Although the five domains of posttraumatic growth (new possibilities, relating to others, personal strength, spiritual change and appreciation of life) have been studied extensively in adults, little ...is known about these domains and their correlates in children. We aimed to examine whether demographic and/or social characteristics are related to children's reports of overall posttraumatic growth and of growth in specific domains. In a general population study, children aged 8-12 years who had been exposed to adverse events (N = 1290) filled out questionnaires on their experiences, demographic characteristics (gender, age, time lag since event), stress reactions, peer support, religiosity and posttraumatic growth. All demographic and social characteristics were related to overall posttraumatic growth, except time lag. Associations varied across the five domains with the strongest effects being found for stress reactions and religiosity. A higher level of stress reactions was related to more growth in all domains (general effect), whereas religious children experienced more spiritual growth than non-religious children without differences on other domains (domain specific effect). Other effects were small, and some did not remain significant after Bonferroni corrections. These findings suggest the presence of both general and domain-specific correlates of child posttraumatic growth. Although effects were generally small, the current findings show the need to differentiate between the domains of posttraumatic growth in both further research and clinical practice. This will allow a better understanding of the mechanisms of posttraumatic growth in children as well as more tailored assessment and intervention.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
We retrospectively investigated moral injury and mental health related to immigration detention on Nauru.
Participants conveyed the impact of deprivation, lack of agency, violence, and ...dehumanization.
Evaluations of their experiences fit with conceptualizations of moral injury.
Immigration detention is associated with detrimental mental health outcomes but little is known about the underlying psychological processes. Moral injury, the experience of transgression of moral beliefs, may play an important role.
Our aim was to explore moral injury appraisals and associated mental health outcomes related to immigration detention on Nauru.
In this retrospective study, we conducted in-depth interviews with 13 individuals who had sought refuge in Australia and, due to arriving by boat, had been transferred to immigration detention on Nauru. At the time of the study, they lived in Australia following medical transfer. We used reflexive thematic analysis to develop themes from the data.
Major themes included 1) how participants' home country experience and the expectation to get protection led them to seek safety in Australia; 2) how they experienced deprivation, lack of agency, violence, and dehumanization after arrival, with the Australian government seen as the driving force behind these experiences; and 3) how these experiences led to feeling irreparably damaged. The participant statement 'In my country they torture your body but in Australia they kill your mind.' conveyed these three key themes in our analysis.
Our findings suggest that moral injury may be one of the processes by which mandatory immigration detention can cause harm. Although refugees returned to Australia from offshore detention may benefit from interventions that specifically target moral injury, collective steps are needed to diminish deterioration of refugee mental health. Our results highlight the potentially deleterious mental health impact of experiencing multiple subtle and substantial transgressions of one's moral frameworks. Policy makers should incorporate moral injury considerations to prevent eroding refugee mental health.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
To examine the impact of adverse childhood experiences (ACEs) and support on self-reported work inability of adults reporting disability.
Adults (ages 18-64) who participated in the Behavioral Risk ...Factor Surveillance System in 2009 or 2010 and who reported having a disability (n = 13,009).
The study used a retrospective cohort design with work inability as the main outcome. ACE categories included abuse (sexual, physical, emotional) and family dysfunction (domestic violence, incarceration, mental illness, substance abuse, divorce). Support included functional (perceived emotional/social support) and structural (living with another adult) support. Logistic regression was used to adjust for potential confounders (age, sex and race) and to evaluate whether there was an independent effect of ACEs on work inability after adding other important predictors (support, education, health) to the model.
ACEs were highly prevalent with almost 75% of the sample reporting at least one ACE category and over 25% having a high ACE burden (4 or more categories). ACEs were strongly associated with functional support. Participants experiencing a high ACE burden had a higher adjusted odds ratio (OR) 95% confidence interval of 1.9 1.5-2.4 of work inability (reference: zero ACEs). Good functional support (adjusted OR 0.52 0.42-0.63) and structural support (adjusted OR 0.48 0.41-0.56) were protective against work inability. After adding education and health to the model, ACEs no longer appeared to have an independent effect. Structural support remained highly protective, but functional support only appeared to be protective in those with good physical health.
ACEs are highly prevalent in working-age US adults with a disability, particularly young adults. ACEs are associated with decreased support, lower educational attainment and worse adult health. Health care providers are encouraged to screen for ACEs. Addressing the effects of ACEs on health and support, in addition to education and retraining, may increase ability to work in those with a disability.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Children exposed to disasters are a vulnerable population, making the assessment of children post-disaster an important issue. Utilizing a Multiple Gating Stepped Care framework, we
highlight recent ...literature
related to post-disaster assessment and intervention for children. In particular, we focus on screening, clinical evaluation, and feedback-informed service delivery. Screening allows large populations of children to be assessed at a relatively low cost. Children identified by screening as being at risk may then be assessed through more in-depth clinical evaluations, in order to assess clinical symptoms, strengths, and stressors, and to make determinations about appropriate interventions. Continued assessment during therapy provides important feedback for the delivery of appropriate care. New formats for assessment, as well as issues related to identifying sources for assessment, are discussed. Recommendations for future directions are provided.
