Psychological Services for Pediatric Victims of Non Accidental Trauma

51 Pages·2016·1.09 MB·English

by  Robyn Finckbone

Loma Linda University
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Loma Linda University Electronic Theses, Dissertations & Projects
6-2015
Psychological Services for Pediatric Victims of Non
Accidental Trauma
Robyn Finckbone
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Theses, Dissertations & Projects. 245.
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LOMA LINDA UNIVERSITY
School of Behavioral Health
in conjunction with the
Department of Psychology

________________________________

Psychological Services for Pediatric Victims of Non Accidental Trauma
by
Robyn Finckbone, M.A.

__________________________________

Doctoral Project submitted in partial satisfaction of
the requirements for the degree of
Doctor of Psychology

___________________________________

June 2015
© 2015
Robyn Finckbone
All Rights Reserved
Each person whose signature appears below certifies that this doctoral project in his/her opinion
is adequate, in scope and quality, as a doctoral project for the degree Doctor of Psychology.
____________________________________________________, Chairperson
Cameron Neece, Assistant Professor of Psychology

Edward Tagge, Professor, School of Medicine

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ACKNOWLEDGMENTS

I would like to express my appreciation to the individuals who helped me
complete this study. I am grateful to Loma Linda University Medical Center and
Children’s Hospital Trauma Registry for providing the data.
I would like to thank Cameron Neece, my chair, for providing me with support
and mentorship throughout this process. Thank you for the endless hours, meetings,
edits, and support that you have given me, I truly could not have done this without you!!
I also wish to thank Edward Tagge and the department of Pediatric Surgery for
providing support and sharing their medical knowledge and resources throughout this
process.
Finally, I dedicate this project to all of the children who endure the lifelong
affects of non-accidental trauma. May this research raise awareness and shed light on the
need for greater care and increased psychological services for all children who experience
non-accidental trauma.

iv
TABLE OF CONTENTS

Page
Approval Page .................................................................................................................... iii
Acknowledgments.............................................................................................................. iv
List of Tables ..................................................................................................................... vi
Abstract ............................................................................................................................. vii
Chapters:
1. Introduction ..........................................................................................................1
Risk Factors for Maltreatment .....................................................................5
Maltreatment, Psychopathology and Adult Outcomes ................................6
Benefits of Psychological Interventions ......................................................7
The Current Study .......................................................................................9
2. Methods .............................................................................................................11
Participants ................................................................................................11
Measures and Procedures ..........................................................................11
3. Results ................................................................................................................13
Participant Characteristics .........................................................................13
Demographic Characteristics .........................................................13
Injury Characteristics and Response ..............................................14
Hospitalization and Discharge ...................................................................22
Consultation ...................................................................................22
Discharge Recommendations.........................................................24

4. Discussion ..........................................................................................................27
Coordination of Care..................................................................................30
Early Interventions .....................................................................................31
Future Direction .........................................................................................32
References ..........................................................................................................................34
Appendix ............................................................................................................................37
v
LIST OF TABLES

Tables Page
1. Demographic Characteristics of Children with Non Accidental Trauma ......................14
2. Injury Characteristics of Children with Non Accidental Trauma ..................................16
3. Hospital Response to Non Accidental Trauma and Level of Trauma ...........................20
4. Top 13 ICD-9 Diagnoses Combined into Larger Categories within Sample ................21
5. Consultation Services Provided to Non Accidental Trauma Patients ............................23
6. Discharge Recommendations, Evaluation, and Disposition Outcomes .........................26

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ABSTRACT

Psychological Services for Pediatric Victims of Non Accidental Trauma
by
Robyn Finckbone
Doctor of Psychology, Graduate Program in Psychology
Loma Linda University, June 2013
Dr. Cameron Neece, Chairperson

Child abuse is a significant problem within our society. In 2010, there were
approximately 1,560 fatalities as a result of child abuse; 17.6% of those deaths were the
direct result of physical abuse and 80% occurred in children under the age of 4. There is a
dearth of research examining severe physical abuse among children and, as a result, the
demographics of this population are unclear as are the psychological referrals and
services provided to these children. The aims of the current study are to identify the
demographic characteristics of child victims of non-accidental trauma (NAT, i.e. physical
abuse) as well as examine the psychological services provided to these children in the
hospital and at discharge. The current sample included 743 children who were admitted
to Loma Linda University Children’s Hospital after suffering NAT. The majority of NAT
patients were under the age of 5 (96%), and of Caucasian (39.4%), Latino (38.8%) or
African American (16.9%) decent. Consultations, referrals and recommendations for
psychological services were minimal. While in the hospital, less than two percent of the
children and families in this sample received a Psychiatry consultation and less than three
percent were seen by Psychology consultation services. Upon discharge, only 3 children
(0.4%) were documented to have been referred directly for psychological services. The
implications of this study show the great need for a medical system of care which ensures
vii
that children with NAT receive psychological treatment as very few of these children
received psychological interventions during their initial admission when intervention is
felt to be most beneficial.

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CHAPTER 1

PSYCHOLOGICAL SERVICES FOR PEDIATRIC VICTIMS OF NON
ACCIDENTAL TRAUMA

Child abuse is a significant problem within our society. Approximately 1,560
child fatalities were reported in the United States due to maltreatment in 2010 (Child
Maltreatment Report, 2010). Of these children, approximately 80% were under the age of
4 and approximately 62% were 1 year or under (Child Maltreatment Report, 2010).
Physical abuse appears to account for a significant number of mortalities in that among
those who suffered fatal maltreatment, 22% died from the effects of physical abuse alone
and approximately 45% from physical abuse which occurred in combination with sexual
abuse, psychological abuse, neglect, and/or medical neglect (Child Maltreatment Report,
2010). Unfortunately, 12% of the children who died from abuse or neglect had received
family preservation services (i.e., family crisis intervention) within the past five years
(Child Maltreatment Report, 2010). This may suggest that these families are not receiving
the support services that they need to prevent fatal maltreatment. It may also suggest that
most of these children are not being identified by CPS prior to their fatal injuries. This is
significant because research shows that maltreatment, specifically physical abuse, is
generally chronic in nature, and that injury requiring hospitalization is likely not the first
occurrence of maltreatment (Brown, 2003). Despite the high prevalence of physical abuse
(17.6% of all maltreatment reported in 2010; Child Maltreatment Report, 2010) very little
research has examined the characteristics of this population, identified risk and protective
factors, or investigated the development of these children over time leaving a critical gap
in our current understanding of child maltreatment.
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