A Scalable mHealth Resource to Facilitate Behavioral and Emotional Recovery after Pediatric Traumatic Injury

项目总结/摘要 儿科创伤性损伤（PTI）是公共卫生的优先事项，有近30万儿童受伤， 严重的是，他们每年都需要住院治疗。PTI与每年的个人和社会成本有关， 870亿美元，并增加了创伤后应激障碍，抑郁症和其他健康风险后果的风险， 影响生活质量、身体恢复、情绪和行为结果、家庭角色和日常生活，以及 学术功能。对受影响儿童和照顾者的后续护理对于支持行为和 情绪恢复，但很少有创伤中心提供这些服务和建立，可扩展的护理模式 缺乏。需要成本效益高、可持续的干预措施，以减少护理障碍并惠及家庭 最需要它的人候选人收集的试点数据表明，技术增强型护理模式是 对护理人员具有吸引力，并具有通过提供实时帮助来解决服务障碍的高潜力， 帮助照顾者管理自己的痛苦和他们的孩子的行为和情绪恢复。的 候选人建议开发和系统地评估CAARE（护理人员的援助，以加速恢复 儿科急诊后），通过我们正在进行的临床计划以及 与PTI后幼儿照顾者的定性半结构化访谈。CAARE将包括 教育、自我监控和应对资源。具体目标包括：1）最终确定CAARE模型， PTI后约15名护理人员参与的研究方案; 2）通过开放试验（n=60）进行CAARE初步试验; 3）评估 家庭（n~20）、创伤中心主任（n~15）和项目经理的CAARE实施可行性 （n~15）。MUSC的研究环境，设施和资源非常适合指导职业生涯 儿童创伤应激研究的进展。与研究目标相吻合，K23培训目标是 目的：1）熟练掌握临床试验设计、实施和评价; 2）提高 使用基于迭代设计技术的解决方案; 3）发展实施科学方面的专业知识; 4）增强 临床试验、纵向分析和定性数据分析方面的统计培训;以及5）扩展以下技能： 科学交流，包括资助写作，演讲和出版物。指导和咨询 来自儿科创伤、卫生技术解决方案、实施科学和高级统计学专家 确保实现培训目标。候选人的长期职业目标是建立一个研究组合 开发，严格测试和扩展创新，具有成本效益，以证据为基础的健康技术 资源，以改善在现实世界环境中受创伤影响的家庭获得护理的机会和质量。这些 研究和培训目标直接对应于NICHD的儿科创伤和关键 疾病分支，并将使候选人成为国际公认的儿童和家庭领导者 创伤预防和治疗研究。本文件所建议的培训旨在发展以下方面的专门知识： 这一领域，代表了一个明确的进展，从以前的培训，将不可能没有这个K23。

PROJECT SUMMARY/ABSTRACT Pediatric traumatic injury (PTI) is a public health priority, with nearly 300,000 children incurring injuries so severe that they require hospitalization each year. PTI is associated with annual individual and societal costs of $87 billion and elevates risk for posttraumatic stress, depression, and other health risk consequences that affect quality of life, physical recovery, emotional and behavioral outcomes, family roles and routines, and academic functioning. Follow-up care for affected children and caregivers is critical to support behavioral and emotional recovery, but few trauma centers provide these services and established, scalable models of care are lacking. Cost-effective, sustainable interventions are needed to reduce barriers to care and reach families that need it most. Pilot data collected by the candidate suggest that a technology-enhanced model of care is appealing to caregivers and has high potential to address service barriers by providing real-time assistance to help caregivers manage their own distress and their children’s behavioral and emotional recovery. The candidate proposes to develop and systematically evaluate CAARE (Caregivers’ Aid to Accelerate Recovery after pediatric Emergencies), an intervention informed by our ongoing clinical initiatives together with results of qualitative semi-structured interviews with caregivers of young children after PTI. CAARE will consist of education, self-monitoring, and coping resources. Specific aims include: 1) finalize the CAARE model and research protocol with ~15 caregivers after PTI; 2) pilot test CAARE via an open trial (n=60); and 3) assess CAARE implementation feasibility with families (n~20), trauma center directors (n~15), and program managers (n~15). The research environment, facilities, and resources at MUSC are ideally suited for mentored career development in child traumatic stress research. Dovetailing with the research aims, K23 training objectives are to: 1) develop proficiency in clinical trial design, implementation, and evaluation; 2) enhance proficiency in the use of iterative-design technology-based solutions; 3) develop expertise in implementation science; 4) enhance statistical training in clinical trials, longitudinal analyses, and qualitative data analysis; and 5) expand skills in scientific communication, including grant writing, presentations, and publications. Mentorship and consultation from experts in pediatric trauma, health technology solutions, implementation science, and advanced statistics will ensure training goals are met. The candidate’s long-term career goal is to establish a research portfolio that develops, rigorously tests, and scales innovative, cost-efficient, evidence-based health technology resources to improve access and quality of care for trauma-impacted families in real-world settings. These research and training goals directly correspond with priorities detailed in NICHD’s Pediatric Trauma and Critical Illness Branch, and will allow the candidate to become an internationally recognized leader in child and family trauma prevention and treatment research. The training proposed herein is designed to develop expertise in this area, represents a clear progression from prior training, and would not be possible without this K23.