A Pilot Intervention Study Addressing Parental Responses to Child Trauma

针对父母对儿童创伤反应的试点干预研究

• 批准号: 2381188
• 金额: --
• 依托单位: University of Bath
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2020
• 资助国家: 英国
• 起止时间: 2020 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-2381188
• 关键词: Pilot; Intervention; Study; Addressing; Parental

It has been estimated that around 31% of young people will experience a traumatic event during childhood (Lewis et al, 2019), most commonly serious accidents that lead to hospitalisation. Around 15% of children who experience such events go on to develop PTSD symptoms including excessive fear, reexperiencing the traumatic event, negative changes in beliefs about the world and the future, anger and hyperarousal (Hiller et al, 2018).A growing body of research highlights significant associations between parental responses to child trauma and subsequent child PTSS (Hiller et al, 2018; Morris, Gabert-Quillen, & Delahanty, 2012). Notably, child trauma can trigger changes in parenting behaviour, including negative trauma appraisals and coping mechanisms (Cobham & McDermott, 2014). Consequently, it is important to engage parents in providing positive support for children's recovery post-trauma.In preliminary work, involving parents as co-therapists in child trauma interventions has had positive treatment outcomes (Berkowitz, Stover, & Marans, 2011; Deblinger & Steer, 2010). However, to date, interventions have been delivered individually or in group sessions and high attrition rates reflect their limited accessibility.Hence, this research aims to create an online intervention targeting parental responses to child trauma in the early post-trauma. Collaboration with families and clinicians will ensure that the intervention is acceptable and can be easily embedded within routine services for trauma-exposed children. Enormous burdens are placed on emergency departments and it is difficult to address the mental wellbeing of patients and families. Therefore, piloting and up-scaling a low-level intervention will help families to support children's psychological adjustment following a traumatic experience.Objectives1. To conduct a systematic review of the evidence base relating to influences of parental responses on child PTSS & identify key target domains for intervention.2. To co-design an online intervention for parents of trauma-exposed children, combining evidence-based intervention components with consultation with families and the clinical teams that support them. 3. To conduct a pilot feasibility study to examine whether the intervention addressing parental response to child acute distress has the potential to reduce child PTSS.4. To establish clear pathways to intervention delivery, through collaboration with key health care providers.MethodsPhase OneI will conduct a systematic review to explore the effect of parental responses on child posttraumatic stress symptoms and which treatment components would be effective in addressing these dysfunctional parenting responses.Phase TwoA user-led, internet-based pilot intervention will be co-designed in close collaboration with families and clinicians, to ensure acceptability and effective delivery. Development work will include focus groups and pilot testing with feedback and adjustment. Subsequently, through collaboration with the Emergency Department at the Bristol Royal Hospital for Children, 60 parents of children who have experienced acute trauma will be recruited and randomised to the intervention or to treatment as usual in a pilot feasibility trial. The intervention will aim to address the following goals through cognitive-behavioural therapy techniques:* To increase positive parental communication between parents & children, and parental awareness of children's PTSS;* To encourage parents to model positive thinking patterns and adaptive coping behaviours for the children.Child PTSS will be examined post-intervention and at a 3-month follow-up. Qualitative work will inform detailed perspectives from families, consistent with the major goal of feasibility trials. Phase ThreeQualitative research will be conducted with emergency department clinicians and other support services to establish pathways to scaling up the intervention.

据估计，约31%的年轻人在童年时期会经历创伤事件（刘易斯et al，2019），最常见的是导致住院的严重事故。大约15%经历过这些事件的儿童会继续发展PTSD症状，包括过度恐惧，重新经历创伤事件，对世界和未来的信念发生负面变化，愤怒和过度觉醒。（Hiller et al，2018）。越来越多的研究强调了父母对儿童创伤的反应与随后的儿童PTSS之间的显著关联（Hiller et al，2018; Morris，Gabert-Quillen，& Delahanty，2012）。值得注意的是，儿童创伤可以引发父母行为的变化，包括负面创伤评估和应对机制（Cobham & McDermott，2014）。因此，重要的是让父母参与为儿童创伤后的恢复提供积极的支持。在初步工作中，让父母作为儿童创伤干预的共同治疗师，已经取得了积极的治疗效果（Berkowitz，秸秆，& Marans，2011; Deblinger & Steer，2010）。然而，到目前为止，干预措施已交付单独或在小组会议和高损耗率反映其accessibility.因此，本研究的目的是创建一个在线干预，针对父母的反应，儿童创伤后早期创伤。与家庭和临床医生的合作将确保干预措施是可接受的，并且可以很容易地嵌入到创伤暴露儿童的常规服务中。急诊部门承受着巨大的负担，很难解决患者和家属的心理健康问题。因此，试点和扩大低水平的干预将有助于家庭支持儿童在创伤经历后的心理调整。对有关父母反应对儿童PTSS影响的证据基础进行系统回顾，并确定干预的关键目标领域。为创伤暴露儿童的父母共同设计在线干预，将循证干预成分与家庭和支持他们的临床团队的咨询相结合。3.进行一项试点可行性研究，以检查干预解决父母对儿童急性痛苦的反应是否有可能减少儿童PTSS。通过与主要卫生保健提供者的合作，建立明确的干预途径。MethodsPhaseOneI将进行系统的回顾，探讨父母的反应对儿童创伤后应激症状的影响，以及哪些治疗成分将有效地解决这些功能失调的父母反应。PhaseTwoA将与家庭和临床医生密切合作，共同设计以用户为主导的，基于互联网的试点干预，以确保可接受性和有效交付。开发工作将包括焦点小组和试点测试，并进行反馈和调整。随后，通过与布里斯托皇家儿童医院急诊科的合作，将招募60名经历过急性创伤的儿童的父母，并随机接受干预或常规治疗。试点可行性试验。透过认知-行为治疗技术，介入计划旨在达致以下目的：* 增加父母与子女之间的正面沟通，以及家长对儿童创伤后应激障碍的认识;* 鼓励家长为儿童树立正面的思维模式及适应性的应对行为。定性工作将告知家庭的详细观点，与可行性试验的主要目标一致。第三阶段将与急诊科临床医生和其他支持服务机构进行定性研究，以建立扩大干预的途径。