Optimizing Collaborative Care for Youth with Persistent Post-Concussive Symptoms

项目摘要/摘要 每年有100多万美国青年遭受脑震荡，高达30%的人经历了持续的脑震荡后 脑震荡症状(PPCS)，如头痛、疲劳或难以集中注意力，持续一个月或更长时间。 PPC会干扰青少年的正常发育，导致社交和情感问题 功能障碍，甚至学业失败。尽管有这些担忧，但几乎没有基于证据的治疗方法可用于 患有PPCS的年轻人。我们使用协作护理(CC)框架进行了广泛的工作， 将心理健康护理转化为医学模式，我们将这种方法适应于患有PPCS的年轻人，结合 以脑震荡为重点的认知行为疗法(cf-CBT)、育儿技能培训(PST)和护理 管理层(CM)为患有PPCS的青少年创建环绕式治疗，可在以下两种方式中提供- 个人或虚拟(使用视频会议软件)。我们与CC一起完成了R01资助的随机对照试验 方法，寻找治疗青少年PPCS的有效性，并改善脑震荡症状和 一年的生活质量，60%的参与者完全虚拟地完成了干预。值得注意的是，这 干预的独特之处在于，其中两个组成部分都集中在父母或父母和青少年身上 (PST、CM)，只有一个组成部分(cf-cbt)仅以青年为重点。我们现在提议 优化和细化CC方法，实施高效的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 干预，从而使我们能够简化干预，只包括主动成分。分析 将是23个阶乘，有三个干预成分，每个成分有两个水平(存在或不存在)，结果是8 可能的治疗组合。MOST方法的好处是它结合了所有获得 成分，使我们能够评估所有治疗成分，只需适度的样本量。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的年轻人，将他们随机分为8人之一 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，关于主要结果的完整调查(脑震荡症状和与健康相关的 3个月、6个月和12个月时的生活质量)和次要结果(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 完成这项研究，我们将对青少年PPCS进行全面优化和细化的干预 为大规模实施和传播做好准备。

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.