From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC.
Department of Psychiatry, Medical University of South Carolina, Charleston, SC (Davidson, Espeleta, Ridings, Hanson, Ruggiero).
J Am Coll Surg. 2023 Dec 1;237(6):810-825. doi: 10.1097/XCS.0000000000000862. Epub 2023 Nov 15.
Annually, over 600,000 adults served in US trauma centers (≥20%) develop posttraumatic stress disorder (PTSD) and/or depression in the first year after injury. American College of Surgeons guidelines include screening and addressing mental health recovery in trauma centers. Yet, many trauma centers do not monitor and address mental health recovery, and it is a priority to learn how to implement evidence-informed mental health programs in trauma centers.
This report describes our application of the Exploration, Preparation, Implementation, Sustainment model to implement the Trauma Resilience and Recovery Program (TRRP) in 3 Level I and II trauma centers to address patients' mental health needs. TRRP is a scalable and sustainable stepped model of care-one of the few in the US-that provides early intervention and direct services after traumatic injury.
Trauma centers are well positioned to accelerate patients' mental health recovery via early identification, education, screening, and referrals to mental health agencies that provide best-practice care. We found that TRRP was acceptable to the 3 partnering trauma centers we studied. Early engagement of patient, provider, and hospital administration stakeholders enhanced buy-in during the early stages of the implementation process and promoted sustainability. Active processes to support monitoring, evaluation, and adaptation were critical.
Our work demonstrates the feasibility of implementing and adapting TRRP, a cost-efficient and sustainable stepped care intervention, in Level I and II trauma centers. Several factors should be carefully considered by trauma centers seeking to integrate behavioral health interventions into their trauma program.
每年，超过 60 万名在美国创伤中心服务的成年人（≥20%）在受伤后的第一年都会出现创伤后应激障碍（PTSD）和/或抑郁症。美国外科医师学院的指南包括在创伤中心筛查和解决心理健康康复问题。然而，许多创伤中心并没有监测和解决心理健康康复问题，因此优先学习如何在创伤中心实施基于证据的心理健康项目。
本报告介绍了我们应用探索、准备、实施和维持模型，在 3 个一级和二级创伤中心实施创伤恢复和康复计划（TRRP），以满足患者的心理健康需求。TRRP 是一种可扩展和可持续的阶梯式护理模式，是美国为数不多的模式之一，它在创伤后提供早期干预和直接服务。
创伤中心通过早期识别、教育、筛查以及向提供最佳实践护理的心理健康机构转介，可以很好地促进患者的心理健康恢复。我们发现，我们研究的 3 家合作创伤中心都可以接受 TRRP。在实施过程的早期阶段，积极参与患者、医护人员和医院管理人员的利益相关者，增强了实施过程中的接受度，并促进了可持续性。积极的监测、评估和调整支持过程至关重要。
我们的工作表明，在一级和二级创伤中心实施和调整 TRRP 是可行的，TRRP 是一种具有成本效益和可持续性的阶梯式护理干预措施。寻求将行为健康干预措施纳入其创伤项目的创伤中心应仔细考虑几个因素。
