P3.070: Caring for children who have experienced trauma: Learning from caregivers’ experiences with the pediatric health care system

Background: Recent data suggests that around 75% of high school students have experienced a potentially traumatic event before the age of 18. Exposure to traumatic events and the subsequent effects on the developing child can manifest into significant health issues. Pediatricians, as health and child development experts, are uniquely positioned to partner with families to identify the effects of trauma in children, promote recovery/build resilience, and most importantly, prevent children from experiencing trauma. The American Academy of Pediatrics (AAP) is working to support pediatricians and pediatric healthcare providers in providing trauma-informed care to all patients and families in their care. To support pediatricians in providing care that is trauma-informed, and family centered, it’s important to partner with caregivers and learn from their lived experiences with the pediatric healthcare system – especially as it relates to caring for their children who have experienced trauma.

Methods: Focus groups were conducted to collect qualitative information from caregivers of children who have experienced trauma, to better understand caregivers’ experiences with the pediatric health care system. Guidelines were approved by the AAP Institutional Review Board (IRB). Participants were recruited from a list of individuals who submitted applications to join the AAP Family Partnership Team related to trauma-informed care (TIC). Participants represented a broad range of caregiver types including but not limited to grandparent caregivers, foster/adoptive caregivers, and biological caregivers. Four virtual 90-minute focus groups were conducted with 18 caregivers total and were facilitated by AAP staff and a Licensed Clinical Psychologist. Participants were asked 10 questions about psychological safety during pediatric visits, effects of trauma on health, and interactions between providers and families to better understand their experiences with their child’s health care providers related to caring for their child who had experienced trauma. Feedback was captured using a note taker/recording transcription. An inductive data analysis approach was used to capture categories and themes.

Results: Caregivers shared a variety of experiences in various settings, including in-patient, primary care, and subspeciality care. Themes from favorable experiences included providers partnering with caregivers and integrating components of TIC: offering choices when possible, speaking calmly/clearly, supporting the referral process, and conveying a sense of respect and genuine curiosity – not making assumptions based on biases.

Themes from less favorable experiences with health care providers included feeling like the child’s concerns were not taken seriously, not acknowledging/asking about the wellbeing of the family, and not following up on/supporting referral processes. Most caregivers indicated that the providers had not explained the connection between trauma and physical/mental health symptoms.

Conclusion: Leveraging the principles of trauma-informed care in all pediatric health care visits with patients and families may improve caregiver and family experiences with care and build trust between providers and families, resulting in better health outcomes.