Date Presented 04/01/2022
This qualitative study explored the construct of trauma-informed care (TIC) in pediatric OT. Grounded theory methodology revealed a central theme of OTs addressing TIC through direct and indirect interventions. Subthemes included support systems, targeting areas of difficulty, and characterization influencing intervention. The study concluded that therapists consider trauma and formulate interventions on the basis of the child’s needs from a holistic approach.
Primary Author and Speaker: Aimee Piller
Additional Authors and Speakers: Ali Achord
The concept of trauma-informed care (TIC) was initially recognized on a wide scale after the Adverse Childhood Experiences (ACE) study exposed the long-term negative health effects of living through abuse, violence, and other traumatic experiences in childhood. There is emerging research regarding occupational therapy practitioner’s (OTP) role in treating persons with trauma, more specifically post-traumatic stress disorder in adults (Torchalla et al., 2019; Edgelow et al., 2019). These studies have shown the negative effects of on functional abilities and participation daily roles, routines, and habits. This is also true for children, who may be impacted significantly after experiencing or witnessing traumatic events. Though the role of a pediatric OTP is not to treat the trauma itself, providing interventions and education addressing the effects of trauma on daily activities, school performance, and social participation falls within the OTP’s scope of practice. Examples of this include community programs to encourage health promotion and prevention(Gronski et al., 2013) and sensory-based interventions to improve trauma processing physically in the body (McGreevy & Boland, 2020). While the prevalence of experiences of trauma in childhood is assumed to be high, current research on trauma in pediatrics and occupational therapy is very limited. There are few evidence-based studies that even define what trauma-informed care from the lens of an OTP working in pediatrics. Without a consistent definition, it is difficult to determine what role the OTP plays in TIC in pediatrics. This study aims to define TIC from the standpoint of the pediatric occupational therapist and identify how trauma is addressed in practice. Ten pediatric occupational therapists were recruited using a purposeful, snowball sampling method. Data were collected using semi-structured interviews and analyzed using a grounded theory approach with triangulation occurring between three independent researchers. Results indicated a central theme of OTP provide direct and indirect interventions to address trauma. Although nearly all participants indicated there was little evidence on occupational therapy’s role in TIC, participants reported that they address trauma in practice and often refer to it as TIC, even if trauma was not documented in the medical record. Sub themes indicated that support systems are key to intervention, areas of difficulty in the client drive intervention, and the identification of trauma influences in occupational therapy intervention choices. Concepts such as a holistic view of treatment and the importance of environment, routine, and space were described as key components of intervention. Finally, the definition of trauma emerged as an abrupt and harsh change in routines, often occurring unexpectedly. Overall, this study supports a unified understanding of the role of occupational therapy in the treatment of children with a history of trauma from the perception of OTPs. Interventions on the direct level of using space strategically, keeping routines, and utilizing sensory strategies are specific examples. Indirect interventions including education, therapeutic use of self, interprofessional collaboration, and family involvement are all important aspects of trauma informed care in occupational therapy. OTPs can utilize the information from this study to guide their interventions and assessment methods when working with children who may have a history of trauma.
IMPACT STATEMENT: This study provides a foundation to further study and define the unique role in occupational therapy in children with a history of trauma in order to develop evidence-based interventions to target the needs of children through a TIC lens.
Edgelow, M. M., MacPherson, M. M., Arnaly, F., Tam-Seto, L., & Cramm, H. A. (2019). Occupational therapy and posttraumatic stress disorder: A scoping review. Canadian Journal of Occupational Therapy, 86(2), 148–157. https://doi.org/10.1177/0008417419831438
Gronski, M.P., Bogan, K.E. Kloeckner, J., Russell-Thomas, D., Taff, S.D., Walker, K.A., & Berg, C. (2013) The issue is-- childhood toxic stress: a community role in health promotion for occupational therapists. American Journal of Occupational Therapy, 67, e148-e153. http://dx.doi.org/10.5014/ajot.2013.008755
McGreevy, S. & Boland, P. (2020) Sensory-based interventions with adult and adolescent trauma survivors: An integrative review of the occupational therapy literature. Irish Journal of Occupational Therapy, 14(1), 31-54. https://doi.org/10.1108/IJOT-10-2019-0014
Torchalla, I. Killoran, J., Fisher, D., & Bahen, M. (2019) Trauma-focused treatment for individuals with posttraumatic stress disorder: The role of occupational therapy. Occupational Therapy in Mental Health, 35(4), 386-406. https://doi.org/10.1080/0164212X.2018.1510800