Systematic Review: A Reevaluation and Update of the Integrative (Trajectory) Model of Pediatric Medical Traumatic Stress

Experience of post-traumatic growth among parents of children with biliary atresia undergoing living-related liver transplantation: a descriptive phenomenological study

Objectives: To explore the experience of post-traumatic growth among parents of children with biliary atresia undergoing living-related liver transplantation.Methods: Participants were recruited within 2 weeks of their child's transplant surgery using purposive sampling. Transcripts were analyzed using Colaizzi's descriptive analysis framework, with collaborative analysis conducted using NVivo 12 software and a post-traumatic growth model.Results: Five themes were identified: (a) experiencing a devastating blow, (b) cognitive reconstruction under overwhelming pain, (c) an arduous journey of decision-making, (d) rebirth in adversity and (e) post-traumatic growth. Parents undergo significant post-traumatic responses to their child's diagnosis of biliary atresia and liver transplantation, marking two major traumatic events. During the diagnostic stage, parents experience intense post-traumatic reactions characterized by emotional fluctuations and intrusive thoughts. The early treatment phase represents a crucial time for parents to transition from `denial of reality' to `accepting diseases'. The process of liver transplantation is also a significant traumatic event, accompanied by a final hope. Parents in the stable period after liver transplantation feel fortunate, hopeful and grateful, and their post-traumatic growth manifests gradually.Conclusions: Parents' experience of post-traumatic growth involves dynamic changes. Tailored intervention strategies should be developed for different stages to enhance their post-traumatic growth and psychological well-being. During the early treatment stage, mental health professionals could provide cognitive interventions to encourage parents to express their negative emotions and guide them to develop positive cognition toward traumatic events. The coping strategies and increasing personal growth are also important. In the postoperative stage, mental health professionals need to fully evaluate the coping styles of parents, and encourage them to establish effective internal coping strategies, while classic gratitude interventions could be given during the post-traumatic growth stage. Future research could involve a longitudinal qualitative study to explore parents' post-traumatic growth experiences at different stages of their children's transplantation process.

Bouncing Back Better: development of a family intervention program after young child burn injury

OBJECTIVE

Burn injuries are a common form of unintentional childhood injury. The psychological sequelae of pediatric burn injury on the injured child and caregivers can be significant, including traumatic stress, anxiety, and depression. Factors such as parent capacity for monitoring and child ADHD (attention-deficit/hyperactivity disorder) symptoms can significantly increase the risk of injury in early childhood. A dual-foci intervention was created to improve family functioning and coping after a burn injury. The current proof-of-concept study examines the Bouncing Back Better (BBB) intervention, which targets parent mood and child externalizing behaviors after unintentional burn injury.

METHODS

BBB intervention was completed by 10 parent-child dyads (12 enrolled). Inclusion comprised children (2-5 years) who sustained an unintentional burn injury and demonstrated hyperactivity symptoms upon standard clinical care psychosocial screening. BBB included four (30-45 min) sessions that involve CBT-focused behavioral intervention skills. Feasibility was assessed through recruitment, enrollment, and retention rates. Acceptability was assessed through satisfaction questionnaires and qualitative interviews. Proof-of-concept was demonstrated through analyses of findings from validated measures of depression, distress, and ADHD symptoms.

RESULTS

Findings support acceptability and feasibility of the intervention and provide evidence of a successful proof-of-concept by demonstrating significant decreases in reported parental depression symptoms and improvements in child inattentive and hyperactive behaviors.

CONCLUSIONS

An intervention focused on both caregiver well-being and child behaviors improves overall family functioning. Future research aims to expand the BBB intervention to a larger sample and examine initial efficacy through pilot testing using a randomized design and a larger team of treatment providers.

Short-term effects of clown visits in child and adolescent psychiatric care: a pilot study on patient stress and mood outcomes and staff evaluations

Background

Clown visits are an effective intervention to alleviate patients' stress and anxiety in pediatric hospital settings. However, while children and adolescents in inpatient psychiatric treatment might uniquely benefit from healthcare clowning, little research has addressed the effectiveness of clown visits in this setting.

Method

This pilot study examined the short-term effects of clown visits on psychological (self-reported stress and mood) and physiological (salivary cortisol) outcomes in 29 children and adolescents aged between 7 and 17 years (M = 12.69, SD = 2.90) in a noncontrolled repeated pre-post design over 4 weeks. In addition, 21 care staff members reported separately on their perceived impact of clown visits.

Results

Self-reported stress levels of children and adolescents were decreased significantly from before to after clown visits, whereas salivary cortisol indicated a similar, but nonsignificant decrease. According to the Multidimensional Mood Questionnaire (MDMQ), patients showed significant improvements in energetic arousal, but there were no effects on mood valence and calmness. The effectiveness of the clown visits did not change over repeated visits. Care staff reported that clown visits had a positive impact on patients' and their own well-being, but their evaluations regarding their stress levels and work processes on the ward were mixed.

Discussion

The present results provide preliminary evidence that the stress-reducing and energizing effects of clown visits, which previous studies have demonstrated in various pediatric settings, can also be transferred to the field of inpatient child and adolescent psychiatry. Mixed self- and work-related evaluations from care staff suggest that improvements in the implementation of clown visits could help eliminate disruptive elements of this intervention.

A Knowledge, Attitude, and Practice Study on Trauma-Informed Care Among Nurses Working in a Hospital in Lucknow District

Background Trauma-informed care (TIC) is a framework that acknowledges the widespread impact of trauma and integrates knowledge about its effects into healthcare practices. As frontline caregivers, nurses frequently encounter patients with trauma histories. Their knowledge, attitude, and practice (KAP) regarding TIC are crucial in ensuring compassionate, effective, and patient-centered care. However, there is limited research assessing the understanding and implementation of TIC among nurses in Indian healthcare settings, particularly in Lucknow District. Materials and methods A cross-sectional, web-based survey was conducted from March 2024 to July 2024, using a random sampling method to assess nurses' KAP regarding TIC at Chandan and Fatima Hospitals. Results Among 208 nurses, 52.88% had 1-5 years of experience. No significant association was found between age and trauma-related perceptions (p> 0.05). Education (p = 0.049) and gender (p = 0.004) significantly influenced TIC techniques, with general nursing and midwifery (GNM) nurses and females predominantly using a broader range of therapeutic approaches. Conclusions This study is significant because it will provide evidence-based insights into the preparedness of nurses in Lucknow District regarding TIC. The findings can contribute to improved nursing education, hospital policies, and patient outcomes by promoting a more trauma-sensitive healthcare environment.

Trajectory of Post-Traumatic Stress During the First Year after Pediatric Traumatic Brain or Orthopedic Injury

Up to 50% of children sustaining physical injury develop post-traumatic stress symptoms (PTSS). Most studies of PTSS have not included patients with traumatic brain injury (TBI); consequently, the influence of injury type and severity on the longitudinal course of PTSS is unclear. To address this gap, we completed a longitudinal prospective cohort study examining the trajectory of self-reported PTSS severity during the first year after TBI or orthopedic injury (OI). Within a biopsychosocial framework, we examined PTSS in relation to injury variables, demographic characteristics, and pre-injury child and family functioning. Patients ages 9-15 years with TBI or OI were recruited from two level I pediatric trauma centers. Online surveys were completed as soon as possible following injury (mdn = 8 days). Caregivers rated pre-injury family, sociodemographic, and child characteristics. Follow-up surveys assessing children's self-reported PTSS using the Children's PTSD Symptom Scale (CPSS) were scheduled 3,6, and 12 months after injury. English-speaking families completed surveys either online or by telephone interview; Spanish-speaking families were interviewed. Baseline surveys were completed by 303 families; 265 (87%) completed at least 1 follow-up and comprised the cohort. General linear mixed models examined the influence of injury group and severity, age, sex, and time of assessment on CPSS scores. Pre-injury estimates of child and family functioning were examined as predictors in supplemental models. Participants (72% boys, mean [SD] age 12.7 [1.9] years) included 204 with TBI (76 mild, 82 complicated-mild/moderate, 46 severe) and 61 with OI. Relative to OI, patients with TBI had significantly elevated mean CPSS scores at 3 (3.7 points, 95% confidence intervals [CI]: 1.1, 6.3); 6 (3.2, 95% CI: 0.7, 5.7) and 12 months (2.3, 95% CI: 0.1, 4.5). The primary model indicated that TBI severity had a nonlinear relation with CPSS. Mild TBI (mTBI) had the highest mean scores; with significant differences relative to OI at 3 (4.6 points, 95% CI: 1.6, 7.6); 6 (5.7, 95% CI: 2.7, 8.6) and 12 months (3.2, 95% CI: 0.6, 5.8). This model also revealed that adolescent females had higher CPSS scores than children or adolescent males. Differences relative to younger males at 6 and 12 months were 4.9 (95% CI: 1.6, 8.3) and 5.0 points (95% CI: 2.1, 8.0). In supplemental models, higher symptom burden was associated with poorer baseline family functioning and with higher levels of children's pre-injury anxiety, affective problems, and conduct problems. PTSS persisted for a significant minority of patients with TBI across the first year of recovery, particularly those with mTBI. Screening should emphasize risk factors to target patients with the greatest need for trauma-focused intervention. Cost-effective, scalable, evidence-based trauma-focused interventions are essential to meet American College of Surgeons standards to provide psychological screening and treatment to children sustaining PTSS.

