Illness Providing Trauma Informed Care Tiara T Muhr RN MSN UW PPC Trainee Madison WI Overview Prevalence of Chronic Childhood Illness Medical Traumatic Stress Stress Responses ID: 544750
Download Presentation The PPT/PDF document "Traumatic Stress and Childhood" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Traumatic Stress and Childhood Illness: Providing Trauma Informed Care
Tiara
T.
Muhr
, RN,
MSN
UW PPC
Trainee
Madison, WISlide2
Overview
Prevalence of Chronic Childhood Illness
Medical Traumatic Stress
Stress Responses
Prevalence of Medical Traumatic Stress
Treatment Implications
Trauma Informed Care
Screening Tools
Post-Traumatic Growth
Resources for ProvidersSlide3
Epidemiology Chronic Childhood Illness
13 – 20% of U.S. children have chronic health conditions
1/3 have moderate to severe health conditions
(
Knafl
&
Santacroce
, 2010)Slide4
Each Year in the U.S.
5 out of 100 children hospitalized for a major acute or chronic illness, injury, or disability
11,000
+
children diagnosed with new cancers
250,000 children who are cancer survivors
1,000
+
children have organ transplants
several thousand more are awaiting transplants
(National Child Traumatic Stress Network - NCTSN)Slide5
Pediatric
Medical Traumatic Stress
Psychological
and physiological responses of children
and their
families to pain, injury, serious illness, medical procedures,
and invasive
or frightening treatment
experiences.
(NCTSN, 2011)Slide6
Why do medical events potentially lead to traumatic stress?
These events challenge beliefs about the world as a safe place; they
are harsh
reminders of one’s own (and child’s) vulnerability.
There
can be a realistic (or subjective) sense of life threat.
High-tech
, intense medical treatment may be frightening, and the child
or parent
may feel helpless.
There
may be uncertainty about course and outcome.
Pain
or observed pain is often involved.
Exposure
to injury or death of others can occur.
The
family is often required to make important decisions in times of
great distress
.Slide7
Traumatic Stress Responses
Arousal
Fearful
Jumpy
Insomnia
Re-experiencing
Intrusive thoughts
Flashbacks
Avoidance
Avoidance of reminders of trauma
Dissociation
Memory ProblemsSlide8
Children’s vs. Parental Responses
Children react to medical procedures and treatments
Somatic symptoms
Mimic those of illness
Parents, grandparents, & siblings undergo different stressors
Psychological
Higher rates of PTSDSlide9
Prevalence of Significant Traumatic Stress Symptoms
2006 Meta-analysis found average of
20% in studies of injured children
12% in studies of ill children
Similar rates for parents of ill children
(
Kahana
, et al., 2006)Slide10Slide11
PTSD and Chronic Health Conditions
PTSD identified in 22% of parents of children with chronic health conditions
19.6% - mothers
11.5% - fathers
85% of siblings of cancer survivors found to have traumatic stress
(
Cabizuca
, et al., 2009)Slide12
Family Experience of
Traumatic Stress in Cancer Survivors
(Kazak, et al., 1997)Slide13
Traumatic Stress Responses
Treatment ImplicationsSlide14
Dissociation
Inability to integrate information into memory
Inability to recall condition, treatment, prognosis information
Emotionally unavailable to child
(
Santacroce
, 2002)Slide15
Avoidance & Treatment Adherence
Frequent hospitalizations
Increased provider visits
Higher health care costs
Increased burdens of care on families
26% of heart transplant recipient deaths attributed to non-adherence. PTSD a contributing factor. (Shaw, 2001)Slide16
Stuber & Shemesh Study
19 pediatric liver transplant patients
6 had PTSD symptoms
3 of 19 non-compliant
All 3 had PTSD symptoms
All 3 became compliant when treated for PTSD
(
Stuber
&
Shemesh
, 2006)Slide17
Hypervigilance
Overprotect child
Forbid participation in beneficial activities
Overemphasize illness
Fail to discipline
Behavioral issuesSlide18
Trauma Informed Care
Information for ProvidersSlide19
Trauma Informed Care Objectives
Ensure that children have access to effective trauma services and interventions
Increase knowledge about trauma within systems
Increase skills for identifying and triaging traumatized children
Promote strong collaborations across systems and disciplinesSlide20
What Providers Can Do
Every child and family will not need the same level of support.
