Treatment Of Trauma In Children Research Articles

Single centre analysis of factors influencing surgical treatment of splenic trauma in children.

This study aims to investigate determinants impacting the surgical management of splenic trauma in paediatric patients by scrutinizing age distribution, etiological factors and concomitant injuries. The analysis seeks to establish a foundation for delineating optimal operative timing. A cohort of 262 paediatric cases presenting with splenic trauma at our institution from January 2011 to December 2021 underwent categorization into either the conservative or operative group. Significantly disparate attributes between the two groups included age, time of presentation, blood pressure, haemoglobin levels, blood transfusion requirements, thermal absorption, American Association for the Surgery of Trauma (AAST) classification and associated injuries. Logistic regression analysis revealed age, haemoglobin levels, AAST classification and blood transfusion as autonomous influencers of surgical intervention (OR = 1.024, 95% CI: 1.011-1.037; OR = 1.067, 95% CI: 1.01-1.127; OR = 0.2760, 95% CI: 0.087-0.875; OR = 7.873, 95% CI: 2.442-25.382; OR = 0.016, 95% CI: 0.002-0.153). The AAST type and age demonstrated areas under the receiver operating characteristic (ROC) curve of 0.782 and 0.618, respectively. Age, haemoglobin levels, AAST classification and blood transfusion independently influence the decision for surgical intervention in paediatric patients with splenic trauma. Age and AAST classification emerge as viable parameters for assessing and prognosticating the likelihood of surgical intervention in this patient cohort.

The bidirectional associations between caregiver and child symptoms in the parent-led treatment stepping together for children after trauma

BackgroundAn innovative approach to child trauma treatment in which caregivers are allocated treatment tasks has shown promising results, but less is known about the bidirectional associations between caregiver and child symptoms during treatment. MethodsEighty-two child-caregiver dyads who participated in the parent-led therapist-assisted Stepping Together for Children after Trauma (ST-CT) were included (child age: 7–12 years, mean = 9.9 years). Caregivers' emotional reactions and anxiety/depression and children's posttraumatic stress (PTS) and depression were assessed pretreatment, mid-treatment, and posttreatment. We investigated the possible directional associations between caregivers' emotional reactions and anxiety/depression and children's PTS and depression using random intercept cross-lagged panel models. ResultsSymptoms improved in both caregivers and children. Lower levels of caregiver emotional reactions at pretreatment predicted improved child PTS at mid-treatment; lower levels of caregiver emotional reactions at mid-treatment predicted improved child depression at posttreatment; and lower levels of child PTS at mid-treatment predicted improved caregiver emotional reactions at posttreatment. ConclusionsThese findings suggest that caregivers and children can impact each other's responses to a parent-led child trauma-focused treatment. Notably, children with caregivers who were less affected by their own emotional reactions exhibited greater improvement in both PTS and depression. Supporting the caregivers may benefit both children and caregivers. Clinical trial registrationClinicalTrials.gov NCT04073862; https://clinicaltrials.gov/ct2/show/NCT04073862.

Eye movement desensitisation and reprocessing as a treatment for PTSD, trauma, and trauma related symptoms in children with intellectual disabilities: a general review

PurposeThis paper aims to discuss the utility of eye movement desensitization and reprocessing (EMDR) therapy as a treatment for children with intellectual disabilities (ID) who have experienced trauma.Design/methodology/approachRelevant National Institute for Health and Care Excellence (NICE) guidance and literature were reviewed to provide support for the use of EMDR as a treatment for trauma in children with ID.FindingsThere is a growing body of evidence which demonstrates that EMDR therapy is successful for the treatment of trauma in adults and children. However, for children with ID, the research is limited despite those with ID being more likely than non-disabled peers to experience trauma such as abuse or neglect.Practical implicationsEMDR can only be facilitated by trained mental health nurses, psychiatrists, psychologists (clinical, forensic, counselling or educational) or occupational therapists or social workers with additional training. Finally, general practitioners who are experienced in psychotherapy or psychological trauma and have accreditation. Therefore, this highlights that there may be a lack of trained staff to facilitate this intervention and that those who are generally working with the client closely and long term such as learning disability nurses are not able to conduct this intervention.Originality/valueThis paper presents an account of NICE guidance and evidence of the efficacy of EMDR as a treatment for adults, children and those with ID.

