Understanding and Approaching Care for Children with Complex Developmental Trauma

Contemporary Clinic® interviewed Bethany Hall, MSN, the owner of Healing Connection, on how understanding the role nurse practitioners have in understanding and approaching care for children with complex developmental trauma (CDT).

In this discussion, Hall discusses the cumulative nature of the economic and social burden of childhood trauma, making trauma competent caregiving in the field of nursing critical.

Alana Hippensteele: What is the role of trauma competent caregiving in the field of nursing, and what role do nurse practitioners have in understanding and approaching care for children with CDT?

Bethany Hall: So, I love nurses. I was a nurse before I was a nurse practitioner. Nurses are, in my opinion, the hearts and hands of the medical community. So, nurses spend a lot more time in a patient bedside in building a rapport with patients than any of us as nurse practitioners or physicians do. So, they have a unique opportunity as they raise their own education and awareness to build rapport with these patients, to be advocates for them, to help train the other people around them, and how to approach a child that has experienced trauma, to do things like increase their feeling of safety, to make their surroundings more comfortable, to help them know that they have a voice in their medical care, that they can speak out about how they're feeling or how their medications are making them feel, or interacting with their other activities of daily living.

So, the more nurses are educated, I think they can do great work with the patients one-on-one, and in their multiple interactions with patients. As far as nurse practitioners and physicians, I think the more we understand that there is meaning behind the behavior of our patients, the better we can create plans that are holistic in nature and that take into account the changes that have occurred in these children as a result of trauma in their brains, their bodies, and their biology.

So, I mentioned earlier I think this is changing somewhat. Dr. Nadine Burke Harris has written a book called The Deepest Well, and basically [it] catalogs her journey of educating herself on childhood trauma, how she created her pediatric practice, and how she changed it to really create a holistic and family-based approach that takes into account a child's [Adverse Childhood Experiences (ACE)] score. So, in her practice now, utilizing the ACE score is just like getting a vital sign, so it's just like a blood pressure, every child gets their ACE score. That really helps drive care, helps them make sure that if there are problems in the family, that if the child is still in the midst of trauma that they're experiencing, then providing resources to the parents.

Oftentimes children who have parents who are neglectful or abusive, it is a direct result of their parents’ experiences as children. So, she takes a family-based approach of saying how can we help you to heal from your trauma so that you can be a better parent to your child, and how can we give you resources—if it's food, clothing, or safety as far as a living situation—how can we help you and give you resources because, when we can help the parents, then we help the children, and we really improve health outcomes across the board. So, I think the more that we educate ourselves, the better we can do, and from a public health standpoint, the need for us to educate ourselves as nurse practitioners can't be overstated.

So, the cumulative economic and social burden of childhood trauma is extremely high, and I think it's something that we just don't realize as a medical community. I have here based on the data from a variety of sources I was looking up right before our interview a conservative annual cost of childhood abuse and neglect is estimated at about 103.8 billion dollars, so that includes like the direct cost associated with hospitalizations like I was talking about with the emergency department mental health care for these children—child welfare systems, law enforcement—to kind of create these systems that we need around them. But it also includes indirect costs related to the secondary or long-term effects of their abuse, which again then you're talking about special education services, juvenile delinquency services, long-term mental health care, criminal justice system, loss of productivity to society.

So, it's our job—I feel like the onus is on us as a medical community to understand that this is a public health crisis that's gone unnoticed for a long period of time as we live through this pandemic. That's only likely to increase. So, the impact on parents and their ability to parent well and the impact on these children with compounded stressors that may or may not be able to be discussed and given space to help them work through these things, so that they don't become traumatic is often not there. So, I think it can't be overstated the role that we have as nurse practitioners to educate ourselves and then to become champions among our colleagues in this area.