Emergency department clinicians’ views on implementing psychosocial care following acute paediatric injury: a qualitative study

ABSTRACT

Introduction: The early post-trauma period is a key time to provide psychological support to acutely injured children. This is often when they present to emergency departments (EDs) with their families. However, there is limited understanding of the feasibility of implementing psychological support for children and their families in EDs. The aim of this study was to explore UK and Irish ED clinicians’ perspectives on developing and implementing psychosocial care which educates families on their children’s post-trauma psychological recovery.

Methods: Semi-structured individual and group interviews were conducted with 24 UK and Irish ED clinicians recruited via a paediatric emergency research network.

Results: Clinicians expressed that there is value in offering psychological support for injured children and their families; however, there are barriers which can prevent this from being effectively implemented. Namely, the prioritisation of physical health, time constraints, understaffing, and a lack of training. Therefore, a potential intervention would need to be brief and accessible, and all staff should be empowered to deliver it to all families.

Conclusion: Overall, participants’ views are consistent with trauma-informed approaches where a psychosocial intervention should be able to be implemented into the existing ED system and culture. These findings can inform implementation strategies and intervention development to facilitate the development and delivery of an accessible digital intervention for acutely injured children and their families.

HIGHLIGHTS

• The emergency department provides an opportunity for early trauma-informed care for acutely injured children and their families.

• Addressing psychological distress in emergency care for acutely injured children and their families should adopt a universal trauma-informed approach.

• The development of a paediatric trauma-informed intervention should consider barriers which can impact implementation into emergency care. Particular barriers highlighted by clinicians include staff shortages, time constraints, and high caseloads.

Introducción: El periodo postraumático temprano es un momento clave para proporcionar apoyo psicológico a los niños con lesiones agudas. A menudo, esto ocurre cuando acuden a los servicios de urgencias (SU) con sus familias. Sin embargo, existe una comprensión limitada sobre la viabilidad de implementar apoyo psicológico para niños y sus familias en los SU. Sin embargo, existe una limitada comprensión sobre la viabilidad de la implementación de apoyo psicológico para niños y sus familias en SU. El objetivo de este estudio fue explorar las perspectivas de los médicos de urgencias del Reino Unido e Irlanda sobre el desarrollo y la aplicación de la atención psicosocial que educa a las familias en la recuperación psicológica de sus hijos después del trauma.

Método: Se realizaron entrevistas semiestructuradas individuales y en grupo a 24 médicos del SU del Reino Unido e Irlanda reclutados a través de una red de investigación en urgencias pediátricas.

Resultados: Los médicos expresaron que ofrecer apoyo psicológico a los niños heridos y a sus familias tiene valor; sin embargo, existen obstáculos que pueden dificultar que esto se lleve a cabo de forma eficaz. Específicamente, la priorización de la salud física, las limitaciones de tiempo, la falta de personal y la falta de formación. Por lo tanto, una posible intervención tendría que ser breve y accesible, y todo el personal debería estar capacitado para ofrecerla a todas las familias.

Conclusiones: En general, las opiniones de los participantes son coherentes con los enfoques informados en trauma, donde una intervención psicosocial debería poder implementarse en el sistema y la cultura existentes del SU. Estos hallazgos pueden dar información sobre la intervención y la implementación de estrategias para facilitar el desarrollo y entrega de intervenciones digitales accesibles para niños con trauma agudo y sus familias.

KEYWORDS:

• PTSD
• trauma
• emergency care
• paediatric trauma
• trauma-informed care

PALABRAS CLAVES:

• TEPT (Trastorno de estrés postraumático)
• trauma
• atención de urgencia
• trauma pediátrico
• servicios informados en trauma

Acknowledgements

The authors would like to thank Niall Mullen from PERUKI for assisting with recruitment.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.

Additional information

Funding

This work is part of an Economic and Social Research Council (ESRC) SWDTP-funded PhD project.