Little is known about children's experiences and involvement in disaster preparation and recovery, in particular in low- and middle-income countries. Eliciting community members' perspectives on the ...2015 floods in Tamil Nadu, India, may generate useful insights for improving services in low-resource settings. This qualitative study aimed to understand how children in Chennai experienced the floods, as reported by the adults in their community, and to explore children's involvement in disaster preparedness, response and recovery efforts as reported from the adults' perspective. We conducted in-depth, semi-structured interviews (N = 48) with family members (n = 36), and with staff of non-governmental organizations (NGOs) (n = 12) who actively participated in relief and recovery efforts. We also conducted two focus group discussions (n = 14) with NGO staff about a year after the 2015 South Indian floods in Chennai, India. Six broad themes regarding children's experiences and behaviours during and after the floods emerged: (1) unexpectedness of the floods; (2) children's safety - barriers and facilitators; (3) parents' reactions - helplessness, fear and pride; (4) children's reactions - helping hands, fun and fear; (5) barriers to a return to 'normal'; and (6) a determination to be prepared for next time. Children and families were deeply impacted by the floods, in part owing to a lack of preparation, as perceived by the study participants. It was also clear from the data analysis that caste and socioeconomic status played an important role in the families' ability to evacuate safely. Helplessness on the part of the parents was apparent, as was children's concern over recurrence of the flood. Similarly, gender appeared to affect child safety, recovery and other outcomes such as continued education. Priorities for future efforts involve the development and evaluation of child-centred education about flood awareness, child participation and safety.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background
It has been estimated that around 31% of children will experience a traumatic event during childhood, most commonly serious accidents that lead to hospitalisation. Around 15% of children ...who experience such events go onto develop post‐traumatic stress disorder. Emergency department (ED) clinicians have a unique opportunity to intervene during the early peri‐trauma period, which can involve incorporating a trauma‐informed approach within their care. The available evidence indicates that clinicians internationally need further education and training to enhance their knowledge and confidence in providing trauma‐informed psychosocial care. However, UK/Ireland specific knowledge is limited.
Methods
The current study analysed the UK and Irish subset of data (N = 434) that was collected as part of an international survey of ED clinicians. Questionnaires indexed clinician confidence in providing psychosocial care, and a range of potential barriers to providing that care. Hierarchical linear regression was used to identify predictors of clinician confidence.
Results
Clinicians reported moderate levels of confidence in providing psychosocial care to injured children and families (M = 3.19, SD = 0.46). Regression analyses identified negative predictors of clinical confidence, including a lack of training, worrying about further upsetting children and parents, and low levels of perceived departmental performance in providing psychosocial care (R2 = 0.389).
Conclusions
The findings highlight the need for further training in psychosocial care for ED clinicians. Future research must identify nationally relevant pathways to implement training programmes for clinicians, in order to improve their skills in relation to paediatric traumatic stress and to reduce the perception of barriers identified in the present study.
Clinical practice guidelines, such as those focusing on traumatic stress treatment, can play an important role in promoting inclusion and equity. Based on a review of 14 international trauma ...treatment guidance documents that explicitly mentioned children, we reflect on two areas in which these guidelines can become more inclusive and equitable; a) representation of children's cultural background and b) children's opportunity to have their voice heard. While a few guidelines mentioned that treatment should be tailored to children's cultural needs, there was little guidance on how this could be done. Moreover, there still appears to be a strong white Western lens across all stages of producing and evaluating the international evidence base. The available documentation also suggested that no young people under the age of 18 had been consulted in the guideline development processes. To contribute to inclusion and equity, we suggest five elements for future national guideline development endeavours. Promoting research and guideline development with, by, and for currently under-represented communities should be a high priority for our field. Our national, regional and global professional associations are in an excellent position to (continue to) stimulate conversation and action in this domain.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
There has been an increasing research and policy focus internationally on the role of child-centred disaster risk reduction and resilience (CC-DRR), including disaster risk reduction and resilience ...education programs for children and youth. This paper summarises developments and emphasises current progress and challenges. While research has increased in the past 15 years, there are significant research gaps, including those regarding the effectiveness of programs and their relatively patchy implementation. How to solve these problems has been the focus of a world-first national program of research funded by the Bushfire and Natural Hazards CRC. Building on international and national research to date, this paper focuses on the question of ‘how can we create, evaluate, implement and scale up CC-DRR programs that work over time, including during disasters and into adulthood, to reduce risk and increase resilience for children, youth, schools, households and communities?’ This includes a guiding model for research and use, and a set of research-informed tools either developed or being developed to facilitate further progress., There has been an increasing research and policy focus internationally on the role of child-centred disaster risk reduction and resilience (CC-DRR), including disaster risk reduction and resilience education programs for children and youth. This paper summarises developments and emphasises current progress and challenges. While research has increased in the past 15 years, there are significant research gaps, including those regarding the effectiveness of programs and their relatively patchy implementation. How to solve these problems has been the focus of a world-first national program of research funded by the Bushfire and Natural Hazards CRC. Building on international and national research to date, this paper focuses on the question of 'how can we create, evaluate, implement and scale up CC-DRR programs that work over time, including during disasters and into adulthood, to reduce risk and increase resilience for children, youth, schools, households and communities?' This includes a guiding model for research and use, and a set of research-informed tools either developed or being developed to facilitate further progress.
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