Pediatric Injury; Modules to Manage Medical Stress

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PROJECT SUMMARY / ABSTRACT Post-traumatic stress symptoms (PTSS) and associated psychological impairment affect from 25 to 57% of children after an injury and contribute to worse health related quality of life. Because children's PTSS emerge after they are discharged home from the hospital, they are often invisible to the trauma system and are neither detected nor treated. Although evidence-based treatment for PTSS exists, limited parental awareness and access to trained providers hinder community access. The goal of this project is to provide a research and treatment resource for the management of psychological distress in children who have been hospitalized for a physical trauma. In Aim 1, we will develop an innovative, brief e-health approach to treatment of PTSS designed to be delivered through the trauma system. We will create interactive web-based psychoeducational modules that are developmentally tailored for school age children (8 to 11 years) and youth (12 to 16 years) for use with synchronous e-health therapy sessions with a trained therapist. Modules will target two evidence based treatment methods: cognitive behavioral therapy coping skills (coping CBT) and direct exposure to trauma reminders through a trauma narrative. All modules will be piloted iteratively with parent, child, and expert practitioner input incorporated at each step. We will develop parent modules that accompany the child treatment programs that address parent concerns including managing their own stress, parenting skills and how to help children with a common injury-specific concern, sleep. Treatment resources will be designed specifically for ease of dissemination and incorporation into the trauma system. In Aim 2, we will perform a pilot three-armed RCT to examine the feasibility, acceptability and preliminary efficacy of the two brief treatments (coping CBT and trauma narrative) compared to an untreated comparison group (N = 54). Injured children and their families will be recruited to participate from the inpatient wards of the three participating sites. The treatment program will serve as a research resource for a subsequent large clinical trial designed to confirm efficacy and to examine potential treatment modifiers. To aid in dissemination of this treatment resource, we will create a webinar that provides training in the use of the manualized therapies and online modules.