In providing trauma-informed care, not every child and family will need the same level of support. The 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. Similar to a public health prevention model, trauma informed care can be grouped into three distinct levels:
Many doctors and nurses can provide universal trauma-informed care as part of everyday clinical treatment. Some of the key elements of universal care include:
- 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 coping
Assessing all patients, not only the ones who seem anxious or depressed, on their level of distress allows doctors and nurses to provide the appropriate level of support to each family. In 2015, the American College of Surgeons' Commission on Cancer will require all accredited cancer programs to screen patients for distress since "it concluded that problems with emotions or more practical matters like transportation add to suffering and can make it harder for patients to follow doctors' orders and get better". One social worker speaks about a recently screened patient, she believed her "hospital was doing a good job of finding patients who needed help, but here was one who would have flown under the radar without the survey", providing a real world example for the need for universal screening.
For physicians and nurses working with pediatric cancer patients and families, the Psychosocial Assessment Tool (PAT) is a comprehensive questionnaire assessing psychosocial risk in families of children newly diagnosed with cancer. The PAT helps identify children and families who would benefit from targeted psychosocial intervention.