What's the best approach to preventing long term traumatic stress in ill or injured children (and their families)?
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, two promising screening tools have been developed and evaluated: the Screening Tool for Early Prediction of PTSD (STEPP; Winston, et al., 2003) and the Child Trauma Screening Questionnaire (CTSQ; Kenardy, et al., 2006). Both have evidenced good sensitivity and reasonable specificity in identifying those at risk for persistent and impairing traumatic stress symptoms.
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 pediatric palliative care, the Neonatal Intensive Care Unit and the Pediatric 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 to prevent traumatic stress symptoms in children is much more preliminary, but research is underway in this area (Robert et al., 1999; Saxe, Stoddard, Courtney et al., 2001).
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.
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.
