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Supporting Children Through Firearm Trauma
Amy Koch
+ Children and Firearms in the U.S.
13 children die every day 2nd leading cause of death 2,711 children and adolescents 0-19 years old died 15,576 injured
+ Research Question
How do Child Life Specialists support children and families in the hospital who experience trauma due to firearm injuries ED PICU Rehabilitation
+ What did I Hope to Find Out
How Child Life interventions differ by a child’s age and developmental level?
How often Child Life professionals intervene with patients who have been injured due to firearm activity?
What do Child Life Specialists focus on with this population of patients?
What other members of the medical team do Child Life Specialists collaborate with?
+ Prevalence of Firearms in the Home
Handgun usage is seen most in trauma
Firearms Handguns Long guns Assault weapons Air guns
200 million firearms owned 9 million adolescents have
access to firearms
+ Children and Trauma
4 types of injuries Assault Homicide Suicide Unintentional
2 types of trauma Emotional Physical
+ The Role of the Child Life Specialist
Strengths Well-being Promoting Optimal
Development Minimizing Adverse Effects
Play Build Rapport Normalize Environment Activities for Emotional
Expression
+ Methods and Procedures 7 Certified Child Life
Specialists Semi-structured Interviews Qualitative Investigation
Specific Interventions Occurrence Needs of the Patients Collaboration
+ Data Collection & Analysis
Data Collection Child Life Forum and personal connections Nation wide
Data Analysis Verbatim Transcripts Grounded theory (Auerbach & Silverstein, 2003; Merriam,
2009) Focused on recurring themes
+ Results: Themes
Themes
Needs of the Patient and Family
Interventions Used
Responses to Trauma
Differences Between Units
+ Results: Background
Participant #
Unit # of CLS on Unit
# of GSW Patients Seen on Unit
1 Rehab Primary CLS 4-52 ED 3 CLS 35-453 Rehab Primary CLS 34 Rehab Primary CLS 4-55 Rehab Primary CLS 2-36 ICU Primary CLS 47 ED Primary CLS 7-12
+ Results: Needs of the Patient & Family
“A lot of what needs to happen is building that therapeutic relationship first, and really getting to know what that patient’s interests are…Figuring out what’s going on for them.”
“For the families, it’s just the need to feel safe”
“Support the family when their lives might need to change.”
“Family members often need emotional support more than anything”
Emotional Support
Education
+ Results: Interventions Used
Building a Therapeutic Relationship Procedural Preparation
Concrete Examples Expressive Arts Medical Play
Normalization through play Maintaining Routines Providing Choices Preserving Boundaries
+ Results: Interventions Used
Building a Therapeutic Relationship Procedural Preparation
Concrete Examples Expressive Arts Medical Play
Normalization through play Maintaining Routines Providing Choices Preserving Boundaries
+ Results: Interventions Used
Building a Therapeutic Relationship Procedural Preparation
Concrete Examples Expressive Arts Medical Play
Normalization through play Maintaining Routines Providing Choices Preserving Boundaries
+ Results: Child Responses to Trauma
“I think it's the loss of control that they feel the worst about. They're just fearful of so many things…all the people coming in their room…of just not being in control of the situation.”
“I think that the anger and loss of control go hand in hand”
Loss of Control
Guilt Fear
+Results: Differences Between Units
“In the ER you’re dealing with the here and now, in the PICU it’s a lot of support cause they have different procedures, in the rehab setting, the interventions are around what life is going to look like going forward.”
More Time More Space More Room to Grieve
ED
PICU
Rehab
+ Limitations and Implications
More Participants
Equal Representation of Units Clarify GSW
Trauma vs. Trauma in General
Utilize Multidisciplinary Teams
Educate Through Trauma Training
Set Aside Personal Biases Understand Implications of
Firearm Injuries
+ References Amoreira Gepp, R., & Nadal, L. (2012). Spinal cord trauma in children under 10 years of age: clinical characteristics and prevention. Child's Nervous System, 28(11), 1919-1924. doi:10.1007/s00381-012-1846-1
Byard, R. W., Haas, E., Marshall, D. T., Gilbert, J. D., & Krous, H. F. (2009). Characteristic Features of Pediatric Firearm Fatalities—Comparisons Between Australia and the United States. Journal Of Forensic Sciences (Wiley-Blackwell), 54(5), 1093-1096. doi:10.1111/j.1556-4029.2009.01125.x
Christoffel, K. (2007). Firearm Injuries: Epidemic Then, Endemic Now. American Journal Of Public Health, 97(4), 626-629. doi:10.2105/AJPH.2005.085340
DiScala, C., & Sege, R. (2004). Outcomes in Children and Young Adults Who Are Hospitalized for Firearms-Related Injuries. Pediatrics, 113(5), 1306-1312.
Hamrin, V., Jonker, B., & Scahill, L. (2004). Acute Stress Disorder Symptoms in Gunshot-Injured Youth. Journal Of Child & Adolescent Psychiatric Nursing, 17(4), 161-172.
Moront, M; & M, R. Eichelberger. (1994). Pediatric Annals, 23, 4.
Sabin, J. A., Zatzick, D. F., & Rivara, F. P. (2005). A role for school health personnel in supporting children and families following childhood injury. The Journal of School Health, 75(4), 141-4. Retrieved from http://search.proquest.com/docview/215673219?accountid=25251
Turner, J., & Fralic, J. (2009). Making Explicit the Implicit: Child Life Specialists Talk About Their Assessment Process. Child & Youth Care Forum, 38(1), 39-54. doi:10.1007/s10566-009-9066-x
Waller, A. E., Baker, S. P., & Szocka, A. (1989). Childhood Injury Deaths: National Analysis and Geographic Variations. American Journal Of Public Health, 79(3), 310-315.
Widome, M. D. (1991). Remembering As We Look Ahead: The Three E's and Firearm Injuries. Pediatrics, 88(2), 379.
W, Max & D P Rice. Shooting in the dark: estimating the cost of firearm injuries Health Affairs, 12, no.4 (1993):171-185 doi: 10.1377/hlthaff.12.4.171
+ Thank You!
+ Validity
No gun family Location Media
Critical friends group Program advisor Thesis advisor