Understanding adverse childhood experiences and the call for trauma-informed healthcare system in Turkey: a review.

Over the past four decades, research has underscored the significance of approaching and preventing trauma from a systemic standpoint. Trauma-informed care (TIC) methodologies offer a structure for healthcare practices, striving to convert organizations into trauma-informed systems that employ trauma-specific interventions. This review employs epidemiological and household data from Turkey to underscore the importance of integrating trauma-informed care as a means of prevention and intervention. Through a desk review, the study examines the role of adverse childhood experiences (ACEs), delving into their origin from family dynamics, migration, violence, exposure to violence, juvenile delinquency, and child maltreatment. The research highlights innovative healthcare approaches that leverage data to address complex patient health issues while considering mental health needs. In contemporary times, healthcare organizations acknowledge the value of a data-driven approach to make informed clinical decisions, enhance treatment procedures, and improve overall healthcare outcomes. The reviewed research and empirical data furnish proof of the importance of effective and efficient treatment methods that prioritize trauma prevention and treatment, integrating the role of ACEs. This paper seeks to contribute to discussions on transforming the healthcare system to meet the healthcare needs of Turkish households, all the while taking into account the evolving sociopolitical factors that shape Turkey's population characteristics.

Treating the sequelae of chronic childhood emotional abandonment.

Chronic emotional abandonment is traumatic for children, and often leads them to identify with the aggressor (IWA)-in order to hold onto their needed attachment to their parents, they feel, think, and do what their parents require, blame themselves for being abused and for their family's unhappiness, and feel ashamed. IWA often persists as a general tendency. Treatment requires therapists' dependability, attunement, empathy, interest, humility, and perhaps playfulness. Patients' history of abandonment should be explored in detail, though patients may be protective of their parents. Therapists should explore their own behavior if necessary, and acknowledge lapses; normalize and explore patients' shame; and avoid trying to "rescue" patients. Patients must be helped to re-find authority and agency over their own lives, and mourn their early loss of feeling "the right to a life." The treatment of "Claire," a 40-something child of two depressed parents, illustrates some of these points.

The effect of relationship-based interventions for maltreated children and adolescents: a systematic review and meta-analysis.

Child maltreatment is characterized by a harmful relational environment which can have negative cascading consequences for the child's development. Relationship-based interventions may improve maltreated children's functioning by addressing key aspects of the parent-child relationship at various stages of development. The objective of the current study was to perform a systematic review on relationship-based interventions for maltreated children and a meta-analysis on the impact of these interventions on observed parent-child relational behavior. Data collection consisted of a comprehensive literature search in six databases and contacting experts in the field and hand searching relevant publications. In total, 5,802 abstracts were screened, of which 81 relevant publications were identified, representing 4,526 participants. The meta-analysis found large improvements in observed parent interactive behavior (g = 0.888), smaller improvements in child attachment (g = 0.403) and child interactive behavior (g = 0.274). The effect on parent interactive behavior was larger in interventions addressing middle childhood. Risk of bias assessments showed that a large number of studies suffer from poor reporting, which limits the conclusions of the findings. Future research should examine parent-child relationship behavior across multiple developmental stages, as well as the impact of developmentally appropriate intervention elements on maltreated children.

Feasibility and Acceptability of Group Compassion-Focused Therapy to Treat the Consequences of Childhood Maltreatment in People With Psychiatric Disorders in France.

ABSTRACT: Childhood maltreatment contributes to the development of psychiatric disorders. Shame appears to be an important mediating factor. Compassion-focused therapy (CFT) targets shame and seems relevant for adults with hard-to-treat psychiatric disorders associated with childhood maltreatment. Nevertheless, few studies have examined the feasibility and relevance of group CFT for this population and none in a French routine care setting. The aim of our study was to evaluate the feasibility and acceptability of group CFT for psychiatric disorders associated with childhood maltreatment. Eight adult patients with a history of childhood maltreatment participated in the 12-session group CFT. Feasibility and acceptability were assessed via a standardized satisfaction questionnaire, dropout rates, and attendance. Clinical benefits were assessed via changes in scores on scales of self-compassion, shame, and psychopathological dimensions. Adherence to therapy (75%) and attendance (88.3%) were high, and all participants reported high satisfaction. Posttreatment, self-compassion significantly increased (p = 0.016), and depression, anxiety, and posttraumatic scores decreased. Our study is the first to show that transdiagnostic group CFT (difficult-to-treat psychiatric disorders associated with a history of child maltreatment) is feasible in a French routine care setting. Changes in clinical scale scores after the intervention suggest the clinical value of the intervention and encourage further research of its effectiveness.

