The Development of an Intervention Addressing Parental Responses to Child Post-Traumatic Stress Symptoms Following Acute Injury

: (Alternative Format Thesis)

Abstract

Acute paediatric injuries are common, and up to 60% of acutely injured children experience post-traumatic stress symptoms (PTSS). The acute post-trauma period presents opportunity for intervention, where families and emergency department (ED) clinicians can provide early preventative support. However, such interventions have not been developed for a UK ED context. Therefore, this thesis aimed to develop an intervention for parents of acutely injured children, delivered via ED clinicians. The five core chapters aimed to: develop the evidence base on parental responses to child trauma exposure; explore the feasibility of implementing an intervention into paediatric EDs; and develop an intervention. To achieve this, this thesis integrated the Medical Research Council framework with the Person-Based Approach across three phases: intervention planning, intervention design, and intervention optimisation. Chapter Two systematically reviewed the relationship between parental responses and child PTSS. More consistent evidence was found for parental overprotection, lack of parent-child trauma communication, trauma-related appraisals, and distraction and avoidance. Chapters Three and Four explored barriers and facilitators to the implementation of psychosocial interventions into EDs. A secondary quantitative analysis (Chapter Three) (N = 434) revealed that clinician confidence was related to worrying about further upsetting children, a lack of training, and departmental support for trauma-informed care. A qualitative investigation with ED clinicians (N = 24) further revealed barriers and facilitators to intervention implementation. These findings guided the development of Parenting After the Trauma (PAT), which was optimised in consultation with parents, ED clinicians, and clinical psychologists. This work develops the understanding of how an intervention promoting parental coping assistance can be implemented into paediatric EDs. Findings provide avenues for future research to further optimise the intervention and implementation strategies, and explore acceptability, feasibility, and clinical effectiveness. This research can ensure that families of acutely injured children are empowered to support their child’s psychological recovery.

Date of Award	2024
Original language	English
Awarding Institution	University of Bath
Supervisor	Sarah Halligan (Supervisor) & Maria Loades (Supervisor)