Pediatric medical traumatic stress (PMTS) is defined as “a set of psychological and physiological responses of children and their families to pain, injury, serious illness, medical procedures, and invasive or frightening treatment experiences” (The National Child Traumatic Stress Network, 2018). Adolescents and young adults (AYAs) with chronic illness are particulary susceptible to PMTS due to their increased likelihood of experiencing potentially traumatic medical events and the psychosocial complexities of adolescence. Social support is a protective factor against PMTS, but chronically-ill AYAs express isolation from social support systems due to hospitalizations and treatment. To address this need of social support, the project aims to establish a Streetlight program. Streetlight is a peer-support, palliative care program that helps AYAs with chronic and life-limiting conditions navigate illness with psychosocial support. This project will be developed in collaboration with a joint children’s and adult public hospital to hire staff and create a trained volunteer team to provide developmentally appropriate psychosocial support to hospitalized AYAs. This project aims to mitigate the impacts of PMTS on AYAs with chronic health conditions by building supportive relationships and increasing coping skills through peer support
Streetlight will primarily address the individual, relationship, and community levels (CDC, 2022). At the individual level, Streetlight seeks to build resilience, increase coping skills, and preserve identity in the face of the complexities of illness (CDC, 2022). Streetlight provides support through diversion activities, including board games, video games, and art supplies to distract and provide entertainment in the hospital. Streetlight also creates opportunities for meaning making, including legacy projects and milestone celebrations, to provide personalized palliative care support for patients. At the relationship level, Streetlight intends to increase the number of supportive, nurturing relationships in an AYA’s life (CDC, 2022). The heart of the Streetlight program is the volunteer team of college students who create and sustain relationships across a patient’s illness journey. These positive relationships create environments of emotional safety for AYAs and encourage the development of social and emotional health and coping mechanisms (Crouch, 2019). Social support, especially within this aged population, is an integral feature of quality of life, perhaps buffering and mitigating stress (Cohen & Wills, 1985). At the community level, Streetlight creates a network of relationships between staff, volunteers, and patients (CDC, 2022). These connections can increase community resilience, and encourage all individuals within the community to overcome adversity and cultivate hope (Trauma Informed Care Implementation Resource Center, 2020). Previous research on Streetlight has shown patients view Streetlight as being a part of a family (Walker, 2022). The focus on relationships between the Streetlight team and patients, as well as between AYA patients, creates a self-healing community that prioritizes capacity building, nurtures hope, and encourages patient leadership and participation (Danielson, 2019).
Streetlight is organized as a peer support program that emphasizes the therapeutic value of reciprocal relationships in navigating the difficulties of chronic illness. Peer within this model refers to college-aged volunteers; however, Streetlight also prioritizes the trauma-informed definition of peer as individuals who have experienced trauma (SAMHSA, 2014), by prioritizing volunteers living with chronic illness. Many volunteers are survivors of medical trauma, and they offer a unique form of support to patients by building trust and hope through shared experience. Streetlight emphasizes the healing role of relationships and recognizes that peer support can mutually benefit individuals by establishing solidarity, hope, and resilience. Streetlight’s model of peer support is coupled by the trauma-informed principles of shared-decision making and empowerment (SAMHSA, 2014). A core mantra of Streetlight is, “We are here as much as or as little as you like,” to emphasize the role of agency of patients in an environment in which they have very little decision power in who enters the room and what is done to them. Patients ideally take the lead in social interactions, and volunteers help patients bring forward their embedded resources for healing. There is also a commitment to addressing vicarious trauma among volunteers (Trauma Informed Care Implementation Resource Center, 2020) In addition to protection of agency and dedication to shared power, Streetlight seeks to promote the trauma-informed principles of psychological safety and trust through active listening and empathetic interpersonal interactions (SAMHSA, 2014). Streetlight volunteers receive 10 hours of initial orientation and 1-hour of weekly palliative care education to educate volunteers on the experiences of illness and caregiving skills. This includes trainings in cultural competency and sexual orientation and gender identity to acknowledge the complex, cultural and identity-based needs of AYA patients.
This grant will provide resources to implement a Streetlight program at the intended joint children’s and adult public hospital. Using trauma-informed principles and a focus on the individual, relational, and community level, Streetlight seeks to mitigate PMTS in AYAs with chronic and life-limiting health conditions.
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Walker, A. L., Rujimora, J., Swygert, A., McNiece, Z., Yoon, E., Machado, M., Myers, K., Richardson, E., Lenes, E., Hebert, L., Marchi, E., Arthurson-McColl, Z., Lagmay, J., & Puig, A. (2022). A Novel Palliative Care Peer Support Program for Adolescents and Young Adults: Survey and Factor Analytic Study. Journal of Palliative Medicine. https://doi.org/10.1089/jpm.2022.0299
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