Addressing Community Violence-related Traumatic Stress Symptoms in Children

解决儿童与社区暴力相关的创伤性应激症状

• 批准号: 9925083
• 负责人: Joel Fein
• 金额: $ 60.51万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-11 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9925083
• 关键词: 18 year old; Accident and Emergency department; Address; Alcohol or Other Drugs use; Anxiety; Attitude; Behavior; Behavioral; Caregivers; Case Management; Cessation of life; Child; Child Rearing; Childhood Injury; Coercion; Communication; Communities; Critical Care; Critical Illness; Data; Development; Early Intervention; Effectiveness; Emergency Care; Emergency Department Physician; Emergency department visit; Emotional; Enrollment; Evaluation; Exhibits; Family; Gun injury; Health; Healthy People 2020; Hospitals; Housing; Individual; Injury; Interpersonal Violence; Intervention; Investigation; Link; Literature; Measures; Mediation; Mediator of activation protein; Medical; Medical center; Mental Health; Meta-Analysis; Morbidity - disease rate; National Institute of Child Health and Human Development; Operative Surgical Procedures; Outcome; Parents; Post-Traumatic Stress Disorders; Prevention; Psychosocial Assessment and Care; Public Health; Randomized Clinical Trials; Randomized Controlled Trials; Recording of previous events; Recovery; Reporting; Research; Resources; Risk; Risk Behaviors; Risk Factors; Sampling; Services; Severities; Symptoms; System; Testing; Trauma; United States Agency for Healthcare Research and Quality; Victimization; Violence; Violent injury; Youth; acute stress; adverse outcome; aged; assault; behavioral health; brief intervention; comorbidity; depressive symptoms; design; effective therapy; effectiveness evaluation; follow-up; group intervention; high risk; improved; improved outcome; injured; intervention effect; mortality; neurophysiology; novel strategies; parent-child communication; pediatric trauma; post-traumatic symptoms; prevent; programs; prospective; protective factors; psychological trauma; psychosocial; public health intervention; severe injury; social; standard of care; stress symptom; trauma care; trauma units; traumatic event; traumatic stress

Project Summary Young victims of community violence whose injuries are severe enough to warrant an Emergency Department (ED) visit are at high risk for developing posttraumatic stress symptoms (PTSS) and other psychiatric, functional and behavioral issues. They are also at high risk for retaliatory behaviors, re-injury and death and according to an AHRQ sponsored meta-analysis there is no evidence of effective treatment to prevent PTSS in violently injured youth. The proposed research is designed to test a novel approach to support and expedite the recovery of assaulted youth and their families. We propose to conduct a Randomized Clinical Trial evaluating the effectiveness of the Child and Family Traumatic Stress Intervention (CFTSI) in reducing PTSS in youth 10-18 years old who are also receiving Case Management (CM) after an assault injury. CFTSI is a 4-6 session manualized intervention focused on improving communication between the caregiver and their child about their PTSS in order to enhance a key protective factor: caregiver emotional support. It is the first intervention demonstrating effectiveness in preventing posttraumatic stress disorder (PTSD) and decreasing PTSS in youth traumatized by a range of trauma types (a small subset of the sample were assault injured youth) when delivered within 45 days of a traumatic event, but has not been fully studied in youth who have been assault-injured or in conjunction with a hospital-initiated Case Management (CM) program. Post- discharge CM is an emerging standard of care throughout large medical center EDs and trauma units, whereby assault-injured youth receive a comprehensive psychosocial assessment, navigation to a range of medical, housing, behavioral health, recreational, vocational and other services. The aims and hypotheses propose that CFTSI will significantly reduce PTSS in assault-injured youth and a participating parent, measured 4 months and 10 months after enrollment into the study. In addition, we will evaluate the mechanisms of communication and parental support and investigate mediators and moderators of the effect of CFTSI on PTSS. The study will also explore how CFTSI influences retaliatory attitudes, re-injury and general health after being victimized, and will elucidate the mechanisms involved in child and family-level recovery in the months after an assault. The research literature supports that individuals with PTSS have a range of poor psychosocial outcomes. Reducing significant PTSS (primary aim) after assault injury provides an important way by which to reduce the risk of further adverse outcomes. The proposed study advances the aims of the NICHD Pediatric Trauma and Critical Illness Branch to perform “research on prevention, treatment, management, and outcomes of physical and psychological trauma and the surgical, medical, psychosocial, and systems interventions needed to improve outcomes for critically ill and injured children across the developmental trajectory.”

项目摘要 社区暴力的年轻受害者，他们的伤势严重到需要急诊室 (ED)访问是在高风险发展创伤后应激症状（PTSS）和其他精神， 功能和行为问题。他们也有很高的报复行为，再次受伤和死亡的风险， 根据AHRQ赞助的荟萃分析，没有证据表明有效的治疗可以预防PTSS， 暴力伤害青年拟议的研究旨在测试一种新的方法，以支持和加快 帮助受害青年及其家人康复我们建议进行随机临床试验 评估儿童和家庭创伤应激干预（CFTSI）在减少PTSS方面的有效性 在10-18岁的青少年中，他们也在遭受攻击性伤害后接受病例管理（CM）。 CFTSI是一种4-6节的手动干预，重点是改善护理人员之间的沟通 和他们的孩子关于他们的PTSS，以加强一个关键的保护因素：照顾者的情感支持。是 第一次干预证明了预防创伤后应激障碍（PTSD）的有效性， 减少受一系列创伤类型创伤的青年的PTSS（样本的一小部分是攻击性的）， 受伤的青年）在创伤事件发生后45天内分娩，但尚未在 被殴打受伤或与医院发起的病例管理（CM）计划有关。后 出院CM是整个大型医疗中心ED和创伤单位的新兴护理标准， 袭击受伤的青年接受全面的心理社会评估，导航到一系列医疗， 住房、行为健康、娱乐、职业和其他服务。目标和假设提出， CFTSI将显着降低PTSS在殴打受伤的青年和参与的父母，测量4个月 以及入组研究后10个月。此外，我们将评估沟通机制 和父母的支持，并探讨CFTSI对PTSS的影响的中介和调节。这项研究将 还探讨了CFTSI如何影响报复态度，再伤害和受害后的一般健康状况， 将阐明袭击发生后几个月内儿童和家庭层面恢复的机制。 研究文献支持PTSS患者有一系列不良的心理社会结果。 减少攻击性损伤后的PTSS（主要目标）是减少创伤后应激障碍的重要途径。 进一步不良后果的风险。拟议的研究推进了NICHD儿科创伤的目标， 危重病分支进行“研究的预防，治疗，管理和结果的身体 和心理创伤以及手术，医疗，心理社会和系统干预， 改善危重和受伤儿童在整个发展轨迹上的结果。”