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

项目摘要/摘要 儿童创伤(PTI)是公共卫生的优先事项，有近30万儿童因此而受伤 严重到他们每年都需要住院治疗。PTI与年度个人和社会成本相关 并增加了创伤后应激、抑郁和其他健康风险后果的风险 影响生活质量、身体康复、情绪和行为结果、家庭角色和日常生活，以及 学术功能。对受影响的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成熟的、可扩展的护理模式 都是缺乏的。需要具有成本效益的、可持续的干预措施，以减少护理和接触到家庭的障碍 最需要它的人。候选人收集的试点数据表明，一种技术增强的护理模式 对照顾者有吸引力，并通过提供实时帮助来解决服务障碍 帮助照顾者处理他们自己的痛苦以及他们孩子的行为和情绪恢复。这个 候选人建议开发和系统评估CAARE(照顾者援助以加速康复 儿科急诊后)，根据我们正在进行的临床倡议以及以下结果进行干预 对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模型和 PTI后约15名照顾者参与的研究方案；2)通过公开试验进行CAARE的试点测试(n=60)；以及3)评估 家庭(n~20)、创伤中心主任(n~15)和项目经理实施CAARE的可行性 (n~15)。南加州大学的研究环境、设施和资源非常适合指导职业生涯 儿童创伤应激研究进展。配合研究目标，K23的培训目标为 1)提高临床试验设计、实施和评估的熟练程度；2)提高临床试验设计、实施和评估的熟练程度 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门知识；4)加强 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)扩展以下方面的技能 科学交流，包括拨款撰写、演示文稿和出版物。辅导和咨询 来自儿科创伤、卫生技术解决方案、实施科学和高级统计方面的专家 将确保达到培训目标。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、经济高效、以证据为基础的健康技术 用于改善现实环境中受创伤影响的家庭的机会和护理质量的资源。这些 研究和培训目标直接对应于NICHD《儿科创伤和危急事件》中详细说明的优先事项 疾病科，并将使候选人成为国际公认的儿童和家庭领导人 创伤防治研究。在此建议的培训旨在培养以下方面的专业知识 在这方面，与以前的培训相比，这是一个明显的进步，没有K23是不可能的。

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.