Design, delivery, and evaluation of early interventions for children exposed to acute trauma

Figures & data

Table 1 Summary of early interventions for children exposed to acute traumatic events and randomized trial results

	Level of preventive care	Nature of intervention	Who delivers/Where delivered	When post-trauma	Type of event(s)	Child age	N in trial	Main effect on child PTSD	Other findings
Initiated in peri-trauma period
‘So you've been in an accident’ booklet (Kenardy, Thompson, Le Brocque, & Olsson, 2008)	Universal	Informational booklet (parent–child)	Nurse/at hospital	72 h	Injury	7–15	103	no	Reduced anxiety symptoms
Stepped preventive care (SPC) (Kassam-Adams et al., 2011)	Stepped care model: Targeted/	One session plus phone follow-up, with option for more intensive services as needed. (parent–child)	Nurse or social worker/at hospital	Screen and initiate intervention within 1 week	Injury	8–17	85	no	Effective risk screening protocol
Preventive medication (Nugent et al., 2010)	Targeted	10-day trial of propranolol (child)	Physician/at hospital	Initiated within 12 h of admission	Injury	10–18	29	no	In treatment-adherent group: trend for reduced PTS in boys, increased PTS in girls
Preventive medication (Stoddard et al., 2011)	Universal	24-week course of sertraline (child)	Physician/at hospital	Initiated during hospitalization	Burn injury/post-burn reconstructive surgery	6–20	26	mixed	Reduced parent reported child PTS; No difference in self-reported child PTS
Initiated in early post-trauma period
Individual psychological debriefing (Stallard et al., 2006)	Universal	One session (child)	Mental health professional/at hospital	Within 4 weeks	Road traffic accident	7–18	158	no	–
Classroom-based group intervention (Karam et al., 2008)	Universal	12 sessions on consecutive school days	Teacher/in classroom	1 month	War	6–18	194	noa	–
Kids and Accidents website (Cox & Kenardy, 2010)	Universal	Printed informational materials (parent–child) website (child)	Research staff/by mail plus website	Within 2 weeks	Road traffic accident	7–16		no	Reduced anxiety symptoms
Psychological interventions in children after road traffic accidents (PICARTA) (Zehnder, Meuli, & Landolt, 2010)	Universal	One session (parent–child)	Mental health professional/at hospital	10 days	Road traffic accident	7–16	99	no	Pre-teens: Reduced depression, behavior problems
Child and Family Traumatic Stress Intervention (CFTSI) (Berkowitz et al., 2011)	Targeted	Four sessions (parent–child)	Mental health professional	Screen within 1 month	Road traffic accident, assault, sexual abuse, violence, injury	7–17	106	yes	–
Child- and family-focused Cognitive-behavioral Early Intervention for PTSD (Kenardy et al., 2010)	Stepped care model: Indicated	Two-stage screening followed by child-focused (6 sessions) or family-focused (10 sessions) CBT if symptomatic at second screen	Mental health professional	Screen at 1–2 weeks and at 4–6 weeks; Treatment initiated after second screen	Injury	7–16	(140)	Trial is ongoing	–
Psychological interventions in children after road traffic accidents or burns (PICARTA-B) (Landolt, 2010)	Targeted	Two sessions (parent–child)	Mental health professional	Screen within 1 week; Intervention within 2 weeks	Road traffic accident, burn injury	2–16	(120)	Trial is ongoing	–
Coping Coach (Marsac et al., 2013)	Universal	Web-based intervention/game in three modules (child)	Introduced by research staff at hospital/Delivered online	Within 2 weeks	Acute medical event	8–12	(70)	Trial is ongoing	–

a Compared to children in schools not receiving the intervention. Schools could not be randomly assigned due to local authority mandating which schools received intervention.

Table 2 Proposed early intervention models/programs and selected intervention targets

	Intervention targets
	Appraisals/interpretationsa	Excessive avoidanceb	Social/interpersonalc
Psychological first aid (PFA) (National Child Traumatic Stress Network and National Center for PTSD, 2006)	–	–	yes
DEF protocol for pediatric healthcare providers (Kazak et al., 2006)	–	–	yes
‘So you've been in an accident’ information booklet (Kenardy et al., 2008)	–	–	yes
Kids and Accidents website (Cox & Kenardy, 2010)	yes	–	yes
Stepped preventive care (SPC) (Kassam-Adams et al., 2011)	variesd	variesd	variesd
Child and Family Traumatic Stress Intervention (CFTSI) (Berkowitz, et al., 2011)	variesd	variesd	yes
Psychological interventions in children after road traffic accidents (PICARTA) (Zehnder et al., 2010)	yes	–	yes
Child- and family-focused cognitive–behavioral early intervention for PTSD (Kenardy et al., 2010)	yes	yes	variese
Coping Coach web-based intervention (Marsac et al., 2013)	yes	yes	yes

a Intervention is designed to directly target maladaptive trauma-related appraisals or interpretations.

b Intervention is designed to directly target reduction of avoidance behaviors, thought suppression, or avoidance coping strategies.

c Intervention is designed to directly target social/interpersonal processes to increase social support or modify parent–child interactions.

d Intervention includes optional modules that may address this target for some children.

e One version of the intervention involves parents and targets family processes.

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