Systematic Review and Meta-Analysis of Prevalence and Population-Level Factors Contributing to Posttraumatic Stress Disorder in Pediatric Intensive Care Survivors

OBJECTIVES

In survivors of illnesses or surgeries requiring PICU admission, there is a risk of posttraumatic stress disorder (PTSD). We aimed to estimate PTSD prevalence and potential contributing factors in survivors of PICU admission.

DATA SOURCES

We performed a PROSPERO registered systematic review (CRD42022348997; Registered August 2022) using MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) databases, 2000 to 2022, with no language restrictions.

STUDY SELECTION

Observational or interventional studies evaluating the incidence or prevalence of PTSD in patients' after PICU admission and/or contributing factors to PTSD. We used studies describing patients younger than 18 years old. Since there were a large number of citations, we used an integrated crowdsourcing and machine-learning model for citation screening. Each citation was reviewed independently and in duplicate by two reviewers at each stage of screening and abstraction.

DATA EXTRACTION

Data items included study and participant demographics, details of case definition (PTSD screening), and risk factors.

DATA SYNTHESIS

We followed the Preferred Reporting items for Systematic Reviews and Meta-analysis guidelines. Random-effects models were used to analyze PTSD prevalence and subgroup differences. In 24 citations meeting final review criteria, 19 had data for meta-analysis. There were 1898 PICU survivors with a median (interquartile range) cohort size of 59 (49-76). PTSD prevalence in the studies ranged from 3% to 37%; PTSD occurred in 529 of 1898 survivors ( I2 = 72%). Factors influencing PTSD variability included timing of assessment ( p < 0.01) with the highest prevalence (29%) at 6 months and the type of assessment instrument ( n = 10; range, 4-27%; p = 0.04). There was lower prevalence of PTSD (8%) in postoperative cardiac patients ( p < 0.01). Last, we failed to find an association between PICU length of stay and PTSD prevalence ( p = 0.62; I2 = 80%).

CONCLUSIONS

PICU follow-up studies from 2000 to 2022 indicate that one-in-three of admissions surviving to 6 months have PTSD. However, there are population, study design factors and heterogeneity in PTSD assessment that indicate more standardization in this research is needed.

Communicating a Pediatric Leukemia Diagnosis to a Child and Their Family: A Qualitative Study Into Oncologists' Perspectives

BACKGROUND

A pediatric cancer diagnosis is overwhelming and stressful for the whole family. Patient-centered communication during the diagnostic conversation can support medical and psychosocial adaptation to the disease. Treatment of pediatric leukemia has become increasingly complex and requires a specific skillset from clinicians in effectively conveying information to families. The objective of the current study was to gain insight in the experiences and perspectives of pediatric oncologists when communicating leukemia diagnoses to families.

PROCEDURE

In this exploratory qualitative study, oncologists were eligible to participate for each diagnostic conversation between May 2022 and February 2023 of families participating in a larger study. Twenty-six semi-structed interviews with 16 oncologists were thematically analyzed.

RESULTS

Two interrelated conversational goals were identified: (i) informing the family about the illness, prognosis, and treatment; and (ii) creating trust and comfort for the family implying they are in the right place for maximal chance of survival. Oncologists experienced a challenge in balancing a high amount of information provision in a short timespan with simultaneously monitoring the (emotional) capacity and needs of the family to process information. Remarkably, oncologists commonly seem to rely on intuition to guide the family through the diagnostic conversation. They mentioned to sometimes postpone answering to family-specific informational needs and prioritized information they assume to be more helpful for the family at that time.

CONCLUSIONS

During diagnostic conversations, oncologists aim to convey information they assume supports the needs of the family. Future research should investigate how these communication strategies are perceived by families.

Understanding the Psychological Impact of Medical Care Experiences on Adults With Craniofacial Conditions: A Pilot Survey of Traumatic Stress Symptoms and Resilience

Craniofacial conditions often require extensive medical care and surgeries throughout childhood and adolescence. However, there is limited research investigating the psychological effects of craniofacial care, including risks for medical traumatic stress. This cross-sectional study investigated the medical care experiences of adults with craniofacial conditions, including the frequency of potentially traumatic medical events, post-traumatic stress disorder (PTSD) symptoms, and resilience. Participants (N=34; mean age 35.2 ± 12.2 y; 71% female) were recruited at 3 US pediatric hospitals and craniofacial support organizations. Participants completed the PTSD Checklist (PCL-5), Connor-Davidson Resilience Scale, the Craniofacial Experiences Questionnaire, and open-ended questions about their medical care experiences. Most participants reported experiencing potentially traumatic medical experiences, such as prolonged and/or painful dental (79%) and medical treatments (73%) and hospitalization in the intensive care unit (70%). On the PCL-5, 21% met the criteria for PTSD, which is similar to other medical populations and higher than the 6% rate of PTSD in the general US population. Participants reported both stressors and positive aspects related to living with a craniofacial condition; however, resilience scores were lower relative to a US community sample. Qualitative analysis of open-ended responses identified themes including interactions with providers, medical treatment experiences, and psychosocial impacts. Adults with craniofacial conditions appear to be vulnerable to post-traumatic stress symptoms related to their medical care experiences, and report reduced resilience relative to community samples. Implications for clinical care and research include the integration of trauma-informed care approaches and strategies to support coping and resilience across the lifespan.

Multidisciplinary approach to optimizing long-term outcomes in pediatric kidney transplant recipients: multifaceted needs, risk assessment strategies, and potential interventions

The post-transplant course of pediatric kidney transplant recipients is marked by a myriad of challenges, encompassing medical complications, recurrent hospitalizations, physical and dietary restrictions, and mental health concerns such as depression, anxiety, and post-traumatic stress disorder. Moreover, pediatric recipients are at risk of neurodevelopmental impairment, which may result in neurocognitive deficits and pose significant psychosocial obstacles. Addressing these multifaceted demands necessitates a multidisciplinary approach to pediatric kidney transplant care. However, the existing literature on the effective implementation of such a model remains scarce. This review examines the psychosocial and neurodevelopmental challenges faced by pediatric kidney transplant recipients and their families, discussing their impact on long-term transplant outcomes. Furthermore, it provides insights into risk assessment strategies and potential interventions within a multidisciplinary framework, aiming to enhance patient care and optimize post-transplant outcomes.

The acceptability, feasibility and adoption of a co-designed electronic post-injury psychosocial screening tool for carers of children admitted to hospital following injury

PURPOSE

This study aimed to evaluate the feasibility, acceptability and adoption of a co-designed electronic post-injury psychosocial screening tool for carers of paediatric trauma patients.

DESIGN AND METHODS

A mixed methods approach with a parallel convergent design was used. The study occurred at a tertiary paediatric hospital in Australia, with data collected between April 2023 and February 2024. Data were collected through electronic surveys, semi-structured interviews, and the psychosocial screening tool. Participants included caregivers of hospitalised children and clinicians from the hospital's trauma service.

RESULTS

Although both caregivers and clinicians found the tool feasible and acceptable, adoption rates were lower than expected. Key barriers included the tool's timing, which conflicted with caregivers' focus on physical recovery and emotional challenges discussing trauma. Clinicians viewed the tool as research-focused, limiting engagement. Logistical barriers, such as lack of clinician support and timing, further reduced adoption.

CONCLUSION

The tool showed potential for improving psychosocial support post-injury, but adoption was hindered by timing, emotional challenges and clinician engagement.

PRACTICE IMPLICATIONS

Clinicians must prioritise the acceptability, feasibility and adoption of tools when implementing caregiver support interventions for children with traumatic injuries. Future research should focus on overcoming implementation barriers and optimising psychosocial screening tools. Subsequent versions should align with caregivers' recovery timelines, embrace trauma-informed principles, promote clinician buy-in and be culturally tailored. Enhanced integration into clinical workflows and greater clinician engagement will boost adoption and effectiveness.

