A trauma-informed approach to the pediatric COVID-19 response.

To effectively care for children during COVID-19, pediatricians need to appreciate the stress and potential traumatic effect of the pandemic. By employing the "CARES" framework, pediatric providers can openly discuss the pandemic with patients and families, collaborate to build resiliency, and encourage engagement in activities and resources that are protective. This approach could potentially prevent both the short and long term health consequences resulting from the toxic stress and traumatic exposure of COVID-19. Pediatricians are uniquely positioned to mitigate the extent to which the pandemic affects the nation's children and we believe it is our responsibility to do so, to uphold the health and wellness of pediatric patients across their lifespan.

[Children and the traumatogenic impact of images: what protection in the Internet age?] / Enfant et impact traumatogène des images : quelles protections à l'ère d'Internet ?

Although screen assistance does not prevent all image traumas, especially those that are likely to disturb the youngest children, it does help to anticipate them and reduce their impact. This is why the protection of minors against the dangers of images requires three series of measures: a reform of public broadcasting, in particular the composition and role of classification panels; more comprehensive information for parents; training for teachers, school psychologists, socio-cultural workers and educators. As part of their initial and ongoing training, all should be trained in the issue of images and their reception by children.

Psychological Consequences in Abused and Neglected School Children Exposed to Family Violence.

Although family should be the basis for the development and formation of a child's personality, violence is mostly done in the family, and remains undiscovered for a long time. The real number of abused children is much more than that displayed in the registered cases. The secrecy of the problem is an important feature of this phenomenon. Families in which abuse takes place are mostly isolated. Social isolation does not come about by chance; secrecy is usually encouraged by an abuser to control over famoly members. In most cases, social reaction to violence is late, inadequate and focused on the consequences, but not on the causes. "Abuse implies an act of execution that directly inflicts damage, while neglect implies an act of non-fulfillment of something that is necessary for the well-being of a child". The most common forms of domestic violence are physical, emotional abuse in the presence of violence against the mother, and in a lesser extent sexual abuse. In addition, there is physical, emotional, educational and medical neglect. The presence of violence against the mother and the feeling of impotence leave the same consequences as the endured violence. It is considered that children living in violent families are likely to live under cumulative stress. Traumatic responses include a wide range of conditions from acute stress reactions through post-traumatic stress disorder to complex long-lasting, repeated trauma syndrome. All children will not react to this kind of experience in the same way, with the protective and risk factors in developmental psychopathology having a significant role to play. Because of their developmental vulnerability and dependency, children are at greater risk of violence than adults. Researches point to the need for a multidisciplinary approach to treatment and prevention of child abuse, with greater interaction between health institutions, relevant centers for social work, police, court, government and non-governmental sector, and the existence of adequate family and criminal laws.

Women's experience of psychological birth trauma in China: a qualitative study.

BACKGROUND: The psychological birth trauma is a universal phenomenon in childbearing women. The influences could extend in a wide range, which includes the mothers' health, mother-infant relationship, partner relationship. The medical staff could even choose to quit playing their part in the birthing process. The phenomenon has gradually garnered attention around the world. However, it has rarely been discussed under Chinese special conditions. The study was to explore Chinese women's lived experiences of psychological birth trauma during labor and birth. METHODS: A descriptive phenomenological approach was adopted in this study. Twenty-four women were recruited, who reported having experienced psychological birth trauma. In-depth interviews were conducted within 1 week after birth. Colaizzi's method was used to analyze the data. RESULTS: Twenty-four women participated in the study. Four themes emerged to describe the women's experience of psychological birth trauma: "How am I supposed to relieve the endless pain?" " Can't I be weak?" "Am I not important?" "What uncertainties are waiting for me?" CONCLUSIONS: The findings provide deep insight into Chinese women's unique experience of psychological birth trauma. The social and health system could prevent psychological harm during birth and promote maternal health by measures of pain management, thoughtful attention, adequate caring, and prenatal preparation.

Leveraging a public-public partnership in Los Angeles County to address COVID-19 for children, youth, and families in underresourced communities.

