Caregiver experiences of public services following child trauma exposure: a qualitative study

Victoria Williamson,Bronwyne Coetzee,Ian Butler,Sarah Skeen,Mark Tomlinson,Sarah L Halligan,Jackie Stewart

doi:10.1186/s13033-018-0190-6

Abstract

BackgroundMany children in low and middle income countries (LMIC) are exposed to trauma. Contact with public services are a potential influence on parent–child reactions and coping post-trauma. Little is known about how caregivers perceive these interactions.MethodsThe aim of this study was to explore caregivers’ experiences of accessing and interacting with public services post-trauma and perceptions of needed improvements to public services in a LMIC context. Qualitative interviews were conducted with 20 female caregivers from a high-risk settlement in South Africa after child trauma exposure.ResultsThree themes and seven sub-themes were identified regarding caregivers’ perceptions of interactions with public services post-trauma. The key themes identified related to (1) communication and exchanges with law enforcement, (2) consequences of an under-resourced justice system and (3) importance of communication and empathy in the healthcare system. Interactions with police were often positive. However, caregivers explained that police-family communication post-trauma could be improved and may help to lessen caregiver anxiety and concerns for the child’s safety post-trauma. Caregivers perceived the judicial system to be under-resourced as contact with the judicial system was often protracted and caused child anxiety and distress. Medical treatment was reportedly rushed, with extensive waiting times and little information provided to caregivers regarding the child’s injuries or treatment. Some medical staff were perceived as unsympathetic during the child’s treatment which was found to exacerbate caregiver and child distress post-trauma.ConclusionsThis study provides insight into caregiver experiences of accessing public services following child trauma exposure in a high-risk LMIC context. Public services were perceived as oversubscribed and under-resourced and negative interactions often influenced caregiver responses and appraisals of child safety. Given the impact of poor interactions with public services on families post-trauma, additional research is needed to investigate feasible improvements to public services in LMIC.

Highlights

Many children in low and middle income countries (LMIC) are exposed to trauma
Children were reportedly exposed to three traumatic events in the last 2 years
Index traumas included: sexual assault (20%), physical assault (25%), road traffic accidents (20%), witnessing a sudden death of a close friend or family member (15%), and witnessing or experiencing community violence (20%)

Summary

Introduction

Many children in low and middle income countries (LMIC) are exposed to trauma. Contact with public services are a potential influence on parent–child reactions and coping post-trauma. Families are often in contact with medical, police, or social services Contact with such services can have a substantial effect on parent–child reactions and coping post-trauma [21]. The impact of child trauma exposure can potentially be mitigated by trauma-informed care delivery by services that are prevention oriented and focused on improving the mental health functioning of children and their families [21]. Little is known about families’ experiences of interacting with services post-trauma in highrisk, LMIC contexts. An in-depth exploration of families’ experiences of interacting with public services following child trauma exposure in a high-risk, LMIC context may provide insight into families’ support needs and have implications for improvements to clinical practice and policing. The objective of this study was to explore families’ experiences of accessing formal support following child trauma exposure, interactions with public services, and caregivers’ perceptions of needed improvements to public services

Objectives

Results

Discussion

Conclusion