Dr Penelope Burns
Dr Penelope Burns is a general practitioner and a senior lecturer at Western Sydney University. She has a range of experience in general practice in rural and urban areas. She worked for several years in paediatrics in Sydney and Papua New Guinea. She is on the steering committee of the Australian Child and Adolescent Trauma Loss and Grief Network at the Australian National University and the GP member on the NSW Mental Health Disaster Advisory Committee.
1. What is the relationship between trauma and mental health issues in children?
Trauma in the early years can have a long-term effect on children, creating ill health in adult life.
It can affect the way people think (cognitive ability), the way they manage their feelings (emotional regulation), and how they relate to others (interpersonal relationships).
Trauma in childhood can also result in physical effects in adulthood including liver, lung and heart disease.
In adult life there may be increased use of cigarettes, alcohol and injection drugs, or increased anxiety or depression.
Children affected by trauma may also present with issues such as headaches, stomach pain, recurrent colds, bedwetting, sleep problems or difficulty concentrating. Behavioural symptoms can include aggressiveness or withdrawal, or decline in school grades.
2. Can you outline how GPs approach supporting children affected by trauma?
GPs are with their patient for the long haul, with a long term commitment to holistic care and a reduction of long term impacts.
The key principles of a GPs approach to supporting children affected by trauma are: look, listen, collaborate and coordinate.
Actively looking for sign of trauma
A GP’s role is to actively look for signs of trauma in all their patients and respond when it is suspected.
Supporting children and families
The crucial first step in supporting children affected by trauma is developing or maintaining a supportive ongoing relationship with the child, the parents and the siblings; engaging and respecting the child (and relevant adult), validating their experience, and working with the child and parent to find solutions.
GPs can help patients understand what is happening to them. Explaining, at an age appropriate level, what the child is feeling. “Your body is very healthy and normal. That pain in your tummy is from chemicals made by your brain when it is a bit stressed.“ It is important to avoid medicalising
Giving the children a sense of purpose including small tasks they can undertake for themselves e.g. caring for an animal helps give them a sense of control. Focusing on the child’s strengths and their future helps empower the child.
Referring and coordinating care
Referring and coordinating care to reduce gaps and duplication are key roles in general practice.
Sometimes a “holding” role is required, spending time with the child, or parent, until they are ready to be referred.
GPs can help to minimise costs by bulk-billing, and using available tools as appropriate such as Access to Allied Psychological Services (ATAPS), Mental Health Plans or GP Management Plans.
3. Why is early identification and intervention important?
It is crucial to identify children affected by trauma and intervene early because childhood trauma has serious life-long consequences.
There is evidence that prevention or early intervention can create a better outcome. The impact of trauma can be mitigated through early intervention. When children are significantly impacted by trauma and are not offered help and intervention, the difficulties they experience can worsen over time.
Programs such as parenting training programs and nurse home visitation have been shown to be effective.
Cognitive behavioural interventions for children who have been sexually abused have been shown to be modestly helpful.
4. How are psychologists and other mental health professionals involved in the supporting children affected by trauma?
Children will respond differently to trauma according to their age and stage of development, their family and their personality.
It is important to have the right professionals with the right experience. The aim is to form a cross-disciplinary team tailored to support those affected (i.e. the child and the family) to create the best care possible.
GPs may assist in the referral process by providing “warm referrals” when helping connect the child to a specialist by walking them through who the specialist is and how they will help the child.
Useful referrals include psychologists, mental health nurses, early childhood programs, parenting programs using Triple-P Positive Parenting, domestic violence workers, drug and alcohol services, and others.
Children can also be supported within schools by mental health and other school welfare professionals.
Professionals in these services are experienced in identifying the vulnerability and strengths of children and parents and giving tailored support, psycho-education and practical guidance that is informed by the effect trauma is having on the child’s ability to self-regulate.
For more information
View of recording of the recent webinar and additional resources on supporting children affected by trauma.