There is growing concern about the mental health and social impact of COVID-19 on underresourced children, youth, and families given widespread social disruption, school closures, economic impact, and loss of lives. In this commentary we describe how an existing public-public partnership between a large county mental health department and a state university responded to COVID-19. This partnership, originally designed to address workforce needs, rapidly pivoted to support providers through a trauma- and resilience-informed approach to mitigating adverse mental health effects among youth and families in Los Angeles County. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

On the frontlines: Protecting low-wage workers during COVID-19.

An examination of the trajectory of the coronavirus disease (COVID-19) pandemic and its subsequent economic impacts has revealed that this crisis will impact low-wage workers more severely than all others. The present commentary highlights the unique factors associated with low-wage work that make these workers particularly vulnerable to the effects of the pandemic, identifies potential adverse effects on the mental health of this population, and provides recommendations to maintain the safety, wellbeing, and dignity of low-wage workers. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Mitigating social and economic sources of trauma: The need for universal basic income during the coronavirus pandemic.

The COVID-19 pandemic is projected to cause an economic shock larger than the global financial crisis of 2007-2008 and a recession as great as anything seen since the Great Depression in 1930s. The social and economic consequences of lockdowns and social distancing measures, such as unemployment, broken relationships and homelessness, create potential for intergenerational trauma extending decades into the future. In this article, we argue that, in the absence of a vaccine, governments need to introduce universal basic income as a means of mitigating this trauma. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The psychosocial impact of COVID-19 pandemic in Italy: A lesson for mental health prevention in the first severely hit European country.

Italy was the first European country severely hit by the COVID-19 pandemic. While the containment measures were relatively effective in the acute phase, the current postemergency phase addressing the long-term psychosocial consequences is the key challenge for our healthcare system, where the importance of mental health prevention is not sufficiently recognized. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Traumatic stress in the age of COVID-19: A call to close critical gaps and adapt to new realities.

THE ISSUE: Coronavirus-19 (COVID-19) is transforming every aspect of our lives. Identified in late 2019, COVID-19 quickly became characterized as a global pandemic by March of 2020. Given the rapid acceleration of transmission, and the lack of preparedness to prevent and treat this virus, the negative impacts of COVID-19 are rippling through every facet of society. Although large numbers of people throughout the world will show resilience to the profound loss, stress, and fear associated with COVID-19, the virus will likely exacerbate existing mental health disorders and contribute to the onset of new stress-related disorders for many. RECOMMENDATIONS: The field of traumatic stress should address the serious needs that will emerge now and well into the future. However, we propose that these efforts may be limited, in part, by ongoing gaps that exist within our research and clinical care. In particular, we suggest that COVID-19 requires us to prioritize and mobilize as a research and clinical community around several key areas: (a) diagnostics, (b) prevention, (c) public outreach and communication, (d) working with medical staff and mainstreaming into nonmental health services, and (e) COVID-19-specific trauma research. As members of our community begin to rapidly develop and test interventions for COVID-19-related distress, we hope that those in positions of leadership in the field of traumatic stress consider limits of our current approaches, and invest the intellectual and financial resources urgently needed in order to innovate, forge partnerships, and develop the technologies to support those in greatest need. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Preventive intervention for trauma reactions in young injured children: results of a multi-site randomised controlled trial.

BACKGROUND: Young children are at particular risk for injury. Ten per cent to twenty-five per cent develop posttraumatic stress disorder (PTSD). However, no empirically supported preventive interventions exist. Therefore, this study evaluated the efficacy of a standardised targeted preventive intervention for PTSD in young injured children. METHODS: Injured children (1-6 years) were enrolled in a multi-site parallel-group superiority prospective randomised controlled trial (RCT) in Australia and Switzerland. Screening for PTSD risk occurred 6-8 days postaccident. Parents of children who screened 'high-risk' were randomised to a 2-session CBT-based intervention or treatment-as-usual (TAU). Primary outcomes were PTSD symptom (PTSS) severity, and secondary outcomes were PTSD diagnosis, functional impairment and behavioural difficulties at 3 and 6 months postinjury using blinded assessments. Trials were registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000325606) and ClinicalTrials.gov (NCT02088814). Trial status is complete. RESULTS: One hundred and thirty-three children screened 'high-risk' were assigned to intervention (n = 62) or TAU (n = 71). Multilevel intention-to-treat analyses revealed a significant intervention effect on PTSS severity over time (b = 60.06, 95% CI: 21.30-98.56). At 3 months, intervention children (M = 11.02, SD = 10.42, range 0-47) showed an accelerated reduction in PTSS severity scores compared to control children (M = 17.30, SD = 13.94, range 0-52; mean difference -6.97, 95% CI: -14.02 to 0.08, p adj. = .055, d = 0.51). On secondary outcomes, multilevel analyses revealed significant treatment effects for PTSD diagnosis, functional impairment and behavioural difficulties. CONCLUSIONS: This multi-site RCT provides promising preliminary evidence for the efficacy of a targeted preventive intervention for accelerating recovery from PTSS in young injured children. This has important clinical implications for the psychological support provided to young children and parents during the acute period following a single-event trauma.