Efficacy of Supportive Care Interventions for Improving Posttraumatic Stress Symptoms and Resilience in Family Caregivers of Cancer-Affected Children: A Meta-Analysis of Randomized Controlled Trials

BACKGROUND

The diagnosis of pediatric cancer is a major shock to family caregivers, and posttraumatic stress symptoms (PTSSs) emerge as the most prevalent adverse psychological outcomes. However, not all family caregivers have sufficient resilience to cope with these challenges; thus, supportive care interventions are necessary. These interventions, which include psychosocial support, education, and other forms of assistance, are designed to enhance the well-being of those affected by disease. In the past few years, more research has been delving into supportive care interventions for family caregivers of cancer-affected children, yet there is still a variance in the results.

OBJECTIVE

To investigate the impacts of supportive care interventions on PTSSs and resilience in family caregivers of cancer-affected children, also focusing on the impacts of prerecruitment time to diagnosis, duration, type of intervention, and recruitment area on the outcomes.

METHODS

Nine databases (Cochrane Library, Ovid MEDLINE, CINAHL Plus with Full Text, Embase, CNKI, Sinomed, WANFANG, VIP, and Web of Science) were searched from their inception to February 21, 2024. The revised Cochrane Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method were used to evaluate the quality of evidence. To gauge the effectiveness of the interventions, we computed the standard mean difference (SMD) and the 95% confidence interval (CI) utilizing StataCorp (version 16.0). Sensitivity analysis and Egger's test were also conducted.

RESULTS

Supportive care interventions significantly improved the PTSSs (SMD = -0.86, 95% CI [-1.39, -0.33], p < 0.01, I2 = 94.95%) and resilience (SMD = 0.85, 95% CI [0.26, 1.44], p < 0.01, I2 = 88.3%) among family caregivers of cancer-affected children. Subgroup analyses revealed that early interventions for family caregivers after the diagnosis of children and the short-term interventions were associated with improvements in their PTSS and resilience. Moreover, cognitive behavioral interventions were the most common type of interventions and were effective in supporting family caregivers. Additionally, supportive care interventions did not improve PTSSs among family caregivers in middle-income countries.

LINKING EVIDENCE TO ACTION

Supportive care interventions have demonstrated efficacy in improving PTSSs and resilience among family caregivers of cancer-affected children. This research proved the imperative of providing prompt supportive care to family caregivers early after the pediatric cancer diagnosis. Additionally, it is also necessary to further study and explore the optimal way to combine different intervention components based on caregivers' need and to develop regionally adapted and culturally sensitive supportive care interventions to better improve health outcomes for family caregivers.

Parental Psychological Adjustment in Pediatric Acute Lymphoblastic Leukemia: The Mediating Role of Family Functioning and Resilience

Background/Objectives: Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer, with intense treatments affecting both children and their families. Limited information is available on parental distress and psychological well-being during the first treatment year, with most studies focusing on individuals rather than the family system. This study explores longitudinal changes in parental distress (psychological morbidity and traumatic stress symptoms), coping strategies, family resilience and functioning, and psychological well-being. The study also examines the mediating roles of family resilience, family functioning, and coping strategies in the relationships between parental distress and psychological well-being. Methods: A prospective study was conducted with 46 parents of children newly diagnosed with ALL, assessing parental distress, family functioning and resilience, coping, and psychological well-being across three treatment phases: consolidation (T0), delayed intensification (T1), and maintenance (T2). Results: Parental distress and family resilience significantly decreased from T0 to T2, while parental coping improved over time. Family functioning deteriorated from T0 to T1, stabilizing thereafter. Psychological well-being followed a non-linear trajectory, initially declining from T0 to T1 and improving from T1 to T2. Mediation analyses revealed that family resilience and family functioning partially mediated the relationships between parental distress and psychological well-being. Parental coping did not emerge as a mediator. Conclusions: Parental psychological adjustment in the context of ALL is dynamic and influenced by individual and family factors. Interventions that strengthen family functioning and resilience are crucial for supporting parental psychological well-being during treatment. A family-centered approach in healthcare delivery is essential to address individual and systemic challenges.

Pediatric Post-Intensive Care Syndrome and Current Therapeutic Options

Post-intensive care syndrome (PICS) impacts most pediatric critical care survivors. PICS spans physical, cognitive, emotional, and social health domains and is increasingly recognized in survivorship literature. Children pose unique challenges in identifying and treating PICS given the inherent population heterogeneity in pediatric samples with biological differences across ages and neurodevelopmental stages, unique disease pathophysiology, strong environmental influences on disease and recovery, and lack of standardized measurements to identify morbidities or track response to intervention. Emerging literature and the recent development of specialized multidisciplinary clinics highlight opportunities for intervention across PICS domains in inpatient and outpatient settings.

When care hurts: parents' experiences of caring for a child with epidermolysis bullosa

BACKGROUND

Epidermolysis bullosa (EB) comprises a group of genetically and clinically heterogeneous diseases characterized by skin fragility and blistering. EB is incurable, and treatment consists of preventing blisters in addition to painful and time consuming skin care, often performed by the parents, in addition to monitoring other symptoms in cases of severe EB.

RESULTS

The purpose of this study was to explore parental experiences of caring for a child with EB. Data were collected from semi-structured interviews, and analyzed through reflexive thematic analysis. The sample consisted of 15 parents. Our analysis revealed three main themes: Becoming a self-taught provider of home-based skin care; Balancing roles; and Ahead of every challenge. The results indicate aspects of caring for a child with EB that may be under-recognized by healthcare professionals (HCPs) and allied caretakers. Examples of this was extensive home care, learning skin care through trial-and-error, tension between illness-demands and the child's psychological needs, and parents being gatekeepers of their child's well-being.

CONCLUSIONS

Caring for a child with EB may imply practical and emotionally demanding tasks for the parents, and possible unmet healthcare needs. It is important that HCPs recognize and understand the potential burden of extensive home care these parents experience as part of providing for their child with EB and the family.

Child Maltreatment and Medical Traumatic Stress-A Double-Edged Sword

BACKGROUND/OBJECTIVES

Medical procedures can be a traumatic event for both children and their parents. Children who have experienced maltreatment or early traumatic experiences are at a higher risk for various emotional, behavioral, and health issues, including declining mental health. This may include experiencing heightened distress following medical procedures. The goal of this paper is to investigate the risk of distress symptoms following medical procedures for children with a history of child maltreatment vs. controls.

METHODS

A prospective study of 219 parents and children hospitalized in a pediatric surgical ward was conducted, with participants divided into study and control groups based on their reports of early traumatic experiences. Questionnaires measuring psychological distress were administered before the medical procedure and 3-5 months after discharge.

RESULTS

Children from the study group displayed significantly more distress symptoms before and after the procedure, with a substantial post-procedure increase. Parents of children who endured prior trauma and child maltreatment also exhibited elevated pre-procedure distress. Prior trauma and child maltreatment independently contributed to heightened medical distress. Post-procedure child distress was influenced by the early traumatic events and also by family support, socioeconomic status, and parental procedure-related post-traumatic stress symptoms.

CONCLUSIONS

Children with a history of child maltreatment and trauma show an increased chance of psychological distress following medical procedures. Medical teams should be aware of this heightened risk and provide appropriate support.

How to meet coping strategies and preferences of children during invasive medical procedures: perspectives of healthcare professionals

Children with negative procedural experiences have an increased risk of fear and distress, with psychological consequences for subsequent procedures and future healthcare behaviors. Gaining control and feeling trust are important aspects for children to decrease fear. To enable professionals providing personal care during medical procedures, a systematic, evidence-based approach that supports children in expressing their preferences is needed. This study will gain insight into the experiences and needs of professionals involved in small invasive medical procedures to meet the coping strategies and preferences of children undergoing these procedures. A qualitative design was used to gain insight into professionals' perspectives. Data were collected through online focus groups with various professionals involved in medical procedures, such as anesthetists, laboratory staff, nurses, and pediatricians. Five interdisciplinary focus groups, with a total of 32 participants, were held. One overarching theme was revealed: "Balancing between different actors within the context of the hospital." Professionals reported they had to deal with different actors during a medical procedure: the child, the parent, the colleague, and themselves. Each actor had its own interests. They were aware of the child and parents' priority to gain control and feel trust. Nevertheless, they perceive organizational and personal aspects that hinder addressing these needs.

CONCLUSION

To provide personalized care, professionals experience balancing between the needs and interests of diverse actors during medical procedures. The findings underscore the importance of a policy supporting HCPs in integrating patient-centered care into practice through practical tools and training initiatives such as scenario training.

WHAT IS KNOWN

• Unresolved pain and stress arising from medical procedures can have significant short- and long-term impacts on children. Empowering children to gain control and fostering a sense of trust are crucial factors in reducing fear associated with medical procedures. • Children and parents expect to receive child-tailored care from professionals including respect for their own, unique needs, and boundaries. Professionals should build trustful relationships and provide appropriately tailored autonomy around medical procedures.

