Evaluation of Trauma Center-Based, Technology-Enhanced Stepped Care Intervention for Adolescent Traumatic Injury Survivors

基于创伤中心、技术增强的青少年创伤幸存者分级护理干预的评估

• 批准号: 10693158
• 负责人: Tatiana Margarita Davidson
• 金额: $ 57.66万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10693158
• 关键词: Accreditation; Address; Admission activity; Adolescent; Adoption; Adult; Affect; Age; American College of Surgeons; Attention; Caring; Cause of Death; Child; Childhood; Childhood Injury; Critical Illness; Data; Dissemination and Implementation; Early Intervention; Education; Effectiveness; Emotional; Enhancement Technology; Evaluation; Family; Future; Guidelines; Health; Health Services Accessibility; Hospitalization; Hospitals; Human Resources; Hybrids; Improve Access; Infrastructure; Injury; Intervention; Interview; Medical Care Costs; Mental Depression; Mental Health; Mental Health Services; Modeling; Morbidity - disease rate; National Institute of Child Health and Human Development; Outcome; Participant; Patients; Personal Satisfaction; Persons; Policies; Post-Traumatic Stress Disorders; Prevalence; Quality of life; Randomized; Randomized, Controlled Trials; Reaction; Recommendation; Recovery; Research; Resources; Risk; Risk Reduction; Services; Severities; Site; Social Functioning; Structure; Suggestion; Survivors; Symptoms; System; Telephone; Training; Trauma; Traumatic injury; Youth; acceptability and feasibility; acute care; adolescent patient; automated text message; barrier to care; behavioral outcome; cost effective; effectiveness/implementation trial; evidence base; experience; follow up assessment; functional outcomes; health care service utilization; implementation facilitators; implementation process; improved; informant; innovation; multidisciplinary; pediatric trauma; post-traumatic stress; programs; psychologic; psychosocial; recruit; resilience; satisfaction; screening guidelines; service programs; societal costs; sustainable resource; telehealth; therapy design; trauma centers; treatment as usual

PROJECT SUMMARY/ABSTRACT Pediatric traumatic injury (i.e., injury of sudden onset and severity requiring immediate attention) is the leading cause of death and morbidity among US adolescents and are associated with mental health and health risk outcomes. Pediatric traumatic injuries are associated with medical and societal costs of $87 billion and elevates risk for a wide range of health risk consequences that affect quality of life, physical recovery, social functioning, and return to previous activities. The prevalence of PTSD and depression is high among pediatric traumatic injury patients; however, most pediatric trauma centers don’t have the resources to implement models of care that address mental health following injury. Current guidelines by the American College of Surgeons (ACS) Committee on Trauma strongly recommend screening and addressing emotional recovery in traumatic injury patients. The ACS Committee on Trauma has identified this as a priority and likely will begin to mandate mental health programs in Level I and II pediatric trauma centers nationally. It is therefore critical that policy and practice is guided by the implementation and evaluation of scalable and sustainable models of care. In 2015 our team launched the Trauma Resilience and Recovery Program (TRRP), a scalable and sustainable, technology-enhanced, multidisciplinary stepped model of care – one of the few in the US - that provides early intervention and direct services to improve access to evidence-based mental health care after traumatic injury for children, adults and families. We have found this model of care to be feasible and acceptable to adolescent patients (ages 12-17) at each level of service. TRRP includes 3 major steps: (1) in-hospital education, brief risk reduction session, and tracking patients’ emotional recovery via an automated text-messaging system, (2) conducting a 30-day screen via telephone to identify patients who are good candidates for psychological treatment, and (3) providing referral to best-practice telehealth-based or in-person assessment and treatment. We have partnered with three accredited Level I and II pediatric trauma centers and propose a multi-site hybrid 1 effectiveness-implementation trial with 300 adolescent (ages 12-17) traumatic injury patients to: 1) assess the extent to which TRRP promotes improvement in quality of life and emotional recovery and 2) gather preliminary data on the potential for TRRP to be implemented in other Level I trauma centers. Directly in line with NICHD’s Pediatric Trauma and Critical Illness Research and Training (PTCIB) Strategic Research and Training agenda, this study will provide valuable data on the efficacy, preliminary effectiveness and potential for implementation of an innovative, cost-effective, sustainable technology-enhanced intervention designed to address the unique needs of adolescent injury patients and mitigate short- and long-term impact of injury on mental health, quality of life, and overall well-being.

项目概要/摘要 儿童创伤性损伤（即突然发生且严重需要立即处理的损伤）是主要的 美国青少年的死亡和发病原因，并与心理健康和健康风险相关 结果。儿童创伤造成的医疗和社会成本高达 870 亿美元 增加了影响生活质量、身体恢复、社交能力的广泛健康风险后果的风险 功能，并返回到以前的活动。儿童中 PTSD 和抑郁症的患病率很高 跌打损伤患者；然而，大多数儿科创伤中心没有资源来实施 解决受伤后心理健康问题的护理模式。美国学院当前的指导方针 外科医生 (ACS) 创伤委员会强烈建议对患者进行筛查并解决情绪恢复问题 外伤患者。 ACS 创伤委员会已将此确定为优先事项，并且可能会开始 在全国一级和二级儿科创伤中心强制实施心理健康计划。因此至关重要的是 政策和实践以可扩展和可持续的护理模式的实施和评估为指导。 2015 年，我们的团队启动了创伤复原力和恢复计划 (TRRP)，这是一项可扩展且可持续的、 技术增强的多学科阶梯式护理模式——美国为数不多的模式之一——提供早期治疗 干预和直接服务，以改善创伤后获得循证精神卫生保健的机会 适合儿童、成人和家庭。我们发现这种护理模式对于青少年来说是可行且可接受的 各个服务级别的患者（12-17 岁）。 TRRP包括3个主要步骤：（1）院内教育、简要风险 减少疗程，并通过自动短信系统跟踪患者的情绪恢复情况，(2) 通过电话进行为期 30 天的筛选，以确定适合心理治疗的患者 (3) 提供基于最佳实践的远程医疗或现场评估和治疗的转介。 我们与三个经过认证的一级和二级儿科创伤中心合作，提出了一个多站点混合方案 对 300 名青少年（12-17 岁）创伤性损伤患者进行 1 项有效性实施试验，目的是：1) 评估 TRRP 在多大程度上促进生活质量和情绪恢复的改善以及 2) 收集 关于 TRRP 在其他一级创伤中心实施的可能性的初步数据。直接排队 与 NICHD 的儿科创伤和危重疾病研究与培训 (PTCIB) 战略研究和 培训议程，本研究将提供有关功效、初步效果和潜力的宝贵数据 实施创新、具有成本效益、可持续的技术增强干预措施，旨在 满足青少年伤害患者的独特需求，减轻伤害对患者的短期和长期影响 心理健康、生活质量和整体福祉。