Trauma Systems Therapy: 15-Month Outcomes and the Importance of Effecting Environmental Change
Trauma Systems Therapy: 15-Month Outcomes and the Importance of Effecting Environmental Change
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DOI：
10.1037/a0025192
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发表时间：
2012-11-01
影响因子：
6.3
通讯作者：
Saxe, Glenn
中科院分区：
文献类型：
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作者：
Ellis, B. Heidi;Fogler, Jason;Saxe, Glenn
本研究追踪124名接受创伤系统治疗（TST）的儿童的临床过程。此外，探索性分析比较了模型实施前后的住院率，并估计了相对成本节约。经历过潜在创伤性事件的3-20岁儿童接受TST干预。在入院、4-6个月和12-15个月时测量临床病程、儿童精神和社会心理功能以及社会环境稳定性。通过比较实施前和实施后在县精神卫生部门护理的儿童的住院率和住院时间，评估了成本节约的探索性分析。情绪调节、社会环境稳定性和儿童功能/力量在治疗后显著改善。儿童功能/优势和社会环境稳定性的改善显著有助于情绪调节的整体改善。在早期治疗期间病情稳定到可以过渡到以办公室为基础的服务的儿童往往会继续接受治疗并继续改善。完成治疗的儿童在15个月时需要危机稳定服务的人数减少了一半以上。较差的基线情绪调节与住院有关，较差的社会环境稳定性预示着较短的住院天数。探索性分析表明，实施后住院率下降了36%，平均住院时间减少了23%，这表明有必要进一步探索潜在的成本节约。这些研究结果强调了干预和长期治疗对稳定创伤后应激儿童和青少年的社会环境的临床重要性，并强调了在县一级采用强化的、以社区为基础的治疗方法的潜在成本效益。
This study tracked the clinical course of 124 children receiving trauma systems therapy (TST). In addition, exploratory analyses compared hospitalization rates before and after implementation of the model and comparative cost savings were estimated. Children ages 3-20 who experienced potentially traumatic events received TST intervention. Measures of clinical course, children's psychiatric and psychosocial functioning, and social-environmental stability were taken at intake, 4-6 months, and 12-15 months. Exploratory analyses of cost savings were evaluated by comparing pre- and post-implementation hospitalization rates and lengths of stay for children under the care of the county mental health department. Emotion regulation, social-environmental stability, and child functioning/strengths improved significantly with treatment. Improvement in child functioning/strengths and in social-environmental stability significantly contributed to overall improvement in emotion regulation. Children who became stable enough to transition to office-based services during early treatment tended to stay in treatment and continued to improve. The number of children needing crisis-stabilization services at 15 months was reduced more than half for those who completed treatment. Poorer baseline emotion regulation was associated with hospitalization, and poorer social-environmental stability predicted fewer days-to-hospitalization. Exploratory analyses show that post-implementation hospitalization rates dropped 36% and average length of stay decreased by 23%, suggesting that further exploration of potential cost savings is warranted. These findings underscore the clinical importance of intervention and long-term treatment to stabilize the social environment of children and adolescents with posttraumatic stress, and emphasize the potential cost effectiveness of an intensive, community-based treatment approach at the county level.