementioning

confidence: 99%

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Trauma-Informed Care: Essential Elements for Pediatric Health Care

Hornor¹,

Davis²,

Sherfield³

et al. 2019

Journal of Pediatric Health Care

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Childhood psychosocial trauma exposure is highly prevalent and associated with risk for poor physical and mental health outcomes extending throughout life. In a study of nearly 54,000 adult Americans (Gilbert et al., 2015), 60% reported experiencing at least one adverse childhood experience (ACE). According to the National Survey of Child Health, 48% of American children have suffered at least one ACE (Bethell, Newacheck, Hawkes, & Halfon, 2014). The U.S. Department of Health and Human Services (2017) states that more than 650,000 American children experienced child maltreatment in 2016 and up to 10 million children in the United States witness domestic violence each year (National Coalition Against Domestic Violence, 2015).

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Section: Trauma and Trauma-informed Carementioning

confidence: 99%

Section: Trauma and Trauma-informed Carementioning

confidence: 99%

Trauma-Informed Care: Essential Elements for Pediatric Health Care

Hornor¹,

Davis²,

Sherfield³

et al. 2019

Journal of Pediatric Health Care

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“…Adolescence/youth is often characterized as a stage of biological and social transitions with a range of risky behaviors, including sexual risk behaviors, alcohol and substance use as well as peer violence [ 19 – 22 ]. However, interventions at the individual, family, and community level that support resilience and recovery from adverse events can positively impact health trajectories [ 23 , 24 , 25 ]. Identifying risk factors and populations at risk are a foundation of focusing prevention and intervention efforts.…”

Section: Introductionmentioning

confidence: 99%

Association of adverse childhood experiences and health risk behaviors among young adults visiting a regional primary healthcare center, Federation of Bosnia and Herzegovina

et al. 2018

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BackgroundMany studies have linked adverse childhood experiences (ACEs) to long-term health outcomes, as well as health risk behaviors. In the post-war period in Bosnia and Herzegovina, many young people grew up in an environment of deteriorated living standards due to high unemployment and economic insecurity. The objectives of the study were to: 1) describe the health risk behaviors of young adults accessing primary healthcare; and 2) examine associations of these risk factors with adverse childhood experiences in this context.MethodsThis was a cross-sectional survey, conducted from April to October 2014. Participants were recruited from the Primary Healthcare Center Zenica. Patients between the ages of 18 and 24 were eligible for inclusion. The informed consent and self-administered questionnaire were offered to patients during clinic intake. The questionnaire contained questions on sexual and reproductive health, use of alcohol and drugs, dating violence, and adverse childhood experiences.ResultsDuring the study period 520 questionnaires were distributed, and 400 complete surveys were returned, for a response rate of 76.9%. Among the 400 respondents, 166 were males (41.5%) and 234 were females (58.5%). Our study showed that 48.7% of respondents had experienced some form of childhood adversity. Emotional neglect was the most common type of adverse childhood experience (25.6%) and was significantly more prevalent among females. Our study indicated that more than 15% of respondents had witnessed domestic violence. Overall, ACEs were associated with increased odds of early sex initiation, alcohol use, drug use, and dating violence, although some of these associations did not reach statistical significance. Emotional neglect was the exception, and reporting emotional neglect was associated with a significantly elevated odds ratio for all four of the health risk behaviors. Emotional abuse was associated with an increased odds of drug abuse (OR = 2.78; 95% CI = 1.31–5.90) and dating violence (OR = 2.31; 95% CI = 1.10–4.89). Sexual abuse was marginally associated with increased early sex initiation (OR = 3.2; 95% CI 0.93–10.8). Parental divorce was significantly associated with alcohol abuse.ConclusionThe results of this study demonstrated associations between adverse experiences in childhood and the probability of engaging in health risk behavior which has implications for health outcomes in the long-term.

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“…It is also likely to require a commitment from institutional leadership to train all staff who interact with pediatric patients in specific new skills and sensitivities (e.g., recognizing the psychological impact of medical events and treatment on children, providing effective support for children during challenging treatment experiences, and helping parents provide effective assistance to children throughout a child's ED or hospital stay) [37]. Even brief training can increase professionals' knowledge and confidence in implementing trauma-informed practices in their daily interactions with pediatric patients, an important first step [38]. Physicians can play a key role in training medical staff and in providing leadership in trauma-informed care in collaboration with nursing leaders and psychosocial staff.…”

Section: Resultsmentioning

confidence: 99%

What Do Clinicians Caring for Children Need to Know about Pediatric Medical Traumatic Stress and the Ethics of Trauma-Informed Approaches?

Kassam‐Adams¹,

Butler

2017

AMA Journal of Ethics

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Medical experiences can be frightening and traumatic for children. Ill and injured children can experience pediatric medical traumatic stresspsychological and physiological distress responses related to their medical event and subsequent medical treatment experiences-which can lead to symptoms of posttraumatic stress disorder (PTSD) and suboptimal health outcomes. Trauma-informed care provides a framework for acknowledging, addressing, and mitigating the risks of psychological trauma associated with medical treatment experiences and is congruent with the ethical principles of respect for autonomy, beneficence, nonmaleficence, and justice. Health care systems and professionals are encouraged to apply the principles of trauma-informed care to address the effects of pediatric medical traumatic stress. IntroductionFor the sick or injured child, being treated in the emergency department (ED) or admitted to the hospital can be a frightening and confusing experience that leads to subsequent psychological distress [1]. Experiencing pain, feeling helpless and out of control, and being separated from one's parents are all factors that contribute to the potentially traumatic nature of medical events. How does a physician's ethical obligation to "first, do no harm" square with the prospect of providing a therapeutically necessary procedure for a frightened child who does not understand what is being done and why? How do we understand the ethical issues involved when a medically beneficial course of treatment for a pediatric patient also has the potential to engender stress, fear, anxiety, pain, or discomfort for this child? In this brief review, we first describe two concepts that are key to understanding and addressing the psychological distress that can affect ill and injured children: pediatric medical traumatic stress and trauma-informed pediatric care. We then discuss four core principles of medical ethics (respect for autonomy, beneficence, nonmaleficence, and justice [2]) and explain how the application of these principles underscores the need for trauma-informed care.

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Application of a Framework to Implement Trauma-Informed Care Throughout a Pediatric Health Care Network

Cited by 54 publications

References 22 publications

Trauma-Informed Care: Essential Elements for Pediatric Health Care

Trauma-Informed Care: Essential Elements for Pediatric Health Care

Association of adverse childhood experiences and health risk behaviors among young adults visiting a regional primary healthcare center, Federation of Bosnia and Herzegovina

What Do Clinicians Caring for Children Need to Know about Pediatric Medical Traumatic Stress and the Ethics of Trauma-Informed Approaches?

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