Case study of therapist-client co-creation for the treatment of relational trauma in children

This article presents a relational art therapy model of therapist-client co-creation as an approach to treating relational trauma in children. It examines the case study of an 18-month art therapy process with a 7-year-old with encopresis in a community clinic. In therapy there were clear indications that the client had likely been the victim of sexual assault at home. Through therapy and parental guidance, the maltreatment stopped. During the therapeutic process, the therapist shifted bidirectionally from a self-state of being the figure of responsibility who “holds” the therapy and accepts the child, his needs and desires, to embracing her inner child state in the artistic co-creation. When working with children, the therapist engages with the client’s need to reconstruct the relational trauma. At the same time, the therapist’s subjective presence and experiences as a vulnerable being facilitate the construction of an “authentic” rehabilitation aimed at the child’s wellbeing. The discussion centers on the principles of this new dynamic therapeutic model of co-creation and its potential applications.

Analysis of the efficacy and safety of conservative treatment of blunt abdominal trauma in children: retrospective study. Conservative treatment of blunt abdominal trauma in children

RESUMO Introdução: no Brasil, o trauma é responsável por 40% dos óbitos na faixa etária entre 5 e 9 anos, e 18% entre 1 e 4 anos, e o sangramento é a principal causa de prevenção morte na criança traumatizada. O manejo conservador de trauma abdominal contuso com lesão de órgãos sólidos - iniciado na década de 60 - é a tendência mundial atual, com estudos mostrando taxas de sobrevivência acima de 90%. O objetivo do presente trabalho foi avaliar a eficácia e segurança do tratamento conservador em crianças com trauma abdominal contuso tratado no Hospital das Clínicas da Universidade de Campinas, nos últimos cinco anos. Métodos: análise retrospectiva de prontuários de pacientes classificados por níveis de gravidade da lesão, em 27 crianças. Resultados: apenas uma criança foi submetida a cirurgia por falha inicial do tratamento conservador (instabilidade hemodinâmica persistente), resultando em uma taxa de sucesso global de 96% do tratamento conservador inicial. Outras cinco crianças (22%) desenvolveram complicações tardias que exigiram cirurgias eletivas: lesão na bexiga, dois casos de coleção perirenal infectada (secundária à lesão de sistema de coleta renal), um pseudocisto pancreático e um cisto esplênico. Resolução da complicação foi atingida em todas as crianças, com preservação anatômica e funcional do órgão afetado. Não houve mortes nesta série. Conclusão: a abordagem inicial conservadora no tratamento de trauma abdominal contundente foi eficaz e segura com alta resolução e baixa taxa de complicações levando a uma alta taxa de preservação dos órgãos afetados. Nível de evidência III - estudo prognóstico e terapêutico.

Analysis of the efficacy and safety of conservative treatment of blunt abdominal trauma in children: retrospective study. Conservative treatment of blunt abdominal trauma in children.

in Brazil, trauma is responsible for 40% of deaths in the age group between 5 and 9 years old, and 18% between 1 and 4 years, and bleeding is the leading cause of preventable death in the traumatized child. Conservative management of blunt abdominal trauma with solid organs injury - started in the 60s - is the current world trend, with studies showing survival rates above 90%. The objective was to assess the efficacy and safety of conservative treatment in children with blunt abdominal trauma treated at the Clinical Hospital of the University of Campinas, in the last five years. retrospective analysis of medical records of patients classified by levels of injury severity, in 27 children. only one child underwent surgery for initial failure of conservative treatment (persistent hemodynamic instability), resulting in a 96% overall success rate of the conservative treatment. Five other children (22%) developed late complications that required elective surgery: a bladder injury, two cases of infected perirenal collections (secondary to injury of renal collecting system), a pancreatic pseudocyst and a splenic cyst. Resolution of the complications was attained in all children, with anatomical and functional preservation of the affected organ. There were no deaths in this series. the conservative initial approach in the treatment of blunt abdominal trauma was effective and safe with high resolution and low rate of complications leading to a high preservation rate of the affected organs. Level of evidence III - prognostic and therapeutic study.

