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Background: Physician burnout has been identified as a significant occupational hazard for decades. Burnout prevention may target individual and workplace environment factors; however, a gold standard approach to prevention has yet to be established. Components for Enhancing Clinician Experience and Reducing Trauma (CE-CERT) is both a practice and peer supervision model for promoting wellness among helping professionals. This study sought to explore the experiences of a group of attending physicians at a mid-size pediatric residency program in an urban free-standing children’s hospital as they learned and implemented CE-CERT. Methods: A total of seven attending physicians participated in CE-CERT during the academic year between 2020 and 2021. Semi-structured interviews were conducted with five of the seven participants (71%) after completion of the program to explore their experiences with CE-CERT in their personal and professional lives. Through constructivist grounded theory methods, attending physician experiences with CE-CERT were systematically analyzed. Results: Rigorous analysis revealed six common themes around the attending experiences with the CE-CERT model in their personal and professional lives. The six themes were as follows: 1) It’s given me a framework, 2) It’s given me insight, 3) Taking a minute, 4) Gave me skills to use, 5) You can do this without being overwhelmed, and 6) We connected. The themes were organized in a pictorial representation of their interactions. Conclusions: This study found that the CE-CERT program taught skills and concepts to our sample of attending physicians that were applicable and promoted self-motivation with potential to mitigate burnout and promote compassion satisfaction and professional quality of life.

In contrast to the DSM-5, which expanded the posttraumatic stress disorder (PTSD) symptom profile to 20 symptoms, a workgroup of the upcoming ICD-11 suggested a reduced symptom profile with six symptoms for PTSD. Therefore, the objective of the study was to investigate the dimensional structure of DSM-5 and ICD-11 PTSD in a clinical sample of trauma-exposed children and adolescents and to compare the diagnostic rates of PTSD between diagnostic systems. The study sample consisted of 475 self-reports and 424 caregiver-reports on the child and adolescent trauma screen (CATS), which were collected at pediatric mental health clinics in the US, Norway and Germany. The factor structure of the PTSD construct as defined in the DSM-5 and in alternative models of both DSM-5 and ICD-11 was investigated using confirmatory factor analyses (CFA). To evaluate differences in PTSD prevalence, McNemar's tests for correlated proportions were used. CFA results demonstrated excellent model fit for the proposed ICD-11 model of PTSD. For the DSM-5 models we found the best fit for the hybrid model. Diagnostic rates were significantly lower according to ICD-11 (self-report: 23.4%; caregiver-report: 16.5%) compared with the DSM-5 (self-report: 37.8%; caregiver-report: 31.8%). Agreement was low between diagnostic systems. Study findings provide support for an alternative latent dimensionality of DSM-5 PTSD in children and adolescents. The conceptualization of ICD-11 PTSD shows an excellent fit. Inconsistent PTSD constructs and significantly diverging diagnostic rates between DSM-5 and the ICD-11 will result in major challenges for researchers and clinicians in the field of psychotraumatology.

BACKGROUND The aim of this study is to provide a better understanding of the central symptoms of DSM-5 posttraumatic stress disorder (PTSD) in children and adolescents from the perspective of the child and its caregiver. Identifying core symptoms of PTSD can help clinicians to understand what may be relevant targets for treatment. PTSD may present itself differently in children and adolescents compared to adults, and no study so far has investigated the DSM-5 PTSD conceptualization using network analysis. METHODS The network structure of DSM-5 PTSD was investigated in a clinical sample of n~=~475 self-reports of children and adolescents and n~=~424 caregiver-reports using (a) regularized partial correlation models and (b) a Bayesian approach computing directed acyclic graphs (DAGs). RESULTS (a) The 20 DSM-5 PTSD symptoms were positively connected within the self-report and the caregiver-report sample. The most central symptoms were negative trauma-related cognitions and persistent negative emotional state for the self-report and negative trauma-related cognitions, intrusive thoughts or memories and exaggerated startle response for the caregiver-report. (b) Similarly, symptoms in the negative alterations in cognitions and mood cluster (NACM) have emerged as key drivers of other symptoms in traumatized children and adolescents. CONCLUSIONS As the symptoms in the DSM-5 NACM cluster were central in our regularized partial correlation networks and also appeared to be the driving forces in the DAGs, these might represent important symptoms within PTSD symptomatology and may offer key targets in PTSD treatment for children and adolescents.

Background Systematic screening is a powerful means by which children and adolescents with posttraumatic stress symptoms (PTSS) can be detected. Reliable and valid measures based on current diagnostic criteria are needed. Aim To investigate the internal consistency and construct validity of the Child and Adolescent Trauma Screen (CATS) in three samples of trauma-exposed children in the US (self-reports: n=249; caregiver reports: n=267; pre-school n=190), in Germany (self-reports: n=117; caregiver reports: n=95) and in Norway (self-reports: n=109; caregiver reports: n=62). Method Internal consistency was calculated using Cronbach's α. Convergent-discriminant validity was investigated using bivariate correlation coefficients with measures of depression, anxiety and externalizing symptoms. CFA was used to investigate the DSM-5 factor structure. Results In all three language samples the 20 item symptom score of the self-report and the caregiver report proved good to excellent reliability with α ranging between .88 and .94. The convergent-discriminant validity pattern showed medium to strong correlations with measures of depression (r =.62–.82) and anxiety (r =.40–.77) and low to medium correlations with externalizing symptoms (r =−.15–.43) within informants in all language versions. Using CFA the underlying DSM-5 factor structure with four symptom clusters (re-experiencing, avoidance, negative alterations in mood and cognitions, hyperarousal) was supported (n =475 for self-report; n =424 for caregiver reports). Limitations The external validation of the CATS with a DSM-5 based semi-structured clinical interview and corresponding determination of cut-points is pending. Conclusion The CATS has satisfactory psychometric properties. Clinicians may consider the CATS as a screening tool and for symptom monitoring.