Predicting optimal treatment outcomes in phase-based treatment and direct trauma-focused treatment among patients with posttraumatic stress disorder stemming from childhood abuse.

Research over the last few decades has demonstrated the effectiveness of various treatments for posttraumatic stress disorder (PTSD). However, the question of which treatment works best remains, especially for patients with PTSD stemming from childhood abuse. Using the Personalized Advantage Index (PAI), we explored which patients benefit more from phase-based treatment and which benefit more from direct trauma-focused treatment. Data were obtained from a multicenter randomized controlled trial (RCT) comparing a phase-based treatment condition (i.e., eye-movement desensitization and reprocessing [EMDR] therapy preceded by Skills Training in Affect and Interpersonal Regulation [STAIR]; n = 57) and a direct trauma-focused treatment (EMDR only; n = 64) among individuals with PTSD related to childhood abuse. Machine learning techniques were used to examine all pretreatment variables included in the trial as potential predictors and moderators, with selected variables combined to build the PAI model. The utility of the PAI was tested by comparing actual posttreatment outcomes of individuals who received PAI-indicated treatment with those allocated to a non-PAI-indicated treatment. Although eight pretreatment variables between PTSD treatment outcome and treatment condition were selected as moderators, there was no significant difference between participants assigned to their PAI-indicated treatment and those randomized to a non-PAI-indicated treatment, d = 0.25, p = .213. Hence, the results of this study do not support the need for personalized medicine for patients with PTSD and a history of childhood abuse. Further research with larger sample sizes and external validation is warranted.

Seeing the past in a new light: change in reports of childhood abuse and neglect before and after inpatient psychotherapy and its relevance for change in depression symptoms.

OBJECTIVE: As changes in mental representations have been discussed as mechanisms of change in psychotherapy, the question arises whether recollections of childhood abuse and neglect are altered as well and how they relate to symptom changes. METHOD: Individuals in psychosomatic inpatient treatment (N = 488, 60.5% women) filled out the Childhood Trauma Questionnaire (CTQ) and Patient Health Questionnaire (PHQ-9). Changes in both were investigated with correlations and t-tests. Linear regression analysis was used to test whether CTQ changes predicted symptom changes. Network analysis was performed to ascertain structural connections between somatic and emotional-cognitive depression symptoms and CTQ subscales before and after treatment. RESULTS: After treatment (duration in days: M = 52.83, SD = 20.94), patients reported fewer depression symptoms (d = 0.84), while CTQ scores increased slightly (d = 0.11). Changes in the CTQ predicted recovery from depression symptoms in a statistically significant way (ß = .133, p = .001). We did not observe changes in the overall network structure between baseline assessment and discharge. CONCLUSION: The findings suggest that the evaluation of past experiences can change over multiple weeks of psychotherapy. Further, these updated mental representations, indicating a greater recognition of past adversity, may contribute to symptom relief.

Quality of Resuscitative Care Provided to an Infant With Abusive Head Trauma in Community Emergency Departments: An In Situ, Prospective, Simulation-Based Study.