Child and adolescent mental health amidst emergencies and disasters.

The mental health of children and young people can be disproportionally affected and easily overlooked in the context of emergencies and disasters. Child and adolescent mental health services can contribute greatly to emergency preparedness, resilience and response and, ultimately, mitigate harmful effects on the most vulnerable members of society.

Experiencias en mujeres víctimas del conflicto armado del municipio de san juan de nepomuceno-colombia / Experiences in women victims of the armed conflict of the municipality of san juan de nepomuceno-colombia

RESUMEN Objetivo: Describir el significado de las experiencias vividas en las mujeres víctimas del conflicto armado en San Juan de Nepomuceno, Colombia. Material y Método: Estudio cualitativo-fenomenológico cuya población estuvo conformada por 10 mujeres pertenecientes a una fundación del municipio de San Juan de Nepomuceno durante agosto a septiembre de 2018, la cual se obtuvo mediante la saturación de datos. Para el análisis de la información se clasificaron en tablas los descriptores, teniendo en cuenta la similitud conceptual en cada uno de ellos, ayudado con las notas de campo. Resultados: Se identificó el desplazamiento, asesinato, tortura e intimidación y violación sexual como hechos violentos experimentados por las mujeres durante el conflicto armado. Asimismo, transcurrido 15 años de los hechos violentos, aún se percibe por las mujeres afectaciones psicosociales en el presente, caracterizados por sueños recurrentes relacionados con el hecho violento, ruptura de vínculos sociales, alteraciones mentales, crisis depresivas, ansiedad y las ideas recurrentes de repetición de los hechos violentos. Conclusión: Es importante que desde enfermería se aborde esta problemática a fin de crear estrategias de intervención para esta población vulnerable, que permitan su estabilidad psicosocial tanto para las mujeres como para su núcleo familiar.

ABSTRACT Objective: To describe the meaning of experiences lived by women victims of the armed conflict in the municipality of San Juan de Nepomuceno, Colombia. Materials and Methods: Qualitative, phenomenological study; the population consisted of 10 women belonging to a foundation of the municipality of San Juan de Nepomuceno from August to September 2018, which was obtained by data saturation. For the data analysis, descriptors were classified into tables, considering the conceptual similarity in each of one of them and complementing with field notes. Results: Displacement, murder, torture, intimidation and rape were identified as violent acts experienced by women during the armed conflict. Additionally, after 15 years of violent events, women still perceive psychosocial effects, characterized by recurring dreams related to the violent events, the breakdown of social ties, mental disorders, depression, anxiety and ideas of repetition of the violent events. Conclusion: It is important that the field of nursing addresses this issue in order to create strategies to help this vulnerable population, which can contribute to psychosocial stability for women and their families.

