Adolescent Trauma Recovery and Stress Disorders Collaborative Care (ATRSCC) Model Program Trial
Condition: Post-traumatic Stress Disorder; Alcohol Abuse; Alcohol Dependence
MeSH terms: Alcoholism; Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      Recent needs assessments suggest that difficulties exist in care coordination between
      emergency medical services (EMS) systems and primary care for injured adolescents with
      alcohol problems and post-traumatic stress disorder (PTSD). This project will implement,
      evaluate, and disseminate the adolescent trauma support service model program that aims to
      enhance coordination between EMS systems and primary care/community services.
    

Detailed description: 
      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.
    

Intervention name(s): Adolescent Trauma Support Program
Intervention type(s): Behavioral
Intervention description(s): 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.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Adolescents; Quality Assurance and Improvement; Substance Abuse; Posttraumatic Stress; Family Centered Care; Trauma Systems