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Reducing Stress After Trauma (ReSeT) Supplement

减轻创伤后压力 (ReSeT) 补充剂

基本信息

批准号：
10620963
负责人：
LINDA EWING-COBBS
金额：
$ 11.94万
依托单位：
UNIVERSITY OF UTAH
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-10 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10620963
关键词：
17 year old Accreditation Address Admission activity Adolescent Affect Age American College of Surgeons Behavioral Budgets Caring Cause of Death Cessation of life Child Child Support Childhood Childhood Injury Cognitive Cognitive Therapy Combined Modality Therapy Communities Coping Skills Development Disadvantaged Drops Enrollment Ethnic Origin Evidence based intervention Evidence based treatment Face Family Funding Geographic Locations Geography Health Services Health system Home Hospitalization Hospitals Impairment Improve Access Injury Insurance Coverage Link Mental Health Mental Health Services Online Systems Outcome Pain Parents Patients Pediatric Hospitals Physical Function Pilot Projects Population Heterogeneity Process Provider Public Health Race Randomized Recovery Resources Risk Rural Population Sampling Schools Secondary Prevention Self-Injurious Behavior Services Site Stress System Testing Time Training Translations Trauma Traumatic injury United States Urban Population Visit animation anxiety symptoms arm behavioral health cost desensitization design disability eHealth efficacy testing efficacy trial ethnic diversity evidence base experience falls follow-up health related quality of life implementation barriers innovation meetings novel pandemic disease parent grant parent project pilot test post-traumatic symptoms programs psychoeducational psychologic psychological distress recruit rural residence satisfaction screening sleep difficulty socioeconomics symptom management trauma care trauma centers traumatic event treatment as usual usability usual care arm website development

项目摘要

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.

项目摘要高达50%的儿童受到创伤后应激症状（PTSS）和相关心理障碍的影响并导致与健康相关的生活质量下降。因为孩子们的PTSS是在他们从医院出院回家，他们往往是看不见的创伤系统，也不治疗。儿童在获得PTSS循证治疗方面存在重大障碍，包括对高危人群的识别有限，农村和城市人口中缺乏提供者，行为健康服务的保险范围。为了解决这一护理差距，在家长项目中， [R24 HD 096350]我们开发并试行了一种创新的简短认知行为电子健康治疗，儿童创伤后应激反应量表（PTSS）是专门为创伤系统设计的创伤后恢复工具包（ReSeT）.这种方法整合了基于网络的交互式创伤认知行为治疗为8至17岁的儿童提供模块，与训练有素的治疗师同步进行电子保健治疗。八个模块针对应对技能和症状管理，通过复述创伤性经历来描述创伤性事件。额外的4个模块为家长地址常见的伤害具体的问题，如睡眠困难和疼痛，以及管理自己的压力。我们试点研究记录了良好的可用性、可行性、可接受性和满意度。母研究包括一项2组RCT，记录ReSeT项目的疗效。然而，这一流行病给以下方面带来了障碍：由于对模块开发和招聘产生不利影响，无法顺利完成研究。为大流行排除了在模块中使用真人演员，我们转向并以更高的成本转向动画和时间延迟。由于创伤量显著下降，大流行还改变了所有地点的招募情况和住院治疗。总之，这些因素延迟了两组RCT疗效试验的招募为期4个月，直至2021年9月。我们已成功地招募了106个拟议样本中的20% 孩子为了获得目标样本，我们预计需要增加第四个研究中心，并扩大招募范围，额外4个月。为了解决这些障碍，我们增加了全国儿童医院，它有一个多样化的人口，并将于2022年6月开始招募。支持第四个研究中心的资金由以下方面提供：减少PI的工作量。然而，我们还需要在夏季创伤高峰期扩大招募 2023年。将招聘延长到2023年夏季超出了我们的预算范围;因此，我们请求考虑追加资金我们预计有有限的结转，到2024年2月完成6个月的随访。成功完成RCT将提供主要的循证资源，可以随时通过创伤服务传播，以解决来自不同民族、种族、社会经济和地理环境的儿童的心理健康需求社区.