Research In Action

With an international group of experts, I recently co-authored an editorial published in the European Journal of Psychotraumatology that examines inclusivity and equitability in traumatic stress treatment guidelines for children globally. What we found, based on a review of 14 international pediatric trauma treatment guidance documents, indicates limited consideration of cultural background, which could possibly be due to limited diversity in the empirical evidence used to inform these guidelines, as well as no consideration of the youth perspective during the development of trauma treatment guidelines.

A systematic review, published in the Journal of Pediatric Psychology, found that 30% of children with medical conditions and their parents experience significant emotional trauma reactions related to the child's medical condition. The COVID-19 pandemic and the recent “Black Lives Matter” protests have brought attention to the urgency of achieving health equity globally. Clinical practice guidelines, such as those focusing on traumatic stress treatment, can play an important role in promoting equity.

While treatment guideline recommendations can improve access to quality care across settings and populations, how they are derived is also crucial. To promote inclusivity and equitability in future guidelines, we recommend the following approach with step-by-step guidance.

Steps to Foster Inclusion and Equity

1. Establish a guidelines committee that includes a diverse group of young people and parents as members. Pay explicit attention to ensuring all voices are heard.
2. Include historians, sociologists, anthropologists, educationalists, public health economists, and local ethicists on the committee. They can bring a deeper understanding of the local history, culture, norms, strengths, and vulnerabilities of the population.
3. Review one or more recent pediatric trauma care guidelines and their underlying systematic reviews. Be sure to assess potentially relevant studies for cultural competence and representation of children's voice.
4. Gather already available local evidence on needs and opportunities for cultural adaptations. Where possible, review local treatment studies and reports of cultural adaptations with attention for evidence that has been communicated only in a local language. 
5. Include equity as a standard agenda item throughout the guideline development process.

Action Needed

Promoting research and guideline development with, by, and for currently under-represented communities, led by investigators who themselves represent those communities, should be a high priority for our field. It’s time for our national, regional, and global professional associations to take action. We need to advocate for improved access to trauma treatment with policymakers and support the careers of young scholars from diverse backgrounds so that we can achieve equity and inclusivity in pediatric trauma care internationally.