Ugeskrift for Læger, 24. Nov 2014 - Ugeskr Læger 2014;176:V05140266
Forfattere: Lasse Posborg Michelsen, Ditte Bruun Eriksen & Carolina Magdalene Maier Tværfagligt Videnscenter for Patientstøtte, Rigshospitalet
I denne artikel introduceres begrebet traumeinformeret praksis, der især er udbredt i USA. Begrebet betegner indsatser for børn og unge, der har været udsat for traumatiske hændelser. Der er ikke tale om et terapeutisk program, men om at informere professionelle, der i forvejen møder børn og unge i deres arbejde. I sundhedsvæsenet handler det således om at uddanne sundhedsprofessionelle til at opdage og støtte børn, der har været udsat for traumatiske hændelser, med målet at nedbringe udbredelsen af posttraumatisk belastningsreaktion (PTSD). Formålet med artiklen er dels at præsentere et samlet argument for at indføre traumeinformeret praksis i en dansk kontekst, dels at formulere en række best practice-principper for fremtidige indsatser på området.
14. Nov 2014
Investigators: Principal Investigator: Lasse P Michelsen, MA Rigshospitalet, Denmark; Principal Investigator: Ditte B Eriksen, LPsy Rigshospitalet, Denmark; Study Director: Carolina M Maier, MSc Rigshospitalet, Denmark
Sponsor: Carolina Magdalene Maier
Collaborators: The Egmont Foundation; Ramboll Group
Information provided by (Responsible Party): Carolina Magdalene Maier, Rigshospitalet, Denmark
Background: International studies have shown that a substantial number of children and adolescents are exposed to potentially traumatic events. Many of these children and adolescents, some of whom will experience posttraumatic stress disorder (PTSD), are submitted to health care departments shortly after exposure as the most common types of traumatic events are accidental injury, serious somatic illness or death of someone close. There has been some research on early psychological interventions for prevention and treatment of PTSD. However, very little research has examined the efficacy of trauma-informed practice among health care professionals (HCPs). The present trial aims to evaluate and compare trauma-informed health care with usual practice.
Methods/Design: The primary clinical question under investigation is the efficacy of an early, trauma-informed intervention for the prevention of PTSD in children and adolescents following exposure to a potentially traumatic event. The trail compares a standardized trauma-informed practice with usual care (no intervention) in health care departments receiving children and adolescents after exposure to determine if trauma-informed care is associated with a reduction in psychological outcome measures over time. Specifically, the investigators examine the efficacy of health care professional's active use of trauma-informed standards of action and a trauma training program for HCPs in the intervention group. The primary outcome will be a reduction in trauma, anxiety and depressive symptoms on self-reports in the active intervention compared to usual care.
Discussion: This trial will be the first controlled trial to examine a trauma-informed intervention carried out by HCPs. It will provide the first evidence on the efficacy of health care delivered by trauma-educated HCPs using trauma-informed standards of action. A successful implementation of this protocol will support the thesis that prevention of PTSD among children and adolescents benefits from a focus on the practice of HCPs. If efficacious, the results will be a call for future research to extend the investigation of interventions from psychological treatment to HCP-based care.
Ugeskrift for Læger, 30. Jul 2014 - Ugeskr Læger 2014;176:V05130282
Forfatter: Lasse Posborg Michelsen Tværfagligt Videnscenter for Patientstøtte, Rigshospitalet
It is the explicit, political ambition of the Region of the capital in Denmark to apply the principle of patient empowerment on all levels of the health-care system. However, precise operationalized criteria for the application of patient empowerment are still not well-defined. In this article the premises of such an application is analysed and it is shown what kind of evidence should be required as criteria for interventions by the health-care system. A differentiation between two forms of interventions is made: one supporting patients who already control most of their own health care, an other increasing patients’ responsibilities.