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

项目摘要/摘要 儿童创伤性损伤(即突发性损伤和需要立即注意的严重程度)是最主要的 美国青少年死亡和发病率的原因，与心理健康和健康风险有关 结果。儿童创伤性损伤与870亿美元的医疗和社会成本有关， 增加一系列健康风险后果的风险，这些后果会影响生活质量、身体康复、社交 运行，并返回到以前的活动。创伤后应激障碍和抑郁在儿童中的患病率很高。 创伤患者；然而，大多数儿科创伤中心没有资源来实施 解决受伤后心理健康问题的护理模式。美国科学院的最新指导方针 创伤外科医生委员会强烈建议对患者进行筛查并解决情绪恢复问题 创伤性损伤患者。美国癌症协会创伤委员会已将此确定为优先事项，并可能开始 强制在全国一级和二级儿科创伤中心开展心理健康计划。因此，至关重要的是 政策和实践以可扩展和可持续的护理模式的实施和评价为指导。 2015年，我们的团队启动了创伤复原力和恢复计划(TRRP)，这是一个可扩展和可持续的 技术增强的多学科阶梯式护理模式-美国为数不多的提供早期护理的模式之一 干预和直接服务，以改善创伤后获得循证精神卫生保健的机会 适用于儿童、成人和家庭。我们发现这种护理模式对青少年来说是可行的和可以接受的 每个服务级别的患者(12-17岁)。TRRP包括3个主要步骤：(1)住院教育，简要风险 减少疗程，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，以确定哪些患者适合心理健康检查 治疗，以及(3)提供转诊至基于远程保健的最佳实践或面对面评估和治疗。 我们已经与三个经认证的I级和II级儿科创伤中心建立了合作伙伴关系，并提出了一个多站点混合中心 对300名青少年(12-17岁)创伤患者进行的有效性-实施试验：1)评估 TRRP在多大程度上促进了生活质量的提高和情绪的恢复 关于TRRP在其他I级创伤中心实施的可能性的初步数据。直接排成一队 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，这项研究将提供关于有效性、初步有效性和潜力的宝贵数据 实施创新、具有成本效益、可持续的技术强化干预措施，旨在 满足青少年伤害患者的独特需求，减轻伤害对 心理健康、生活质量和总体幸福感。

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.