Interventions in Medical Settings

Abstract

Acute and chronic injury and illness and their associated medical care are among the most frequent potentially traumatic events (PTEs) experienced by children worldwide. Following medical PTEs up to 30% of children and parents develop persistent and impairing PTSS. Impairment related to PTSS can be especially problematic in medically-involved children: PTSS is associated with poorer adherence, health-related quality of life, and health outcomes, and greater use of healthcare services. Medical settings can serve as an ideal place to identify children and families who are experiencing emotional difficulties related to medical diagnoses and care and to begin interventions. Taking a trauma-informed approach to medical care, interventions and screening can be integrated into standard care. Based on child and family’s needs, interventions can be implemented at universal, targeted, and/or indicated levels across the peri-trauma, acute medical care, and ongoing care or discharge from care phases of medical PTEs. More research is necessary to establish the most efficacious treatments for those children who are experiencing significant PTSS related to the medical events. Injury, illness, and associated medical care are among the most frequent potentially traumatic events (PTEs) experienced by children (Murray and Lopez 1996). While most children are resilient and display transient distress after PTEs, a notable subset demonstrates adverse psychological reactions that often include (but can extend beyond) posttraumatic stress symptoms (PTSS; Kahana et al. 2006; Kassam-Adams et al. 2013; Price et al. 2016). Medical traumatic stress is defined as PTSS and other emotional reactions that develop because of injury, illness, or their treatment in children and families (Kazak et al. 2006). A meta-analysis revealed that nearly 20 % of injured and 10 % of ill children develop persistent and impairing PTSS; similar rates are reported for parents (Kahana et al. 2006; Landolt et al. 2003). A recent systematic review suggests that roughly 30 % of ill and injured children and their parents experience subthreshold yet clinically significant PTSS (Price et al. 2016). PTSS can be especially problematic in medically involved children, as they are associated with poorer adherence, health-related quality of life, and health outcomes (e.g., mental health, functional impairment, pain perception, general health; Landolt et al. 2009; Zatzick et al. 2008). In addition, as described in Chaps. 2 and 3, millions of children have encountered other PTEs such as witnessing violence or natural disasters (Copeland et al. 2007). After PTE exposure, many children interact with healthcare networks, with most families visiting their primary care provider first if they need help managing reactions (Schappert and Rechsteiner 2008). Thus, medical settings can be an ideal setting to identify PTSS and intervene.