Objective of this study is to identify background infant and maternal characteristics that predict child maltreatment (CM) incidence reporting among Neonatal Intensive Care Unit (NICU) graduates by health care providers versus community sentinels with the goal of identifying ways to improve CM risk surveillance. Demographic, medical data including diagnoses and caregiving needs at discharge for infants treated in a NICU during 2005 to 2008 were obtained from the neonatology databases. CM outcome data was obtained from child welfare databases. Latent class analysis procedures were used to identify observable infant and maternal characteristics that define unobserved groups (latent classes) that predict NICU graduates CM incidence reporting among health care providers versus community sentinels. Medical surveillance (reports made by health care providers) accounted for only 37% of the CM reports made to child welfare. Infant health was more predictive of medical surveillance than maternal characteristics suggesting that health providers may assess risk differently than community sentinels. Based on a simple, two latent class model, the latent class with high infant health indicator membership probabilities was a better predictor of health care provider related reports than the class with lower membership probabilities (odds ratio = 2.72; 95% confidence interval [1.76, 4.20]). Health care providers may be keyed more to an infant's medical frailty than to caregiver (maternal) contextual characteristics and thus may miss an opportunity to identify and intervene to prevent CM among children with medical problems. Findings raise the question of whether increased attention to contextual factors can aid or increase early identification of infants at risk of child maltreatment in NICU settings.

Background Child death review (CDR) programs examine the circumstances of children's deaths to gain information on how and why children die for the purpose of promoting the health, safety, and protection of children. Purpose The purpose of this study was to conduct a systematic review of the 50 states and District of Columbia CDR programs, with specific focus on the use of standardized procedures and best-practice recommendations. This included assessment of which deaths are reviewed, the model of review, team membership, and standardization of data collection and reporting. Methods Data were collected through semistructured phone interviews with representatives of the 50 states and District of Columbia CDR programs and online sources. Data collection and analyses were conducted in 2009. Results Forty-eight states and the District of Columbia have active CDR programs at the state and/or local level, and the majority use a national data collection system. However, results revealed numerous inconsistencies across programs in policies, procedures, and data collection. Conclusions This study reflects the minimal progress that has been made in the CDR process in the U.S. since the last systematic review of the programs in 2001. The study documents substantial discrepancies among the U.S. CDR programs, affecting the consistency of data obtained by individual states and, ultimately, prevention efforts at the national level. Information from this review can inform CDR programs as they develop and refine procedures and guide future research on the effectiveness and limitations of variations in procedures.

Studies suggest that neonatal illness may cause increased risk for child maltreatment (CM), but these findings may be biased by observed and unobserved confounding factors (social, family, and maternal characteristics) including increased surveillance by health care providers. This study expands on previous research by examining and controlling for these potential study biases and confounders using a sibling discordance retrospective cohort study design. Infants born in a Level IV neonatal intensive care unit (NICU) were matched with non-NICU born sibling controls. Cox proportional hazard models with shared frailty terms were used to account for clustering and heterogeneity in CM survival time (time to CM event). Potentially key covariates were selected using the directed acyclic graph approach, and surveillance reports were identified and systematically included or excluded from analyses. Managing these sources of bias reduced but did not eliminate the association between neonatal illness and CM report risk. Risk was especially high during the first year of the NICU infant’s life and among families with multiple well-known CM risk factors.

Newborns discharged from intensive care are at elevated risk for child welfare reports, especially for child neglect. This study investigates the role of caregiving burden as a risk predictor among the NICU graduate population. Discharge data were captured for 2,463 infants graduating from a Neonatal Intensive Care Unit (NICU) during 2005–2008, then linked to child welfare reports at a median 3.2 year follow-up. Survival analyses were used to examine child welfare report outcomes conditional on caregiving burden and its moderating relationships with other family risk factors. Caregiving burden was associated primarily with an increased risk of child welfare reporting during the first few months to first year of life, after which risk was similar to NICU graduates without caregiving burden. Caregiving burden effects were potentiated by having three or more siblings in the family. A history of prior child welfare reports predicted very high risk, regardless of caregiving burden. Young maternal age increased risk. The findings suggest that the immediate months after NICU discharge may be an important window of child neglect prevention opportunity among newborns with special caregiving needs. This may be a key time to provide caregiver support and monitoring, particularly when caregivers have multiple children.

Ethical decision-making about trauma-related studies requires a flexible approach that counters assumptions and biases about victims, assures a favorable ethical cost-benefit ratio, and promotes advancement of knowledge that can benefit survivors of traumatic stress. This paper reviews several ethical issues in the field of traumatic stress: Benefit and risks in trauma-related research, whether trauma-related research poses unique risks and if so what those might be, informed consent and mandatory reporting, and supervision of trauma-related research. For each topic, we review potential ethical issues, summarize the research conducted thus far to inform ethical practice, and recommend future practice, research questions and policies to advance the field so that research on trauma can continue to be a win-win situation for all stakeholders in the research enterprise.