Psychological debriefing. Research methodology was inadequate.
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Crisis Intervention↗
Biomedical subjects
P Stallard
Publications and source records attributed to P Stallard.
Prevalence and morbidity associated with non-malignant, life-threatening conditions in childhood.
OBJECTIVE: To determine the prevalence of non-malignant life-threatening illness in childhood and associated morbidity in the affected child and their family members. DESIGN: Cross-sectional survey. SETTING: Bath Clinical Area (total population 411,800). SUBJECTS: Children aged 0-19 years. RESULTS: One hundred and twenty-three children were identified, giving a prevalence of 1.2/1000 children. Morbidity assessed in 93 children showed 60% in pain or discomfort, 35% unable to walk and 25% with severe cognitive impairment. Mental health problems were found in 54% of mothers and 30% of fathers, and significant emotional and behavioural problems in 24% of healthy siblings. CONCLUSIONS: Non-malignant life-threatening illness is more prevalent than reported in previous studies. Considerable morbidity is experienced by the child and their family. An individual and family approach is required. Key messages (1) The prevalence of non-malignant life-threatening illness is four times greater than previous estimates. (2) This group of conditions have significant implications for all family members. (3) Early comprehensive assessment and access to effective interventions may pre-empt later problems.
Adolescent↗
Pain in cognitively impaired, non-communicating children.
AIM: To detail the everyday occurrence of pain in non-communicating children with cognitive impairment. METHODS: Thirty four parents of cognitively impaired verbally non-communicating children completed pain diaries over a two week period. Each day, for five defined periods, parents rated whether their child had been in pain, and if so, its severity and duration. RESULTS: Twenty five (73.5%) children experienced pain on at least one day, with moderate or severe levels of pain being experienced by 23 (67.6%). Four children (11.7%) experienced moderate or severe pain lasting longer than 30 minutes on five or more days. No child was receiving active pain management. CONCLUSIONS: Everyday pain in children with severe cognitive impairment is common, yet is rarely actively treated.
Analgesics↗
Coping and psychological distress in children involved in road traffic accidents.
OBJECTIVE: The purpose of this study is to detail the natural coping strategies used by children involved in everyday road traffic accidents (RTAs). The relationship between coping strategies, post-traumatic stress disorder (PTSD), gender and age was investigated. DESIGN: Children aged 7-18 who attended an accident and emergency department following involvement in a RTA were assessed, 6 weeks after their accident (N = 97). A subgroup of 36 children were re-assessed approximately 8 months after the trauma. METHODS: The presence of PTSD was determined via a semi-structured interview incorporating the Clinician Administered Post-traumatic Scale for Children (CAPS-C). Self-completed psychometric assessments were undertaken to assess the presence of clinically significant levels of depression (Birleson Depression Inventory), anxiety (Revised Manifest Anxiety Scale) and coping style (Kidcope). RESULTS: Children involved in RTAs used between 5 and 7 different coping strategies. Younger children and those with PTSD used more strategies than older children and those not suffering from PTSD. Children with PTSD were more likely to use the strategies of distraction, social withdrawal, emotional regulation and blaming others. CONCLUSION: The limitations of Kidcope are discussed and the need to develop more complex ways of assessing childhood coping within a developmental framework highlighted.
Accidents, Traffic↗
Psychological screening of children for post-traumatic stress disorder.
One hundred and seventy children attending a hospital accident and emergency department following everyday trauma were interviewed and completed the Post-traumatic Stress Disorder (PTSD) screening battery suggested by Yule and Udwin (1991). Diagnostic interviews (CAPS-C) confirmed that 39 (22.9%) fulfilled the DSM-IV criteria for PTSD. There were significant differences between children with and without PTSD on each individual component of the screening battery. Various criteria for caseness were evaluated and at 6 weeks post trauma the screen identified up to 90% of children diagnosed with PTSD and 73% with borderline conditions. A subset of 36 children were reassessed 8 months post trauma and all children with persistent PTSD were correctly identified by initial screen scores. The limitations of the study and the role of screening for PTSD in the absence of proven psychological interventions are discussed.
Accidents, Traffic↗
Prospective study of post-traumatic stress disorder in children involved in road traffic accidents.
OBJECTIVE: To determine the prevalence of severe psychological trauma --that is, post-traumatic stress disorder--in children involved in everyday road traffic accidents. DESIGN: 12 month prospective study. SETTING: Accident and emergency department, Royal United Hospital, Bath. SUBJECTS: 119 children aged 5-18 years involved in road traffic accidents and 66 children who sustained sports injuries. MAIN OUTCOME MEASURE: Presence of appreciable psychological distress; fulfillment of diagnostic criteria for post-traumatic stress disorder. RESULTS: Post-traumatic stress disorder was found in 41 (34.5%) children involved in road traffic accidents but only two (3.0%) who sustained sports injuries. The presence of post-traumatic stress disorder was not related to the type of accident, age of the child, or the nature of injuries but was significantly associated with sex, previous experience of trauma, and subjective appraisal of threat to life. None of the children had received any psychological help at the time of assessment. CONCLUSIONS: One in three children involved in road traffic accidents was found to suffer from post-traumatic stress disorder when they were assessed 6 weeks after their accident. The psychological needs of such children after such accidents remain largely unrecognised.
Accidents, Traffic↗
Palliative care services for children must adopt a family centred approach.
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Child↗
The impact of childhood non-malignant life-threatening illness on parents: gender differences and predictors of parental adjustment.
