Beyond the patient: What support

systems do our pediatric trauma patients need?

Olivia Burrola Hernandez, M.S., CCC-SLP

Amanda Uribe, BSN, RN

Objectives…

Participants will have a better understanding of: The need for multi-disciplinary coordination of

services

Addressing age-appropriate responses to traumatic events

Long Term Consequences“She is a beautiful 4-year old. She was in

the hospital for several months and has a

severe brain injury. She can’t speak and has

difficulty maintaining balance for sitting. She

is more like a 2-year-old than a 4-year-old.

We know there are many challenges before

us in getting all the services she will need

throughout her life.”

--Jessica’s parents, who found their daughter comatose in

her crib at the age of 3 weeks, injured while in the care of

her nanny

“I have headaches and can’t concentrate in

school. I am a little impatient with my

friends, and they don’t call like they used to.

Maybe I am just over-stressed with sports

and schoolwork?”

--Kiesha, 17, a varsity volleyball player, one year after

sustaining a concussion when she hit her head on the gym

floor and was returned to play in that game against the

recommendation of the athletic trainer.

Long Term Consequences

“Our son is now 11 and has begun to do

poorly in school. We can’t figure out what is

bothering him. He was a great student until

third grade, but he just can’t keep up

anymore. His friends are a little on the wild

side and influence him to do bad things. He

is physically fine. Maybe he should play

sports and get rid of some of this energy.”--Matthew’s parents, discussing academic and behavioral

changes in their son, who was hit by a car when he was 8

years old. Matthew was unconscious for 24 hours,

hospitalized for three days, and discharged home with no

further recommendations.

Long Term Consequences

Core Team Members

Patient

Family

Medical Team

Nursing Team

Case Management

Respiratory Therapy

Laboratory

Radiology

Physical Therapy

Occupational Therapy

Speech-Language Pathology

Child Life Services

Family Support Services

Social Work

Clinical Nutritional Services

Pharmacy

Trauma Informed Care

Incorporating an understanding of posttraumatic stress in

each clinical encounter with ill or injured children and

their families.

SAMHSA promotes the approach of shifting away from

the view of “What’s wrong with this person?” to a more

holistic view of “What happened to this person?”

An organization that is trauma-informed follows the

four “Rs”: Realizes the widespread impact of trauma and understands potential paths

for recovery

Recognizes the signs and symptoms of trauma in clients, families, staff, and

others involved with the system

Responds by fully integrating knowledge about trauma into policies,

procedures, and practices

Actively seeks to resist re-traumatization

ACEs study

Adverse Childhood Experiences (ACEs).

ACEs have been linked to

risky health behaviors,

chronic health conditions,

low life potential, and

early death.

As the number of ACEs increases, so does the risk for these outcomes.

The original ACE Study was conducted at Kaiser

Permanente from 1995 to 1997 with two waves of data

collection.

The ACE Pyramid

12 Core Concepts- NCTSN1. Traumatic experiences are inherently complex.

2. Trauma occurs within a broad context that includes children’s

personal characteristics, life experiences, and current

circumstances.

3. Traumatic events often generate secondary adversities, life changes,

and distressing reminders in children’s daily lives.

4. Children can exhibit a wide range of reactions to trauma and loss.

5. Danger and safety are core concerns in the lives of traumatized children.

6. Traumatic experiences affect the family and broader caregiving

systems.

7. Protective and promotive factors can reduce the adverse impact of trauma.

8. Trauma and posttrauma adversities can strongly influence development.

9. Developmental neurobiology underlies children’s reactions to traumatic

experiences.

10. Culture is closely interwoven with traumatic experiences, response,

and recovery.

11. Challenges to the social contract, including legal and ethical issues, affect trauma

response and recovery.

12. Working with trauma-exposed children can evoke distress in

providers that makes it more difficult for them to provide good care.

Stages of Cognitive Development Sensorimotor Stage: Birth to 2 years

Infant knows and learns about their

environment through movements and

sensations.

Children learn about the world through basic

actions, such as, sucking, grasping, looking

and listening.

Infants develop object permanence.

Infants learn they are separate beings from

the people and objects around them.

Children realize that their actions can cause

things to happen in the world around them.

Stages of Cognitive Development Preoperational Stage: 2 years to 7 years

Children begin to think symbolically and learn

to use words and pictures to represent

objects.

Children are egocentric and struggle to see

things from the perspective of others.

Think about things in very concrete terms.

Stages of Cognitive Development Concrete- Operational: 7 years to 11 years

Children begin to think logically about

concrete events.

Children begin to understand the concept of

conservation (equal volume in various

containers).

Children begin to use inductive logic, or

reasoning, from specific information to a

general principle.

Stages of Cognitive Development Formal Operational: 12 years and older

Individuals begin to think abstractly and

reason about hypothetical problems.

Abstract thought emerges

Individuals begin to think more about moral,

philosophical, ethical, social, and political

issues that require theoretical and abstract

reasoning.

Individuals begin to use deductive logic from a

general principle to specific information.

Ages and Developmental Stages:

Symptoms of Exposure:

ReferencesDePompei, R. (2010). Pediatric Traumatic Brain Injury Where Do We Go From Here?. The ASHA Leader. Vol. 15, 16-

20.

Kassam-Adams, N., Rzucidlo, S., Campbell, M., Good, G., Bonifacio, E., Slouf, K., . . . Grather, D. (2015). Nurses'

Views and Current Practice of Trauma-Informed Pediatric Nursing Care. Journal of Pediatric Nursing,

(30), 478-484. Retrieved October 10, 2017, from http://www.pediatricnursing.org/article/S0882-

5963(14)00328-5/fulltext?cc=y=

National Child Traumatic Stress Network - Child Trauma Home |. (n.d.). Retrieved November 25, 2017, from

http://www.nctsn.org Ages and Developmental Stages: Symptoms of Exposure and 12 Core Concepts

O’Connell, K., Fritzeen, J., Guzzetta, C., Clark, A., Lloyd, C., Scott, S., Aldridge, M., Kreling, B. (May 2017). Family

Presence During Pediatric Trauma Care Benefits Patients, Families and Medical Teams. American

Journal of Critical Care. Vol. 26, 229-239

Owens, R. (2015). Language Development An Introduction, 9th Ed., New York, Pearson.

C. (2016, September 01). SAMHSA's Efforts to Address Trauma and Violence. Retrieved November 25, 2017, from

https://www.samhsa.gov/topics/trauma-violence/samhsas-trauma-informed-approach Efforts to Address

Trauma and Violence

Violence Prevention. (2016, April 01). Retrieved November 25, 2017, from

https://www.cdc.gov/violenceprevention/acestudy/index.html

ACEs Study

Thank you!

If you have questions, contact us at:

Amanda 915.298.5444 extension 40653

Olivia 915.242.8360