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.

项目摘要/摘要 小儿创伤损伤（即突然发作和严重程度需要立即注意的伤害）是领导 美国青少年的死亡原因和发病率，与心理健康和健康风险有关 结果。小儿创伤性伤害与870亿美元的医疗和社会成本有关， 增加影响生活质量，身体恢复，社会质量的多种健康风险后果的风险 功能，返回以前的活动。 PTSD和抑郁症的患病率很高 创伤性损伤患者；但是，大多数儿科创伤中心都没有实施的资源 受伤后心理健康的护理模型。美国学院的当前指南 外科医生（ACS）创伤委员会强烈建议筛查和解决情绪恢复 创伤性损伤患者。 ACS创伤委员会已将其确定为优先事项，很可能会开始 在全国范围内，在I和II级儿科创伤中心授权心理健康计划。因此至关重要 政策和实践以对可扩展和可持续的护理模型的实施和评估为指导。 2015年，我们的团队启动了创伤弹性和恢复计划（TRRP），这是一个可扩展且可持续的， 技术增强的，多学科的跨学科护理模型（美国少数几个）提供了早期的 造成创伤后的干预和直接服务，以改善获得基于证据的精神卫生保健的机会 适用于儿童，成人和家庭。我们发现这种护理模式是可行的，并且可以接受青少年 每个服务水平的患者（12-17岁）。 TRRP包括3个主要步骤：（1）院内教育，简短的风险 减少会议，并通过自动文本消息系统跟踪患者的情绪恢复，（2） 通过电话进行30天的屏幕，以识别是心理良好候选者的患者 治疗，以及（3）向最佳实践远程医疗或面对面评估和治疗提供转诊。 我们已经与三个认可的I级和II级儿科创伤中心合作，并提出了多站点混合动力 1有效性实施试验，有300名青少年（12-17岁）创伤性损伤患者：1）评估 TRRP促进生活质量和情感恢复的改善程度以及2）聚集 关于TRRP潜在在其他I级创伤中心实施的可能性的初步数据。直接排队 NICHD的儿科创伤和重症疾病研究与培训（PTCIB）战略研究和 培训Agernda，这项研究将提供有关有效性，有效性和潜力的宝贵数据 用于实施创新，具有成本效益，可持续技术增强的干预措施 满足青春期损伤患者的独特需求，并减轻伤害对损伤的短期和长期影响 心理健康，生活质量和整体福祉。