Reducing Stress After Trauma (ReSeT) Supplement

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Project Summary Abstract Post-traumatic stress symptoms (PTSS) and associated psychological impairment affect up to 50% 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. Children have significant barriers to accessing evidence-based treatments for PTSS, including limited identification of those at risk, scarcity of providers in both rural and urban populations, and lack of insurance coverage for behavioral health services. To address this gap in care, in the parent project [R24HD096350] we developed and piloted an innovative brief cognitive-behavioral e-health treatment for children’s PTSS designed specifically for use within the trauma system, the Recovery after Stress Toolkit (ReSeT). This approach integrates interactive web-based trauma-focused cognitive behavioral therapy modules for children 8 to 17 years of age with synchronous e-health therapy sessions with a trained therapist. Eight modules target coping skills and symptom management and provide desensitization and reframing of the traumatic event through retelling the traumatic experience. An additional 4 modules for parents address common injury-specific concerns such as sleep difficulties and pain as well as managing their own stress. Our pilot study documented favorable usability, feasibility, acceptability, and satisfaction. The parent study included a 2-arm RCT to document efficacy of the ReSeT program. However, the pandemic has presented barriers to successful completion of the study due to adverse impacts on module development and recruitment. As the pandemic precluded using live actors in the modules, we pivoted and switched to animation at increased cost and time delay. The pandemic also altered recruitment at all sites due to a significant drop in trauma volume and hospitalization. Together, these factors delayed beginning recruitment into the two-arm RCT efficacy trial for 4 months until September 2021. We have successfully recruited 20% of the proposed sample of 106 children. To attain the targeted sample, we anticipate needing to add a 4th site and extend recruitment for an additional 4 months. To address these barriers, we added Nationwide Children’s Hospital, which has a diverse population and will begin recruitment in June 2022. Funding to support the 4th site was accomplished by reducing PI effort. However, we will also need to extend recruitment through peak trauma volume in summer of 2023. Extending recruitment through summer 2023 is beyond the scope of our budget; thus, we are requesting consideration for supplemental funding. We anticipate having limited carryforward to allow completion of the 6 month follow-up through February 2024. Successful completion of the RCT will provide a major evidence-based resource that can be readily disseminated through trauma services to address the psychological health needs of children from diverse ethnic, racial, socioeconomic, and geographic communities.