Duodenal Trauma in Children: What is the Status of Non-Operative Conservative Treatment?

Conservative treatment of duodenal trauma in children has long been the first line of treatment for duodenal wall hematomas. However, it has rarely been described in duodenal perforations. Our purpose is to highlight the possibility of conservative treatment in selected cases of duodenal perforation. In the period between 2009 and 2022, 6 children were treated for duodenal injury following abdominal blunt trauma in the pediatric surgical emergency department. The clinical presentation, diagnosis and treatment are reported and analyzed. Three patients presented with duodenal hematomas, they were treated non-operatively with hospital stays between 12 and 20 days and good clinical outcome. One child presented with duodenal hematoma and retroperitoneal air bubbles; non-operative conservative treatment was carried with favorable results. The fifth patient had a duodenal perforation; he underwent a primary duodenal 2-layers closure. The last patient had a combination of duodenal hematoma and perforation involving 75% of the duodenal diameter for which he underwent a gastro-jejunostomy with pyloric exclusion. An isolated duodenal lesion can be subject to a conservative treatment whenever allowed by a stable clinical condition and the availability of appropriate clinical and radiological monitoring.

The effectiveness of phasic, family-based, trauma-informed treatment within a Canadian community mental health center

Interpersonal trauma affects children and families in multiple domains and leads to wide a wide range of symptoms. Those at higher risk of trauma and its impact tend to be those with limited access to quality mental health treatment and frequently served at community mental health clinics. Despite the nuances of trauma treatment and prevalence of trauma in these underserved populations, rarely do community mental health settings house dedicated trauma treatment teams. The purpose of this study was to examine the effectiveness of a triphasic, family-based trauma treatment for children provided by a dedicated trauma team within a community mental health setting. This retroactive case-review study involved 31 families presenting for trauma treatment at a community mental health setting in a large Canadian city. T-tests and reliable change indices were used to compare pre- and posttreatment means across various domains. Treatment gains were large and statistically significant across all domains and reliable change from pre- to posttreatment was likewise found across all domains. These findings suggest that tri-phasic, family-based trauma treatment for children provided by a dedicated trauma team in a community mental health setting is a promising and effective option to address the chronically underserved high-risk and low-­resourced segments of the population.

Feasibility and Satisfaction with Virtual Trainings for Evidence-Based Child Trauma Treatments during the COVID-19 Pandemic

ABSTRACT The COVID-19 pandemic necessitated a change to virtual formats for evidence-based treatment trainings, including child trauma treatments. However, there has been limited research on trainee perceptions of virtual training. The present study examined trainee experiences in statewide dissemination of Child-Parent Psychotherapy (CPP), Trauma-Focused Cognitive Behavior Therapy (TF-CBT) and Parent–Child Interaction Therapy (PCIT) in both virtual and in-person formats. In all models, participants reported several benefits of virtual trainings related to pragmatics, balancing personal obligations, overall physical and emotional comfort, and increased access. Within treatment models, there were some relative weaknesses noted about virtual training compared to the in-person format. Virtual PCIT participants perceived lower knowledge gains and stated that the teaching format was not as conducive to learning. Virtual TF-CBT participants noted lower intention to use the treatment model and assessment measures. Virtual CPP participants did not note any perceived weaknesses. Despite these relative weaknesses noted, overall feasibility and satisfaction remained high across both formats, supporting virtual training as a feasible and acceptable format. Written feedback demonstrated significant variability in format preference, suggesting that multiple format options could create a more inclusive and accessible space. Lessons learned include increasing technological competencies and breaks, acknowledging the benefits and challenges of virtual training, and holding benevolence for trainees and trainers. The results of this study have implications for clinicians, trainers, and stakeholders seeking virtual dissemination and implementation methods.

Measuring clinician stuck points about trauma-focused cognitive behavior therapy: The TF-CBT Stuck Points Questionnaire.