Majority will benefit from
psychoeducation
, comfort, and basic assistance.
A smaller number with acute distress will need interventions that promote medical adjustment or adherence.
Only a few families with severe distress will need mental health treatment.Slide21
UNIVERSAL trauma-informed care
Minimize potentially traumatic aspects of medical care and procedures
Provide child and family with basic support and information
Address distress (pain, fear, loss)
Identify family strengths and resources (help parents and family help the child)
Screen to determine which children and families might need more support, and make appropriate referrals
Provide anticipatory guidance about adaptive ways of copingSlide22
Health Professionals Can…
Provide information and basic coping assistance for all children & families facing potentially traumatic medical experiences (illness, injury, painful procedures).
Promote early identification and preventive interventions with children & families who may be more vulnerable to posttraumatic stress.
Refer high-risk families and those with persistent traumatic stress symptoms for mental health assessment and intervention.
Further educate yourself through continuing education, reading professional literature, and consultation with knowledgeable colleagues.Slide23
D-E-F Protocol for Trauma Informed CareSlide24
Screening Tools
D-E-F Nursing Assessment Form
Hospital Emotional Support Form
PCL-C for DSM-IV
Psychosocial Assessment Tool (PAT)
Screening Tool for Early Predictors of PTSD (STEPP)Slide25
Post Traumatic Growth
Transformation resulting in positive growth as result of experiencing trauma
Personal strength
Belief in new possibilities
Enhanced abilities in relating to others
Deeper appreciation of life
Spiritual changes
(Kilmer & Gil-Rivas, 2010)Slide26
Provider Resources
National Child Traumatic Stress Network
http://www.nctsn.org/
Health Care Tool Box – Trauma Informed Care
http://www.healthcaretoolbox.org
Center for Pediatric Traumatic Stress
The Children’s Hospital of Philadelphia
Phone: 267-426-5205
E-Mail:
cpts@email.chop.eduSlide27
Handouts
D-E-F Nursing Assessment Form
Hospital Emotional Support Form
309.811 DSM-IV Criteria for PTSDSlide28
Sources
Cabizuca
, M., Marques-
Portella
, C.,
Mendlowicz
, M.V.,
Coutinho
, E. S. F.,
Figueira
, I. (2009). Posttraumatic stress disorder in parents of children with chronic illnesses: A meta-analysis.
Health Psychology
,
28
(3).
Kazak,
Alderfer
,
Rourke
, et al. (1997). Posttraumatic stress symptom and posttraumatic stress disorder in families of adolescent cancer survivors. Journal of Pediatric Psychology.
Kahana
, S.Y.,
Feeny
, N.C.,
Youngstrom
, E.A., &
Drotar
, D. (2006). Posttraumatic Stress in Youth Experiencing Illnesses and Injuries: An Exploratory Meta-Analysis.
Traumatology
12; 148.
Kilmer, R.P. & Gil-Rivas, V. (2010). Exploring posttraumatic growth in children impacted by hurricane Katrina: Correlates of the phenomenon and developmental considerations.
Child Development, 81
(4), p. 1211-1227.
Knafl
, K.A. &
Santacroce
, S.J. (2010). Chronic conditions and the family in P.J. Allen, J.A.
Vessey
, & N.A. Shapiro (Eds.)
Primary Care of the Child with a Chronic Condition
. St Louis, MO: Mosby Elsevier.
National Child Traumatic Stress Network (2010). Medical stress in children and families (
pdf
).
http://www.nctsnet.org/nctsn_assets/pdfs/edu_materials/MedicalTraumaticStress.pdf
Santacroce
, S.J. (2002). Uncertainty, anxiety, and symptoms of posttraumatic stress in parents of children recently diagnosed with cancer.
Journal of Pediatric Oncology, 19,
p. 104-111.
Shaw, R.J. (2001) Treatment adherence in adolescents: Development and psychopathology.
Clinical Child Psychology and Psychiatry, 6
(137).
Stuber
, M.L. &
Shemesh
, E. (2006). Post-traumatic stress response to life-threatening illnesses in children and their parents.
Child and Adolescent Psychiatric Clinic of North America.