CIRP researchers studied children in car crashes to understand the prevalence and risk of traumatic stress in injured children.
In addition to the medical and biomechanical aspects of pediatric injury, researchers at the Center for Injury Research and Prevention (CIRP) also address its psychosocial consequences. Over more than a decade, a multi-faceted research program at CIRP has examined the range of responses that children (and their parents) experience after pediatric injury.
Our early studies found that psychological distress, such as acute stress disorder (ASD) and posttraumatic stress disorder (PTSD), occurs in significant numbers of:
- children with unintentional injuries such as traffic-related injuries
- youth injured by interpersonal violence
- parents of injured children
For children, youths, and parents facing pediatric injuries and other difficult medical events, CIRP researchers are working to:
- document the prevalence of acute and longer-term posttraumatic distress
- understand risk and resilience factors that affect emotional recovery after injury
- create valid measures for acute stress symptoms in children and youth
- create practical and valid screening tools to help emergency and acute care clinicians identify children and parents at risk
- develop effective preventive intervention methods to reduce posttraumatic stress after injury
Understanding Children’s and Parents’ Emotional and Physical Recovery After Injury
- PTSD in Children and Parents Up to One Year After a Traffic Crash (1998)
The CIRP research team conducted a prospective assessment of PTSD symptoms in 102 children after traffic crashes. Telephone follow-up interviews with parents, seven months to a year after the injuries occurred, revealed significant psychological distress in children and parents: 25 percent of the children and 15 percent of the parents met symptom diagnostic criteria for PTSD.
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- Prospective Study of Children's and Parents' Reactions to Traffic Crashes (1999-2002)
With funding from the Maternal and Child Health Bureau, CIRP researchers initiated a prospective study to follow 360 children hospitalized after being injured in a traffic crash (as a passenger, a pedestrian, or a bicyclist). Results of this study provided strong evidence that injured children and their parents may be affected by traumatic stress disorders and that early screening for PTSD risk is possible. The study also identified key factors in the etiology of PTSD that helped to inform our subsequent development of preventive interventions.
A 12-item screening measure, Screening Tool for Early Predictors of PTSD (STEPP), was developed to aid in the delivery of improved services through triaging. The STEPP measure demonstrated excellent screening tool properties, including very high sensitivity and reasonable specificity for prediction of later PTSD outcome in injured children admitted to the hospital and their parents.
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- Development of a Measure of Acute Stress Disorder for Children (2001- present)
Acute stress disorder (ASD) is a constellation of early posttraumatic stress symptoms occurring in the first month after a traumatic event. In a project funded in 2001 by the National Institutes of Mental Health (NIMH), the CIRP team developed a self-report checklist of ASD, the Acute Stress Checklist for Children, also known as the ASC-Kids. Prior to this work there were no established and well-validated child self-report measures of ASD. In a validation sample of 176 children and teenagers with recent traumatic injuries, the ASC-Kids showed excellent reliability and demonstrated strong predictive validity for posttraumatic stress symptoms assessed several months later. In a second NIMH-funded project beginning in 2007, the CIRP team worked with colleagues in Los Angeles and Miami to examine the validity of the ASC-Kids in both English and Spanish versions in a large sample of 479 children across all three cities. Results indicate that the checklist functions well in both languages.
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Creating and Disseminating Information and Interventions
- Screening and Secondary Preventive Interventions for Injured Children and Their Parents (2002-present)
Building on earlier findings, the CIRP team developed and tested models for screening and prevention of posttraumatic stress after pediatric injury. With funding from the Emergency Medical Services for Children (EMSC) Program, CIRP researchers developed and piloted a range of methods for integrating screening or brief preventive interventions for recently injured children and their parents within pediatric care:
- examined the feasibility of screening for PTSD risk in a busy emergency room setting by having Emergency Department (ED) nurses administer the STEPP during the course of their normal clinical encounters.
- piloted trauma surgeon discharge letters to primary care providers, with information on traumatic stress, tips for providing anticipatory guidance to injured children and their families, and evidence-based handouts for parents.
- piloted an automated alert in the primary care electronic health record after a child’s Emergency Department treatment for unintentional injury.
With funding from the Centers for Disease Control and Prevention (CDC), Center researchers conducted a randomized controlled trial of an integrated intervention, the Stepped Preventive Care (SPC) model. In the SPC model, hospital-based nurses and social workers screen injured children for risk of PTSD symptoms, and deliver “just enough” care to help prevent persistent posttraumatic stress or depression.
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- Web-based tools for parents and children (2005-present)
The CIRP team has developed a number of web-based tools for children and parents, involving these key audiences each step of the way to ensure that tools are user-friendly. CIRP researchers carefully evaluate the impact and effectiveness of web-based information and interventions. For example, AfterTheInjury.org is a web-based resource for parents that has been shown to increase parents’ knowledge of child traumatic stress reactions and how to help children recover.
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