OBJECTIVES: Abusive head trauma (AHT) is a very common and serious form of physical abuse, and a major cause of mortality and morbidity for young children. Early Recognition and supportive care of children with AHT is a common challenge in community emergency department (CEDs). We hypothesized that standardized, in situ simulation can be used to measure and compare the quality of resuscitative measures provided to children with AHT in a diverse set of CEDs. METHODS: This prospective, simulation-based study measured teams' performance across CEDs. The primary outcome was overall adherence to AHT using a 15-item performance assessment checklist based on the number of tasks performed correctly on the checklist. RESULTS: Fifty-three multiprofessional teams from 18 CEDs participated in the study. Of 270 participants, 20.7% were physicians, 65.2% registered nurses, and 14.1% were other providers. Out of all tasks, assessment of airway/breathing was the most successfully conducted task by 53/53 teams (100%). Although 43/53 teams (81%) verbalized the suspicion for AHT, only 21 (39.6%) of 53 teams used hyperosmolar agent, 4 (7.5%) of 53 teams applied cervical spine collar stabilization, and 6 (11.3%) of 53 teams raised the head of the bed. No significant difference in adherence to the checklist was found in the CEDs with an inpatient pediatric service or these with designated adult trauma centers compared with CEDs without. Community emergency departments closer to the main academic center outperformed CEDs these that are further away. CONCLUSIONS: This study used in situ simulation to describe quality of resuscitative care provided to an infant presenting with AHT across a diverse set of CEDs, revealing variability in the initial recognition and stabilizing efforts and provided and targets for improvement. Future interventions focusing on reducing these gaps could improve the performance of CED providers and lead to improved patient outcomes.

Caregiver maltreatment history and treatment response following an intensive Emotion Focused Family Therapy workshop.

This single-arm, repeated measures study investigated the impact caregiver trauma history may have on treatment response following an intensive, 2-day Emotion Focused Family Therapy (EFFT) caregiver workshop. Caregivers (n = 243) completed questionnaires regarding their child's emotion regulation and clinical symptoms, as well as their own childhood trauma history (i.e., exposure to various forms of child maltreatment), caregiver self-efficacy and caregiver blocks (e.g., fears) to support their child's treatment and recovery. Questionnaires were administered prior to and immediately following the workshop and again 4, 8 and 12 months later. At baseline, caregivers who reported experiences of childhood maltreatment demonstrated more blocks compared with caregivers who did not (B = 6.35, SE = 2.62, p < 0.05). Results indicated that caregivers with and without maltreatment histories reported similar, significant gains in their child's total difficulties (B = 0.64, SE = 0.41, p = 0.12) and emotional negativity and lability (B = 0.51, SE = 0.48, p = 0.29) at 12-month post-workshop. Caregivers with maltreatment histories reported greater improvements in caregiver blocks (B = 5.15, SE = 1.34, p < 0.001) and child emotion regulation (B = 0.90, SE = 0.18, p < 0.001) than caregivers without maltreatment histories. They also report less, but still significant, improvement in parental self-efficacy (B = -0.68, SE = 0.26, p < 0.01) when compared with caregivers without maltreatment histories. Findings suggest that EFFT workshops may be an acceptable and effective trans-diagnostic intervention for families presenting with complex histories, including caregiver exposure to childhood maltreatment.

The Incidence of Child Maltreatment Resulting in Hospitalizations for Children Under Age 3 Years.

OBJECTIVE: To assess the incidence of child maltreatment-related hospitalizations for children under 3 years for the population of Washington State. STUDY DESIGN: A population-based study using retrospective linked administrative data for all children born in Washington State from 2000 through 2013 (n = 1 191 802). The dataset was composed of linked birth and hospitalization records for the entire state. Child maltreatment-related hospitalizations were identified using diagnostic codes, both specifically attributed to and suggestive of maltreatment. Incidence were calculated for the population, by birth year, by sex, and by maltreatment subtype. RESULTS: A total of 3885 hospitalizations related to child maltreatment were identified for an incidence of 10.87 per 10 000 person-years. Hospitalizations related to child maltreatment accounted for 2.1% of all hospitalizations for children under the age of 3 years. This percentage doubled over time, reaching a high in 2012 (3.6%). More than one-half of all hospitalizations were related to neglect. Maltreatment-related hospitalizations occurred most frequently in the first year of life for all subtypes except for neglect, which occurred the most between 1 and 2 years of age. Male children had higher incidence than female children in general (11.97 vs 9.70 per 10 000 person-years) and across all subtypes. CONCLUSIONS: Hospitalizations can be a useful source of population-based child maltreatment surveillance. The identification of neglect-related hospitalizations, likely the result of supervisory neglect, because the most common subtype is an important finding for the development of prevention programming.

Amongst Norwegian paediatricians there is little agreement in management of cases of suspected child maltreatment.

