Child Traumatic Stress

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Child traumatic stress (CTS) is a psychological reaction that some children have to a traumatic experience.  Not every child experiences CTS after a trauma, but one out of every four children will experience a traumatic event before the age of sixteen, and some of these children will develop CTS. Some of these children will be identified and receive effective evidence-based trauma-focused treatments from mental health practitioners, but many of these children are more likely to be first identified by practitioners in other child-serving systems (e.g., schools, health care).  Additionally, for many cultural groups, it is more acceptable to access services in a traditional health care setting versus a specialty mental health setting. Providing culturally competent trauma treatment and practices in a wide array of child-serving systems, including primary care, is therefore fundamental to increasing access and improving the standard of care for traumatized children and families across the nation.

The National Child Traumatic Stress Network (NCTSN) was established by Congress in 2000 and is a unique collaboration of academic and community-based service centers whose mission is to raise the standard of care and increase access to services for traumatized children, their families and communities across the United States. Combining knowledge of child development, expertise in the full range of child traumatic experiences, and attention to cultural perspectives, the NCTSN serves as a national resource for developing and disseminating evidence-based interventions, trauma-informed services, and public and professional education. The Network comprises 70 member centers-45 current grantees and 25 previous grantees-and is funded by the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services through a congressional initiative: the Donald J. Cohen National Child Traumatic Stress Initiative.

Pediatric Medical Traumatic Stress Toolkit for Health Care Providers by the National Child Traumatic Stress Network

Pediatric Illness, Injury and Traumatic Stress

Children and families are often distressed by:
• sudden or life-threatening illness or injury
• painful or frightening treatment procedures
• just being in the hospital or ED
 
Most children and parents are able to cope well, with some extra support and with time. Some will have persistent traumatic stress reactions such as Posttraumatic Stress Disorder (PTSD).

Prevalence of Traumatic Stress
• Many ill or injured children, and their families (up to 80%) experience some traumatic stress reactions following a life threatening illness, injury, or painful medical procedure.
• It has been reported that between 20 - 30 % of parents and 15 - 25% of children and siblings experience persistent traumatic stress reactions that impair daily functioning and affect treatment adherence and recovery.

When they persist, traumatic stress reactions can:
• impair day-to-day functioning
• affect adherence to medical treatment
• impede optimal recovery

By incorporating an awareness of traumatic stress in their encounters with children and families, health care providers can:
• minimize potentially traumatic aspects of medical care
• identify children and families with (or at higher risk for) persistent distress
• provide anticipatory guidance to help prevent long-lasting traumatic stress

Why A Toolkit?
A toolkit was produced by the Medical Traumatic Stress Working Group of the National Child Traumatic Stress Network to:

• Raise awareness among health care providers about traumatic stress associated with pediatric medical events and medical treatment, as it may affect children and families.
• Promote “trauma-informed practice” of pediatric health care in hospital settings across the continuum of care and in a variety of settings within the hospital – e.g., from emergency care, to the ICU, to specialized inpatient units, to general pediatrics.

This compendium of materials is designed for hospital-based health care providers (physicians, nurses, and other health care professionals.) The materials may also be of use to mental health professionals who work in health care settings. The materials provide:

• An introduction to traumatic stress as it relates to children facing illness, injury, and other medical events. Practical tips and tolls for health care providers.
• Handouts that can be given to parents that present evidence-based tips for helping their child cope.

Preventing and Treating Traumatic Stress
Health care professionals providing optimal care for ill or injured children and families should incorporate an awareness of traumatic stress reactions that may interfere with the children’s health and functioning into their routine clinical encounters. In some cases, traumatic stress reactions can have serious implications for medical outcomes. For example, research studies have suggested that avoidance symptoms (e.g., wanting to stay away from reminders of illness) may interfere with optimal adherence to medical regimens post-transplantation.

It may be useful to think of preventing and treating traumatic stress reactions as a pyramid:
• Universal (at the base): Most children and families need general information and support.
• Targeted (in the middle): A few higher-risk or more distressed children and families need increased support and focused guidance to help them anticipate challenges and to strengthen their coping skills.
• Clinical/Treatment (at the top): Finally, a much smaller group of children and families need more extensive psychosocial support and evaluation or treatment by a mental health professional.
This preventive intervention model suggests that the health care team provide every ill or injured child and family with basic support and information and regularly screen for acute distress and risk factors to determine which children and families might need more support.

Roles for Health Care Providers
Health care providers caring for children in emergency and hospital settings can:
• incorporate an understanding of traumatic stress in their encounters with children and families
• minimize the potential for trauma during medical care
• provide screening, prevention, and anticipatory guidance
• identify children and families in distress, or at risk, and make appropriate referrals

Assessing and Treating Traumatic Stress Using the D-E-F Protocol:
All health care providers treating children, regardless of discipline, should be “trauma-informed.” This means that they should incorporate an understanding of traumatic stress and related responses into their routine encounters with children and families. Trauma-informed health care professionals should be able to provide basic interventions to children and families that will minimize the potential for ongoing trauma and maximize continuity of care. The D-E-F protocol provides a straightforward and reliable method for identifying, preventing, and treating traumatic stress responses at the time of need and within scope of practice. Healthcare providers are experts in treating illness, restoring functioning, and saving lives. After attending to the basics of children’s physical health (the A-B-C’s), providers can promote their patients’ health and recovery by paying attention to the next steps — “D-E-F”
• Reduce DISTRESS
• Promote EMOTIONAL SUPPORT
• Remember the FAMILY

DISTRESS
• Actively assess and treat pain, using your hospital’s protocol.
• Provide child with information about what is happening and choices regarding treatment decisions when possible.
• Listen carefully for child’s understanding and clarify any misconceptions.
• Ask about fears and worries.
• Provide reassurance and realistic hope.

EMOTIONAL SUPPORT
• Encourage parents to be with their child as much as possible and to talk with their child about worries and fears.
• Empower parents to comfort and help their child.
• Encourage child’s involvement in age-appropriate activities when possible.

FAMILY
• Gauge family distress and other life stressors; identify family strengths and coping resources.
• Encourage parents to use own coping resources or support available at the hospital or in the community.

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Recent Comments

It is critical for health care providers to understand pediatric traumatic stress and the impact it has on a child's health and functioning. The toolkit is a very practical and useful resource for providers. (10/17/07)

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