WHAT IS NEW

• Healthcare professionals vary in their awareness of children's needs during a medical procedure. Beside this, the organizational dynamics of the hospital, along with the presence of actors such as the child, parent, colleague, and oneself, collectively influence the conduct of medical procedures. • Providing person-centered care during medical procedures can present challenges. The results highlight the significance of a policy to assist healthcare professionals in incorporating patient-centered care into their practice through practical tools and a culture of self-reflections regarding patient-centered values.

Examining the psychometric properties of the CEFIS-AYA using item response theory

OBJECTIVE

The COVID-19 Exposure and Family Impact Scale, Adolescent and Young Adult Version (CEFIS-AYA; Schwartz, L. A., Lewis, A. M., Alderfer, M. A., Vega, G., Barakat, L. P., King-Dowling, S., Psihogios, A. M., Canter, K. S., Crosby, L., Arasteh, K., Enlow, P., Hildenbrand, A. K., Kassam-Adams, N., Pai, A., Phan, T. L., Price, J., Schultz, C. L., Sood, E., Wood, J., & Kazak, A. (2022). COVID-19 exposure and family impact scales for adolescents and young adults. Journal of Pediatric Psychology, 47, 631-640. https://doi.org/10.1093/jpepsy/jsac036) was developed to assess the pandemic's effects on adolescents and young adults (AYA). Via principal component analysis, measure developers examined the structure and reliability of the CEFIS-AYA and identified seven exposure and five impact components. This study built upon prior work through use of item response theory (IRT) models to characterize the dimensionality of the CEFIS-AYA, determine the strength of relations between items and underlying trait(s), and examine associations between trait scores and pandemic-related distress.

METHODS

This was a secondary analysis of data collected between July 2020 and July 2021 from three studies of emerging adults (ages 18-29; N = 834).

RESULTS

The CEFIS-AYA structure was multidimensional, with the strongest support for five traits. Trait 1 represented pandemic impact on social/emotional functioning and self-care. Trait 2 reflected other pandemic disruptions. Trait 3 represented pandemic disruptions to education and/or other milestones. Trait 4 represented pandemic impact on physical well-being. Trait 5 assessed pandemic disruptions to work/financial circumstances. Item loadings and parameters indicated variability in how consistently trait level was associated with item endorsement. Trait scores did not predict distress, except that increases in Trait 3 were associated with lower distress.

CONCLUSIONS

The present study examined the psychometric properties of the CEFIS-AYA among emerging adults using a statistical framework better suited for modeling categorical data. The identified dimensional structure was relatively consistent with the initial psychometric evaluation of the CEFIS-AYA, albeit more parsimonious. However, replication is critical in light of sample demographic characteristics.

Assessment of Psychological Impact among Hospitalized Children; Single Centre Study

Background: The goal of the contemporary hospital setting is to give patients suffering from a range of diseases a secure and therapeutic space. Aim: Psychosocial and mental health assessment among hospitalized children between 7 to 12 years of age. Methods: This Cross-Sectional Study was carried out at the Children's Hospital Faculty of Medicine for 1-year duration. Results: Higher statistically significant positive results were found in cases than in control regarding all Vanderbilt subscales except in the conduct subscale. Higher results were found in chronic cases than control in all subscales except for oppositional defiant disorder results. Conclusion: Hospitalized Children, due to chronic or acute conditions, are at a higher risk for Psychosocial and mental health disorders such as depression, anxiety, ADHD, PTSD, and pain in comparison with healthy children.

Validation of the Abbreviated PTSD Checklist-Civilian as a Traumatic Stress Screener for Parents of Children With Cancer

Background: Researchers and clinicians often use the six-item abbreviated Posttraumatic Stress Disorder Checklist-Civilian (PCL-6) for screening; however, the PCL-6 has not been validated for parents of children with cancer. A valid and reliable short screener like the PCL-6 would allow bedside and/or advanced practice nurses to quickly screen parents for traumatic stress and expedite referrals for support services. Method: This study used data collected during a multisite trial examining an intervention for children with cancer and their parents. This dataset included parental self-report measures of traumatic stress (PCL-6; Impact of Events Scale-Revised [IES-R]), mood disturbance (Profile of Mood States-Short Form [POMS-SF]), and wellbeing (Index of Wellbeing [IWB]). The sample included 136 parents of children (3-8 years old) undergoing cancer treatment at four hospitals. Analysis: For construct validity, we calculated Spearman's correlation coefficient using baseline scores of the PCL-6 with baseline scores for the IES-R, POMS-SF, and IWB. For internal consistency, we calculated Cronbach's alpha using the scores of each of the six items of the PCL-6 for all parent/caregiver participants at baseline. Results: Results indicate good convergent construct validity, reasonable divergent construct validity, and good internal consistency.

Analysis of the survival journey and post-traumatic growth process of children and their families following paediatric intensive care unit admission: A grounded theory study

OBJECTIVES

Advances in critical care technology have lowered mortality rates among critically ill individuals. Nonetheless, survivors and their families may develop new physical, mental, cognitive, and social challenges due to paediatric intensive care unit (PICU) treatments, impacting their quality of life. The aim of this study was to investigate the survival journey and post-traumatic growth process of children and their families following PICU admission within the Chinese cultural context.

METHODS

Twenty-six children who have been or are currently admitted to the PICU, alongside their parents and three PICU nurses, were chosen through purposive and theoretical sampling. Data collection involved face-to-face interviews and observations, with data analysis conducted through continuous comparison, open coding, and selective coding techniques.

FINDINGS

A model outlining the survival journey and post-traumatic growth process of critically ill children and their families post PICU admission has been established. This model encompasses two central trajectories: an upward trajectory consisting of confusion, charging, action, and sublimation phases and a downward trajectory comprising confusion, doubt and fear, inhibition (including confrontation and avoidance), and drowning phases.

CONCLUSIONS

Critically ill children and their families encounter diverse survival experiences and psychological journeys following traumatic events in the PICU. The survival experience has alternative upwards or downwards trajectories that are flexible/adaptable. Hence, offering timely psychological support can alter their developmental trajectories and foster post-traumatic growth.

Association of Family-Centered Care With Psychological Distress Among Caregivers of Children With Cancer at a Tertiary-Level Hospital in Ethiopia: Cross-Sectional Study

BACKGROUND

Psychological distress (PD) is a common mental health problem faced by caregivers of children with cancer. The involvement of families in childcare was found to be associated with lower levels of distress.

OBJECTIVE

The study aims to determine the associations between family-centered care (FCC) and PD among caregivers of children with cancer receiving treatment at Tikur Anbessa Specialized Hospital (TASH), Ethiopia.

METHODS

An institution-based, cross-sectional study was conducted from June to December 2022. Caregivers of children with cancer aged 0-14 years receiving cancer treatment at the pediatric oncology unit completed a face-to-face, interviewer-administered, structured questionnaire during a routine inpatient or outpatient visit. The questionnaire included questions on the characteristics of the child and caregiver, PD (measured by the Kessler Psychological Distress Scale [K10]), FCC (measured by the Measure of Processes of Care [MPOC-20]), and social support (measured by the Oslo-3 Social Support Scale [OSS-3]). Data were collected using the Kobo toolbox and exported to SPSS (version 26; IBM Corp) for cleaning and analysis. A multivariable logistic regression model was used. An odds ratio with a 95% CI was calculated, and a P value less than .05 was considered statistically significant.

RESULTS

A total of 384 caregivers of children with cancer participated in the study. The total PD score ranged from 10 to 50, with a mean score of 17.30 (SD 8.96; 95% CI 16.84-18.60). The proportion of caregivers found to have mild, moderate, and severe levels of PD was 43 (11.2%), 35 (9.1%), and 51 (13.3%), respectively. The overall prevalence of mild to severe PD symptoms was 33.6% (95% CI 28.9%-38.3%). A statistically significant negative association was found between FCC and PD (adjusted odds ratio [AOR] 0.68, 95% CI 0.53-0.86). In addition, having no formal education (AOR 2.87, 95% CI 1.28-6.45), having a history of relapse (AOR 3.24, 95% CI 1.17-9.02), beginning cancer treatment at TASH (AOR 2.82, 95% CI 1.4-4.85), beginning treatment within the last 3 months (AOR 3.99, 95% CI 1.73-9.23), and beginning treatment within the last 4 to 18 months (AOR 2.68, 95% CI 1.25-5.76) were significantly associated with higher level of PD.

CONCLUSIONS

A total of 1 in 3 caregivers have reported PD. FCC was found to be protective of PD. The finding of this study suggests the need for FCC intervention to improve the mental health condition of caregivers. In addition, the intervention needs to consider the educational status of the caregivers, the time since the cancer diagnosis, and the history of relapse.

