Pediatric Reflections on Trauma-informed Care

Trauma-informed Care Encourages Families to Talk About Underlying Issues

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Children's Doctor

K.P. and his mother have come to our primary care practice for 6 years, and after typical preschool years, his behavior began to cause concern. His mother brought him in after he was suspended from kindergarten for 2 days because he turned over a chair and hit another student. Weeping, she said he always has had trouble listening at home and at school. After actively listening, we referred for a hearing test and suggested his mother request an evaluation through school to see if he had a learning disability and, therefore, eligible for an individualized education program (IEP).

We suggested counseling to work on behavior modification strategies for home and school. His mom and teachers completed Vanderbilt questionnaires, leading to an ADHD diagnosis. Armed with an IEP and a therapeutic support staff worker to assist with his self-control in class, K.P.’s behavior improved—for a while.

In second grade, K.P. again began to get into trouble, requiring mom to pick him up from school so often that she lost her job. He began using inappropriate language with his teacher and was becoming increasingly aggressive, leading to a suspension. Even medication for his aggressive behaviors (prescribed by Psychiatry) didn’t help.

When mom and K.P. presented in the office to discuss the latest issues, we became concerned about mom’s high stress level. We used a trauma-informed care approach, focusing on the DEF of patient care (Distress, Emotional Support, and Family). Specifically, we acknowledged mom’s distress, asked about her concerns related to K.P.’s behavior and performance, provided reassurance/support, and tried to understand if mom had any hypotheses about the causes of K.P.’s current behavior. Instead of focusing on “what’s wrong,” we attempted to focus on “what happened.” During the discussion, mom revealed she had concerns that an extended family member was sexually abusing K.P. We continued to provide emotional support and affirm mom’s clear efforts to care for K.P. Because we are mandated reporters, we also explained to mom that we were required to contact Children and Youth Services (CYS).

A CYS investigation substantiated the abuse. K.P. continued with counseling and support more specific to the abuse. Medication was no longer required and, with time, K.P. became more engaged with school, his peers, and his family. The PCP continued supporting family members as they worked toward a healthier family life and restoring K.P.’s well-being. Trauma-informed care better equips primary care providers to see families through significant struggles, which remains one of the more gratifying aspects of our practice.

Learn more about CHOP’s approach to trauma-informed care.

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