A/Prof. Megan Simons1,2, Professor Gillian (Gill) Harvey3,4, Ms Lucinda McMillan2, Dr Elizabeth G Ryan5,6, Dr Alexandra G. De Young2,7, Professor  Steven M McPhail4,6, A/Prof Sanjeewa  Kularatna4, Dr Sameera Senanayake4, Professor  Roy Kimble1,2, Dr Zephanie Tyack2,4

1Queensland Children’s Hospital, Brisbane, Brisbane 4101, Australia, 2Centre for Children’s Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Brisbane 4101, Australia, 3Caring Futures Institute, Flinders University, Adelaide 5042, Australia, 4Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane 4059, Australia, 5QCIF Faculty for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane 4072, Australia, 6Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane 4102, Australia, 7School of Psychology, The University of Queensland, Brisbane 4072, Australia

Abstract:

Background: Trauma-informed care practices are associated with a culture of safety following traumatic experiences, including medical trauma. An interactive, web-based education package (‘Responsive CARE’) was developed for tertiary paediatric healthcare providers. The primary objective of this study was to examine feasibility of both the intervention and approach to implementation, using a logic model to propose the intended impact and outcomes.

Method: Using a mixed methods design, participants included children and caregivers attending an outpatient burns service and health professionals involved in their care. Interview and training meta-data were used as indicators of engagement. Preliminary evidence of effectiveness was estimated from self- or proxy-report outcome measures for child pain and distress, collected using a pretest-posttest design.

Results: Thirteen health professionals (all female) with mean 10 years (SD=11) of experience with paediatric hospital-based care enrolled. Twenty-five semi-structured interviews were completed with health professionals (21 female) and 14 caregivers (11 female). ‘Responsive CARE’ content was acceptable and resulted in increased self-efficacy for trauma-informed care. Effectiveness data included 177 participants (median age 2 years, median total body surface area burn 1%). Using mixed effects regression models, there was no significant difference for pain (p=0.242) or distress (p=0.834) pre- and post-intervention.

Discussion: The advantage of the ‘Responsive CARE’ intervention to inform trauma-informed practice compared to usual care in the pretest period was not realised in this study. Although staff acknowledged the relevance of trauma-informed care to their roles, trauma-informed practices appear to remain an ambiguous concept. Thus, there was a lack of readiness to commit to routine implementation. Adaptations required to both the intervention and implementation strategies prior to further investigation of effectiveness will be discussed (e.g., the routine use of screening tools, role clarification, promotion of self-referral pathways to psychosocial supports, and having a nominated care coordinator).


Biography:

A/Prof Megan Simons has worked clinically predominantly in paediatric burn care for almost three decades. She is a clinician researcher, whose interests extend to patient-reported outcome measures, implementation science and collaborative leadership in teams. This work was funded by a General Heath Services Research Grant (SRSG0162018), Children’s Hospital Foundation.