Prevalence of Traumatic Stress
What percentage of ill/injured children and their families experience some traumatic stress reactions following a life-threatening illness, injury, or painful medical procedure?
What is 80%
Children and parents may have traumatic stress reactions to pain, injury, serious illness, medical procedures, and invasive or frightening treatment experiences.
Describe what Health care providers caring for children in emergency and hospital settings can do to preventing and treating traumatic stress
What is:
• 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
In working with children and families with complex and challenging illnesses or injuries, it is recommended that health care providers routinely:
• Be aware of their own emotional reactions and distress when dealing with distressed families.
• Talk to another team member or supportive other about their emotional reactions.
• Increase self-care (e.g., relaxation, exercise, stress management, etc.) when they begin to see signs of negative effects.
How to Assess: Family
Assess Parents’ or Siblings’ and Others’ Distress
Gauge Family Stressors & Resources
Address Other Needs (Beyond Medical)
It has been reported that between ___% of parents experience persistent traumatic stress reactions that impair daily functioning and affect treatment adherence and recovery.
What is 20% to 30%
True or False: Studies of ill and injured children and their parents show that the occurrence of traumatic stress reactions is more closely related to the person’s subjective experience of the event rather than its objective medical severity.
True
• Reduce DISTRESS
• Promote EMOTIONAL SUPPORT
• Remember the FAMILY
How to Assess Distress
Pain: Use your hospital’s pediatric pain assessment. Ask:
• Current pain: “How is your pain right now?”
• Worst pain: “What was the worst pain you have had
since this happened?”
Fears and Worries:
• “Sometimes children are scared or upset when
something like this happens. Is there anything that has
been scary or upsetting for you?”
• “What worries you most?”
Grief or Loss:
• Anyone else hurt or ill?
• Other recent losses? (loss/damage to home, pet, etc.)
How to help: Family
Encourage parents’ basic self-care.
Remember family members’ emotional needs.
Be sensitive to resource needs of the family.
When they persist traumatic stress reactions can _____________
impair day-to-day functioning
affect adherence to medical treatment
impede optimal recovery
An ill or injured child may be at greater risk for persistent traumatic stress reactions if s/he:
• has had severe early traumatic stress reactions
• has experienced more severe levels of pain
• is exposed to scary sights and sounds in the hospital
• is separated from parents or caregivers
• has had previous traumatic experiences
• has had prior behavioral or emotional problems
• lacks positive peer support
List Recommendations for 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.
How to Help Distress
Provide the child with as much control as possible
over the clinical encounter. The child should:
• understand what is about to happen
• have a say in what is about to happen
• have some control over pain management
Actively assess and treat pain.
• Use your hospital’s pain management protocol
Listen carefully to hear how the child understands
what is happening.
• After explaining diagnosis or procedure,
ask the child to say it back to you.
• Remember that the child’s understanding may be
incomplete or in error.
Clarify any misconceptions.
• Provide accurate information.
• Use words and ideas the child can understand.
Provide reassurance and realistic hope.
• Describe what is being done to help the child
get better.
• State that there are many people working together
to help the child.
Pay attention to grief and loss.
• Mobilize your hospital’s bereavement service
and/or grief protocols.
• Encourage parents to listen to their child’s
concerns and be open to talking about their
child’s experience.
List Ways a Parent can help their child cope in the Hospital
You are the best person to help your child.
Be patient with your child.
Help your child understand what is happening.
Allow your child to talk about worries or feelings about being in the hospital.
Talk about your feelings together.
Help your child see the hospital staff as helpers.
Young children are often more affected by being left alone.
Take care of yourself.
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
A parent may be at greater risk for persistent traumatic stress reactions related to his/her child’s illness or injury if s/he:
• has had severe early traumatic stress reactions
• has had previous traumatic experiences
• has had prior emotional or mental health problems
• is experiencing other life stressors or disruption
• lacks positive social support
List Recommendations for 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.
How to Assess Emotional Support
What Does The Child Need Now?
• Ask parents: “What helps your child cope with upsetting or scary things?”
• Ask child: “What has been the best thing so far that helps you feel better?”
Who Is Available To Help The Child?
• Do the parents understand the illness or injury and treatment plan?
• Are they able to help calm their child?
• Are they able to be with their child for procedures?
How Can Existing Supports Be Mobilized?
• Ask parents: “Who can you or your child usually turn to for help or support? Are they aware of what’s happened?”
List a temporary reaction of a child coming home from the hospital.
After being in the hospital, it is also common for some children to have minor changes in behavior. A few children and parents keep thinking about the experience and get upset frequently. Sometimes they also try to avoid places (such as the hospital) and things that remind them of it. These reactions usually get better with time, understanding, and support.
Give an example of a Traumatic Stress Reaction
Re-experiencing
Avoidance
Hyper-arousal
Other reactions: feeling in a daze, new somatic complaints, new fears related to medical event
Name 3 Parts of Preventing Traumatic Stress Pyramid
What are:
Universal
Targeted
Clinical
Recommendations for 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
How to help: Emotional Support
Encourage parent presence.
Empower parents to comfort and help their child.
Encourage social support & involvement
in “normal” activities.
List a sign that a child may need extra help
• Watching out for danger all the time
• Having new fears
• Not wanting to go to school, or doing a lot worse in school
• Not wanting to be with friends or go back to usual activities
• Arguing a lot with friends or family