Research In Action

How many children are affected by a potentially traumatic event each year? Globally, 400 million children each year are injured, and more than 70 million are exposed to disasters. Millions more experience other types of public, community-wide trauma (such as armed conflict or community violence) or trauma that happens out of the public eye (such as violence within families or physical and sexual abuse of children).

Research suggests that 10% to 40% of these children will go on to develop trauma-related mental health issues. Treatment for children that develop posttraumatic stress or other mental health consequences is vitally important. However, these numbers make it clear that limiting our attention to individual treatment would leave millions of children, and the communities in which they live, struggling with the impact of trauma. 

Recognizing the population-level impact of trauma for adults and children around the world, the International Society for Traumatic Stress Studies (ISTSS) recently commissioned a Trauma and Public Health Task Force. Key implications for practice and policy have just been published in a “call to action” paper in the European Journal of Psychotraumatology.

Key Messages

• Consider primary, secondary, and tertiary prevention. Primary prevention efforts that reduce prevalence of injury, violence, abuse, and human-caused disasters are essential and needed. We can think of timely and effective mental health treatment as tertiary prevention of long-term consequences of trauma. However, in many communities, mental health service systems are non-existent or over-burdened; globally, the existing mental health workforce is not adequately prepared to provide trauma-focused services for children and adolescents. This call to action recognizes that a public health approach focused on secondary prevention of the impact of trauma for children and adolescents may be particularly important. For acute traumatic events, this means reaching children soon after trauma exposure to promote recovery and social support and to reduce the onset of post-trauma mental health challenges.
• Efficacy is not enough -- think about “reach.” A public health approach suggests that we must balance efficacy with ‘‘reach’’-- the proportion of the target population that will be served and assisted by a given intervention. Developing a highly effective intervention that is not practical for wide delivery will have limited population impact. Promising methods that may achieve wide reach include online and e-health tools and embedding trauma-informed services within the many systems that come into contact with children after trauma.
• Think big -- from the individual to society. As one example, the paper describes efforts by trauma professionals to apply a public health perspective to the response to the terrorist attacks in Norway in 2011, an event that impacted an entire nation.  A multi-level response was key. Beginning immediately after the terrorist attacks, comprehensive responses were targeted to direct survivors and their families, bereaved families, and the public.

The vast population-level impact of trauma exposure among children and youth provides a compelling example of the need for a public health approach. Organizations like ISTSS are increasingly championing this perspective. CIRP@CHOP researchers have also contributed to the knowledge base that is helping to define wide-reaching screening and prevention efforts.

Learn more about CIRP@CHOP research on preventing pediatric traumatic stress.