The Supporting Purposeful Interventions & Resilience In Trauma (SPIRIT) program will implement trauma-specific screening and stratified intervention by triaging youth with chronic medical conditions. SPIRIT will use the Pediatric Traumatic Stress Care Process Model (CPM) to assess youth and families for trauma-related psychological distress and match them with an appropriate intervention. Care coordination will be embedded within each service. Youth enrolled will be aged 8-18 years. It is anticipated that youth most youth will have Medicaid as their insurance payor, the majority will be from racially minoritized populations, and presenting with an array of trauma exposures based on historical demographics of youth served by SPIRIT providers. SPIRIT staff will work directly with medical providers to provide education and training on trauma-specific screening within the CPM framework. Each intervention pathway provides stratified care based on the needs of the youth and include online modules, group psychotherapy, and individual/family therapy. SPIRIT patient navigator will assist all families with case coordination and patient advocacy. SPIRIT will serve 150 youth and families in Year 1 and 1,250 youth and families throughout the life of the project. Goal 1: Increase pediatric healthcare provider ability to identify trauma exposure and distress and link with appropriate matched interventions. SPIRIT will recruit clinics to provide trauma screening and referrals, will tailor workflows specific to clinic needs and policies, and use the CPM to match to appropriate treatment. Goal 2: Decrease trauma symptoms and impairment via evidence-based, trauma-focused treatment services. SPIRIT will use patient care navigation to problem-solve barriers to treatment engagement with goal of ≥ 75% session attendance. 70% of participants will demonstrate a clinically reliable improvement in functional impairment and posttraumatic stress symptom severity at program discharge. Goal 3: Elicit stakeholder feedback on stratified intervention processes and incorporate feedback. SPIRIT staff will complete independent focus groups to adapt interventions. An advisory board with patient, parent, and medical providers will meet quarterly and consult on project implementation. All intervention materials will be tailored for youth living with a chronic medical condition. Goal 4: Deliver training related to the intersection of trauma exposure and chronic medical conditions on youth development and functioning. SPIRIT staff will implement professional education on trauma exposure and chronic medical conditions. SPIRIT will develop a brief web-based curriculum for medical providers, on-demand training for school nurses, and provide live trainings within the hospital and within the community as requested. Goal 5: Use programmatic outcome evaluation to justify institutional and state support for expanding the developed screening and stratified intervention model. SPIRIT staff will analyze outcome data, provide statistics on program impact on trauma symptoms and impairment, measure program acceptability and satisfaction, and present results at state and national forums and conferences.