Unveiling the Psychosocial Impact: Pediatric Organ Transplantation and Posttraumatic Stress Disorders: A Systematic Review

OBJECTIVES

This systematic review delves into the intricate relationship between pediatric organ transplantation and posttraumatic stress disorder, shedding light on interventions crucial for addressing the psychosocial well-being of young transplant recipients. This review of the multifaceted nature of posttraumatic stress disorder in the context of pediatric transplantation examined the effects of transplant on the mental health of recipients. We aimed to review studies on posttraumatic stress disorder among pediatric patients who have had or were waiting for organ transplant and to systematically analyze the results of these studies.

MATERIALS AND METHODS

This systematic review was conducted by retrospectively searching PubMed, Scopus, ScienceDirect, Web of Science, and Cochrane electronic databases using the keywords "pediatric kidney transplantation," or "pediatric liver transplantation," or "pediatric heart transplantation," and "posttraumatic stress disorders." Descriptive studies were included if they met the association between posttraumatic stress disorder and pediatric organ transplant recipients.

RESULTS

From 267 articles, 5 articles were included in the systematic review. Posttraumatic stress disorder was shown to be more common in pediatric transplant recipients. Rate of low-level posttraumatic stress disorder ranged from 9.2% to 85.2%, whereas rate of high-level posttraumatic stress disorder ranged from 13.1% to 22.6%.

CONCLUSIONS

This review highlighted the imperative need to recognize and address the psychosocial effects of pediatric organ transplantation, with a specific focus on posttraumatic stress disorder. By incorporating comprehensive mental health care into the transplant journey, psychiatric nurses can contribute to the overall well-being of young recipients and their families, ensuring that the transformative power of organ transplant extends beyond mere physical survival to encompass psychological resilience and recovery. By acknowledging and addressing the emotional dimensions of the transplant journey, nurses can contribute to the well-being of recipients, ensuring a more holistic and resilient recovery.

Mental health screening in pediatric lower limb deficiency population

BACKGROUND

Youth with lower limb deficiency (LLD) may be at increased risk for mental health difficulties. However, guidelines around psychosocial screening are not well established.

OBJECTIVE

To describe the implementation and results of a mental health screening process in a multidisciplinary prosthetics clinic.

DESIGN

Survey.

SETTING

Outpatient specialty care clinic located within a children's hospital.

PATIENTS

All patients ages 0-18 years with LLD seen at a monthly multidisciplinary prosthetics clinic between September 2019 and January 2023 (n = 75).

INTERVENTIONS

Not applicable.

MAIN OUTCOMES MEASURES

Quality of life was measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric proxy survey. Psychological functioning was measured using the Strengths and Difficulties Questionnaire (SDQ).

RESULTS

Descriptive statistics were used to determine the proportion of patients who endorsed clinically significant concerns. Of the 75 clinic visits during the study time frame, the psychosocial screeners were completed at 38 (51%). A total of 25 unique patients completed the screeners; 12 patients completed the screener more than once. The most commonly endorsed concerns on the PROMIS were issues with physical mobility (65%) and upper extremity function (40%). The SDQ revealed that a majority (62.5%) of the screened patients had an overall score above the clinical cutoff, indicating psychosocial distress in more than one area. The most commonly reported mental health concern was peer problems (62.5%). Post hoc analysis of repeat screenings indicated that most problems identified during the first screening persisted at follow-up screenings.

CONCLUSIONS

Clinically significant psychological concerns were common among the sample, indicating the need to address this aspect of patients' well-being. Preliminary data on repeat screenings suggest that clinically significant concerns may not self-resolve. Routine psychosocial screening is critical for early identification of mental health problems and timely referral to evidence-based psychological interventions.

Medical traumatic stress: Integrating evidence-based clinical applications from health and trauma psychology

Medical events in both childhood and adulthood, including components of the illness or injury and subsequent medical intervention, recovery, and disability, are increasingly being recognized as potentially traumatic. There has been an increased focus on scholarly work related to medical trauma and medically induced posttraumatic stress disorder (PTSD). Existing evidence suggests that trauma-focused treatment can promote both physical and psychological recovery. However, there continues to be a dearth of clinical guidance on how to (a) best identify and treat prior trauma exposure that complicates adjustment to illness and increases the risk for medically induced PTSD and (b) address medically induced PTSD while concurrently targeting health-related concerns (e.g., pain, adjustment to illness, acquired disability) that may negatively impact recovery. Originally presented as a premeeting institute at the 2023 Annual Meeting of the International Society for Traumatic Stress Studies, this paper describes the biopsychosocial impacts of medical trauma on adults and considerations for assessment and intervention in both traditional trauma and integrated care settings. This includes clinical applications, including assessment, case conceptualization, and health and rehabilitation interventions, that can promote health-related adjustment and coping within the context of trauma-focused treatment.

Prevalence and associated factors of post-traumatic stress symptoms in hospitalised children with cancer and their parents in South China: A multicentred cross-sectional study

Objective

This study aimed to examine the prevalence and risk factors of Post-Traumatic Stress Symptoms (PTSS) in hospitalised children with cancer and their parents and explore the PTSS correlation between parents and children.

Methods

Data were collected using the University of California at Los Angeles (UCLA) Posttraumatic Stress Disorder-Reaction Index for DSM-IV and the Chinese version of the Impact of Event Scale-Revised Questionnaire.

Results

Out of 203 families with hospitalised children with cancer, 77.3% of parents and 7.9% of children experienced PTSS. Time since diagnosis of less than 3 months (β = -0.063, P < 0.001), actively seeking financial help (β = -0.190, P = 0.031), children living in rural areas (β = 0.166, P = 0.023) and having a daughter with cancer (β = 0.135, P = 0.040) were risk factors for parental PTSS. At the early stages of diagnosis (β = 0.118, P = 0.017), recurrence (β = 0.140, P = 0.042) and low monthly household income (β = -0.283, P = 0.003) were risk factors for children's PTSS. No significant correlation between parental PTSS and children's PTSS (r = -0.06, P > 0.05).

Conclusions

The hospitalised children with cancer had a low prevalence of PTSS, but their parents' PTSS prevalence was high. No significant correlation was observed between parental and children's PTSS. Attention should be given to the mental health of families with hospitalised children with cancer. Early psychosocial support should be provided, especially to families with poor economic situations and a newly diagnosed or relapsed child.

Common mental health conditions and considerations in pediatric chronic kidney disease

The mental health of youth with chronic kidney disease (CKD) has been increasingly recognized as an area of clinical need. The development of mental health concerns is influenced by a range of physiological, psychological, and environmental factors. Some of these factors are common across child development, but some are more unique to youth with CKD. Mental health concerns are associated with increased risk for a range of poor medical outcomes (e.g., adherence, risk of transplant rejection) and quality of life concerns. In this educational review, we discuss the current evidence base regarding the development of mental health concerns in youth with CKD. The review covers multiple domains including mood and anxiety disorders, traumatic stress, and neurodevelopmental disorders. Estimated prevalence and hypothesized risk factors are outlined, and the potential impact of mental health on medical care and functional outcomes are reviewed. Finally, we introduce options for intervention to support positive mental health and offer recommendations for building access to mental health care and improving the mental health education/training of medical professionals.

The factors associated with paediatric medical post-traumatic stress: A systematic review

We examined and synthesised existing literature on factors associated with paediatric medical-related posttraumatic stress among children and their parents. Children experiencing a broad spectrum of medical conditions, diseases and injuries were of interest. A search of relevant literature concerning PMTS in children and their parents, as well as factors associated with PMTS, was conducted using Medline, PubMed and Scopus. Only studies published in English between January 2018 and November 2023 were included. Twelve articles met inclusion criteria. A broad range of correlates of PMTS were identified for children and parents, which were thematically organised into six key areas: hospital practices and environments; the parent-child relationship; parental mental wellbeing; psychological factors; sociodemographic factors; and the physical consequences of the condition. Bearing in mind constraints on causal inference due to the design of the included studies, knowledge of the factors associated with PMTS may enable clinicians to identify at-risk children and parents, with a view to intervention.

Integrated Psychological Services in Pediatric Oncology: Caregiver Perspectives at Diagnosis

BACKGROUND/OBJECTIVES

Pediatric oncology patients and families are at risk for increased distress at diagnosis. The New Oncology Program in Psychology (NOPP) aligns psychological care with the established standards of care at diagnosis. This project aimed to evaluate NOPP and understand the differences between caregivers' perceptions of feeling informed and prepared to navigate psychosocial concerns for those who did and did not receive psychological services at diagnosis.

METHODS

A survey was administered via a virtual platform. Frequency analyses summarize caregiver experiences and concerns. Mann-Whitney U tests assess the differences in caregiver knowledge and preparedness between caregivers who did and did not receive psychological services.

