Stepped Preventive Care to Reduce the Impact of Acute Pediatric Injury

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1 in 6 children with unintentional injuries develops persistent, impairing symptoms of posttraumatic stress disorder (PTSD) but most go undiagnosed and untreated. PTSD and other sequelae can have significant impact on health and functional outcomes, yet medical providers' awareness of injury-related traumatic stress is limited. Hospital trauma programs offer unique opportunities for secondary prevention of persistent psychosociat distress and promotion of optimal health outcomes for injured children. Expert consensus recommendations for PTSD prevention call for stepped care incorporating screening, follow-up with those at risk, and evidence-based interventions that are matched to individual need. Despite the documented impact of pediatric injury-related PTSD, no such program has been evaluated for injured children. Objectives: We propose a randomized effectiveness trial to address the following specific aims: 1) Evaluate the impact of the intervention on psychosocial outcomes (PTSD and depression symptoms); 2) Evaluate its impact on health outcomes (adherence to discharge instructions, health-related quality of life); 3) Provide preliminary data to inform cost-effectiveness analyses: describe the costs of providing the intervention and describe its impact on subsequent health service utilization. We hypothesize that at-risk children receiving the intervention will have lower PTSD and depression scores, better health outcomes, and more appropriate use of post-injury health services. Study Design: Randomized controlled trial comparing Stepped Preventive Care intervention to usual care, with baseline, 6 week, and 6 month assessments. Setting: Urban Level I Pediatric Trauma Center. Participants: 270 children age 8 to 17 admitted for unintentional injury. Interventions: Stepped Preventive Care intervention for at-risk injured children. Outcome Measures: Assessments 6 weeks and 6 months post-injury will evaluate PTSD and depression symptoms in children and parents, adherence, and health-related quality of life. Health record data will gauge adherence with discharge instructions and health service utilization over the 6 months post-injury.