Although evidence-based treatments (EBTs) for youth trauma have been developed, trauma-informed EBTs are rarely used in community settings. Clinician concerns about evidence-based trauma treatment may be a barrier to adoption and delivery. However, few instruments to assess clinician beliefs about specific EBTs, such as trauma-focused cognitive behavior therapy (TF-CBT) are available. This study evaluated an instrument of clinician concerns about TF-CBT, the TF-CBT Therapist Stuck Points questionnaire, in a sample of community mental health clinicians training in a year-long TF-CBT community-based learning collaborative. The 26 items in the instruments, which aim to assess clinician views on child trauma treatment and TF-CBT, indicate preliminary psychometric support (i.e., item-total correlations, internal consistency, negative correlations with measures of attitudes towards evidence-based practice). Scores on the TF-CBT Therapist Stuck Points questionnaire revealed that, on average, clinicians expressed concerns about having children talk about their trauma in session, the effectiveness of certain TF-CBT components, and whether to involve caregivers in treatment. Clinician doubts could be targeted during a TF-CBT implementation effort and clinical supervision to facilitate treatment delivery. Implications for assessing TF-CBT specific beliefs during implementation are discussed.

Online training for evidence-based child trauma treatment: evaluation of the German language TF-CBT-Web

ABSTRACT Background Evidence-based trauma-focused interventions for treating PTSD in children and youth are barely used in practice. Web-based training has proven to be an effective way of transferring knowledge to healthcare professionals. Objective TF-CBT Web is a web-based training programme designed to foster the dissemination of Trauma Focused Cognitive Behavioural Therapy (TF-CBT) for children and youth, and is run by the Medical University of South Carolina. This paper describes the characteristics of healthcare professionals who registered for the adapted German language version of TF-CBT Web. It evaluates the effectiveness and user friendliness of the programme. Method : Similar to the TF-CBT treatment manual, the German language TF-CBT Web contains 12 modules. Between 2018 and 2020, 4,020 users registered for the programme. During the registration process users provided demographic information. The knowledge of users regarding the TF-CBT components was assessed via pre-tests and post-tests in each module. Results The programme was accessed by a sample of mostly German users with varying professional health care backgrounds and a wide-ranging spread of work experience. The results indicated a significant knowledge gain and high rates of user satisfaction with the programme. Conclusions In summary, the results of this study suggested that web-based training is an effective and well-accepted method for knowledge gain in trauma-focused interventions. Future research should evaluate the actual application of the taught methods in clinical practice. HIGHLIGHTS Children and adolescents with PTSD require trauma-focused treatment. However, evidence-based interventions for this patient population are barely used. Therefore, it is necessary to expand professional training for the treatment of traumatised children and adolescents. Our evaluation showed the effectiveness and feasibility of a web-based training programme for mental health practitioners in an evidence-based treatment for children and youth with PTSD (TF-CBT). Results show a significant knowledge gain of users who participate in the web-based training programme. The user satisfaction survey also revealed that users found the modus and content of the web-based training applicable and relevant for their clinical practice.

Eye Movement Desensitization and Reprocessing in Young Children (Ages 4-8) with Posttraumatic Stress Disorder: A Multiple-Baseline Evaluation.

To reduce the acute and long-term effects of trauma, early and effective treatment is necessary. Eye movement desensitization and reprocessing (EMDR) therapy is a brief treatment for posttraumatic stress disorder (PTSD), with a substantial evidence base for children and adolescents aged 8 to 18years. In the present study we aimed to provide preliminary evidence of EMDR as a trauma treatment for young children. We studied 9 children, aged 4 to 8years old with a DSM-5 diagnosis of PTSD. A non-concurrent multiple baseline experimental design was used combined with standardized measures. Participants received six 1-h sessions of EMDR. Results post-treatment showed that EMDR was effective in reaching diagnostic remission of PTSD (85.7%), and decreasing severity of PTSD symptoms and emotional and behavioral problems. All gains were maintained at follow-up 3months after treatment. EMDR appears an effective treatment for PTSD in young children aged 4 to 8years. Further research is warranted.