RESULTS

Caregivers reported difficult emotions at diagnosis and expressed concern for the impact of diagnosis and treatment across broad domains of patient functioning. Caregivers of patients who received psychology consultation felt more informed about difficult emotions and how these may change over time. They felt more prepared and equipped with strategies to manage difficult emotions. Caregivers of patients who completed a cognitive assessment also felt more informed and prepared regarding the potential effects of the diagnosis and treatment on patient cognitive/academic functioning.

CONCLUSIONS

Psychological services were associated with caregivers' positive perceptions surrounding the management of difficult emotions and with their knowledge regarding the cognitive/academic impact. The results inform the ongoing modification of NOPP.

Psychological Health of the Adolescent Transplant Recipient

BACKGROUND

Solid organ transplant recipients experience a period of unique vulnerability during adolescence, when normative developmental changes intersect with health-related variables to influence psychological health.

METHODS

This article builds on previous reviews of psychological health in solid organ transplant recipients and proposes opportunities for clinical intervention during adolescence.

RESULTS

Transplant recipients often experience neurocognitive changes, particularly with respect to executive functions, that impact health management tasks and autonomous care. Recipients should be monitored for the development of anxiety, depression, and posttraumatic stress symptoms during adolescence, which in turn can negatively impact adherence to immunosuppression. Recent research in posttraumatic growth and resiliency factors may represent a promising avenue of intervention, leveraging normative developmental processes during this time period.

CONCLUSIONS

As pediatric transplant providers, adolescence represents a developmental period for targeted interventions to foster adjustment and adherence and promote a successful transition to adult care.

Clinical Education: Addressing Prior Trauma and Its Impacts in Medical Settings

Prior trauma exposure significantly increases the risk of developing PTSD following medical stressors and may contribute to the development of medically induced PTSD. However, healthcare systems often overlook the interaction between prior trauma and current medical stressors, contributing to negative psychosocial and health-related outcomes for patients. Integration of both trauma-informed and trauma-focused practices into psychosocial programming in medical settings may be key to effectively addressing the needs of trauma-exposed patients. Yet, there is a lack of practical guidance on how clinical psychologists in medical settings can respond to trauma's effects in routine clinical practice. This paper aims to provide an overview of trauma-focused theory, assessment, and treatment considerations within medical settings, emphasizing the importance of incorporating trauma-focused intervention into integrated psychosocial programming to address prior trauma and its impacts on care in order to improve patient outcomes.

Investigation of the Role of Cognitive Emotion Regulation Strategies on Depressive Symptoms in Mothers of Children Given A Diagnosis of Cancer

BACKGROUND

The role of cognitive emotion regulation on depressive symptoms in mothers of children given a diagnosis of cancer is not yet well understood.

OBJECTIVE

The aim of this study was to investigate the effect of cognitive emotion regulation strategies on depressive symptoms in mothers of children with cancer.

METHODS

This study was conducted with a cross-sectional correlational design. The study included 129 participants. Participants completed the sociodemographic characteristics form, Beck Depression Inventory, and Cognitive Emotion Regulation Questionnaire. Hierarchical regression analysis was performed to determine the effect of cognitive emotion regulation strategies on depressive symptoms.

RESULTS

Hierarchical multiple regression revealed that depressive symptoms were independently associated with self-blame (β = 0.279, P = .001) and catastrophizing (β = 0.244, P = .003) after controlling for sociodemographic characteristics of mothers. Emotion regulation strategies explained approximately 39.9% of the variance in depressive symptoms.

CONCLUSION

The results of the study indicate that more frequent engagement of self-blame and catastrophizing were associated with more depressive symptoms.

IMPLICATIONS FOR PRACTICE

Nurses should screen mothers of children with cancer for depressive symptoms and identify mothers of children with cancer who use maladaptive cognitive emotion regulation strategies, such as self-blame and catastrophizing, as a risk group. Furthermore, nurses need to be involved in developing psychosocial interventions including adaptive cognitive emotion regulation strategies to help mothers coping with adverse emotions during a childhood cancer journey.

Implementation outcomes of a digital, trauma-informed care, educational intervention targeting health professionals in a paediatric burns setting: A mixed methods process evaluation

Trauma-informed care practices are associated with a culture of safety following traumatic experiences, including medical trauma. An interactive, web-based training package ('Responsive CARE') was developed for voluntary uptake by paediatric burns health professionals to increase staff knowledge about trauma-informed practice. This paper reports on a mixed methods process evaluation conducted alongside a preliminary effectiveness study of 'Responsive CARE'. The process evaluation was conducted using The Consolidated Framework for Implementation Research (CFIR) and a logic model, to examine feasibility of both the intervention and implementation strategy. Health practitioners (including senior managers) delivering care to children and caregivers attending an outpatient burns service were eligible to enrol in 'Responsive CARE'. Qualitative interview data and quantitative metadata were used to evaluate the implementation outcomes (adoption, acceptability, fidelity, feasibility and preliminary effectiveness). Children and caregivers attending an outpatient service for change of burn wound dressing or burn scar management during the 3-month control or 3-month intervention period were eligible to enrol in the effectiveness study. The impact on child pain and distress, as well as cost, was investigated using a pretest-posttest design. Thirteen (from anticipated 50 enrolled) health professionals (all female) with mean 10 years (SD=11) of experience with paediatric burns hospital-based outpatient care completed an average of 65% (range 36% to 88%) of available content. Twenty-five semi-structured interviews were completed with health practitioners (21 female) and with 14 caregivers (11 female). Four themes were identified as influencing feasibility and acceptability of the intervention: 1) Keeping a trauma-informed lens; 2) Ways of incorporating trauma-informed care; 3) Working within system constraints; and 4) Being trauma-informed. Preliminary effectiveness data included 177 participants (median age 2 years, and median total body surface area burn 1%). Causal assumptions within the logic model were unable to be fully tested, secondary to lower-than-expected adoption and fidelity. We found no significant difference for pain, distress and per-patient hospital care costs between groups (pre- and post-intervention). Future implementation strategies should include organizational support to keep a trauma-informed lens and to incorporate trauma-informed principles within a medical model of care. Despite efforts to co-design a staff education intervention and implementation approach focused on stakeholder engagement, adaptations are indicated to both the intervention and implementation strategies to promote uptake highlighting the complexity of changing clinician behaviours.

The effect of drama on psychosocial problems and emotional states of hospitalized children with cancer

BACKGROUND AND PURPOSE

Hospitalization is a traumatic experience for children. Especially in the case of childhood cancers that require long-term hospitalization, children need psychosocial support. The study aimed to examine the effectiveness of drama in reducing psychosocial problems in hospitalized paediatric children diagnosed with cancer.

METHODS

The study used a mixed method approach, combining both qualitative and quantitative methods with a single group. Drama sessions prepared according to the Tasks and Skills Model were used to support their psychosocial conditions. The Facial Expression Form, The Assessment Scale for Psychosocial Symptoms in Hospitalized Children, and the Drawing and Writing Technique were used before and after the drama sessions.

RESULTS

This study differs from others in its use of drama intervention to reduce psychosocial problems in children undergoing cancer treatment. As a result of the study, it was found that there was a decrease in anxiety, hopelessness, anger-aggression and communication difficulties among psychosocial problems and a change in mood towards feeling happy. The study suggests that drama sessions were effective in relieving emotional distress in paediatric cancer patients.

CONCLUSION

The study suggests that drama sessions were effective in relieving emotional distress in paediatric cancer patients.

PRACTICE IMPLICATIONS

Applying drama to children undergoing long-term hospital treatment can help alleviate psychosocial problems by reducing stress, emotional suppression, and compensating for trauma.

Post-traumatic stress trajectories of children and their parents over the year following intensive care discharge: A secondary analysis

BACKGROUND

New research in the field of psychological trauma has emphasized (a) the heterogeneity of psychological reactions after traumatic events and (b) the existence of distinct symptom trajectories.

AIMS

In this study, existing data on post-traumatic stress disorder (PTSD) symptoms in 66 parent-child dyads were re-examined in the light of this literature in order to establish whether a similar pattern of symptom trajectories also applies to this population.

STUDY DESIGN

A prospective observational cohort study. Participants' PTSD symptoms were assessed 3 and 12 months after discharge from a paediatric intensive care unit (PICU), using a short form of the Davidson Trauma Scale with parents and the Child Revised Impact of Events Scale with children aged 7-17 years.

RESULTS

Results confirmed that the majority of children (58%) and parents (46%) exhibited a 'Resilient' PTSD trajectory over the year, in the sense that their scores remained in the non-clinical range at both timepoints. Children displaying a 'Resilient' trajectory were more likely to have a parent who also displayed a 'Resilient' trajectory (p = .018). However, there was also evidence of a 'Recovery' trajectory in a significant minority in this sample and over 1 in 4 children and parents exhibited a 'Chronic' or 'Delayed' symptom trajectory.

