Complex Trauma in Childhood: Informing Occupational Therapy Practice

Abstract

Background: There is a dearth of evidence available to support occupational therapy practice with children experiencing complex trauma. No occupational therapy-specific guidelines exist. The occupational experiences of these children have received minimal attention in existing research. In Ireland, no research has investigated the occupational therapy practices used to address the challenges faced by these children or the needs of therapists working in this area. The research aims to address these gaps in knowledge and evidence and inform occupational therapy practice development in this field. Objectives: The research objectives were 1) to explore the current practice and needs of occupational therapists working with children experiencing complex trauma in Ireland; 2) to identify and synthesise the empirical evidence which explores the impact of complex trauma on occupations and daily functioning in childhood; and 3) to reach international expert consensus regarding how occupational therapists can adapt their practice to consider and address the impact of complex trauma in childhood. Methodology: An overall mixed-methods methodology was implemented to address the research objectives. Four individual but interconnected studies were conducted to address the objectives using a combination of quantitative and qualitative data collection methods. Study 1, a cross sectional survey of practice, and Study 2, a qualitative semi-structured interview study, were conducted to address objective one. Study 1 was aimed at occupational therapists with identified experience or expertise in working with these children and Study 2 focused on community-based therapists without specific experience or expertise. Study 3, a scoping review, addressed objective two. Study 4 employed the Delphi method to address the third objective. International expert occupational therapy clinicians, academics, and researchers were recruited to form consensus on practice. Findings from all four studies were integrated and interpreted using meta-inference, culminating in an overall discussion and conclusion of the research. Results: The cross-sectional survey identified that children experiencing complex trauma access a range of occupational therapy services in Ireland. Ninety-two percent of therapists identified that their occupational therapy departments lacked protocols, policies, or procedures to guide practice. Therapists addressed various challenges using a wide range of interventions, primarily guided by occupational therapy conceptual models and sensory-based frameworks. Therapists' self-rated confidence and competence varied. Not all training completed by therapists were trauma-specific. To advance practice, therapists identified a need for occupational therapy resources, tools, and training specific to childhood complex trauma. The qualitative interview study identified considerable variation in therapists' awareness and knowledge of childhood complex trauma, with most participants considering it a new area of practice. Participants noted greater complexity and a broader scope of practice required when working with these children. The findings identified variations in practices used and in therapists' abilities to attend to these children's needs. Social environmental, professional, and systemic barriers to practice were highlighted. Supports identified to advance practice included the need to equip community teams to work with these children, and the need to develop education, training, and guidance specific to childhood complex trauma for occupational therapy. The scoping review identified a gap in robust empirical evidence regarding the impact of complex trauma on childhood occupations and daily functioning. There was preliminary evidence that complex trauma impacts various domains of childhood occupations and daily functioning, although there was limited evidence regarding how specifically these areas are impacted. Expert international occupational therapists completed the Delphi process resulting in 124 statements reaching consensus. These statements outlined consensus for practice relating to foundation knowledge needed, guiding theories, models, and frameworks for practice; recognising and acknowledging trauma experiences and needs; considerations for occupational therapy practice; priorities and goals for intervention, information gathering; observation and assessment priorities; key interventions and approaches; collaboration needs; service provision; and therapeutic skills required. Conclusion: The research provided an exploration of the current landscape of occupational therapy practice with children experiencing complex trauma in Ireland and identified the needs of therapists to advance their practice in the field. It offers novel insights into the impact of complex trauma on childhood occupations and daily functioning. This provides valuable groundwork for the development of occupational therapy practice with children experiencing complex trauma. The research contributes to the knowledge base and informs practice by providing expert international consensus regarding how occupational therapists should adapt their practice to meet these children's needs. It outlines a clear role and scope for occupational therapy. Further research is needed to create an evidence-informed practice framework to support therapists in this field and improve outcomes for children experiencing complex trauma following occupational therapy intervention.