AIM: Child maltreatment is not unusual in our society but little is known about the medical management of cases in the Nordic countries. This study investigated physician knowledge and practice in cases of suspected physical and sexual abuse and neglect. METHODS: Using a patient vignette questionnaire, we assessed paediatrician knowledge and clinical decision-making on paediatric wards at 17 hospitals in Norway. Experts and non-experts in child maltreatment responded to the survey which described six potential cases of physical and sexual abuse and neglect. RESULTS: A total of 156 paediatricians, 67% of whom were female and with a mean age of 40, responded. There was a high level of unanimity in recognition of abuse, but wide variation and little consensus in clinical decision-making and adherence to national guidelines, with Fleiss kappa ranging from -0.002 to 0.468. In cases involving physical abuse concerns in infants and toddlers, less than half of all paediatricians reported they would order a full radiologic skeletal survey and head MRI/CT imaging, and less than 30% would plan follow-up consultations. CONCLUSION: This study shows little agreement in the paediatric management of child maltreatment cases. These findings suggest the need for a national plan ensuring appropriate paediatric care for maltreated children.

Treatment outcomes of psychotherapy for binge-eating disorder in a randomized controlled trial: Examining the roles of childhood abuse and post-traumatic stress disorder.

OBJECTIVE: To examine childhood abuse and post-traumatic stress disorder (PTSD) as predictors and moderators of binge-eating disorder (BED) treatment outcomes in a randomized controlled trial comparing Integrative Cognitive-Affective Therapy with cognitive-behavioural therapy administered using guided self-help. METHOD: In 112 adults with BED, childhood abuse was defined as any moderate/severe abuse as assessed by the Childhood Trauma Questionnaire, lifetime PTSD was assessed via the Structured Clinical Interview for DSM-IV, and outcomes were assessed via the Eating Disorder Examination (EDE). Covariate-adjusted regression models predicting binge-eating frequency and EDE global scores at end of treatment and 6-month follow-up were conducted. RESULTS: Lifetime PTSD predicted greater binge-eating frequency at end of treatment (B = 1.32, p = 0.009) and childhood abuse predicted greater binge-eating frequency at follow-up (B = 1.00, p = 0.001). Lifetime PTSD moderated the association between childhood abuse and binge-eating frequency at follow-up (B = 2.98, p = 0.009), such that childhood abuse predicted greater binge-eating frequency among participants with a history of PTSD (B = 3.30, p = 0.001) but not among those without a PTSD history (B = 0.31, p = 0.42). No associations with EDE global scores or interactions with treatment group were observed. CONCLUSIONS: Results suggest that a traumatic event history may hinder treatment success and that PTSD may be more influential than the trauma exposure itself.

Opening the proverbial 'can of worms' on trauma-specific treatment in prison: The association of adverse childhood experiences to treatment outcomes.

A large body of research has shown that incarcerated populations have a high prevalence of adverse childhood experiences (ACEs), increasing their risk for associated mental health problems and violent and aggressive behaviours. Emerging research on treatment for trauma survivors shows evidence that incarcerated women and men, with the most complex histories of trauma and abuse, can be responsive to trauma-specific treatment. Current research assessing two gender-responsive and trauma-specific brief interventions (e.g., Healing Trauma for Women and Exploring Trauma for Men) have demonstrated feasibility, consistency and efficacy among incarcerated populations. The current study uses secondary data analysis to explore the relationship between cumulative ACEs and the impact of the Healing Trauma and Exploring Trauma on participant's (682 women and 624 men) mental health, aggression and anger outcomes. The mixed-method regression results show that the impact of ACEs on treatment outcomes is strong and cumulative (i.e., greater exposure to childhood traumatic events increased the likelihood of participant programme gain on all the mental health and aggression outcomes, ranging from .13 to 1.2 for women and .15 to .77 for the men). The lowest significant coefficient for both women and men was for verbal anger and the largest was for current trauma symptoms. The association of ACEs on anger outcomes varied between women and men (revealing more association among the men). The findings show a strong positive impact for the trauma-specific brief interventions, particularly for those with the highest levels of trauma, whom otherwise might not have been ineligible for any programme participation.

[What is the place in pediatric hospitalization for child abuse ? Criteria and guidance]. / Quelle place en hospitalisation pédiatrique pour la maltraitance infantile ? Critères et orientations.