Tailoring Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for Youth with Intellectual and Developmental Disabilities: A Survey of Nationally Certified TF- CBT Therapists

ABSTRACT In the United States, approximately one in six youth has an intellectual or other developmental disability (DD). Historically, there have been barriers to providing these youths with trauma treatment, although they are at elevated risk for exposure to traumatic events. The current study sought to characterize and assess the delivery of one of the most strongly supported child trauma treatments, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), to youth with DD. In June 2018, 391 TF-CBT therapists completed a self-report survey, sent to all nationally certified TF-CBT therapists, which queried the experience and comfort of using TF-CBT with youth with DD and the types of treatment adjustments made for them. Twenty-five percent of respondents reported having a strong background working with DD and 34% reported comfort treating youth with DD. As expected, there was an association between experience with DD and comfort level doing TF-CBT with youth with DD (X 2 (1, 358) = 70.09, p < .001). Discomfort varied by DD subtype. Consistent with prior recommendations, respondents reported employing a variety of flexible strategies such as adaptations in session/treatment time (e.g., shortening sessions, lengthening course of treatment), treatment content (e.g., simplifying language and/or using visual aids), structure, and increasing caregiver involvement. Experience mattered; of those who reported making an adjustment, 74.1% had some to extensive experience treating youth with DD as compared to 61.2% of those who didn’t report adjustments (X 2 (1, 359) = 6.18, p = .013). Findings highlight the need for additional training and resources for increasing self-efficacy around TF-CBT treatment provision for youth with DD.

Intensive clinical trauma treatment for children and adolescents with mild intellectual disability or borderline intellectual functioning: A pilot study

BackgroundChildren and adolescents with mild intellectual disability (MID) or borderline intellectual functioning (BIF) are at increased risk for posttraumatic stress disorder (PTSD) or trauma-related symptoms due to adverse childhood experiences (ACEs). Weekly provided treatment sessions and/or outpatient treatment may not be effective enough. AimsInvestigate feasibility, safety and potential effectiveness of an intensive clinical trauma treatment in children and adolescents with MID-BIF and trauma-related symptoms as a result of ACEs or PTSD. Methods and ProceduresThirty-three participants between 6 and 17 years of age received intensive clinical treatment after experiencing multiple ACEs (most commonly physical abuse, emotional neglect or abuse, sexual abuse, domestic violence and bullying). Treatment lasted 8.4 days on average and consisted of a daily program of prolonged exposure, eye movement desensitisation and reprocessing and physical activation, embedded in a trauma-sensitive environment. Data were collected at intake, first day of treatment, last day of treatment and at follow-up. Outcomes and ResultsThere was a significant reduction of trauma-related symptoms and emotional and behavioral problems after treatment. In addition, the number of participants fulfilling the DSM-5 criteria of PTSD decreased from 24 at intake to 8 at the end of treatment. There was no drop out and no adverse events were seen. Conclusions and ImplicationsThe results of this pilot study suggest that an intensive clinical trauma treatment is a potentially effective and safe option for children and adolescents with MID-BIF.

Cue-Centered Therapy for Youth Experiencing Posttraumatic Symptoms.

PurposeFew of the existing evidence-based interventions for child trauma exposure were specifically designed to address experiences and outcomes of complex developmental trauma. Stanford’s cue-centered therapy (CCT) was designed to address this gap by offering a flexible, integrative, and insight-oriented treatment approach that is grounded in principles of neuroscience, developmental trauma, client empowerment, and allostasis. This article reviews the CCT rationale, treatment components, evidence base, and training approach.Recent findingsStudies demonstrate promising outcomes indicating CCT effectiveness in reducing child and caregiver posttraumatic stress, and in improving child functioning. Further research, however, is needed to identify which clients are best-suited for CCT (versus other available child trauma treatments) and to identify which components of CCT are most critical for addressing complex developmental trauma.SummaryCCT advances the field of child trauma treatment by offering an intervention approach focused on addressing complex developmental trauma. Positive treatment and training outcomes indicate utility of CCT for clients and clinicians. Innovations in research and training approaches are needed to further dissemination and implementation of CCT and other related child trauma interventions for complex developmental trauma.

