Adolescent Trauma Recovery and Stress Disorders Collaborative Care (ATRSCC) Model Program Trial (ATRSCC)
Maternal Child Health Bureau Adolescent Trauma Recovery and Stress Disorders Collaborative Care (ATRSCC) Model Program Trial
調査の概要
詳細な説明
Goal 1: To coordinate care from EMS systems to primary care for injured adolescents.
Objective 1: To increase rates of connection to primary care providers to 55% for model program adolescents, compared to an anticipated connection rate of 25% in adolescents assigned to standard care, by 2010.
Goal 2: To reduce alcohol consumption over the course of the year after injury.
Objective 2: To reduce rates of alcohol consumption by 25% in adolescents assigned to the model program, compared to adolescents assigned to the standard care, by 2010.
Goal 3: To reduce adolescent PTSD symptoms over the course of the year after injury.
Objective 3: To achieve statistically significant reductions in PTSD symptoms in model program patients, compared to adolescents assigned to standard care, by 2010.
Activities Undertaken to Meet Project Goals:
We propose to implement and evaluate an innovative model program, the adolescent trauma support service, that aims to improve the quality of care for injured adolescents with problematic alcohol use and high levels of PTSD symptoms by enhancing coordination of care between EMS systems and primary care and community services. All injured adolescents ages 12-18 presenting to the Harborview Medical Center with injuries so severe that they require inpatient admission and/or 24 hour observation in the emergency department, will be screened for alcohol use and PTSD. Adolescents who screen into the study will be randomly assigned to the adolescent trauma support service or standard care. Two trauma support specialists will meet each injured adolescent and available family members by the ED gurney or inpatient bedside in order to elicit and address each patient/family's unique constellation of post-injury concerns. Next, the adolescent trauma support specialist will help to coordinate care received within the EMS system with primary care providers. The trauma support specialists will also have the capacity to deliver evidence-based motivational interviewing interventions targeting reductions in adolescent alcohol use. The trauma support specialists will link patients and families to evidence-based PTSD treatment through primary care and community resources. Program evaluation will include a comparison of the outcomes of adolescents randomly assigned to the adolescent trauma support program with those of adolescents assigned to standard care. Adolescents in the model program and standard care will be compared on the presence or absence of post-injury primary care visits and reductions in alcohol use and PTSD symptoms over the course of the year after injury. Nationwide dissemination activities of program evaluation results will include the publication of manuscripts in peer reviewed journals and presentations at national meetings by members of the interdisciplinary collaborative group that includes pediatric, mental health and surgical providers.
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
研究場所
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Washington
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Seattle、Washington、アメリカ、98104
- Harborview Medical Center
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- The investigators will screen all English speaking female and male adolescents ages 12-18, who present to Harborview Medical Center with injuries so severe that they require inpatient admission and/or > 24 hour observation in the emergency department.
- All dyads where both parents consent and adolescents assent to the study will be enrolled in the study and randomized.
Exclusion Criteria:
- Adolescents who have suffered head, spinal cord, or other severe injuries that prevent participation in the baseline interview will be excluded from the protocol.
- Patients who require immediate intervention (e.g., self-inflicted injury, active psychosis, mania, and victims of family abuse) will be excluded and referred to the Harborview Inpatient Psychiatric Consult Service.
- Patients who are currently incarcerated or are likely to face criminal charges will be excluded.
研究計画
研究はどのように設計されていますか？
デザインの詳細
- 主な目的：処理
- 割り当て：ランダム化
- 介入モデル：並列代入
- マスキング：独身
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
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実験的：Intervention
Adolescent Trauma Support Program
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The study team will be organized into an adolescent trauma support service.
The adolescent trauma support service will fundamentally restructure psychosocial care by integrating post-injury medical treatment with alcohol and PTSD detection and treatment.
The adolescent trauma support specialists will deliver a stepped collaborative care intervention to adolescents and their families over the 6-12 months post-injury.
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介入なし：Control
Usual Care Control Condition
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この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Number of Patients With High Levels of Adolescent PTSD Symptoms
時間枠：Baseline (injury), then 2, 5, and 12 months post-injury
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Patients with symptoms consistent with a diagnosis of PTSD on the UCLA PTSD Reaction Index were counted.
The UCLA PTSD-RI can be used to create an algorithm consistent with a diagnosis of PTSD by rating 1 intrusive, 3 avoidant, and 2 arousal symptoms with a rating of moderate severity.
The PTSD-RI is scored on a scale from 0 (none of the time) - 4 (most of the time) with a > = 2 "some of the time" denoting this cutoff for moderate severity.
This algorithm was used to identify patients with high PTSD symptom levels consistent with a diagnosis of PTSD.
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Baseline (injury), then 2, 5, and 12 months post-injury
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Number of Patients Who Self-reported Alcohol Consumption or Drug Use
時間枠：Baseline (injury), and 2, 5, and 12 months post-injury
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Any self-reported alcohol or drug use using one yes or no question
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Baseline (injury), and 2, 5, and 12 months post-injury
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Percentage of Asolescents Linked to Primary Care During the Study
時間枠：Up to12 months post-injury
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Percentage of adolescents self-reporting one or more primary care visits over the course of the 12-months after the injury
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Up to12 months post-injury
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Percentage of Adolescents Who Self-reported Weapon Carriage
時間枠：Baseline (injury), then 2, 5, and 12 months post-injury
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Self-reported carrying of knife, gun, club or other weapon by adolescent
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Baseline (injury), then 2, 5, and 12 months post-injury
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Number of Patients Experiencing High-Level Depressive Symptoms
時間枠：Baseline (injury), then 2, 5, and 12 months post-injury
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The investigators used the Patient Health Questionnaire (PHQ-9) to identify symptoms consistent with a diagnosis of depression on the 9-item Patient Health Questionnaire depression screen.
Scores range from 1 to 27 with higher scores representing worse outcomes.
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Baseline (injury), then 2, 5, and 12 months post-injury
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協力者と研究者
スポンサー
捜査官
- 主任研究者：Douglas F. Zatzick, MD、University of Washington
出版物と役立つリンク
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
追加の関連 MeSH 用語
その他の研究ID番号
- 32685
- 1 H34 MC08508-01-00
- 07-7850-C01 (その他の識別子：University of Washington)
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