Child abuse situations are increasingly common clinical situations in pediatrics and, in extenso, in hospital wards. While it remains obvious that the hospital is a place of care and not of life for a child, the fact remains that in a number of cases, it is necessary to offer the child a multidisciplinary assessment in a neutral and secure environment in order to assess the abuse, its impact on the child, the systemic family disorders that underlie it and the orientation towards the most adequate life environment for the child. The hospital and specialized pediatric services then fulfill this mission, which meets strict admission criteria so that the hospital stay guarantees effective therapeutic action. The purpose of this article is to describe the management of situations of child abuse by using multidisciplinary hospital assessments as they are carried out in the Maltraitance Unit of the Pediatric Department of CHU Liège. We will briefly review the admission criteria, the modalities of care and the clinical interest of such hospitalisations.

Les situations de maltraitance infantile relèvent de situations cliniques de plus en plus fréquentes en pédiatrie et, in extenso, au sein même des services d'hospitalisation. S'il reste évident que l'hôpital est un lieu de soins et non de vie pour un enfant, il n'en demeure pas moins que, dans un certain nombre de cas, il est nécessaire d'offrir à l'enfant un bilan pluridisciplinaire en milieu neutre et sécurisant afin d'évaluer la maltraitance, ses impacts sur l'enfant, les troubles systémiques familiaux qui la sous-tendent et l'orientation vers le milieu de vie le plus adéquat pour l'enfant. L'hôpital et des services pédiatriques spécialisés remplissent alors cette mission qui répond à des critères stricts d'admission afin que le temps d'hospitalisation garantisse une action thérapeutique efficace. Cet article a pour objet de décrire les prises en charge de situations de maltraitance infantile sous forme de bilans hospitaliers pluridisciplinaires tels qu'ils sont réalisés dans le service Cellule Maltraitance du service de Pédiatrie du CHU Liège. Nous passerons rapidement en revue les critères d'admission, les modalités de prise en charge et les intérêts cliniques qui ressortent de telles hospitalisations.

[The Diagnostic and Therapeutic Care of Abused Children and Adolescents]. / Die diagnostische und therapeutische Versorgung von Kindern und Jugendlichen mit Gewalterfahrungen.

The Diagnostic and Therapeutic Care of Abused Children and Adolescents In the following article, an overview of the current German health care situation concerning child abuse, neglect and maltreatment is provided. Interdisciplinary institutions of child protection are important initial contact points for families and professionals wishing to receive help. Furthermore, trauma clinics, victim support organizations and specialized counselling centers are indispensable to meet the complex needs of victims. Overall, the availability and accessibility of the support system in Germany is still insufficient and the number of unknown and untreated cases remains high. An improvement of the current situation should be of high governmental priority.

[Hospital management of the child victim of non-accidental head injury]. / Prise en charge hospitalière de l'enfant victime de traumatisme crânien non accidentel.

The baby victim of a shock is not always diagnosed at the time of his first visit to the emergency room. The recommendation for good practice in situations of shaken baby syndrome, published in July 2017 by the French National Authority for Health, helps in the diagnosis and management of these infants by health care providers. When this diagnosis is made, the baby's care pathway is generally long and punctuated by multiple examinations.

Editorial Perspective: Childhood maltreatment - the problematic unisex assumption.

Childhood maltreatment (CM) is a heterogeneous group of childhood adversities that can range from different forms of abuse (physical, sexual, emotional) or neglect (physical, emotional, cognitive), to severe bullying by peers. With an annual estimated cost of $500 billion in the United States alone, CM is recognized as one of the most significant risk factors for a range of psychiatric and medical conditions (White and Kaffman, 2019). Further, rates of numerous psychiatric, neurological, and medical conditions differ significantly between males and females (Gillies and McArthur, 2010), inspiring decades of research on how sex moderates consequences of CM (Gershon et al., 2008). Although vulnerability to CM has been reported to vary by sex, very few findings have been consistent across studies. Moreover, most work to date has focused on how sex alters the frequencies of different psychopathologies in maltreated individuals, with little attention to whether different developmental processes may underlie these psychopathologies in males and females (White and Kaffman, 2019). The primary goal of this editorial was to advocate for more effective research strategies to address these questions. We first examine the rationale for studying sex as an important moderator of consequences of CM, briefly summarize some of the most consistent clinical findings, and discuss the implications of sex in treatment response. We then highlight important obstacles that contribute to the large number of inconsistent findings and make five recommendations on how to move forward.