Vicarious Trauma and the Impact of Child Trauma Treatment on the Therapist

Mental health clinicians who treat childhood trauma are impacted in a variety of ways by this challenging work. These therapists bear witness to, contain and intervene with countless stories of childhood trauma, including abuse, neglect and other traumatic and adverse childhood experiences that children endure. Therapists who treat childhood trauma are continually engaging with unthinkable events that negatively impact the hearts, bodies, minds and overall functioning of youth. A possible consequence of childhood trauma treatment is for the therapist to experience vicarious trauma. This brief paper outlines the causes of vicarious trauma as well as steps clinicians can take to reduce the severity and frequency of experiencing vicarious trauma.

Understanding the needs of children returning from formerly ISIS-controlled territories through an emotional security theory lens: Implications for practice

BackgroundChildren who spent time in territories formerly controlled by the Islamic State of Iraq and Syria (ISIS) and who are now being reintegrated into their countries of origin have experienced significant trauma and may present with adjustment or mental health problems. ObjectiveIn this paper we describe how Emotional Security Theory (EST; Davies & Cummings, 1994) and its more recent formulation, EST-reformulated (EST-R; Davies & Martin, 2013, 2014), provide a theoretical lens to aid in understanding the ways in which traumatic experiences under ISIS may have an enduring impact on a child’s development and well-being. Methods & resultsThe core assumption of EST is that maintaining safety and security is a central goal for a child growing up in the context of conflict. Children living in conflict zones under ISIS rule may have developed emotional insecurity, which in turn is theorized to lead to developmental cascades across multiple domains of functioning and at times result in clinically significant distress. This theoretical understanding can guide intervention, as it suggests that the foci of intervention must (1) minimize social signals indicative of threat while also (2) reducing behavioral response patterns that limit opportunities for exploration and prosocial affiliation. Trauma Systems Therapy is a multidisciplinary child trauma treatment model that addresses both stressors in the social environment and related emotional dysregulation. ConclusionsChallenges and considerations related to implementing such a comprehensive treatment approach in low- and middle-income countries are discussed.

Telemental health for child trauma treatment during and post-COVID-19: Limitations and considerations

The ongoing COVID-19 pandemic has led to unprecedented disruptions and stress in the lives of children and families internationally. Heightened family stress and turmoil can increase risk for, and exacerbate, child maltreatment. As a result, child maltreatment experts are concerned that there will be an influx of children requiring trauma assessment and treatment during and after COVID-19. As physical distancing measures have been implemented and will likely persist into 2021, organizations providing trauma treatment to children and their families have had to rapidly pivot to telemental health to maintain service delivery with clients. While the benefits of telemental health have been identified, including reduced barriers to access, increased cost effectiveness, and broad availability of services, there are unique limitations to its implementation within a child maltreatment population, such as challenges with attention and emotion regulation skills, difficulties identifying dissociative symptoms, and increased time with perpetrators of abuse due to shelter in place orders. These limitations are exacerbated for children and families who are most marginalized and facing the highest levels of social and economic barriers. Lack of access to reliable technology, lack of a private or confidential space for sessions, and reluctance to process trauma in the absence of a safe environment, are all barriers to conducting effective trauma treatment over telemental health. This article discusses both the benefits and barriers to telemental health in a child maltreatment population and offers considerations for child trauma service provision, program development, and policy during and post the COVID-19 pandemic.

Healing Interpersonal and Racial Trauma: Integrating Racial Socialization Into Trauma-Focused Cognitive Behavioral Therapy for African American Youth.

African American youth are more likely than their peers from other racial and ethnic groups to experience interpersonal traumas and traumatic racist and discriminatory encounters. Unfortunately, evidence-based trauma treatments have been less effective among these youth likely due to these treatments not being culturally tailored to address both interpersonal and racial trauma. In this article, we utilize the racial encounter coping appraisal and socialization theory to propose suggestions for adapting trauma-focused cognitive behavioral therapy-an evidence-based trauma treatment for children and adolescents-to include racial socialization or the process of transmitting culture, attitudes, and values to help youth overcome stressors associated with ethnic minority status. We conclude by discussing implications for the research and clinical community to best promote healing from both interpersonal and racial trauma for African American youth.

Integrating parents with trauma histories into child trauma treatment: Establishing core components.

Integrating parents with trauma histories into child trauma treatment: Establishing core components.