Reducing Stress After Trauma (ReSeT) Supplement

项目摘要摘要 高达50%的儿童受到创伤后应激症状(PTSS)及其相关心理障碍的影响 在受伤后，会导致与健康相关的生活质量下降。因为儿童的PTSS出现在他们 从医院出院后，创伤系统通常看不到他们，也没有发现他们 也不接受治疗。儿童在获得以证据为基础的PTSS治疗方面存在重大障碍，包括 对风险人群的识别有限，农村和城市人口中缺乏提供者，以及缺乏 行为健康服务的保险覆盖范围。为了解决护理方面的差距，在父项目中 [R24HD096350]我们开发并试点了一种创新的简短认知-行为电子健康治疗方案 专为创伤系统设计的儿童PTSS，压力后恢复工具包 (重置)。这种方法集成了基于网络的交互式创伤认知行为疗法 为8至17岁的儿童提供与训练有素的治疗师进行同步电子健康治疗的模块。 八个模块针对应对技能和症状管理，并提供脱敏和重建 通过复述创伤经历来重述创伤事件。针对家长的额外4个模块 常见的特定伤害问题，如睡眠困难和疼痛，以及管理自己的压力。我们的 初步研究记录了良好的可用性、可行性、可接受性和满意度。家长研究包括 用于记录重置计划效果的双臂随机对照试验。然而，这场大流行为 由于对单元开发和征聘产生不利影响，研究顺利完成。作为 大流行病排除了在模块中使用现场演员，我们以更高的成本转向了动画 和时间延迟。由于创伤数量的显著下降，大流行还改变了所有地点的招募人数 和住院治疗。这些因素加在一起，推迟了开始招募进入双臂随机对照试验疗效试验。 为期4个月，直到2021年9月。我们已经成功地招募了106名拟议样本中的20% 孩子们。为了达到目标样本，我们预计需要增加第四个站点并延长招聘时间 另外4个月。为了解决这些障碍，我们增加了全国儿童医院，它有不同的 并将于2022年6月开始招募。支持第四个站点的资金通过以下方式完成 减少PI的工作量。然而，我们也需要通过夏季创伤高峰来延长招募时间。 2023年的。将招聘延长至2023年夏季超出了我们的预算范围；因此，我们 请求考虑补充资金。我们预计将有有限的结转来允许 完成为期6个月的跟踪，直至2024年2月。RCT的成功完成将提供 主要的循证资源，可通过创伤服务随时传播，以解决 不同民族、种族、社会经济和地域儿童的心理健康需求 社区。

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.