1022 Flinders Child Trauma Study
Name
1022 Flinders Child Trauma Study
1022 Flinders Child Trauma Study
PACT/R case ID
Name of Study
PACT/R study ID
Study Group
Case ID
Study Location (Country)
Time (days) to t3 assessment
Time (days) to t5 assessment
Time (days) to t7 assessment
Child Age in Years
Child Gender
Child Race
Relationship of Parent/Caretaker
Relationship of Parent/Caretaker
Parent/Caretaker Age
Parent/Caregiver Age
Parent/Caretaker Race
Parent/Caretaker Race
Parent/Caretaker Relationship Status
Parent/Caretaker Relationship Status
Highest level of parent/caretaker education
Highest level of parent/caretaker education
Year of Event
Primary Index Trauma (Type)
Other - specify field
Type of Exposure to Primary Index Trauma
Unintentional Injury Circumstance
MVA/RTA circumstance
Type of Acute Medical Event
Other Acute Medical Event - Specify
Interpersonal Violence Circumstance
Was Child Admitted to Hospital Because of This Event?
Length of Time in Hospital (in days) with day of admit=1
Was Child Injured?
Did Child Sustain a Fracture?
Did Child Sustain a Burn?
Did Child Sustain Multiple Injuries?
Did Child Have a Head Injury?
Did Child lose consciousness?
What was the Duration of LOC?
Pulse upon hospital triage
Prior trauma history?
Prior unintentional injury?
Prior MVA/RTA?
Prior acute medical event?
Prior interpersonal violence?
Prior exposure to disaster?
Prior abuse/maltreatment?
Prior exposure to war/armed conflict?
Prior refugee trauma?
Other prior trauma?
Other prior trauma (Specified)
Shocking, awful, horrible
Wanted to make it stop
Felt really scared
Thought might die
Didnt have feelings
Things seemed unreal
Felt in a daze
Felt different and far away from people
Cant remember parts of what happened
Pictures or sounds from what happened
Cant stop thinking about it
Seems like its happening all over again
When reminded feel upset
More bad dreams
Try not to think about what happened
Try not to talk about it
Stay away from things that remind me
Stop my feelings about it
Hard to fall or stay asleep
Get angry or bothered more easily
Harder time concentrating
Feel scared something bad might happen
Sudden noise makes me jump
Thoughts or feelings about what happened
Getting along with friends or family
Trouble getting back to doing normal things
Parents or other family members upset
People who understand how I feel
Have way to help myself feel better
Upsetting thoughts or images
Bad dreams or nightmares
Acting / feeling as if event was happening again
Feeling upset when you think / hear about event
Feelings in body when think / hear about event
Try not to think, talk, have feelings about event
Try to avoid activities, people, places that remind of event
Unable to remember important part of event
Less interest in things than used to
Not feeling close to people around you
Not able to have strong feelings
Feeling future plans / hopes not come true
Trouble falling or staying asleep
Feeling irritable or having fits of anger
Trouble concentrating
Overly careful
Jumpy or easily startled
School work
Fun and hobby activities
Relationships with family
Doing your prayers
Relationships with friends
General happiness with your life
Has child ever experienced anything frightening or terrible before the current accident/ trauma
Has child ever had trouble with being really sad or really worred before the accident/ trauma
Did child know where their parents were when injured
When hurt did child feel really afraid
When hurt did child feel they might die
Was anyone else hurt or killed
When child thinks of accident do they sweat, tremble or heart beat fast
Is child still in pain
Is child still upset or scared now
Does child feel they have people who really understand how they feel
When upset does child have ways to help them feel better
medical concerns before the accident/ trauma
seen or experienced anything really scary or terrible before accident/ trauma
behaviour or attention problems for a while
Been sad, depressed , worried for a while
Any family stressful events or changes that have happened recently
Parent/ guardian experienced anything very frightening or terrible
Parent/ guardian had trouble with extreme worry, fear or being very anxious
Did parent/guardian see the incident in which child was hurt
Was parent with child in ambulance or coming to hospital
Did parent feel really helpless when their child was hurt
At present is child upset or scared
At present is child in pain
How serious is child's injury
