Improving Access, Quality, and Equity of Mental Health Care for Trauma-Affected Youth and Young Adults in the Carolinas

Sponsor/Type: The Duke Endowment
Project Period: 01/01/2024 – 12/31/2026

Project Focus

Ensuring access, quality, and equity in mental health care for youth and young adults is a top national priority. We are facing a mental health crisis. Over 40% of young people are struggling with persistent feelings of sadness and hopelessness. Violence, trauma, and social risk factors are key drivers. Nearly 2 in 3 young people have experienced violence or trauma. Firearm violence is the leading cause of death for children in the United States. Annually, US trauma centers provide acute care to hundreds of thousands of vulnerable youth and young adults who are at greatest risk for mental health disorders and socioenvironmental stress.

Trauma centers treat patients who have injuries secondary to intentional violence (e.g., firearm assaults) in addition to unintentional incidents including motor vehicle collisions, falls, fires, and more. Roughly 1 in 3 develops post-traumatic stress disorder (PTSD) and/or depression, both of which raise risk for lost productivity, social and functional impairment, poor quality of life, and chronic disease. Risk of developing PTSD or depression is twice as high among survivors of firearm injury, which disproportionately affects young Black males. Moreover, many patients live in counties designated as "health professional shortage areas" in mental health, and cumulative exposure to adverse childhood experiences and other structural factors (e.g., racism, poverty) increases risk. Trauma centers are uniquely positioned to address the social and mental health needs of patients at greatest risk for developing adverse outcomes, thereby improving quality of life, reducing disparities, and mitigating costs associated with lost productivity.

The 2022 report of the American College of Surgeons (ACS), which standardizes trauma care in the US, underscored this as a top priority and called on trauma centers to address this need. We propose a coordinated approach to improving access, equity, and quality of care among violently injured and trauma-affected youth (ages 6-17) and young adults (ages 18-30) in the Carolinas. First, we will improve access to services by implementing our Trauma Resilience and Recovery Program (TRRP) in four Level I and II pediatric trauma centers in the Carolinas. Second, we will improve equity by integrating our Turning the Tide Violence Intervention Program (TTVIP) with TRRP at the Medical University of South Carolina to establish a model program that improves our capacity to address the social and mental health needs of survivors of firearm injury, particularly Black youth and young adults who are disproportionately affected.

Third, we will provide consultation, training, and new resources to adult trauma centers in the Carolinas that have adopted TRRP to improve their capacity to identify and address the unique needs of firearm injury survivors (e.g., economic stressors, housing and food insecurity, safety concerns). Fourth, we will improve quality of mental health care available to trauma-affected youth and families by empowering providers in youth-serving agencies – many of which receive referrals from pediatric trauma centers – with Supporting Providers and Reaching Kids (SPARK), a web-based, telehealth-compatible platform designed to help providers deliver trauma-focused mental health treatment to youth in an engaging way and with high fidelity to best-practice treatment.

For more information contact
Tatiana M. Davidson