Interventions to support people exposed to adverse childhood experiences: systematic review of systematic reviews.

BACKGROUND: Adverse Childhood Experiences (ACEs) such as abuse, neglect or household adversity may have a range of serious negative impacts. There is a need to understand what interventions are effective to improve outcomes for people who have experienced ACEs. METHODS: Systematic review of systematic reviews. We searched 18 database sources from 2007 to 2018 for systematic reviews of effectiveness data on people who experienced ACEs aged 3-18, on any intervention and any outcome except incidence of ACEs. We included reviews with a summary quality score (AMSTAR) of 5.5 or above. RESULTS: Twenty-five reviews were included. Most reviews focus on psychological interventions and mental health outcomes. The strongest evidence is for cognitive-behavioural therapy for people exposed to abuse. For other interventions - including psychological therapies, parent training, and broader support interventions - the findings overall are inconclusive, although there are some positive results. CONCLUSIONS: There are significant gaps in the evidence on interventions for ACEs. Most approaches focus on mitigating individual psychological harms, and do not address the social pathways which may mediate the negative impacts of ACEs. Many negative impacts of ACEs (e.g. on health behaviours, social relationships and life circumstances) have also not been widely addressed by intervention studies.

Childhood maltreatment predicts daily stressor exposure in college students but not perceived stress or stress reactivity.

The purpose of this observational longitudinal study was to investigate the role of childhood maltreatment in explaining individual differences in daily stress processes. College students (N = 253) completed the Childhood Trauma Questionnaire and a measure of neuroticism at baseline before completing 14 nightly surveys assessing exposure to daily stressors (particularly interpersonal stressors), perceived stressor severity, and negative affect. Given mixed findings in past research, no specific hypotheses were proffered. Generalized linear mixed modeling showed that students with a history of maltreatment experienced roughly one more stressor every 1-to-2 days compared with those without a history of maltreatment, and experienced an interpersonal stressor on approximately half of the 14 study days compared to about one quarter of the study days for those without a history of maltreatment. In contrast, childhood maltreatment (except for physical abuse) was unrelated to perceived stressor severity and stress reactivity, controlling for gender and neuroticism. This suggests that college students reporting childhood maltreatment have more daily stressors, but they neither perceive them as more stressful nor react to them more strongly. In exploratory analyses assessing exposure to specific stressors, childhood maltreatment was associated with reporting more financial, work-related, career, and grade-related stressors in addition to interpersonal stressors. These findings underscore the importance of assessing stressor exposure separately from stress reactions. They also suggest that both individualized skill-based interventions to reduce stressor exposure and campus-wide programs to reduce financial and other burdens on students may be warranted. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Effectiveness of an attachment-based intervention for the assessment of parenting capacities in maltreating families: A randomized controlled trial.

Even though Parenting Capacity Assessments (PCAs) are essential for child protection services to support placement decisions for maltreating families, presently no evidence-based PCA protocols are available. In this randomized controlled trial, we tested the quality of an attachment-based PCA protocol based on Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD). We recruited 56 parent-child dyads (Mage children = 3.48 years) in Dutch family residential clinics that conduct PCAs to support placement decisions. After pretest, families were randomized to receive the Regular Assessment Procedure (RAP) (n = 28), or an additional assessment based on VIPP-SD (n = 28). An immediate post-test and a 10-month follow-up were conducted. Multilevel models showed that therapists felt equally confident about their recommendations regarding child placement for both groups and that they equally often modified their initial placement recommendations. Moreover, children in the VIPP-SD group did not show fewer behavior problems and did not experience recurring child maltreatment less often than children in the RAP group. Thus, we found no evidence that PCAs incorporating the VIPP-SD protocol outperformed PCAs as usual. We discuss possible explanations why in the current study VIPP-SD did not seem to add to the quality of the RAP.