CONCLUSIONS

Although average PTSD scores reduced over time in this sample and 'Resilient' trajectories were common, a significant proportion of children and parents exhibited 'Chronic' and 'Delayed' symptom trajectories.

RELEVANCE TO CLINICAL PRACTICE

These results suggest that, although the majority do well, a significant number of children and family members may develop chronic or delayed symptoms of PTSD in the year following PICU discharge. The monitoring of individual family members' symptoms beyond 3 months post-discharge may help to determine those who might most benefit from further support.

Addressing Obesity Care in Children With Chronic Health Conditions

Obesity care in pediatric populations has entered a new era. The recent discovery of molecular genetic causes for abnormal weight gain, development of antiobesity medications, mounting data on the robust efficacy and favorable safety profile of bariatric surgery, and implementation of clinical guidelines fill a long-standing gap in the care of children affected by obesity, one of the most challenging pediatric diseases. However, these novel clinical approaches do not appear to have reached every individual who is in need, particularly children with chronic health conditions (CHCs), raising important questions for equitable medical care. In this study, we discuss specific etiologies, challenges, and ideas for future directions in diagnosing and managing obesity in children with CHCs. Although this article is not intended to be utilized as clinical guidelines, it underscores potential practical solutions for the current issues.

Profiles of Posttraumatic Growth and Posttraumatic Stress Symptoms in Childhood Cancer Survivors

The experience of childhood cancer (CC) could be a traumatic event that produces long-term emotional responses such as posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) in survivors. The relationship between both PTSS and PTG is not clear in CC survivors. Assessing challenges to core beliefs and rumination could give information regarding the different paths that lead to traumatic responses. Thus, this study aims to identify childhood cancer survivors' profiles from PTSS and PTG measures and to examine the pathways of relationships between PTSS and PTG, rumination, and challenge to core belief. Sixty-two CC survivors completed surveys on their childhood cancer experience, PTSS, PTG, challenge to core beliefs, and rumination. High PTG scores among childhood cancer survivors (Cluster 1), High PTSS scores among childhood cancer survivors (Cluster 2), and Childhood cancer survivors without changes (Cluster 3). Network analysis found that the challenge to core beliefs is the central point in the relationship between the variables, in a direct and positive relationship with PTG. We found an indirect path from challenge to core beliefs to PTSS, mediated by intrusive and deliberative ruminations. The combined findings suggested that there are different profiles related to trauma in CC survivors and the relationship between PTSS and PTG is mediated by the challenge to core beliefs and deliberative and intrusive rumination.

Shifting perspectives and transformative change: Parent perspectives of an active music engagement intervention for themselves and their child with cancer

BACKGROUND

Children with cancer (ages 3-8 years) and their parents experience significant, interrelated distress associated with cancer treatment. Active music engagement (AME) uses music-based play and shared music-making to mitigate this distress. To advance our understanding about how AME works and its essential features, we interviewed parents who received the AME intervention as part of a multi-site mechanistic trial. The purpose of this qualitative analysis was to describe parents' experiences of AME for themselves and their child and to better understand how the intervention worked to lower parent-child distress.

PROCEDURE

We conducted a total of 43 interviews with parents/caregivers, and purposively analyzed all interviews from underrepresented groups based on race/ethnicity and parent role. We used thematic analysis and achieved thematic redundancy after analyzing 28 interviews.

RESULTS

The following statement summarizes resulting themes: Music therapists skillfully use AME to create a safe and healthy space (Theme 1), where parents/children have transformative experiences (Theme 2) that lead to learning and enactment (Theme 3) of new skills that counteract suffering (Theme 4) through empowerment, connectedness, and sustained relief.

CONCLUSIONS

This work elucidates how AME works to counteract stressful qualities of cancer treatment. As parents witnessed positive and transformative changes in their child, they experienced relief and reported shifts in their perspective about cancer treatment. This led to learning and use of music as a coping strategy that extended beyond therapist-led sessions. Accessible, music-based interventions, like AME, offer a developmentally appropriate and effective way to support parents and young children during treatment.

Exploring Factors Affecting Parental Psychological Vulnerability During Their Child's PICU Admission: A Prospective Pilot Cohort Study

INTRODUCTION

Parental psychological responses during their child's pediatric intensive care unit (PICU) admission are often overlooked. This study aimed to identify pre-existing and peri-traumatic factors explaining parental stress and anxiety during their child's PICU admission and one-month follow-up.

METHOD

A prospective pilot study included 60 PICU parents. Parental Stressors Scale and State-trait Anxiety Inventory measured stress and anxiety during PICU admission, and the State-trait Anxiety Inventory and Perceived Stress Scale at a one-month follow-up.

RESULTS

During PICU admission, parental stress correlated with age, race, and adverse childhood experiences (ACEs), anxiety was linked to income. At one-month follow-up, anxiety related to child's health worries, perceived stress was linked to parental ACEs and education. Parental ACEs predicted perceived stress (b = 0.83, p = .028). Children's diagnoses explained anxiety, particularly respiratory and cardiac diagnoses (b = -13.44, p = .023; -10.03, p = .045).

DISCUSSION

Identifying factors helps teams understand parental vulnerability and provide appropriate support.

Diabetes-Related Posttraumatic Stress Symptoms in Adolescents and Young Adults With Type 1 Diabetes: A Pilot Study

BACKGROUND

Posttraumatic stress symptoms (PTSS) may adversely affect glycemic control. Yet no studies have focused on trauma and PTSS induced by diabetes-related events in adolescents and young adults (AYA) with type 1 diabetes.

OBJECTIVE

This study explores PTSS arising from diabetes-related events (e.g., severe symptoms or emergency room visits due to complications) among AYA with type 1 diabetes.

METHODS

In this cross-sectional pilot study, self-reported measures (Posttraumatic Diagnostic Scale for DSM-5, Child Posttraumatic Stress Disorder Symptom Scale 5) were employed to assess trauma experiences and PTSS in AYA with type 1 diabetes at a pediatric diabetes clinic within a large hospital/academic medical center.

RESULTS

Fifty AYA with type 1 diabetes completed questionnaires assessing trauma and PTSS. Of the sample, 82% (n = 41) reported experiencing at least one form of general trauma (e.g., physical abuse, witnessing violence, or serious injuries). Among those who reported trauma, 22% (n = 9) indicated that the most distressing event was specifically diabetes-related. Over a quarter of participants exhibited clinically relevant levels of PTSS related to diabetes events. Females assigned at birth and those with a higher frequency of emergency room visits due to diabetes had an elevated risk of developing clinically relevant levels of diabetes-related PTSS.

CONCLUSIONS

Our results suggest that diabetes itself can serve as a traumatic stressor for some individuals. Therefore, interventions should be designed to prevent or mitigate PTSS starting from the time of diagnosis.

Co-design of a paediatric post-trauma electronic psychosocial screen

PURPOSE

To optimise care pathways and provide greater transparency of the psychosocial needs of injured children after hospital discharge by extending post-discharge psychosocial screening to children admitted with traumatic injury for ≥24 h.

DESIGN AND METHODS

This mixed-methods study used a co-design approach informed by the Experience-Based Co-design (EBCD) framework. Interviews with carers were used to evaluate experiences and generate views on psychosocial support interventions. Online surveys by international child psychologists' indicated preferences for a psychosocial screening tool, and clinician-stakeholder consensus meetings facilitated the development of an electronic post-injury psychosocial screening tool.

RESULTS

Carers found the initial year of follow-up from trauma family support services helpful, appreciating the hospital connection. Flexible follow-up timings and additional resources were mentioned, and most carers were interested in participating in an electronic screening activity to predict their child's coping after injury. Child trauma experts recommended including several screening tools, and the multidisciplinary paediatric trauma service and study investigators collaborated over a year to workshop and reach a consensus on the screening tool and follow-up process.

CONCLUSION

The multidisciplinary team co-designed an electronic psychosocial screening and follow-up process for families with children with traumatic injuries. This tool improves the visibility of injured children's psychosocial needs post-injury and potentially aids clinical targeted resource allocation for trauma family support services.

PRACTICE IMPLICATIONS

The study emphasises the significance of specialised psychosocial screening tools in paediatric nursing, especially in trauma care, for understanding patients' psychosocial needs, tailoring follow-up plans, and promoting a patient-centred approach.

Preventing Pediatric Medical Traumatic Stress in a Pediatric Urology Outpatient Setting: Application of the Pediatric Psychosocial Preventative Health Model (PPPHM)

OBJECTIVE

The objectives of this topical review are to (1) increase understanding of pediatric medical traumatic stress (PMTS) in pediatric urology populations through literature review, (2) identify a theoretical model to guide prevention of PMTS in this population, and (3) provide clinical care recommendations based on the model identified. Authors introduce a new term "uropsychology" to describe psychological practice that specializes in the treatment of urology patients.

