Pediatric Burn Care

Expanding our Knowledge of Hospital Based Programs

By Marion Doctor, LCSW

Jan 6, 2010 Back

The concept that pediatric burn centers have a role and responsibility in identifying and providing appropriate intervention for children and adolescents burned as a result of firesetting behavior has only quite recently been acknowledged and acted upon. We, like many other professionals working with youth, tended to see this as an issue for fire departments, juvenile justice, social services or schools. When, in fact, successful identification and intervention with this population requires the combined, coordinated efforts of all of us. The Children’s Hospital (Colorado) Burn Program JFS (juvenile firesetting) staff has not only embraced its responsibility to serve the needs of children who have been burned as a result of their firesetting behavior, but has broadened its referral base to include firesetting youth from the community. The benefits of offering this level of service to the community are many… as are the challenges.

The challenges of providing a comprehensive hospital based JFS program begin first and foremost with funding. The original format for providing JFS intervention services at The Children’s Hospital (Colorado) included a brief assessment and an educational intervention for patients and parents. This intervention was provided by a burn nurse and a clinical social worker at no additional cost to the family. As volume and complexity of cases increased, it became clear that a more comprehensive, specialized program was needed. This was compounded by the decision to accept assessment and treatment referrals from the community. JFS Program staff now consists of four half-time clinicians and one half-time program assistant. Given the number of low income, uninsured, often court ordered patients and limited success with fund raising and grant applications, financial support for this increased level of service continues to be our biggest challenge.

Other challenges to providing a comprehensive hospital based JFS program include continuity and consistency of referrals and parents’ resistance to seek treatment for their child and themselves. Parent participation is a requirement of treatment at The Children’s Hospital Assessment and Treatment Program. Being based in a metroplex with many jurisdictions can at times create a complexity in terms of referrals, reporting and communication. The advantage of working from a pediatric hospital base is the ability to provide treatment across the age range from very young children through adolescence. It is also a neutral, “safe place” for parents and children to share and receive help with those issues that led to the firesetting behavior. An added benefit is access in-house to all levels of mental health services ranging from the emergency department to an inpatient psychiatric admission.

Path to Solutions

I have shared a brief overview of our treatment model with the hope of hearing from my colleagues in other hospital based programs regarding their treatment models, their successes and their concerns. Issues that require our immediate attention and collaborative work are: establishing a national database, completing and reporting outcome studies that include documentation of recidivism rates, as well as a comparative study of different models of treatment and intervention and shared insights regarding funding for hospital based programs. Matchbook provides us with the perfect opportunity to collaborate not only within our own discipline, but to benefit from the knowledge of all disciplines providing services to youth who engage in firesetting behavior.