A Pilot Intervention Study Addressing Parental Responses to Child Trauma

It has been estimated that around 31% of young people will experience a traumatic event during childhood (Lewis et al, 2019), most commonly serious accidents that lead to hospitalisation. Around 15% of children who experience such events go on to develop PTSD symptoms including excessive fear, reexperiencing the traumatic event, negative changes in beliefs about the world and the future, anger and hyperarousal (Hiller et al, 2018).

A growing body of research highlights significant associations between parental responses to child trauma and subsequent child PTSS (Hiller et al, 2018; Morris, Gabert-Quillen, & Delahanty, 2012). Notably, child trauma can trigger changes in parenting behaviour, including negative trauma appraisals and coping mechanisms (Cobham & McDermott, 2014). Consequently, it is important to engage parents in providing positive support for children's recovery post-trauma.

In preliminary work, involving parents as co-therapists in child trauma interventions has had positive treatment outcomes (Berkowitz, Stover, & Marans, 2011; Deblinger & Steer, 2010). However, to date, interventions have been delivered individually or in group sessions and high attrition rates reflect their limited accessibility.

Hence, this research aims to create an online intervention targeting parental responses to child trauma in the early post-trauma. Collaboration with families and clinicians will ensure that the intervention is acceptable and can be easily embedded within routine services for trauma-exposed children. Enormous burdens are placed on emergency departments and it is difficult to address the mental wellbeing of patients and families. Therefore, piloting and up-scaling a low-level intervention will help families to support children's psychological adjustment following a traumatic experience.

Objectives
1. To conduct a systematic review of the evidence base relating to influences of parental responses on child PTSS & identify key target domains for intervention.
2. To co-design an online intervention for parents of trauma-exposed children, combining evidence-based intervention components with consultation with families and the clinical teams that support them.
3. To conduct a pilot feasibility study to examine whether the intervention addressing parental response to child acute distress has the potential to reduce child PTSS.
4. To establish clear pathways to intervention delivery, through collaboration with key health care providers.

Methods
Phase One
I will conduct a systematic review to explore the effect of parental responses on child posttraumatic stress symptoms and which treatment components would be effective in addressing these dysfunctional parenting responses.

Phase Two
A user-led, internet-based pilot intervention will be co-designed in close collaboration with families and clinicians, to ensure acceptability and effective delivery. Development work will include focus groups and pilot testing with feedback and adjustment. Subsequently, through collaboration with the Emergency Department at the Bristol Royal Hospital for Children, 60 parents of children who have experienced acute trauma will be recruited and randomised to the intervention or to treatment as usual in a pilot feasibility trial. The intervention will aim to address the following goals through cognitive-behavioural therapy techniques:

* To increase positive parental communication between parents & children, and parental awareness of children's PTSS;
* To encourage parents to model positive thinking patterns and adaptive coping behaviours for the children.

Child PTSS will be examined post-intervention and at a 3-month follow-up. Qualitative work will inform detailed perspectives from families, consistent with the major goal of feasibility trials.

Phase Three
Qualitative research will be conducted with emergency department clinicians and other support services to establish pathways to scaling up the intervention.