Parent/guardian been feeling jumpy, agitated since child hurt
When think child being injured, does parent sweat or tremble or heart beat fast
How confident is parent that they will cope with upsetting parts of injury or hospital
Will parent accept help from others while their child is injured and recovering
How confident is parent/guardian that they will be able to help their child cope with their injury
Child's ED triage heart rate over 104 (child under 12), over 97 (child 12 and older)
Extremity fracture
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DASS T1 Question 18
DASS T1 Question 19
DASS T1 Question 20
DASS T1 Question 21
PDS T3 was parent/ guardian injured
PDS T3 was someone else injured
PDS T3 did parent/guardian think their life was in danger
PDS T3 did parent/guardian think that someone else's life was in danger
PDS T3 did parent/guardian feel helpless
PDS T3 did parent/guardian feel terrified
PDS T3 - intrusive thoughts
PDS T3 - nightmares
PDS T3 - reliving event
PDS T3 - distress on reminders
PDS T3 - physiological reactivity
PDS T3 - avoid thinking, talking about
PDS T3 - avoid places, situations, people
PDS T3 - not remembering important part
PDS T3 - less interest in activities
PDS T3 - distant or cut-off from people
PDS T3 - emotionally numb
PDS T3 - future plans not come true
PDS T3 - sleep problems
PDS T3 - irritability
PDS T3 - concentration difficulties
PDS T3 - hypervigiliance
PDS T3 - increased startle response
PDS T3 have problems interfered with areas of parents life - work
PDS T3 have problems interfered with areas of parents life - chores and duties
PDS T3 have problems interfered with areas of parents life - relationships with friends
PDS T3 have problems interfered with areas of parents life - fun and leisure
PDS T3 have problems interfered with areas of parents life - study
PDS T3 have problems interfered with areas of parents life - relationship with family
PDS T3 have problems interfered with areas of parents life - sex life
PDS T3 have problems interfered with areas of parents life - general satisfaction with life
PDS T3 have problems interfered with areas of parents life - overall level of functioning
PDS T3 - numb/distant
PDS T3 - daze
PDS T3 - unreal
PDS T3 - distant from self
PDS T3 - amnesia
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Intrusive thoughts or play - frequency
Intrusive thoughts or play - intensity
Distressing dreams - frequency
Distressing dreams - intensity
Felt happening again or re-enact - frequency
Felt happening again or re-enact - intensity
Psych distress at exposure to cues - frequency
Psych distress at exposure to cues - intensity
Physical distress at exposure to cues - frequency
Physical distress at exposure to cues - intensity
Avoid thoughts feelings conversations - frequency
Avoid thoughts feelings conversations - intensity
Avoid activities places people - frequency
Avoid activities places people - intensity
Inability to recall important aspect - frequency
Inability to recall important aspect - intensity
Diminished interest or participation - frequency
Diminished interest or participation - intensity
Detachment estrangement - frequency
Detachment estrangement - intensity
Restricted range of affect - frequency
Restricted range of affect - intensity
Foreshortened future - frequency
Foreshortened future - intensity
Difficulty falling staying asleep - frequency
Difficulty falling staying asleep - intensity
Irritability / angry outbursts - frequency
Irritability / angry outbursts - intensity
Difficulty concentrating - frequency
Difficulty concentrating - frequency
Hypervigilance - frequency
Hypervigilance - intensity
Exaggerated startle - frequency
Exaggerated startle - intensity
t5 Caps Question 18 (# of months delay in onset)
t5 Caps Question 19 (Duration of Disturbance at least one month)
Overall distress from symptoms
Impairment in social functioning
Impairment in school functioning
Impairment in developmental functioning
Global severity rating
Upsetting thoughts or images
Bad dreams or nightmares
Acting / feeling as if event was happening again
Feeling upset when you think / hear about event
Feelings in body when think / hear about event
Try not to think, talk, have feelings about event
Try to avoid activities, people, places that remind of event
Unable to remember important part of event
Less interest in things than used to
Not feeling close to people around you
Not able to have strong feelings
Feeling future plans / hopes not come true
Trouble falling or staying asleep
