Patterns of toxic stress and trauma for pediatric Hematopoietic Stem Cell Transplantation (HSCT): creating a model of responsive intervention

Figures & data

Table 1. Detailed inclusion criteria for theoretical replication cohorts.

Cohort	Inclusion criteria
All cohorts	Was admitted to receive an HSCT. Was between the ages of 0–17 years of age at the time of admission. Experienced at least one HSCT-related complication. Had at least one consistent caregiver. Hospitalization for HSCT lasted a minimum of five weeks.
Theoretical replication cohorts	Additional inclusion criteria
Late/delayed music therapy referral or engagement	Was referred to or began receiving music therapy after day −4.
Different music therapist	Was referred to or began receiving music therapy at any point during HSCT admission. Received music therapy from a music therapist that was not the first author.
Preschool aged children	Was between the ages of 2–5 years of age at the time of admission.
Children under 18 months of age	Was under the age of 18 months at the time of admission.

Table 2. Defined elements for each time series.

Time series	Defined elements
1. Medical treatment	Medical procedures, surgeries, changes in medical treatment, acute medical status changes, transfer to the PICU, etc. Treatment and events were categorized based on the potential to be perceived as “negative” (i.e., acute decompensation, new onset of distressing complications, unexpected or invasive procedures, unexpected or invasive), “neutral” (routine care), or “positive” (meeting criteria for discharge, signs of recovery like increasing ANC, weaning off medications).
2. Psychosocial support	Thematic analysis of narrative notes for all psychosocial support sessions provided, including social work, pastoral care, child life, and behavioral medicine.
3. Music Therapy	Thematic analysis of narrative notes for all music therapy sessions provided and attempted.
4. EBD lens	Analysis of all reported medical treatments/events, to classify as potential toxic stress (Shonkoff et al. 2012).
5. ITM-PMTS lens	Analysis of all reported medical treatment/events to determine if the event could be “potentially traumatic.” To be coded as such, the event must have the potential to be perceived as life-threatening or evoke fear, horror, and helplessness, consistent with the ITM-PMTS model (Price et al., 2016).

Figure 1. Timeline for Bess (P2).

Key: Red- negative medical experience; green: psychosocial support opportunities; pink: neutral days/ events; yellow: positive steps toward discharge Blue: PFI1; Lime Green: PFI2; Purple: PFI3.

Table 3. Case demographics.

Cohort	Case	Pseudonym	Age	Therapist
1	P1	Aliya	12 yr	1
1	P2	Bess	5 yr	1
1	P3	Jimmy	17yr	1
2	P4	Carrie	16 yr	1
2	P5	Carter	8 yr	2
2	P6	Olivia	9 yr	1
3	P7	Lily	10 yr	2
3	P8	James	7 yr	3
3	P9	Jackie	12 yr	4
4	P10	Ashley	3 yr	2
4	P11	Madison	4 yr	1 & 5
5	P12	Henry	8 mo	1
5	P13	Maggie	16 mo	5
5	P14	Patrick	5 mo	1

Cohorts: 1: Common case; 2: Late referral/engagement in music therapy; 3: Different therapist than author; 4: Preschool age; 5: Under 18 months. *Cohort characteristics may overlap.

Figure 2. Music therapy for pediatric medical trauma model.

Blue: PFI1; Lime Green: PFI2; Purple: PFI3.

Data availability statement

The participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research supporting data is not available.