Current practices in the provision of one-to-one psychosocial support for young people with burn injuries and their families

Introduction Very little published research has evaluated psychosocial interventions for young people with burn injuries. A recent systematic review of psychosocial interventions for those with a range of appearance-altering conditions and injuries found seven papers evaluating interventions specifically for young people with burns (Jenkinson et al,2015) and only one of these, a burn camp evaluation (Gaskell, 2007), was conducted in the UK. The dearth of research into the higher level psychosocial support provided by clinical psychologists working within paediatric burns services is particularly noteworthy. The aim of the study was to investigate how clinical psychologists identify and meet the psychosocial needs of young people with burn injuries and their families. Methods Fourteen clinical psychologists from ten NHS burns services chose to take part in a telephone-based or face-to-face interview, which was guided by a semi-structured interview schedule. The interviews explored how participants decide which young people and their families require support, and how they assess their clients to decide upon a suitable treatment strategy. Different therapeutic approaches were also discussed, along with strategies for assessing clients’ progress. Interviews ranged from 40-70 minutes, with an average length of 51 minutes. Data from the interviews were transcribed verbatim and subjected to a Thematic Analysis. Results Analysis generated four main themes: the psychosocial complexities of a burn injury, for example trauma relating to the injury and subsequent treatment or appearance concerns; differences between screening and assessment procedures, ranging from a tick-box approach for ward staff to highlight psychosocial concerns to an adapted version of a standardised assessment questionnaire; provision of flexible family support so as to ensure that the needs of each family member are considered; tailored care, a requirement to use a combination of therapeutic approaches to meet individual needs. While adolescents often experienced worries, participants felt that it was the parents and sometimes sibling of younger children who needed support. However, children burned at a young age often developed concerns during adolescence, suggesting that this is a crucial time for support. Discussion These findings support previous research which suggests that the whole family should be a part of a client’s treatment (Blakeney et al, 1998). While the majority of participants favoured cognitive-behavioural and systemic approaches, they agreed that a combination of techniques was the most effective approach. Some participants had received training in further techniques such as mindfulness for anxiety, which were felt to produce positive results. Conclusions The wide range of psychosocial difficulties which may be experienced by young people and their families after a burn injury requires psychologists to be flexible in their screening, assessment and treatment of clients to ensure that individual needs are met. Future research could evaluate the use of different therapeutic techniques for particular concerns.