Table 1.

Adolescent development, trauma symptoms, and trauma-informed responses

	Admission	Daily	Discharge
Strengths-based Relationship-based	Inquire about patients’ strengths, consider a self-assessment of strengths, reflect noted strengths back to the patient, and leverage strengths in treatment
	Contact primary care providers and mental health clinicians on admission (with patient permission) Inquire about how to best support patient preferences	Document patients’ interests, passions, and preferences Include these notes in hand-offs to support continuity of therapeutic alliance between teams	Contact primary care providers and mental health clinicians prior to discharge to ensure continuity of care Highlight noted patient preferences and strengths
Safety	Support trusted caregivers and/or peers to be at the bedside Identify with adolescents if certain family members/caregivers/friends make them feel unsafe and determine hospital mechanisms to limit that visitation Discuss and reinforce how to ask for nursing, provider, and team support (social work, child life, chaplaincy)		Discuss home life and identify a safe discharge plan Provide information regarding resources in the community if home life becomes unsafe
Trustworthiness and transparency		Provide care as originally specified; promptly communicate deviations from original plans Communicate work-up, results, and diagnoses directly with adolescents (i.e., not through family members)	Ensure defined discharge criteria and adhere to these criteria throughout hospitalization
Peer support	Identify relationships in the teen’s life that they identify to be meaningful Respect and normalize that relationships with family may be challenging or not existent Discuss how to maintain communication with schools, universities, or employers during hospitalization (consider consulting social work and/or child life to support these discussions)	Discuss with the adolescent how they may lead discussions with peers/family regarding details of the hospitalization Leverage flexible visitation (i.e. friends may have to visit after school/work) and technology to maintain these important relationships Identify diagnosis-related peer support groups	Plan with the adolescent how they will re-engage with their meaningful community activities Work with the adolescent to define scripts to address questions of their absence during hospitalization
Collaboration and mutuality	Elicit adolescent’s goals for hospitalization and collaborate to find shared goals	Focus on working with the patient (i.e., we are not doing this TO you but WITH you) Continually elicit both short-term (daily) goals as well as long term (for hospitalization and beyond)	Convey patient-identified long-term care goals to the primary care provider to ensure continuity of goals
Empowerment, voice, and choice	Close encounters by eliciting questions directly from the adolescent to ensure their understanding Explain procedures prior to initiation and convey how the adolescent can communicate stopping procedures if the adolescent feels unsafe or a loss of control Inquire regarding learning preferences, and provide videos, images, and/or text to ensure the teen understands diagnoses and treatment Support healthy boundaries regarding discussing personal medical information		Discuss that the individual controls the disclosure of personal medical information to peers Ensure supported decision-making (with caregiver, if appropriate) around treatment decisions and discharge planning
Cultural, historical, and gender issues	Initiate every encounter with a medically stable patient with a discussion of names and pronouns Discuss and document which names and pronouns are preferred in which settings Lead with inquiry of cultural or religious practices that can be supported throughout hospitalization (i.e., Kosher diets or Holy communion)	Introduce new members of the team with names and pronouns Consider staff pins or name badges that include pronouns Use simple, clinical language during the physical exam Ask the patient which terms they use to talk about their body (i.e., vagina vs. genital opening)	Attempt to support gender or cultural preferences when selecting referrals for outpatient providers (i.e., an adolescent girl may be more comfortable with a woman as a provider)
Trauma-informed techniques	Practice a trauma-informed physical exam. For further discussion of this exam, we recommend “A Novel, Trauma-Informed Physical Examination Curriculum for First-Year Medical Students” by Elisseou et al. [61••] (noting that this exam is described for adult patients, and principles must be adapted for a pediatric population)