What's the best approach to preventing long term traumatic stress in ill or injured children (and their families)?

doctor_screening tool_pediatric traumatic stress

The research evidence consistently indicates that it is not necessary or effective to provide mental health treatment to ALL children or adults exposed to traumatic experiences.

Instead, best practice recommendations call for empirically-sound screening to identify those children (and parents) at greater risk of persistent distress who could benefit from further monitoring or preventive interventions. This approach has been termed "watchful waiting" or "screen and treat."

Research on screening for risk

An important aim of screening patients within the first few days to weeks of an acute injury or illness event is to identify those who are more likely to have persistent distress, to ensure that appropriate additional monitoring ("watchful waiting") or preventive interventions can be put in place.

  • Among injured children the Child Trauma Screening Questionnaire (CTSQ; Kenardy, et al., 2006) has proved to be more accurate at identifying children who will experience PTSS 6 months post discharge than other screening measures.

A distinct but related screening aim is to identify pediatric patients (and their families) who are likely to need more psychosocial resources to sustain optimal family functioning and participation in care, over the course of ongoing treatment for a chronic or life-threatening illness.

  • The Psychosocial Assessment Tool (PAT) (Pai et al. 2008) is a validated tool that identifies three risk levels for families of children newly diagnosed with cancer, and that has been adapted for use in other illness groups including: Sickle Cell Disease, Craniofacial, pediatric palliative care, and the Neonatal Intensive Care Unit.

Research on preventive interventions

A three-session manualized intervention for parents/caregivers of children newly diagnosed with cancer - Surviving Cancer Competently Intervention Program - Newly Diagnosed (SCCIP-ND; Kazak, Simms et al., 2005) has preliminary data that supports its ability to reduce later traumatic stress symptoms in those families.

A stepped model of preventive intervention integrated within pediatric trauma care has been developed to reduce traumatic stress following pediatric injury. Pilot results are promising and the model is now being evaluated in a randomized trial.

Data on medication has shown varied results ranging from positive, negative or no effect as an early treatment for PMTS (Nugent et al. 2007; Stoddard et al., 2011).

Research on treatment interventions

There has been limited research regarding treatment specifically designed for ill or injured children.

  • One notable exception is the Surviving Cancer Competently Intervention Program (SCCIP; Kazak et al., 1999; Kazak et al., 2004) - a one-day, multi-family group intervention for adolescent cancer survivors and their mothers, fathers, and siblings. In a randomized clinical trial, SCCIP has been shown to reduce traumatic stress responses in survivors and family members.
  • In the past decade, interest has grown in the use of Internet based interventions in the pediatric injury and cancer fields. In two randomized clinical trials of an internet based psychoeducational intervention, preliminary results show a decrease in anxiety in study participants (Cox et al., 2010). In a separate pilot study, an internet based cognitive behavioral intervention showed a decrease in emotional difficulties, including PTSS symptoms, in pediatric cancer survivors (Seitz et al. 2014).

There are effective treatments designed more generally for traumatic stress symptoms in children that are applicable for many ill or injured children.

  • Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is a well-validated treatment approach for child traumatic stress that is likely to be useful for ill or injured children who have persistent traumatic stress symptoms.
  • Cognitive Behavioral Therapy (CBT) has been found to be helpful for youth who evidenced bothersome traumatic stress symptoms within the first few months after an acute medical event.
  • Child and Family Traumatic Stress Intervention (CFTSI) focuses on two key risk factors (poor social or familial support, and poor coping skills in the aftermath of potentially traumatic events) with the primary goal of preventing the development of PTSD.

Additional promising treatments can be found at the National Child Traumatic Stress Network website.