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.

项目概要摘要高达 50% 的儿童受到创伤后应激症状 (PTSS) 和相关心理障碍的影响因为儿童的创伤后应激障碍 (PTSS) 是在受伤后出现的。出院回家后，他们通常不会被创伤系统发现，也不会被发现儿童在获得针对 PTSS 的循证治疗方面存在重大障碍，包括对高危人群的识别有限，农村和城市人口的提供者稀缺，并且缺乏为了解决护理方面的这一差距，在父项目中提供了行为健康服务的保险。 [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专为在创伤系统中使用而设计的儿童 PTSS，即压力后恢复工具包（ReSeT）。这种方法整合了基于交互式网络的创伤认知行为疗法。适合 8 至 17 岁儿童的模块，由训练有素的治疗师提供同步电子健康治疗课程。八个模块针对应对技能和症状管理，并提供脱敏和重构通过重述创伤性经历来讲述创伤性事件另外 4 个模块供家长讨论。常见的伤害特定问题，例如睡眠困难和疼痛以及管理自己的压力。试点研究记录了良好的可用性、可行性、可接受性和满意度。一项记录 ReSeT 计划有效性的 2 组随机对照试验然而，大流行给该计划带来了障碍。由于对模块开发和招聘产生不利影响，研究顺利完成。由于大流行无法在模块中使用真人演员，我们以增加的成本转向动画由于创伤量显着下降，大流行还改变了所有地点的招募。这些因素共同推迟了双臂随机对照试验疗效试验的招募时间。为期 4 个月，直至 2021 年 9 月。我们已成功招募了 106 名建议样本中的 20% 为了获得目标样本，我们预计需要添加第四个站点并扩大招募范围。为了解决这些障碍，我们增加了 4 个月的时间，该医院拥有多元化的设施。人口并将于 2022 年 6 月开始招募。支持第四个站点的资金由然而，我们还需要在夏季创伤量高峰期间扩大招募范围。 2023 年。将招聘延长至 2023 年夏季超出了我们的预算范围，因此，我们我们预计会允许有限的结转。完成 6 个月的随访直至 2024 年 2 月。成功完成 RCT 将提供主要的基于证据的资源，可以通过创伤服务轻松传播，以解决来自不同民族、种族、社会经济和地理区域的儿童的心理健康需求社区。