A pesar de que las Evaluaciones de Capacidad de Crianza (PCA) son esenciales para los servicios de protección al niño para apoyar las decisiones de dónde colocarlo por razones de familias maltratadoras, en el presente no se encuentran disponibles ningún protocolo PCA basado en la evidencia. En este ensayo controlado al azar, pusimos a prueba la calidad de un protocolo PCA basado en la afectividad para lo cual nos basamos en la Intervención de Video Informativo para promover una Crianza Positiva y Disciplina Sensible (VIPP-SD). Reclutamos 56 díadas de progenitor-niño (edad promedio de los niños = 3.48 años) en clínicas residenciales de familias holandesas que utilizan las PCA para apoyar las decisiones de dónde colocar. Después del pre-examen, las familias fueron asignadas al azar para recibir el Procedimiento de Evaluación Regular (RAP) (n = 28), o una evaluación adicional basada en VIPP-SD (n = 28). Se llevaron a cabo un examen posterior inmediato y un seguimiento a los 10 meses. Los modelos de niveles múltiples mostraron que los terapeutas se sintieron igualmente confiados acerca de sus recomendaciones con respecto a dónde colocar al niño en ambos grupos y que ellos igualmente modificaron a menudo su recomendación inicial de dónde colocarlo. Es más, los niños en el grupo VIPP-SD no mostraron menos problemas de conducta y no experimentaron maltrato infantil recurrente menos a menudo que los niños en el grupo RAP. Por tanto, no encontramos evidencia de que las PCA que incorporan el protocolo VIPP-SD tuvieran mejores resultados que las PCA en su forma usual. Discutimos posibles explicaciones de por qué en el presente estudio los VIPP-SD no parecieron agregar nada a la calidad de RAP.

Contexte: Des interventions favorables et ciblées pour les familles sont nécessaires afin d'optimiser l'ajustement parental et la relation parent-bébé conformément à un diagnostic précédant de risque neurodéveloppemental pour les bébés. Buts: Le but de cette revue systématique était de déterminer l'efficacité des interventions pour l'amélioration de l'ajustement psychologique et le bien-être pour les parents ayant un bébé ayant été diagnostiqué comme ayant ou étant à risque d'avoir un trouble neurodéveloppemental. Méthodes: La stratégie de recherche du Cochrane Review Group a été suivie avec une recherche des essais contrôlés du Registre Cochrane Central, de PubMed, CINAHL, PsycINFO, et Embase entre juillet et décembre 2017. La qualité méthodologique des articles inclus a été évaluée au moyen de l'échelle de la base de données de preuve de physiothérapie (PEDro Physiotherapy Evidence Database) par deux évaluateurs indépendants. Résultats: Douze études ont rempli les critères d'inclusion. Un petit nombre d'essais de grande qualité ont révélé une efficacité modérée à importante de la réduction chez les parents de symptômes psychologiques indésirables de trauma et de stress des parents. Des améliorations importantes dans les symptômes de dépression et d'anxiété ont émergé lors de follow up post intervention à plus long terme (6 mois-8 ans). Conclusions: On constate un soutien prometteur pour l'efficacité de certaines interventions à réduire les symptômes psychologiques de mésadaptation chez les parents avec des bébés diagnostiqués comme étant à risque d'un trouble neurodéveloppemental. D'autres ECR de qualité d'intervention psychologiques portant sur les conditions plus grandes de risque neurodéveloppemental sont nécessaires.

[Burns by immersion in children and abuse]. / Brûlures par immersion chez l'enfant et maltraitance.

AIM OF THE STUDY: Ten percent of childhood burns could arise from maltreatment. While describing 6 severe cases of inflicted scalds by immersion in children, we expose our systematic diagnostic approach of abuse and confirm the serious nature of burn when they are inflicted. PATIENTS AND METHOD: The retrospective study concerned children hospitalized for scalds by immersion between 2013 and 2016 and for whom child abuse has been confirmed. Sex, age, burns description, needs of surgery, length of stay at hospital and protection plan set up were collected. RESULTS: Six cases of burns by immersion due to maltreatment were identified (5 boys, 1 girl) with a median age of 12 months. The average total burn surface area was 19%. Burns were of deep second and third degree and always symmetric. Every child underwent surgery at least once. Concern information was transferred for all of them. CONCLUSION: Teams taking care of children with burns must be trained to the difficult diagnostic of abuse or neglect so that early social interventions can be set up in case of maltreatment.