The development and evaluation of a universal preventative web-based early intervention for children and their parents following accidental injury

Accidental injury is a common experience for children (ABS, 2004-2005), yet the debilitating psychological effects of the trauma event often go undetected and thus not treated. Whilst for many the accident will result in some distress, many children will naturally recover and move on (Bryant, 2004). In spite of this, 10-18% of children will continue to experience persistent chronic stress symptoms for up to 2 years post accident (Le Brocque, Hendrikz, & Kenardy, 2009). Unfortunately, little psychological assistance is available or offered to children that may assist in their psychological recovery and even prevent the significant and debilitating effects of psychological distress. Therefore, the aim of this research was to develop and investigate an intervention for children following accidental injury. This was carried out via three stages and presented as three sections within the thesis. Section 1 aimed to develop a theory driven and evidenced-based intervention. Firstly, a meta-analysis was conducted to identify potential risk factors of significance that predict post-traumatic stress symptoms. This analysis resulted in pre-trauma psychopathology, threat to life, gender (female) and parental distress being relatively strong and consistent predictors. This information helps inform potential screening tools as well as directly guidinge the development of the intervention for this thesis. Secondly, this section conducted a comprehensive literature review of relevant approaches and interventions to help guide the development of the intervention. This review drew on models of traumatic stress development such as the Resilience Framework (Kumpfer, 1999), and Paediatric Medical Traumatic Stress (Kazak et al., 2006) as well as preventative frameworks such as the Paediatric Psychosocial Preventative Health Model (Kazak, 2006) that resulted in a Universal approach being argued as the most appropriate. Following this, a review was conducted of relevant universal preventative interventions currently available or recommended following trauma including, Psychological Debriefing (PD), Psychological First Aid (PFA) and information provision. Overall it was concluded that an information provision intervention that drew on strategies used within PD and PFA (such as normalisation and coping strategies) was the most appropriate and practical approach to offering psychological assistance to children and their parents following accidental injury. Finally, this section culminated in a chapter outlining the design, delivery and content of the intervention. The intervention developed aimed to normalise reactions and enhance coping in children following the accident whilst providing parents with accurate information regarding trauma reactions and how they could assist their child’s emotional recovery. Of importance was the decision to place the child’s intervention on the internet. It was argued that this would offer a more child friendly medium and provide greater and easier access for families. Section 2 encompassed the evaluation of the intervention developed. Children (7-16years) and their parents were recruited from the Royal Children’s Hospital and their trauma reactions were assessed over a 6 month period, with three assessment time points; Time 1 (baseline, within 1-2 weeks of the accident), Time 2 (4-6 weeks) and Time 3 (6 months). Children and their parents were randomised into the intervention group following Time 1. Analyses revealed that children within the intervention group reported significantly decreased anxiety, in comparison to a worsening of symptoms for children in the control group. No significant group differences were noted for the parents. Exploratory analysis conducted on high risk children (those with high initial distress) revealed that those in the control group exhibited a significant worsening of anxiety and social phobias over the 6 months. This significant increase in symptoms was not noted for children who had received the intervention. Furthermore, exploratory analyses revealed that children who initially reported high symptoms were the ones most likely to find the intervention helpful and effective. This result was exhibited in the qualitative responses from the parents and children. Overall, the intervention showed promise and encouraging results in its ability to aid child recovery. Furthermore, the results indicated that high risk children may benefit over and above all those recruited suggested the possible appropriateness for a stepped care approach. Section 3 was conducted in light of the results of Section 2, suggesting that children with high initial distress may benefit more greatly from the intervention compared to those with low initial distress. Therefore, this section examined a number of risk factors identified via the meta-analysis conducted in Section 1, to examine whether they would moderate a child’s and parent’s trauma symptoms following treatment compared with no treatment. Thus, this section investigated whether the intervention would be best delivered universally or targeted at children and parents who exhibited certain risk factors. Results indicated that when the child risk factors of initial child distress, attribution of self-blame and parental psychopathology were present, children in the control group had significantly higher trauma symptoms in comparison to those in the intervention. When these factors were not present, there were no significant group differences. For parents, their initial post-accident depression, anxiety and stress levels moderated treatment; in that when it was not present (low) there were no group differences, however when the risk factors was present (high) those in the control group exhibited significantly higher mood disturbances at 6 months. The findings of this section resulted in the conclusion that there are a number of risk factors that impact or influence treatment, thus suggesting that the intervention could be best utilised when targeted at those presenting with risk factors. Therefore, this research developed, investigated and optimised a universal preventative intervention for children and their parents following accidental injury. The limitations and implications for this research are discussed, including debate regarding a universal versus a targeted approach to intervention delivery