Evaluation of Trauma Center-Based, Technology-Enhanced Stepped Care Intervention for Adolescent Traumatic Injury Survivors

项目概要/摘要 小儿创伤性损伤（即，突发性和严重性需要立即注意的伤害）是主要的 美国青少年的死亡和发病原因，并与心理健康和健康风险相关 结果。儿科创伤性损伤与870亿美元的医疗和社会成本有关， 增加了广泛的健康风险后果的风险，影响生活质量，身体恢复，社会 功能，并返回到以前的活动。PTSD和抑郁症的患病率在儿童中很高， 创伤性损伤患者;然而，大多数儿科创伤中心没有资源实施 处理受伤后心理健康的护理模式。美国大学目前的指导方针 外科医生（ACS）创伤委员会强烈建议筛查和解决情绪恢复， 创伤患者。ACS创伤委员会已将此确定为优先事项，并可能开始 在全国一级和二级儿科创伤中心强制实施心理健康计划。因此，至关重要的是， 政策和实践的指导是实施和评价可扩展和可持续的护理模式。 2015年，我们的团队推出了创伤复原力和恢复计划（TRRP），这是一个可扩展和可持续的， 技术增强，多学科的阶梯式护理模式-美国为数不多的模式之一-提供早期 干预和指导服务，以改善创伤后获得循证精神卫生保健机会 适用于儿童、成人和家庭。我们发现这种护理模式对青少年是可行和可接受的 患者（12-17岁）在每个服务级别。TRRP包括3个主要步骤：（1）住院教育，简要风险 减少会议，并通过自动短信系统跟踪患者的情绪恢复，（2） 通过电话进行为期30天的筛查，以确定哪些患者是心理治疗的良好候选人。 治疗，以及（3）提供转介到最佳做法的远程保健或面对面评估和治疗。 我们已经与三个认可的一级和二级儿科创伤中心合作，并提出了一个多站点混合 在300名青少年（12-17岁）创伤性损伤患者中进行的1项有效性实施试验，目的是：1）评估 TRRP在多大程度上促进生活质量和情绪恢复的改善，以及2）收集 关于TRRP在其他一级创伤中心实施潜力的初步数据。直接对准 与NICHD的儿科创伤和危重疾病研究和培训（PTCIB）战略研究和 培训议程，本研究将提供有价值的数据，疗效，初步效果和潜力 实施创新的、具有成本效益的、可持续的技术强化干预措施， 满足青少年受伤患者的独特需求，减轻受伤对青少年的短期和长期影响。 心理健康、生活质量和整体福祉。

PROJECT SUMMARY/ABSTRACT Pediatric traumatic injury (i.e., injury of sudden onset and severity requiring immediate attention) is the leading cause of death and morbidity among US adolescents and are associated with mental health and health risk outcomes. Pediatric traumatic injuries are associated with medical and societal costs of $87 billion and elevates risk for a wide range of health risk consequences that affect quality of life, physical recovery, social functioning, and return to previous activities. The prevalence of PTSD and depression is high among pediatric traumatic injury patients; however, most pediatric trauma centers don’t have the resources to implement models of care that address mental health following injury. Current guidelines by the American College of Surgeons (ACS) Committee on Trauma strongly recommend screening and addressing emotional recovery in traumatic injury patients. The ACS Committee on Trauma has identified this as a priority and likely will begin to mandate mental health programs in Level I and II pediatric trauma centers nationally. It is therefore critical that policy and practice is guided by the implementation and evaluation of scalable and sustainable models of care. In 2015 our team launched the Trauma Resilience and Recovery Program (TRRP), a scalable and sustainable, technology-enhanced, multidisciplinary stepped model of care – one of the few in the US - that provides early intervention and direct services to improve access to evidence-based mental health care after traumatic injury for children, adults and families. We have found this model of care to be feasible and acceptable to adolescent patients (ages 12-17) at each level of service. TRRP includes 3 major steps: (1) in-hospital education, brief risk reduction session, and tracking patients’ emotional recovery via an automated text-messaging system, (2) conducting a 30-day screen via telephone to identify patients who are good candidates for psychological treatment, and (3) providing referral to best-practice telehealth-based or in-person assessment and treatment. We have partnered with three accredited Level I and II pediatric trauma centers and propose a multi-site hybrid 1 effectiveness-implementation trial with 300 adolescent (ages 12-17) traumatic injury patients to: 1) assess the extent to which TRRP promotes improvement in quality of life and emotional recovery and 2) gather preliminary data on the potential for TRRP to be implemented in other Level I trauma centers. Directly in line with NICHD’s Pediatric Trauma and Critical Illness Research and Training (PTCIB) Strategic Research and Training agenda, this study will provide valuable data on the efficacy, preliminary effectiveness and potential for implementation of an innovative, cost-effective, sustainable technology-enhanced intervention designed to address the unique needs of adolescent injury patients and mitigate short- and long-term impact of injury on mental health, quality of life, and overall well-being.