MC3 Clinical Pearls Web Video Series
MC3 and the Michigan Medicine Department of Psychiatry has a web video series, Clinical Pearls, which offers straightforward recommendations for the assessment and management of common pediatric behavioral health resources. Their most recent video is on Trauma-Informed Care in a pediatric setting.
Trauma-Informed Care-Clinical Pearls
Key Takeaways
- A shift in thinking from treatment to prevention of adverse childhood events is essential.
- Routine awareness, regular screening and heightened awareness of trauma and adverse childhood events is essential to early intervention.
- All individuals who work with patients should be trauma informed.
- Promotion of a safe, inclusive medical environment where the patient regains control and self-mastery is essential in the treatment of adverse childhood events and trauma-related injury.
Synopsis
Traumatic events in childhood negatively impact mental and physical health across the lifespan. These adverse childhood experiences, or ACEs, are common but also preventable.
- In the late 1990s, the Center for Disease Control and Kaiser Permanente surveyed 17,000 adults regarding ACEs. The ten ACEs initially researched included child abuse (physical, sexual, or emotional); household stressors/traumas (family violence, substance use, mental illness, divorce and/or incarceration of a family member); and neglect (emotional and/ or physical).
- Researchers discovered over 64% of adults reported experiencing at least one of the negative events/trauma as children or adolescents and over 17% of individuals reported enduring four or more ACES prior to age 18.
- The researchers also discovered that the more adverse experiences a person endured, the more likely they were to have poor physical and mental health outcomes as an adult, including cancer, cardiovascular disease, substance use disorders, depression, and early death.
Individuals who face or witness a life-threatening or traumatic event, serious injury, sexual violence, or learn of a family member who experienced such an event, are at risk of developing Post Traumatic Stress Disorder (PTSD).
- Yearly, PTSD affects 3.5% of adults and 5% of youth in the U.S.
- Approximately one in 11 individuals are diagnosed with PTSD during their life. The development of PTSD is dependent upon many factors, including severity of the event, the nature of the event, the age of the child, a history of other psychiatric disorders, the ability to obtain help and support, and adults’ reactions.
ACEs are linked to an increased risk of chronic health conditions, mental health conditions, and substance use disorders, and decreased educational and vocational achievement.
- PTSD can vary in severity from mild functional impairment to severe and can even become debilitating.
- The neurochemical changes that take place during a traumatic event can hijack brain functioning, leaving an individual trapped in the fight or flight response.
- Youth with PTSD have symptoms related to intrusive memories (nightmares, flashbacks), hyperarousal, avoidance, as well as mood and cognitive alterations.
- Children and adolescents manifest their symptoms in different ways at different ages. Young children are more likely to reenact their trauma through play whereas older children and adolescents may present with suicidal ideation, somatic complaints, social withdrawal, detachment, disorganized, oppositional /defiant behavior, difficulties with concentration, aggression, anger outbursts, anhedonia, irritability, worries about safety, and fear of death.
Although traumatic events and adverse experiences increase an individual’s mental and physical comorbidities, individuals who have been traumatized often avoid seeking care. Avoidance behaviors and the stigma associated with pursuing psychiatric care often prevent individuals from obtaining the care they need.