College of Nursing, Medical University of South Carolina, USA.
Department of Surgery, College of Medicine, Medical University of South Carolina, USA.
J Pediatr Psychol. 2023 Nov 16;48(11):960-969. doi: 10.1093/jpepsy/jsad067.
Over 120,000 U.S. children are hospitalized for traumatic injury annually, a major risk factor for behavioral health problems such as acute/posttraumatic stress disorder (PTSD) and depression. Pediatric trauma centers (PTCs) are well positioned to address the recent mandate by the American College of Surgeons Committee on Trauma to screen and refer for behavioral health symptoms. However, most PTCs do not provide screening or intervention, or use varying approaches. The objective of this mixed-methods study was to assess PTCs' availability of behavioral health resources and identify barriers and facilitators to service implementation following pediatric traumatic injury (PTI).
Survey data were collected from 83 Level I (75%) and Level II (25%) PTC program managers and coordinators across 36 states. Semistructured, qualitative interviews with participants (N = 24) assessed the feasibility of implementing behavioral health education, screening, and treatment for PTI patients and caregivers.
Roughly half of centers provide behavioral health screening, predominantly administered by nurses for acute stress/PTSD. Themes from qualitative interviews suggest that (1) service provision varies by behavioral health condition, resource, delivery method, and provider; (2) centers are enthusiastic about service implementation including screening, inpatient brief interventions, and follow-up assessment; but (3) require training and lack staff, time, and funding to implement services.
Sustainable, scalable, evidence-based service models are needed to assess behavioral health symptoms after PTI. Leadership investment is needed for successful implementation. Technology-enhanced, stepped-care approaches seem feasible and acceptable to PTCs to ensure the availability of personalized care while addressing barriers to sustainability.
美国每年有超过 12 万名儿童因创伤而住院，这是行为健康问题（如急性/创伤后应激障碍（PTSD）和抑郁症）的主要危险因素。儿科创伤中心（PTC）非常适合满足美国外科医师学院创伤委员会最近提出的筛查和转介行为健康症状的要求。然而，大多数 PTC 既不提供筛查或干预，也不采用不同的方法。本混合方法研究的目的是评估 PTC 提供行为健康资源的情况，并确定在发生儿童创伤后（PTI）实施服务的障碍和促进因素。
从 36 个州的 83 个一级（75%）和二级（25%）PTC 项目管理人员和协调员收集了调查数据。对 24 名参与者进行半结构化的定性访谈，评估了对 PTI 患者及其照顾者实施行为健康教育、筛查和治疗的可行性。
大约一半的中心提供行为健康筛查，主要由护士对急性应激/PTSD 进行筛查。定性访谈的主题表明：（1）服务提供因行为健康状况、资源、提供方式和提供者而异；（2）中心对服务实施（包括筛查、住院简短干预和后续评估）非常热心；但（3）需要培训，缺乏工作人员、时间和资金来实施服务。
需要可持续、可扩展、基于证据的服务模式来评估 PTI 后的行为健康症状。需要领导层的投资才能成功实施。对于 PTC 来说，增强技术的阶梯式护理方法似乎是可行且可接受的，这可以确保提供个性化的护理，同时解决可持续性的障碍。
