Much of the discussion about trauma informed care and how to implement it with pediatric patients revolves around care in the hospital or primary care office. But post traumatic stress resulting from an injury or illness may take time to manifest, and its impact may be seen more readily by those who have very regular contact with a child. Which health care providers are in a position to both recognize and intervene with any post injury/ illness traumatic stress reactions?

Stressed School Girl


School nurses. In fact, school nurses are poised not only to recognize the signs of medical traumatic stress, but also adverse childhood experiences (ACEs) and other mental health concerns:


"Schools function as the mental health system for up to 80 percent of children who need help, according to the American Association of Pediatrics. And school nurses? They play a critical role in identifying students with mental health disorders." (NPR, School Nurses Can Be Mental Health 'Detectives' But They Need Help)


Unfortunately, many schools share nurses, leaving students with access to the nurse only on certain days, and many school nurses do not have training in mental health. Thanks to Donna Mazyck, the executive director of the National Association of School Nurses, and Sharon Stephan, co-director of the National Center for School Mental Health at the University of Maryland, school nurses across the country can receive training in mental health concerns. Just as trauma informed care emphasizes that doctors and nurses need not become mental health experts, but rather frame patient care so as to leave the proverbial door open for discussion, Ms. Stephan suggests two questions to guide nurses on how to determine if a student may have mental health concerns:


"Is the student acting or behaving differently than they were before? 

Are they somehow far outside the norm of what you would expect?"


Doctors and nurses interested in learning more about pediatric medical traumatic stress, the DEF Protocol for Trauma Informed Care and best practices for working with children involved with the child welfare system can visit the Online Education section for free continuing education courses.


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