RESUMO Objetivo: Descrever o significado das experiencias vividas em mulheres vítimas do conflito armado em San Juan de Nepomuceno, Colômbia. Material e método: Estudo qualitativo-fenomenológico cuja população foi composta por 10 mulheres pertencentes a uma fundação do município de San Juan de Nepomuceno no período de agosto a setembro de 2018, obtida através da saturação de dados. Para a análise da informação os descritores foram classificados em tabelas, levando em consideração a similaridade conceitual em cada um deles, auxiliada nas anotações de campo. Resultados: Deslocamento, assassinato, tortura e intimidação e estupro foram identificados como eventos violentos vivenciados por mulheres durante o conflito armado. Da mesma forma, após 15 anos de atos violentos, ainda se percebem, no presente, distúrbios psicossociais em mulheres, caracterizados por sonhos recorrentes relacionados ao ato violento, ruptura de laços sociais, alteração mental, crise depressiva, ansiedade e ideias recorrentes de repetição de atos de violência. Conclusão: É importante que esse problema seja abordado desde a enfermagem a fim de criar estratégias de intervenção para esta população vulnerável, que permitam sua estabilidade psicossocial tanto para as mulheres, quanto para o núcleo familiar.

Intervening on Thwarted Belongingness and Perceived Burdensomeness to Reduce Suicidality Among Veterans: Subanalyses From a Randomized Controlled Trial.

Suicide is a growing public health crisis among military veterans. Despite recent attention to this area, there are few empirically supported preventative interventions for suicidality among veterans. In the context of an empirically supported theoretical framework, the Interpersonal Theory of Suicide, the current study targeted suicide risk factors (i.e., perceived burdensomeness and thwarted belongingness) among a sample of 46 veterans selected from a larger clinical trial. Participants were randomized to receive either a newly developed computerized intervention aimed at decreasing perceived burdensomeness and thwarted belongingness, or participate in a repeated contact control condition. Results indicated a direct effect of the intervention on both perceived burdensomeness and thwarted belongingness. Temporal mediation analyses also revealed an indirect effect of condition on suicidality at Month 1 follow-up via reductions in perceived burdensomeness. The current results are the first to indicate that factors from the interpersonal theory of suicide can be reduced among veterans, and to demonstrate that these reductions in perceived burdensomeness lead to reductions in suicidality. Because of the brevity and computer delivery system, this intervention could be widely and rapidly disseminated among military veterans to reduce the public health burden of suicide in this population.

Trauma informed public health nursing visits to parents and children.

Adverse Childhood Experiences (ACEs) research has demonstrated a strong correlation between a traumatic childhood and poor health and social status in adulthood. Maternal/child Public Health Nursing (PHN) home visiting teams frequently encounter families experiencing trauma, thus offering a unique opportunity to assist parents in recognizing the potential harm such stress may have for their child. The Sonoma County Field Nursing team developed a trauma-informed model utilizing ACEs education in a self-reflective approach with parents to increase family resilience and reduce the risk for future childhood trauma. This paper presents the supporting research used to develop the trauma-informed approach and describes the execution of the model by the Sonoma County Field Nursing team.

[Disclosure and silence, protecting the baby from trauma transmission?] / Dévoilement et silence, protéger le bébé de la transmission traumatique.

The differences in how parents communicate their traumatic experience, through silence or by disclosure, play a fundamental role in the transgenerational transmission of trauma. Research into the transmission of trauma from mother to baby, in a humanitarian context, shows the importance of adapting the disclosure of the narrative of the mother's traumatic experience, which appears to be the most appropriate solution for protecting babies.

A Systematic Review of Trials to Improve Child Outcomes Associated With Adverse Childhood Experiences.

CONTEXT: The purpose of this systematic literature review was to summarize current evidence from RCTs for the efficacy of interventions involving pediatric health care to prevent poor outcomes associated with adverse childhood experiences measured in childhood (C-ACEs). EVIDENCE ACQUISITION: On January 18, 2018, investigators searched PubMed, PsycInfo, SocIndex, Web of Science, Cochrane, and reference lists for English language RCTs involving pediatric health care and published between January 1, 1990, and December 31, 2017. Studies were included if they were (1) an RCT, (2) on a pediatric population, and (3) recruited or screened based on exposure to C-ACEs. Investigators extracted data about the study sample and recruitment strategy, C-ACEs, intervention and control conditions, intermediate and child outcomes, and significant associations reported. EVIDENCE SYNTHESIS: A total of 22 articles describing results of 20 RCTs were included. Parent mental illness/depression was the most common C-ACE measured, followed by parent alcohol or drug abuse, and domestic violence. Most interventions combined parenting education, social service referrals, and social support for families of children aged 0-5years. Five of six studies that directly involved pediatric primary care practices improved outcomes, including three trials that involved screening for C-ACEs. Eight of 15 studies that measured child health outcomes, and 15 of 17 studies that assessed the parent-child relationship, demonstrated improvement. CONCLUSIONS: Multicomponent interventions that utilize professionals to provide parenting education, mental health counseling, social service referrals, or social support can reduce the impact of C-ACEs on child behavioral/mental health problems and improve the parent-child relationship for children aged 0-5years.

