Stepped preventive care after trauma

Domain VI · Brief, integrative, trauma, hypnosis & coaching · Nancy Kassam-Adams · 2011 · Philadelphia

What it is

Stepped Preventive Care is a service-delivery model for secondary prevention, not a single therapy. It is a sequence of screening, brief low-intensity contacts and decision points, built into acute medical care, that sends each injured child and family to the lowest level of help that meets their…

Format

• Step 0. Universal trauma-informed medical care (all injured children). Bedside staff use the D-E-F approach: attend to Distress (information, choices, listening, clarifying misconceptions, asking about fears, realistic hope), Emotional support (parent presence, empowering parents, normal…
• Step 1. Session 1, in hospital (indicated step). This took place a mean of 3.0 days after injury and lasted 10–75 minutes (mean 29). It covers the child's and parent's top concern; a semistructured review of current distress, support systems and medical questions; and the psychoeducation binder.…

Who practises it, and how they are trained or regulated

• Format and staff. The model was delivered in a paediatric trauma centre by one nurse and two social workers. They had paediatric experience but no specialised traumatic-stress training, received brief training, and were supervised by a doctoral-level psychologist. A second psychologist was available for assessment and trauma-focused therapy, and child psychiatry for medication assessment. Training hours and…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• no-shows. Confirm that the appointment happened.
• referral drop-out. Make a warm hand-off, with a named person and a date.
• confidentiality boundaries with adolescents. Agree beforehand what will be shared.
• contact that keeps going without a goal. Set a reason and an end point for each extra contact.
• interactions with analgesics, and discrepancies between hospital and community medication lists.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.