Implementing a Trauma-Informed Approach in Pediatric Health Care Networks

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

“…The initial list of items was generated based on reviews of the qualitative and quantitative literature (e.g., Alisic et al, 2012; Fivush et al, 2003; Marsac et al, 2016; Scheeringa & Zeanah, 2001), cognitive and behavioural models of PTSD (e.g., Ehlers & Clark, 2000; Meiser-Stedman, 2002), existing measures of more general parenting (e.g., Edwards, Rapee, & Kennedy, 2010) and measures of adult post-trauma cognitions (Foa et al, 1999). The list was then subject to expert review.…”

“…While it may be an understandable reaction to trying to prevent or reduce the child’s distress or chance of further harm (Scheeringa & Zeanah, 2001), this response can restrict children’s opportunities to engage with material or activities that may assist them in adaptively processing their trauma. Avoidant coping in the child is also likely to maintain fears (Marsac et al, 2016; Trickey et al, 2012). Conversely, providing opportunities for children to discuss the trauma, and positively reframe or confront trauma-related cues, may allow for negative appraisals to be addressed, anxiety responses to extinguish, and more complete trauma memories to be formed (Goodman, Rosenberg, Mueser, & Drake, 1997; Salmon & Reese, 2015).…”

Knowledge and training in paediatric medical traumatic stress and trauma-informed care among emergency medical professionals in low- and middle-income countries

“…It is in this period that interventions can still target the child’s subjective experience of the event (Kazak et al, 2006; Marsac et al, 2014). Research has recognized the important role that medical and nursing professionals, who treat injured children in this acute peri-traumatic period, have in the prevention and identification of paediatric medical traumatic stress (Horowitz et al, 2001; Kassam-Adams, 2014; Marsac et al, 2015; Patel et al, 2007). In LMICs this includes medical and nursing professionals who provide emergency medical care (for simplicity henceforth emergency care nurses and physicians will be referred to as emergency staff ).…”

“…One approach to prevention is the provision of psychosocial care, in particular trauma-informed care (Magruder, Kassam-Adams, Thoresen, & Olff, 2016; Marsac et al, 2015). Trauma-informed care is a type of psychosocial care that can be incorporated into standard acute medical care and involves acknowledging the prevalence of trauma; recognizing how trauma can affect everyone who experiences the potentially traumatic event (including the child, family and emergency staff); responding by incorporating an understanding of the impact of trauma into practice; and aiming to prevent further trauma (Substance Abuse and Mental Health Services Administration, 2014).…”

“…This approach can be incorporated into acute medical care and when provided in the immediate aftermath of paediatric injury aims to change the subjective experience of the potentially traumatic event. This is achieved by reducing pain and distress, providing emotional support and promoting both physical and psychological recovery, thus minimizing the risk of the development of paediatric medical traumatic stress (Ko et al, 2008; Marsac, Kassam-Adams, Hildenbrand, Kohser, & Winston, 2011; Marsac et al, 2015). As such, trauma-informed care, provided by emergency staff, is indicated as a low-cost, low-intensity preventative measure for targeting paediatric medical traumatic stress in LMICs (Ko et al, 2008; Marsac et al, 2015).…”