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

Abstract: Interventions that address families’ quality of life and emotional and behavioral needs after pediatric traumatic injury (PTI) are a public health priority. Posttraumatic stress disorder (PTSD) and/or depression is experienced by 1 in 3 children after PTI, negatively impacting quality of life, physical recovery, emotional and functional outcomes, and family roles and routines. Moreover, over 50% of caregivers develop high distress and PTSD symptoms after PTI, and caregivers’ emotional health is highly correlated with children’s outcomes, particularly among preadolescent children. Interventions that target both caregiver and child distress are therefore needed. This proposal builds on evidence from an NICHD K23 to develop and pilot CAARE (Caregivers’ Aid to Accelerate Recovery after pediatric Emergencies), a technology- assisted, stepped care intervention for families with young children (under age 12 years) who have experienced PTI. CAARE provides (1) a brief inpatient risk-reduction intervention for caregivers and children with significant behavioral health screens, (2) a text messaging-based symptom monitoring service targeting both caregiver and child behavioral health, (3) an mHealth education, coping, and service locator tool, and (4) 30-day caregiver and child behavioral screening and referral to evidence-based treatment for those who need it. We propose to conduct a hybrid type I effectiveness-implementation trial with 300 families randomly assigned to CAARE (n=150) vs. guideline-adherent enhanced usual care (EUC) (n=150) to (1) examine the extent to which CAARE improves children’s and caregivers’ quality of life, emotional and functional health outcomes, service engagement, and self-efficacy and (2) inform widescale implementation of CAARE. Caregivers of children under age 12 hospitalized for traumatic injury will be recruited and assessed by independent, blind evaluators at the bedside and 3-, 6-, and 12-months post-baseline. Families will be recruited and randomized from three sites -- two Level I pediatric trauma centers and one Level II center.