A Pilot Intervention Study Addressing Parental Responses to Child Trauma

据估计，约31%的年轻人在童年时期会经历创伤性事件（Lewis et al ., 2019），最常见的是导致住院的严重事故。经历过此类事件的儿童中，约有15%会出现PTSD症状，包括过度恐惧、重新体验创伤性事件、对世界和未来的信念发生负面变化、愤怒和过度兴奋（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创伤后应激障碍之间的显著关联（Hiller等人，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，包括消极的创伤评估和应对机制（Cobham & McDermott, 2014）。因此，让父母参与为儿童创伤后康复提供积极支持是很重要的。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结果（Berkowitz, Stover, & Marans, 2011; Deblinger & Steer, 2010）。然而，迄今为止，干预措施都是单独或以小组形式提供的，高流失率反映了它们的可及性有限。因此，本研究旨在创建一个在线干预针对父母对儿童创伤后早期的反应。与家庭和临床医生的合作将确保干预是可接受的，并且可以很容易地嵌入到对暴露于创伤的儿童的常规服务中。急诊科承受着巨大的负担，很难解决病人和家属的心理健康问题。因此，试点和扩大低水平干预有助于家庭支持儿童创伤后的心理适应。对父母反应对儿童创伤后应激障碍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一项在线干预措施，将基于证据的干预措施与家庭和支持他们的临床团队的咨询相结合。3. 3 .进行可行性试验研究，探讨父母对儿童急性痛苦反应的干预措施是否有可能减少儿童的创伤后应激障碍。通过与主要卫生保健提供者合作，建立提供干预措施的明确途径。方法第一阶段将进行系统回顾，探讨父母反应对儿童创伤后应激症状的影响，以及哪些治疗成分可以有效地解决这些不正常的父母反应。第二阶段：用户主导、基于互联网的试点干预措施将与家庭和临床医生密切合作，共同设计，以确保可接受性和有效实施。开发工作将包括焦点小组和带有反馈和调整的试点测试。随后，通过与布里斯托尔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，并在试点可行性试验中随机分配到干预组或常规治疗组。干预将通过认知行为治疗技术达到以下目标：*增加父母与子女之间的积极沟通，提高父母对儿童创伤后应激障碍的认识；*鼓励家长为孩子树立积极的思维模式和适应的应对行为。儿童创伤后应激障碍将在干预后和3个月的随访中进行检查。定性工作将提供来自家庭的详细观点，与可行性试验的主要目标相一致。第三阶段将与急诊科临床医生和其他支助服务机构进行均衡研究，以确定扩大干预措施的途径。

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.