A trauma-informed substance use and sexual risk reduction intervention for young South African women: a mixed-methods feasibility study.

OBJECTIVES: Sexual and physical trauma and substance use are intersecting risks for HIV among young women. This study assesses the feasibility, acceptability and preliminary effects of a novel trauma-informed substance use and sexual risk reduction intervention for young South African women. DESIGN: A single arm feasibility test and qualitative interviews of participants. PARTICIPANTS: Sixty women, between 18 and 25 years of age, who reported trauma exposure, substance use and recent condom-less sex were recruited. Twenty participants were randomly selected for qualitative interviews. INTERVENTION: A six-session group-based intervention. MAIN OUTCOME MEASURES: We examined the proportion of women who provided consent, completed counselling and were retained in the study. Qualitative interviews explored intervention acceptability. Preliminary effects of the intervention on substance use, mental health (depression, psychological distress and trauma symptoms) and sexual risk outcomes (STI symptoms, number of partners and condomless sex) were explored. RESULTS: Of the 66 eligible women, 91% were enrolled. Intervention completion rates were low; 35% attended all sessions. On average, participants attended four sessions (M=3.8, SD=1.3). A 93% follow-up rate was achieved at the 3-month endpoint. In this single group design, reductions in the proportion of participants who tested positive for methamphetamine, cannabis and methaqualone were observed at the 3-month endpoint. Symptoms of depression, psychological distress and trauma; number of STI symptoms; and number of sexual partners also decreased. Outcomes were similar for participants who completed up to four and those who completed five or more sessions. Participants thought the intervention was highly beneficial and proposed modifications to enhance acceptability. CONCLUSIONS: This novel intervention seems acceptable and holds potential benefits for trauma-exposed women who use substances. Truncating the intervention may enhance the likelihood of its implementation. The efficacy of the intervention for improving substance use, sexual risk and mental health outcomes requires testing in a controlled design.

[Child Protection in Families with Parental Mental Illness]. / Kinderschutz in Familien mit einem psychisch erkrankten Elternteil.

Child Protection in Families with Parental Mental Illness Children and adolescents from families with parental mental illness face an increased risk to experience abuse, neglect and maltreatment. The effects of imminent, intermittent or chronic distress on the development of the child and to differentiate these from neglect or maltreatment are not easily assignable in such families. Questionnaires and diagnostic instruments can be supportive tools for professionals in hospitals and private practices to identify and differentiate between burdens of children and families and potential endangerment. Different instruments are presented for the assessment of child abuse: For professionals the "Wahrnehmungsbogen für Kinderschutz" (Thurn et al., 2017). As methods of screening at risk the "Eltern-Belastungsbogen zur Kindeswohlgefährdung" (Deegener, Spangler, Körner, Becker, 2009) and the Childhood Trauma Questionnaire (Wingenfeld et al., 2010). For the comprehensive assessment of abuse, we present the Maternal Interview Child Maltreatment (Cicchetti, Toth, Manly, 2003). The prevalence of mentally ill parents is presented based on two samples of patients attending the child protection outpatient clinic or and the trauma outpatient clinic of the Charité. In the child protection outpatient clinic 15.8 % of the mothers and 11.4 % of the fathers fulfilled criteria for psychiatric disorders. In the trauma outpatient clinic we diagnosed a parental mental disorder in 20 % of all cases. A fictitious case report reveals the emotional maltreatment of a child by its mentally ill mother, which suffers from an isolated delusional disorder. Empirical based classification tools seem to be very appropriate to ascertain physical and sexual maltreatment and child neglect in children of parents with mental disorders, as permanent or severe neglect is frequently detectable in these families.