Optimizing Collaborative Care for Youth with Persistent Post-Concussive Symptoms

项目总结/摘要 每年有超过100万的美国年轻人遭受脑震荡，高达30%的人经历了持续的脑震荡后， 脑震荡症状（PPCS），如头痛、疲劳或持续一个月或更长时间的注意力集中困难。 PPCS会干扰正常的青少年发展，导致社交和情感问题。 功能障碍甚至学业失败。尽管存在这些问题，但很少有基于证据的治疗方法可用于 青少年与PPCS我们已经进行了广泛的工作，使用协作护理（CC）框架整合 我们将这种方法应用于患有PPCS的青少年， 以脑震荡为中心的认知行为疗法（cf-CBT），育儿技能培训（PST）和护理 管理（CM），为青少年提供PPCS的综合治疗，可以在- 人或虚拟（使用视频会议软件）。我们与CC完成了一项R 01资助的RCT 方法，发现PPCS治疗青少年的有效性，改善了脑震荡症状， 一年后的生活质量，60%的参与者完全虚拟完成了干预。值得注意的是， 干预措施的独特之处在于，其中两个组成部分侧重于父母或父母和青少年 (PST，CM），只有一个组成部分（cf-CBT）是专门针对青年的。我们现在建议 优化和完善CC方法，实施高效MOST（多阶段优化策略） 评估三个组成部分（cf-CBT、PST和CM）中每一个对 因此，我们可以简化干预措施，只包括积极的组成部分。分析 将是23个因素，有三个干预组成部分和两个水平的每一个（存在或不存在），导致8 可能的治疗组合。社会变革管理计划方法的好处是，它将所有接受社会变革管理计划的青年结合起来， 这使得我们能够仅用适度的样本量来评估所有治疗成分。我们将招募 来自两个地理位置（西雅图和达拉斯）的368名患有PPCS的青少年，将他们随机分配到8个 治疗组。青少年和/或家长将通过视频会议软件参加治疗会议， 三个月，并完成有关主要结果（脑震荡症状和健康相关 生活质量）和次要结局（睡眠、疼痛、情绪和父母痛苦）。我们 还将评估潜在的调解人和主持人，以便今后进行调整和完善。在 这项研究完成后，我们将有一个完全优化和完善的干预与青少年PPCS 准备大规模实施和推广。

PROJECT SUMMARY/ABSTRACT More than 1 million U.S. youth sustain a concussion each year, and up to 30% experience persistent post- concussive symptoms (PPCS) such as headache, fatigue or difficulty focusing lasting one month or more. PPCS can interfere with normal adolescent development, resulting in issues with social and emotional dysfunction and even school failure. Despite these concerns, few evidence based treatments are available for youth with PPCS. We have conducted extensive work using a collaborative care (CC) framework integrating mental health care into a medical model, and we adapted this approach for youth with PPCS, combining concussion-focused cognitive behavioral therapy (cf-CBT), parenting skills training (PST) and care management (CM) to create wraparound treatment for youth with PPCS that could be delivered either in- person or virtually (using video conferencing software). We completed an R01 funded RCT with the CC approach, finding effectiveness for treating youth with PPCS, with improvements in concussive symptoms and quality of life at one year, and 60% of participants completing the intervention completely virtually. Of note, this intervention is unique in that two of the components are focused on parents or parents and youth together (PST, CM), and only one of the components (cf-CBT) is solely youth focused. We are now proposing to optimize and refine the CC approach, conducting a high efficiency MOST (multiphase optimization strategy) trial to assess the contribution of each of the three components (cf-CBT, PST and CM) to effectiveness of the intervention, thereby allowing us to streamline the intervention to only include active components. The analysis will be 23 factorial, with three intervention components and two levels of each (present or absent), resulting in 8 possible treatment combinations. The benefit of the MOST approach is that it combines all youth who receive a component, allowing us to assess all treatment components with only a modest sample size. We will recruit 368 youth with PPCS from two geographic locations (Seattle and Dallas), randomizing them to one of 8 treatment groups. Youth and/or parents will attend treatment sessions via video conferencing software over three months, and complete surveys regarding primary outcomes (concussive symptoms and health-related quality of life) and secondary outcomes (sleep, pain, mood and parental distress) at 3, 6 and 12 months. We will also assess potential mediators and moderators to allow for future tailoring and refinement. At the completion of this study, we will have a completely optimized and refined intervention for youth with PPCS ready for large scale implementation and dissemination.