METHODS

Pediatric uropsychologists from 5 pediatric medical care centers gathered to discuss their experience with treating PMTS in their settings and to review existing literature related to PMTS in pediatric urology, PMTS in other populations, and established models for prevention. Authors provide recommendations based on literature review for preventing PMTS in a pediatric urology population.

RESULTS

Gaps in the evidence base for preventing PMTS in this population are identified. Authors provide a series of clinical care recommendations, utilizing clinical experience, and the Pediatric Psychosocial Preventative Health Model (PPPHM) as a framework.

CONCLUSIONS

While there is limited research on PMTS in pediatric urology populations, urologic interventions can be perceived as invasive, painful, distressing, and traumatic. Application of the PPPHM can guide prevention and intervention efforts. Future research is needed to characterize PMTS in this population, evaluate the efficacy of trauma-informed prevention and intervention practices, and develop screening measures that accurately identify at-risk patients. Authors recommend intradisciplinary collaboration among uropsychologists, urology specialists, and patients and families to create formal standards of care, avenues for other future research, and equitable access to uropsychology care.

Integrated psychological care in pediatric hospital settings for children with complex chronic illness and their families: a systematic review

OBJECTIVE

To synthesize and critically evaluate evidence on the effectiveness of integrated psychological care models for children with complex chronic illness within pediatric hospital settings and provide recommendations for successful implementation.

DESIGN

Six electronic databases (Medline, Cochrane, Embase, PsycINFO, Scopus, CINAHL) were systematically searched for English language studies including families of children aged 0-17 years with complex chronic illness. Eligible studies reported on psychology or neuropsychology screening, assessment, intervention, or services provided within a pediatric hospital setting.

RESULTS

Fifteen studies were identified for review; nine assessed a psychological service, five examined psychosocial screening, and one examined a neuropsychology service. Three studies demonstrated the effectiveness of integrated psychological services in improving child or parent physical, psychological, or behavioral health outcomes. Uptake of psychosocial screening was high (84-96%), but only 25-37% of children or families identified as 'at-risk' engaged with on-site psychology services. Integrated psychological services offering consultations at the same time and location as the child's medical visit reported the highest rates of uptake (77-100%).

CONCLUSIONS

The available evidence supports co-location of child medical and psychological services. A more consistent and comprehensive approach to the assessment of patient- and caregiver-reported outcomes and implementation effectiveness is recommended.

Returning to sport after injury: the influence of injury appraisals and post-traumatic stress symptoms on adolescent risk-taking intentions post-injury

OBJECTIVE

How youth think about injury risk can affect their decisions about whether to engage in behaviors that can lead to injury. Appraisals also influence the development of post-traumatic stress symptoms (PTSS), which occur in approximately 20% of children after a medically treated injury. The current study examined how the injury appraisals of youth are associated with the development of PTSS post-skateboarding injury, and if PTSS or perceived benefits of the sport are also associated with youths' intentions to return to the sport.

METHOD

One hundred three youth who had a medically treated skateboarding injury within the last year provided survey data on injury appraisals, PTSS, the benefits of skateboarding, and intentions to return to the sport.

RESULTS

A two-stage moderated statistical mediation path model was specified. In the first stage, there was a positive relationship between pain at injury and PTSS, which was attenuated by the moderator, perceived bad luck. PTSS fully mediated the association between perceived pain at the time of injury and intentions to return to skateboarding. In the second stage of the mediation model, the moderator perceived benefits of skateboarding, reversed the negative relationship between PTSS and intentions to return to skateboarding.

CONCLUSIONS

Skateboarders are a group at risk for injury that can lead to PTSS, and they also are likely to return to the sport despite PTSS. This research identifies factors that impact the decision to return to skateboarding after injury. Limitations of the study and implications for mental health support and injury prevention are provided.

Portuguese Validation of the TAPQoL: A Health-Related Quality of Life Instrument for Children Aged 0-6 Years

In Portugal, there are few generic and specific instruments to assess health-related quality of life (HRQoL) in children, especially those of preschool age. This study aimed to adapt and validate the Portuguese version of the Preschool Children Quality of Life Questionnaire (TAPQoL) in a community and clinical sample of children aged 0-6 years. The parents of 409 healthy children and 137 children undergoing treatment for burns and acute lymphoblastic leukemia completed the TAPQoL and were assessed on psychological morbidity and family functioning. Exploratory and confirmatory factor analyses were performed, as well as analysis of the psychometric properties as shown by internal consistency measures, convergent validity, and average variance extracted. Confirmatory factor analysis confirmed an 11-factor structure with good psychometric properties. The current version of the TAPQoL is a valid and reliable instrument for assessing HRQoL in Portuguese preschool children in community and clinical settings.

Acceptability and Feasibility of Text Message Interface to Assess Parents' Real-time PICU Experiences

INTRODUCTION

Parents of children in the pediatric intensive care unit (PICU) experience substantial stress; a parent's perception of their child's illness severity, more than objective measures, predicts psychological outcomes. No tools exist to assess parents' real-time experiences. This pilot study evaluated the feasibility and acceptability of a text-based tool to measure parental experience.

METHODS

Inclusion criteria included PICU stay >48 h, physician approval, smartphone access, and English-speaking caregiver. Eligible parents received a text-based baseline survey and surveys every other day while hospitalized regarding their mood/experiences and optional open-ended questions regarding stressors. They received post-discharge follow-up surveys at 1 week and 1, 3, and 6 months. Follow-up surveys assessed mood and symptoms of depression, anxiety, and post-traumatic stress. Interviews and surveys about the interface were conducted 1 week and 3 months following discharge. Feasibility was assessed by descriptive statistics (eg, response rates), and acceptability was assessed by descriptive statistics (survey results) and thematic analyses of interviews.

RESULTS

Of 20 enrolled participants, the first 5 were excluded due to technical issues. Of the 15 included, results demonstrated feasibility and acceptability. Most participants (86%) completed all surveys during the PICU stay and continued to complete surveys at a high rate: 79%-94% 3 months post-discharge. All participants agreed that the system was easy to use and were satisfied with the system at discharge, and 91% remained satisfied 3 months post-discharge. Additionally, 76% reported comfort, and 69% reported benefit. From the interviews, participants lauded the system's convenience and applicability of content. Some proposed changes to improve ergonomics. Many suggested this interface could help teams better support families.

CONCLUSIONS

A text-based interface for measuring experience in the PICU is feasible and acceptable to parents. Further research can explore how this could identify parents most at risk of adverse psychological sequelae and lead to earlier supportive interventions.

Medical trauma in young adults with inflammatory bowel disease: The role of trauma-informed care

Medical trauma is a profound concern for those with chronic conditions like inflammatory bowel disease (IBD), especially young adults. This trauma, arising from both the disease itself and necessary medical interventions, manifests as an accumulation of traumatic experiences impacting a patient's physical and psychological well-being. The Crohn's and Colitis Young Adults Network (CCYAN) conducted a roundtable discussion involving young adult IBD patients and healthcare professionals focused on medical trauma and its implications in the treatment of young adults with IBD. This article summarizes the key insights from this discussion, including medical trauma in IBD as an accumulation of 'micro-traumas,' the impacts of such trauma and disruptions in care regardless of post-traumatic stress diagnosis, the role of adverse childhood experiences and trauma-informed care, practical strategies to cultivate trust during individual patient encounters, and recommendations for providing trauma-informed care within the clinical setting.

Emergency department clinicians' views on implementing psychosocial care following acute paediatric injury: a qualitative study

Introduction: The early post-trauma period is a key time to provide psychological support to acutely injured children. This is often when they present to emergency departments (EDs) with their families. However, there is limited understanding of the feasibility of implementing psychological support for children and their families in EDs. The aim of this study was to explore UK and Irish ED clinicians' perspectives on developing and implementing psychosocial care which educates families on their children's post-trauma psychological recovery.Methods: Semi-structured individual and group interviews were conducted with 24 UK and Irish ED clinicians recruited via a paediatric emergency research network.Results: Clinicians expressed that there is value in offering psychological support for injured children and their families; however, there are barriers which can prevent this from being effectively implemented. Namely, the prioritisation of physical health, time constraints, understaffing, and a lack of training. Therefore, a potential intervention would need to be brief and accessible, and all staff should be empowered to deliver it to all families.Conclusion: Overall, participants' views are consistent with trauma-informed approaches where a psychosocial intervention should be able to be implemented into the existing ED system and culture. These findings can inform implementation strategies and intervention development to facilitate the development and delivery of an accessible digital intervention for acutely injured children and their families.