How do children cope after experiencing a traumatic event like a car accident or gun violence? Are there symptoms that can be identified to prevent post-traumatic stress in kids?
Questions like these have motivated a team of researchers at Akron Children’s Hospital and Kent State University for more than 20 years. While their body of research is plentiful, results from their decades-long research has given way to hospital and primary care best practices, national conversations, trauma-informed schools and a generation of caregivers armed with information to help kids with post-traumatic stress symptoms.
“It all started when my long-time research partner and colleague, Doug Delahanty, met with me to better understand our institutional approach to physical and psychological trauma in our patients,” said Dr. Norman Christopher, chairman of the Department of Pediatrics at Akron Children’s Hospital. “With that question in mind, we sought to identify risk and resilience factors in children who either witnessed or experienced a traumatic event and factors that we hoped could improve longer-term psychological outcomes in our patients.”
Benefits of the collaborative effort were evident from the start. Dr. Christopher and Dr. Delahanty, associate vice president for research and professor at the Department of Psychological Sciences at Kent State University, worked together to establish funding and the human resources needed for the initial study. They also gained support for the collaboration from their internal and academic teams.
“Thanks to the leadership of Drs. Tim Lee and Laura Pollauf and the support from the nursing staff, resident physicians and students, we were able to bring different perspectives and abilities to the research table that we couldn’t have done alone,” said Dr. Christopher. “Our first study gave us our first real look into understanding what causes healthy and non-healthy outcomes in children who have suffered a traumatic event. We also saw how working together would allow us to continue doing meaningful research on acute stress responses and post-traumatic stress disorder (PTSD) in children.”
The cumulative findings from several studies made a strong case for how the hospital could help patient recovery following traumatic injury. The researchers made a recommendation to Akron Children’s quality team to screen kids for trauma when admitted to the Emergency Department. Soon after, trauma screening in the ER became a best practice at Akron Children’s, several years before trauma guidelines were endorsed nationally by the American College of Surgeons’ Committee on Trauma.
“Treating the whole child has always been a mantra at Children’s and the PTSD research proved that patients really did do better if their parents were involved, informed and supportive of their child,” said Dr. Christopher.
A decade later, some members of the PTSD research team changed, but the focus on pediatric PTSD continued. The team continued to apply for grants to fund studies that evaluated things like neurological factors, risk and resilience dynamics and early interventions to help identify and treat children at risk for post-traumatic stress following traumatic injury.
Results from the studies were confirming that many outside factors could reduce the adverse impact of traumatic experiences, including positive family and community interactions. The team wanted to build awareness of the important role families – parents, teammates or classmates – played in helping children manage stress for resilience and recovery from traumatic stress.
Sarah Delahanty, PhD, was part of the original PTSD research team as a doctoral student at Kent State. A few years later, she found herself back on the team, but this time as director of research and education of the NeuroDevelopmental Science Center at Akron Children’s Hospital. She also brought a new element to the collaborative research team thanks to her involvement with the National Child Traumatic Stress Network (NCTSN).
“Sarah’s relationship with the NCTSN was really instrumental in getting us one of the largest grants we ever received for our work on PTSD,” added Dr. Christopher.
The grant gave the research team $2 million over a 5-year term, which allowed them to build programs and best practices at Akron Children’s and in schools and communities throughout Ohio.
“Funds from the grant allowed Missy McClain and our School Health Services team to inform schools and the broader community about how to identify trauma symptoms in kids and what to do when symptoms are noticed,” said Dr. Delahanty. “By making schools and community members trauma-informed we could all work toward addressing a child’s need to help lessen the chance of PTSD.”
Additionally, physicians within Akron Children’s gleaned insight from the PTSD research and applied it to their own practice. Palliative Care and Neonatal Intensive Care began testing strategies used to treat trauma patients with families affected by chronic illness or traumatic birth. At Akron Children’s Hospital Pediatrics Wooster, results from a Johns-Hopkins-sponsored learning collaborative helped usher in best practices for screening high-risk patients in the primary care setting that is now a standard of care across Akron Children’s primary care network.
Results from the group’s PTSD research also brought national exposure to the issue. The PTSD research team invited scientists from around the U.S. to discuss and debate findings from pediatric PTSD research that resulted in a published monograph.
More work to be done
While the positive impact of the PTSD research is far-reaching, the team knows there’s still more work to do. Most recently, the team was awarded a National Institutes of Health 3-year, $460,000 grant to look at how emotional regulation and parenting play into predictors of long-term, post-traumatic stress in children.
“Decades later, we’re able to continue our PTSD research thanks to our collaboration with Kent State,” said Dr. Christopher. “It’s a perfect example of how aligning our interests with academic partners can help us bring high-quality research to our hospital that not only improves patient outcomes, but also allows us to train future leaders in research.”