Mental health, family functioning, effects on employment and relationships, coping style, and perceptions of prognosis were assessed in 93 mothers and 78 fathers of children with a life-threatening non-malignant condition. Results indicated high levels of psychological distress, significant effects upon employment and relationships, and a family environment characterised by low expressiveness, cohesion, and high conflict. Differences between mothers and fathers were found on a number of variables. Length of time since diagnosis, level of family cohesion, and sex of parent significantly predicted parental mental health.
Adaptation, Psychological↗
Helicopter engine protection.
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Aircraft↗
Validity and reliability of the Parent Satisfaction Questionnaire.
The development of a postal consumer satisfaction questionnaire for a child and adolescent psychology service is reported. A preliminary analysis of content, construct and concurrent validity suggests that the questionnaire has an acceptable degree of validity. Factor analysis identified five factors with three being identifiable as relating to the outcome of contact, appointments and the timing of contact. The remaining two factors were minor dyads which were difficult to interpret. The reliability and utility of the questionnaire is good, proving a useful way of identifying service shortfalls and directing service change. The need to methodologically evaluate consumer satisfaction questionnaires is stressed and their routine use in monitoring and assuring service quality highlighted.
Adolescent↗
Parental satisfaction with intervention: differences between respondents and non-respondents to a postal questionnaire.
Parental satisfaction with a child and adolescent psychology service was assessed by postal questionnaire. Follow-up interviews were conducted with 88 percent of the sample, 36 postal questionnaire respondents and 21 non-respondents. Questionnaire non-respondents were more likely to have dropped out of therapy, had fewer appointments, evaluated the service more negatively and differed from respondents in their particular sources of dissatisfaction. They were significantly more dissatisfied with where they met the psychologist and in what family composition they were seen whereas questionnaire respondents were more dissatisfied with the wait before first appointment and the total number of appointments offered. The implications for future studies are discussed and the need to assess the satisfaction of postal non-respondent emphasized.
Adolescent Psychiatry↗
Development and satisfaction with individual programme planning in a disability service.
A consumer survey of a preschool disability service identified parents who did not feel their concerns were fully understood by professionals, nor felt involved or in agreement with treatment decisions, nor that services were provided in a coordinated way. A system of individual programme planning (IPP) was introduced in order to address these issues and other shortfalls of the existing service. Information was obtained from 96% of parents and 87% of professionals who attended IPP meetings over a four month period. Overall satisfaction was high (92% of parents: 96% of professionals). Parents now felt fully involved in decision making, 80% felt their views were understood and 100% agreed with treatment goals. Dissatisfaction was expressed with meeting attendance, the marginalisation of parents, and the timing and chairing of meetings. Consumer satisfaction surveys are recommended for use in highlighting areas of service shortfall, to direct and evaluate service change, and to monitor quality.
Child, Preschool↗
The behaviour of 3-year-old children: prevalence and parental perception of problem behaviour: a research note.
A rating of parental concern was added to the Behaviour Checklist (BCL), which was then used as part of a Health Visitor administered routine developmental assessment of 1170, 3-year-old children. The overall prevalence of behaviour problems using a cut-off score of 10 was 10%, with 66% of parents having one or more concerns about their child. There were no sex differences. Parents of only children had more concerns on 6 of the 19 items even though their children behaved no differently from those with siblings. The usefulness of the BCL as a routine screening measure and the need to identify and address parental concerns at an early stage is discussed.
Child Behavior Disorders↗
Screening and psychological debriefing of adolescent survivors of life-threatening events.
There is a perceived need for schools and casualty departments to receive appropriate information and guidelines in order to minimise the effect of PTSD. A recommended screening battery for PTSD was administered at the start of a two-session debriefing group and again three months later to a group of seven young survivors of a minibus accident. No studies using this screen other than those of shipping disasters have been reported to date. Screen scores were compared with those of survivors of the cruise ship Jupiter. No significant differences were found between minibus survivors when assessed at six months (before intervention), and Jupiter survivors, who when assessed at five months had already undergone debriefing. Post-debriefing assessment of minibus survivors demonstrated significant reductions on all measures.
Adaptation, Psychological↗
Behaviour disturbance: routine assessment of children at three years.
Behavioural problems in pre-school children can be a major source of parenting and family anxiety. Early identification through routine screening can prevent problems escalating, writes Paul Stallard. It can also offer an opportunity to reassure anxious parents. Here he describes a behaviour checklist used by health visitors in Bath district to identify and help parent deal with behaviour problems in their young child.
Child Behavior Disorders↗
How satisfied are parents of pre-school children who have special needs with the services they have received? A consumer survey.
The parents of 41 pre-school children with special needs volunteered to participate in a consumer survey to ascertain their satisfaction with the services they had received and how these could be improved. The survey produced an overall high level of satisfaction, although parents felt they had not received as much information as they wanted on their child's condition (29%), available help for their family (44%), financial benefits (61%), or information about their child's future (61%). Families also felt that they had not received enough family support (43%), and that professionals regularly did not understand their concerns (32%). Ways in which these issues could be addressed are discussed, along with more general issues of such consumer satisfaction surveys.
Adult↗
Groups for parents of pre-school children with severe disabilities.
The emotional impact upon the family following the diagnosis of a child's disability is significant although parents feel that their needs are not specifically addressed by professionals. A series of groups for the parents of pre-school children with severe disabilities are described. The groups are designed to provide parents with an opportunity to discuss in depth the impact of their childs' disability upon themselves, their partners and their families. Feedback from group members is reported and the practical issues in providing such groups discussed.
Adaptation, Psychological↗