Feeling irritable or having fits of anger
Trouble concentrating
Overly careful
Jumpy or easily startled
School work
Fun and hobby activities
Relationships with family
Doing your prayers
Relationships with friends
General happiness with your life
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PDS T5 was parent/ guardian injured
PDS T5 was someone else injured
PDS T5 did parent/guardian think their life was in danger
PDS T5 did parent/guardian think that someone else's life was in danger
PDS T5 did parent/guardian feel helpless
PDS T5 did parent/guardian feel terrified
PDS T5 - intrusive thoughts
PDS T5 - nightmares
PDS T5 - reliving event
PDS T5 - distress on reminders
PDS T5 - physiological reactivity
PDS T5 - avoid thinking, talking about
PDS T5 - avoid places, situations, people
PDS T5 - not remembering important part
PDS T5 - less interest in activities
PDS T5 - distant or cut-off from people
PDS T5 - emotionally numb
PDS T5 - future plans not come true
PDS T5 - sleep problems
PDS T5 - irritability
PDS T5 - concentration difficulties
PDS T5 - hypervigiliance
PDS T5 - increased startle response
PDS T5 - duration
PDS T5 - symptoms began
PDS T5 have problems interfered with areas of parents life - work
PDS T5 have problems interfered with areas of parents life - chores and duties
PDS T5 have problems interfered with areas of parents life - relationships with friends
PDS T5 have problems interfered with areas of parents life - fun and leisure
PDS T5 have problems interfered with areas of parents life - study
PDS T5 have problems interfered with areas of parents life - relationship with family
PDS T5 have problems interfered with areas of parents life - sex life
PDS T5 have problems interfered with areas of parents life - general satisfaction with life
PDS T5 have problems interfered with areas of parents life - overall level of functioning
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DASS T2 Question 21
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Intrusive thoughts or play - frequency
Intrusive thoughts or play - intensity
Distressing dreams - frequency
Distressing dreams - intensity
Felt happening again or re-enact - frequency
Felt happening again or re-enact - intensity
Psych distress at exposure to cues - frequency
Psych distress at exposure to cues - intensity
Physical distress at exposure to cues - frequency
Physical distress at exposure to cues - intensity
Avoid thoughts feelings conversations - frequency
Avoid thoughts feelings conversations - intensity
Avoid activities places people - frequency
Avoid activities places people - intensity
Inability to recall important aspect - frequency
Inability to recall important aspect - intensity
Diminished interest or participation - frequency
Diminished interest or participation - intensity
Detachment estrangement - frequency
Detachment estrangement - intensity
Restricted range of affect - frequency
Restricted range of affect - intensity
Foreshortened future - frequency
Foreshortened future - intensity
Difficulty falling staying asleep - frequency
Difficulty falling staying asleep - intensity
Irritability / angry outbursts - frequency
Irritability / angry outbursts - intensity
Difficulty concentrating - frequency
Difficulty concentrating - frequency
Hypervigilance - frequency
Hypervigilance - intensity
Exaggerated startle - frequency
Exaggerated startle - intensity
t7 Caps Question 18 (# of months delay in onset)
t7 Caps Question 19 (Duration of Disturbance at least one month)
Overall distress from symptoms
Impairment in social functioning
Impairment in school functioning
Impairment in developmental functioning
Global severity rating
Upsetting thoughts or images
Bad dreams or nightmares
Acting / feeling as if event was happening again
Feeling upset when you think / hear about event
Feelings in body when think / hear about event
Try not to think, talk, have feelings about event
Try to avoid activities, people, places that remind of event
Unable to remember important part of event
Less interest in things than used to
Not feeling close to people around you
Not able to have strong feelings
Feeling future plans / hopes not come true
Trouble falling or staying asleep
Feeling irritable or having fits of anger
Trouble concentrating
Overly careful
Jumpy or easily startled
School work
Fun and hobby activities
Relationships with family
Doing your prayers
Relationships with friends
General happiness with your life
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