Trauma-informed care shifts the focus from “what’s wrong with you” to “what happened to you?”; and then, to “what’s strong with you?” 

Trauma-informed care, as defined by Hopper and colleagues, is a "strengths-based framework that is grounded in an understanding of and responsiveness to the impact of trauma, and emphasizes the physical, psychological, and emotional safety for both providers and survivors, and creates opportunities for survivors to build a sense of control and empowerment."

Pediatricians and other pediatric health care professionals are uniquely positioned to partner with families to identify and respond to trauma in children and adolescents. They need to be prepared to: 

  • Promote safe, stable, nurturing relationships
  • Recognize signs of traumatic stress
  • Assess symptoms 
  • Treat when needed

TIC is fundamentally relational health care -  the ability to form safe, stable and nurturing relationships (SSNRs). Pediatricians can support the caregiver-child relationship, the context in which there can be recovery from trauma and the restoration of resilience.

      Image provided by the Centers for Disease Prevention and Control (CDC).

Adverse Childhood Experiences (ACEs) and Trauma 

A traumatic event is a frightening, dangerous or violent event that poses a threat to a child’s life or body integrity. Trauma can result from adversities such as community violence, natural disasters, unintentional injuries, terrorism, racism, immigrant or refugee traumas and/or those involving the caregiving relationship such as intimate partner violence, parental substance use, parental mental illness, caregiver death, separation from a caregiver, neglect or abuse – originally defined as adverse childhood experiences (ACEs). ACEs are prevalent - recent data shows that over 75% of high school students report having experienced at least one ACE.  

Trauma, while not always avoidable, does not need to define a child’s future. Nurturing relationships can dramatically reduce the impact of toxic stress that may be caused by a traumatic event and encourage healing.  

For more information about ACEs, visit the CDC's website.

What are the core principles of trauma-informed care?

Trauma-informed care cannot occur in isolation. Health systems should assess all levels of their organization and align them with the key principles of providing this care.

The Substance Abuse and Mental Health Services Administration (SAMHSA) recognizes the following core principles of a trauma-informed approach to care: 

  • Safety: Create a psychologically and physically safe environment for children,
    families, and staff. 
  • Trustworthiness and transparency: Build and maintain trust among families and health caregivers.
  • Peer support: Help parents or patients identify and establish systems of peer support.
  • Collaboration and mutuality: Partner with children and families, reduce power differential between health care staff and patients. 
  • Empowerment and choice: Focus on strengthening resilience factors and providing choice in clinical settings. 
  • Cultural, historical, and gender issues: Recognize and address historical trauma, adopt policies and processes that are responsive to cultural needs of
    families.

How do I provide trauma-informed care? 

Trauma-informed means we understand the effects of early adversity on the brain and body, and how that resonates across the lifespan. Trauma-informed care is how we can respond to it.  

Click here to view the new infographic “What Is Trauma-Informed Care?”.  

To learn more about the trauma-informed pediatric care, review the 2021 AAP Clinical Report: Trauma-Informed Care, and take the PediaLink course “Trauma-Informed Care and Resilience Promotion”.  

Stress and the Healing Power of Connection

Kids reach out to others when things get tough. This is called the affiliate response, which relies on our strengths, our brains and each other. It's the biology of connection. This video from the American Academy of Pediatrics explains how supporting families to engage in the affiliate response can help kids feel less stressed, build resilience and recover from trauma.

Watch

YouTube Video

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July 22, 2024

ACE Scores & ACEs Screening  

An ACE score is a tally of specific childhood traumatic events that an individual has experienced. Higher ACE scores have been associated with poor health outcomes at the population level. However, ACE scores do not predict individual health – it does not consider all the different forms of trauma, or the severity, chronicity, or frequency of trauma. ACE scores also do not consider the important protective factors in a child’s life that may buffer against the impact of toxic stress.  

For a quick explainer related to ACE scores, view the infographic below, “Moving Beyond ACE Scores”.

The AAP does not support the use of “ACEs screening” for clinical decision-making, and instead, recommends providing trauma-informed care as a universal approach to care. To learn more about the evidence related to ACEs screening, review this article: Screening for Adverse Childhood Experiences: A Critical Appraisal.  

Last Updated

12/16/2024

Source

American Academy of Pediatrics