Trauma-informed care in practice: Observed use of psychosocial care practices with children and families in a large pediatric hospital.

Abstract

Hospitalization for illness or injury can be experienced by children and their families as traumatic, which can impede recovery and lead to ongoing problems. The provision of quality trauma-informed or psychosocial care by hospital staff may mitigate trauma-related problems; however, there is great variability in the use of psychosocial care practices. Most previous research is based on self-report data and focuses primarily on nurses and physicians. The current study aimed to investigate the use of psychosocial care practices among a range of staff in a large urban pediatric hospital, using observations and interviews. A coding matrix of practices and a set of interview questions were developed based on previous research. Participants included 18 direct care hospital staff and 10 patients. Trained observers observed 13 staff and 10 patients, and coded instances of psychosocial care; 17 staff participated in interviews. A large number of instances of psychosocial care were observed but there was substantial variability in overall use and the use of individual practices. Interviewed staff reported many benefits of psychosocial care for patients and staff, although there were some costs, including emotional fatigue. Contrary to current evidence, most staff reported they rely on visible triggers of distress or need before providing psychosocial care. Future research could investigate the optimal ratio of psychosocial to physical care practices, taking into account patient feedback and psychosocial and medical outcomes. To improve the consistency of psychosocial care, training could incorporate the practice examples documented here, include staff self-care, and encourage informal avenues of learning.

Nationwide efforts for trauma-informed care implementation and workforce development in healthcare and related fields: a systematic review

“…50,51 Trauma-informed organizations that use trauma-sensitive practices can decrease traumarelated triggers and improve staff health, resiliency, and efficiency while enhancing the quality of care for patients and families. [52][53][54][55] TIC organizations strive to improve multiple practice domains: education of providers to change practice, early identification of children experiencing adversity, treatment through evidence supported and resiliency-focused services, and collaboration within and across agencies that serve children and families in the broader community. 34,[56][57][58] The Substance Abuse and Mental Health Services Administration (SAMHSA) outlines six broad principles to implement TIC (Table I).…”

Exploring How Sexual Assault Nurse Examiners Practise Trauma-Informed Care

“…It was suggested that mental illness and post-traumatic stress disorder are often concurrent, providing a rationale for TIC within this patient population (Antai-Otong, 2016). The application of TIC in pediatric healthcare settings has been frequently described in the literature, as researchers have estimated that up to 25% of children perceive hospitalizations as traumatic (Moss et al, 2019). It is believed that difficult medical treatments and experiences for young patients and their families contribute to feelings of psychological trauma (Kassam-Adams, 2015).…”

“…It is believed that difficult medical treatments and experiences for young patients and their families contribute to feelings of psychological trauma (Kassam-Adams, 2015). Antai-Otong, 2016;Beckett et al, 2017;Cleary & Hungerford, 2015;Isobel, 2015;Isobel & Delgado, 2018;Isobel & Edwards, 2017;Jacobowitz, Moran, Best, & Mensah, 2015;McEvedy et al, 2017;Muskett, 2013;Stokes et al, 2017;Wilson et al, 2017Occupational Health Beattie et al, 2019Rosemberg, Gultekin, & Pardee, 2017 Pediatrics Broughton et al, 2017;Chokshi et al, 2019;Kassam-Adams et al, 2015;Moss et al, 2019;Regan, 2010;Weiss et al, 2017Perinatal Choi & Seng, 2014 Primary Care Mantler & Wolfe, 2018;Pardee, Kuzma, Dahlem, Boucher, & Darling-Fisher, 2017;Vu et al, 2017…”

A web-based educational intervention to implement trauma-informed care in a paediatric healthcare setting: protocol for a feasibility study using pre-post mixed methods design

“…An international survey ( N = 2648) identified substantial knowledge gaps among hospital-based health professionals regarding child traumatic stress and trauma-informed care [ 20 ]. These results were reflected in a staff survey ( N = 180) at a tertiary paediatric hospital setting in which approximately 60% of knowledge questions about child traumatic stress and trauma-informed care were answered correctly [ 21 ]. In a companion study undertaken at the same centre using observational methods to record the incidence of trauma-informed care practices, the frequency of using trauma-informed care practices was low, varying from 0.07% (use of screening tools) to 29% (asking about needs/concerns) [ 22 ].…”

“…In a companion study undertaken at the same centre using observational methods to record the incidence of trauma-informed care practices, the frequency of using trauma-informed care practices was low, varying from 0.07% (use of screening tools) to 29% (asking about needs/concerns) [ 22 ]. Most staff reported they rely on visible triggers of distress or need before providing trauma-informed care [ 21 ]. The authors concluded that training that improved confidence and knowledge of trauma-informed care practices may change staff behaviours and impact on staff well-being [ 22 ].…”