Improving Quality of Life and Behavioral Health Service Access for Caregivers and Young Children after Pediatric Traumatic Injury

Sponsor/Type: NIH/NICHD

Project Period: 12/01/2024-11/30/2029

 

Interventions that address families’ quality of life and emotional and behavioral needs after pediatric traumatic injury (PTI) are a public health priority, with nearly 120,000 children hospitalized annually for severe injuries. PTI is associated with annual individual and societal costs of $87 billion and elevates risk for post-traumatic stress disorder (PTSD), depression, and other health risk consequences that affect quality of life, physical recovery, family roles and routines, and academic functioning. Caregivers are a key source of support for preadolescent children following PTI, and caregivers’ emotional health is highly correlated with children’s outcomes.

 

One in three children endorse PTSD and/or depression symptoms after PTI, and over 50% of caregivers develop high distress and significant PTSD symptoms. Therefore, interventions targeting caregiver and young child distress that have high potential for uptake in pediatric trauma centers are critically needed. Pediatric trauma centers recognize the need to support behavioral recovery, particularly in response to the American College of Surgeons’ 2022 guidelines to provide mental health screening and intervention to trauma patients at high risk. However, no clear roadmap exists for these centers to support emotional recovery and established, scalable and sustainable models of care are lacking.

 

We are in the final stages of an NICHD K23 where we are piloting CAARE (Caregivers’ Aid to Accelerate Recovery after pediatric Emergencies), a technology-assisted, stepped care intervention informed directly by patients and caregivers after PTI that provides children under age 12 and their caregivers:

1. inpatient emotional and behavioral screening and education,
2. brief inpatient risk reduction intervention,
3. mHealth-facilitated symptom self-monitoring and coping tools, and
4. 30-day evidence-based treatment referrals for families who need it.

 

CAARE was well received by caregivers and providers, with pilot data indicating that this model is appealing to caregivers and has high potential to address service barriers by providing real-time assistance to help caregivers manage their own distress and their children’s behavioral recovery.

 

We now propose to conduct a hybrid effectiveness-implementation trial to examine the extent to which CAARE improves children’s and caregivers’ quality of life, clinical and functional health outcomes, and follow-up treatment engagement and to inform widescale implementation of CAARE.

We will conduct a randomized controlled trial with 348 families randomly assigned to CAARE (n=174) vs. enhanced usual care (n=174). Caregivers of children under age 12 hospitalized for traumatic injury will be recruited and assessed by independent, blind evaluators at baseline, 3, 6, and 12 months. We will assess CAARE acceptability, feasibility, and appropriateness and identify barriers and facilitators that influence implementation, sustainability, and ability to equitably address the needs of families from underrepresented racial, ethnic, and trauma groups. The ultimate goal of this line of work is to achieve population-level impact in U.S. pediatric trauma centers through enhanced service quality, reach, and equity.

For more information contact
Leigh Ridings
Ph.D.
ridingle@musc.edu