+

Supporting Children Through Firearm Trauma

Amy Koch

+ Children and Firearms in the U.S.

13 children die every day 2nd leading cause of death 2,711 children and adolescents 0-19 years old died 15,576 injured

+ Research Question

How do Child Life Specialists support children and families in the hospital who experience trauma due to firearm injuries ED PICU Rehabilitation

+ What did I Hope to Find Out

How Child Life interventions differ by a child’s age and developmental level?

How often Child Life professionals intervene with patients who have been injured due to firearm activity?

What do Child Life Specialists focus on with this population of patients?

What other members of the medical team do Child Life Specialists collaborate with?

+ Prevalence of Firearms in the Home

Handgun usage is seen most in trauma

Firearms Handguns Long guns Assault weapons Air guns

200 million firearms owned 9 million adolescents have

access to firearms

+ Children and Trauma

4 types of injuries Assault Homicide Suicide Unintentional

2 types of trauma Emotional Physical

+ The Role of the Child Life Specialist

Strengths Well-being Promoting Optimal

Development Minimizing Adverse Effects

Play Build Rapport Normalize Environment Activities for Emotional

Expression

+ Methods and Procedures 7 Certified Child Life

Specialists Semi-structured Interviews Qualitative Investigation

Specific Interventions Occurrence Needs of the Patients Collaboration

+ Data Collection & Analysis

Data Collection Child Life Forum and personal connections Nation wide

Data Analysis Verbatim Transcripts Grounded theory (Auerbach & Silverstein, 2003; Merriam,

2009) Focused on recurring themes

+ Results: Themes

Themes

Needs of the Patient and Family

Interventions Used

Responses to Trauma

Differences Between Units

+ Results: Background

Participant #

Unit # of CLS on Unit

# of GSW Patients Seen on Unit

1 Rehab Primary CLS 4-52 ED 3 CLS 35-453 Rehab Primary CLS 34 Rehab Primary CLS 4-55 Rehab Primary CLS 2-36 ICU Primary CLS 47 ED Primary CLS 7-12

+ Results: Needs of the Patient & Family

“A lot of what needs to happen is building that therapeutic relationship first, and really getting to know what that patient’s interests are…Figuring out what’s going on for them.”

“For the families, it’s just the need to feel safe”

“Support the family when their lives might need to change.”

“Family members often need emotional support more than anything”

Emotional Support

Education

+ Results: Interventions Used

Building a Therapeutic Relationship Procedural Preparation

Concrete Examples Expressive Arts Medical Play

Normalization through play Maintaining Routines Providing Choices Preserving Boundaries

+ Results: Interventions Used

Building a Therapeutic Relationship Procedural Preparation

Concrete Examples Expressive Arts Medical Play

Normalization through play Maintaining Routines Providing Choices Preserving Boundaries

+ Results: Interventions Used

Building a Therapeutic Relationship Procedural Preparation

Concrete Examples Expressive Arts Medical Play

Normalization through play Maintaining Routines Providing Choices Preserving Boundaries

+ Results: Child Responses to Trauma

“I think it's the loss of control that they feel the worst about. They're just fearful of so many things…all the people coming in their room…of just not being in control of the situation.”

“I think that the anger and loss of control go hand in hand”

Loss of Control

Guilt Fear

+Results: Differences Between Units

“In the ER you’re dealing with the here and now, in the PICU it’s a lot of support cause they have different procedures, in the rehab setting, the interventions are around what life is going to look like going forward.”

More Time More Space More Room to Grieve

ED

PICU

Rehab

+ Limitations and Implications

More Participants

Equal Representation of Units Clarify GSW

Trauma vs. Trauma in General

Utilize Multidisciplinary Teams

Educate Through Trauma Training

Set Aside Personal Biases Understand Implications of

Firearm Injuries

+ References Amoreira Gepp, R., & Nadal, L. (2012). Spinal cord trauma in children under 10 years of age: clinical characteristics and prevention. Child's Nervous System, 28(11), 1919-1924. doi:10.1007/s00381-012-1846-1

Byard, R. W., Haas, E., Marshall, D. T., Gilbert, J. D., & Krous, H. F. (2009). Characteristic Features of Pediatric Firearm Fatalities—Comparisons Between Australia and the United States. Journal Of Forensic Sciences (Wiley-Blackwell), 54(5), 1093-1096. doi:10.1111/j.1556-4029.2009.01125.x

Christoffel, K. (2007). Firearm Injuries: Epidemic Then, Endemic Now. American Journal Of Public Health, 97(4), 626-629. doi:10.2105/AJPH.2005.085340

DiScala, C., & Sege, R. (2004). Outcomes in Children and Young Adults Who Are Hospitalized for Firearms-Related Injuries. Pediatrics, 113(5), 1306-1312.

Hamrin, V., Jonker, B., & Scahill, L. (2004). Acute Stress Disorder Symptoms in Gunshot-Injured Youth. Journal Of Child & Adolescent Psychiatric Nursing, 17(4), 161-172.

Moront, M; & M, R. Eichelberger. (1994). Pediatric Annals, 23, 4.

Sabin, J. A., Zatzick, D. F., & Rivara, F. P. (2005). A role for school health personnel in supporting children and families following childhood injury. The Journal of School Health, 75(4), 141-4. Retrieved from http://search.proquest.com/docview/215673219?accountid=25251

Turner, J., & Fralic, J. (2009). Making Explicit the Implicit: Child Life Specialists Talk About Their Assessment Process. Child & Youth Care Forum, 38(1), 39-54. doi:10.1007/s10566-009-9066-x

Waller, A. E., Baker, S. P., & Szocka, A. (1989). Childhood Injury Deaths: National Analysis and Geographic Variations. American Journal Of Public Health, 79(3), 310-315.

Widome, M. D. (1991). Remembering As We Look Ahead: The Three E's and Firearm Injuries. Pediatrics, 88(2), 379.

W, Max & D P Rice. Shooting in the dark: estimating the cost of firearm injuries Health Affairs, 12, no.4 (1993):171-185 doi: 10.1377/hlthaff.12.4.171

+ Thank You!

+ Validity

No gun family Location Media

Critical friends group Program advisor Thesis advisor