Children with traumatic injury account for the second largest cohort of hospitalized children and yet there is little research on the psychological sequelae of such hospitalization or on interventions to help them master the sudden trauma. Previous work on psychological preparation of hospitalized children has focused primarily on planned hospitalization and on advance preparation for procedures. This study will build on previous research and will test an intervention designed for children who experience emergency admission for accidental trauma. 300 children, 7-11, will be randomly assigned to one of 5 groups after they are medically stable. Group I will receive a working-through intervention which will promote mastery of the event through accurate information, cognitive desensitization, directed recall and reframing. The intervention will have 4 components: Joining (establishment of empathetic rapport and supportive relationship); revisiting (structured review of the event); and integration (directed generalization and future implications). Children will receive this intervention during hospitalization and at 2 post-discharge sessions. In Group II, the parents will be instructed and supported as they guide the working-through process with their child. Group III will serve as a placebo control for the supportive relationship in the Group I intervention while Group IV will serve the same function for the Group II intervention. Group V will be the control group with no contact with the Investigator. Eight outcome measures (repeated during hospitalization and after discharge) will evaluate the interventions: Demographic and Life Events Measure for Children and Parents; Child Depression Inventory; Impact of Event Inventory for Child and Parent; Human Figure Drawings; Nurses' Ratings of Upset; Recovery Inventory; Length of Stay; and Post-Hospital Checklist. Parents will be asked to complete the Beck Depression Inventory, the Spielberger State-Trait Anxiety Scale and the Ways of Coping Checklist. A 2 factor (treatment by parental anxiety) repeated measures ANOVA will evaluate effectiveness. Pearson Product Moment Corrections will assess relationships among measures and child, parent, and event factors. The numbers of children involved in accidents and the potential impact of nursing on their paradigm for future research on promoting mastery for children experiencing different forms of trauma and violence.
