Common elements of evidence-based trauma therapy for children and adolescents.

Background: Numerous evidence-based trauma therapies for children and adolescents have been developed over several decades to minimize the negative outcomes of post-traumatic stress disorder (PTSD). However, PTSD remains a complex construct and is associated with pervasive problems and high comorbidity. To gain more insight, much could be learnt from the similarities in trauma therapies. Objective: The purpose of this study is to derive common elements from evidence-based trauma therapies for children and adolescents. Method: Therapies were selected from a literature search. Five evidence-based trauma therapies were included in this study. A common element list was created through an existing and modified Delphi method, with a diverse group of Dutch trauma therapists. An element was deemed common when it appeared in three or more of the therapies. The final list was presented to international experts on the included trauma therapies. Results: A substantial commonality of techniques and mechanisms was found across the five evidence-based trauma therapies for children and adolescents, showing a strong overlap between therapies. Conclusion: The identified elements create a basis for research and clinical practice, with regard to targeted trauma therapies tailored to each individual child and his or her support system. This promotes therapy modules that are more flexible and accessible for both therapists and clients, in every environment, from specialized psychiatric units to sites with meagre resources. With current integrated knowledge, we can enhance the effectiveness of child psychiatry and refine trauma therapies. HIGHLIGHTS: Using a modified Delphi method, a substantial commonality of techniques and mechanisms is found in evidence-based trauma therapies for children and adolescents.Understanding the techniques and mechanisms of trauma therapy could be of help in refining upcoming therapies, and creates a basis for future research.Commonalities promote therapy modules that are more flexible and accessible for both therapists and clients, in environments ranging from specialized psychiatric units to sites with meagre resources.

Antecedentes: Una gran cantidad de evidencia relativa a terapias basadas en la evidencia para el trauma en niños y adolescentes se ha desarrollado en las últimas décadas, con el fin de minimizar los resultados negativos del TEPT. Sin embargo, el TEPT sigue siendo un constructo complejo y asociado con problemas generalizados, y una alta comorbilidad. Para obtener más información, se podría aprender mucho de las similitudes entre las terapias para el trauma. Por lo tanto, el propósito de este artículo es derivar elementos comunes de las terapias basadas en evidencia para el trauma en niños y adolescentes.Método: Las terapias fueron seleccionadas a partir de una búsqueda bibliográfica. En este estudio se incluyeron cinco terapias de trauma basadas en la evidencia. Se creó una lista de elementos comunes a través de un método Delphi existente y modificado, con un grupo diverso de terapeutas de trauma holandeses. Un elemento se consideró como común cuando apareció en tres o más de las terapias. La lista final se presentó a expertos internacionales de las terapias de trauma incluidas.Resultados y conclusión: Se encontró una coincidencia sustancial de técnicas y mecanismos en las cinco terapias de trauma basadas en la evidencia para niños y adolescentes, lo que muestra una fuerte superposición entre las terapias. Los elementos identificados crean una base para la investigación y la práctica clínica con respecto a las terapias de trauma específicas adaptadas a cada niño individual y su sistema de apoyo. Esto promueve módulos de terapia que son más flexibles y accesibles tanto para terapeutas como para clientes en cualquier entorno, desde unidades psiquiátricas especializadas hasta sitios con escasos recursos. Con el conocimiento integrado actual podemos mejorar la eficacia de la psiquiatría infantil y refinar las terapias de trauma.

Clinicians' perspective on the implemented KLIK PROM portal in clinical practice.

PURPOSE: Since 2011, the evidence-based KLIK Patient Reported Outcome Measure (PROM) portal has been implemented in clinical practice in > 20 Dutch hospitals. Patients and/or parents complete PROMs on Health Related Quality of Life, symptoms and psychosocial functioning before their outpatient consultation. Answers are converted into an ePROfile and discussed by clinicians during consultation to monitor well-being over time and detect problems early. This study aims to get insight into the KLIK implementation from the clinician's perspective. METHODS: As part of the KLIK implementation process, annual meetings were held with multidisciplinary teams to evaluate the use of KLIK. An online questionnaire was sent regarding (1) overall satisfaction, (2) feeling competent to discuss PROMs, (3) use of KLIK during the consultation, (4) influence of KLIK on the consultation, (5) usability of the KLIK PROM portal, (6) satisfaction with PROMs and feedback, and (7) support of the KLIK expert team. Open questions about (dis)advantages were included. Descriptive analyses were used. RESULTS: One hundred and forty-eight clinicians (response-rate 61%) from 14 hospitals in the Netherlands participated. Results show that: (1) clinicians report an overall satisfaction of median = 69/100 (visual analogue scale), (2) 85.8% feel competent discussing the ePROfile, (3) 70.3% (almost) always discuss the ePROfile, (4) 70.3% think that KLIK improves consultation, (5) 71.6% think KLIK is easy to use, (6) 80.4% are satisfied with the feedback of the overall KLIK ePROfile, (7) 71.6% experience sufficient support of the KLIK team. CONCLUSION: Participating clinicians are generally satisfied with KLIK. Improvements to the KLIK PROM portal are now realized based on the mentioned disadvantages (e.g., shorten PROM completion by use of PROMIS and integrating KLIK with Electronic Health Records).