Cultural Considerations | Patient Centered Care and Trauma Informed Care for Pediatric Patients

What is Culturally-Sensitive Trauma-Informed Pediatric Care?

Culturally-Sensitive Trauma-Informed Care pays attention to both individual and cultural variations in:

child and family values and beliefs about health and illness
how the child and family experience potentially traumatic aspects of medical events and
how they express and cope with related emotional distress.

Important Note:

"Culture" extends beyond ethnicity to include other variables such as faith/religion, sexual orientation, region of residence, and level of acculturation, and closely related factors such as socioeconomic status and literacy level.

Why Attend to Culture in Providing Trauma-Informed Pediatric Health Care?

Cultural factors can influence the child's and family's biopsychosocial experience of medical events and subsequent traumatic stress reactions. For example, ethnocultural factors play an important role in children's and families':

Willingness to disclose psychosocial information to providers
Expression of distress and trauma symptoms
Whether and how they seek help for emotional distress
Communication between family members

For some pediatric patients, cultural considerations occur in conjunction with other issues that impact provision of trauma-informed health care.

Children and families with limited English proficiency:
- Work collaboratively with medical interpreters to provide trauma-informed and culturally-sensitive care.
Children and families with refugee or traumatic immigration experiences:
- Understand core stressors that may impact interactions in the healthcare setting.

How do I implement Culturally-Sensitive Trauma Informed Care?

Providing culturally sensitive pediatric care includes:

Asking children and families what these medical experiences mean to them.
Listening to and integrating the child or family's own terms for what they are experiencing.
Understanding how your helping role is perceived
Paying attention to family dynamics and decision-making.
Being open to including kinship networks and healing practices that the family views as helpful.

Cultural considerations are a key component of the D-E-F protocol - helping providers implement culturally sensitive pediatric care in a manner that considers a child and family's beliefs, values, and practices.

Download D-E-F Pocket Cards with quick screening and intervention recommendations.

D-E-F: Guide to Culturally-Sensitive Trauma-Informed Care D-E-F: Providing Culturally-Sensitive Trauma-Informed Care

Additional tips for culturally-sensitive, trauma-informed care:

Recognize cultural influences on interpretation of medical events and stress responses

A child's or family's perceptions of a medical experience can be quite different from that of the provider or healthcare team. For example, some cultures interpret illness as punishment, a test or rite of passage, or a special message.
Cultural differences may also influence beliefs about if, when, and how to address emotional distress (such as traumatic stress symptoms), and about seeking outside help.

Remember:

Ask and listen for what this medical event means to the child and family.
Incorporate this understanding into assessment and treatment.

Help restore a sense of safety and contribute to establishing trust

Many children and families facing a new medical event feel physically unsafe and emotionally vulnerable; they may have a difficult time trusting others or accepting help as a result.
Given long-standing experiences of racism and inequity, some children and families are understandably less likely to trust health care providers with the details of their symptoms, worries or anxieties, or treatment recommendations.
Nonverbal communication can play a huge role – including eye contact, tone of voice, facial expressions, body language and touch.
Culturally appropriate communication practices have been shown to result in higher levels of perceived trust and increased reporting of information.

Remember:

Safety and trust is established not only through words, but through actions.
Take a step back to assess how your helping role is perceived.
Try to connect the family with resources they trust – including other types of professionals and helpers.

Attend to child and family distress, in the way that they define it

Family and cultural factors often combine to define what is considered an appropriate reaction to illness or trauma.
Pain, fear, worry, or hyperarousal are sometimes expressed somatically.
Traumatic stress reactions can be extremely subdued or can appear magnified.
Some families and cultural groups are less comfortable responding to personal questions about emotional distress; being distressed may be stigmatized or seen as a sign of mental illness.

Remember:

Understand emotional reactions by asking about specific behaviors (sleep and eating patterns, jitters, etc.).
Listen to and incorporate the child's or family own terms for what they are experiencing into discussions and treatment planning.
Provide psychoeducation about common, universal reactions to trauma, using language that matches the family's.

Work with and through the family structure to promote support and coping

Some families and cultural groups have distinct customs about who makes decisions and how they are communicated.
These customs may limit how a child or other family member is expected to be involved in discussions and decisions.

Remember:

Pay attention to family communication patterns and ask who should be involved in key discussions.
When appropriate, incorporate extended family / kinship networks, or other types of healing professionals and practices that the child and family view as helpful.

Additional Resources and Suggested Reading

The National Child Traumatic Stress Network (NCTSN) website features various resources related to culture and trauma.

The Refugee Trauma & Resilience Center at Children's Hospital - Boston (an NCTSN Center) offers resources to help providers serve immigrant and refugee children and families, including an online Refugee and Immigrant Core Stressors Toolkit .

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Important Note: