Annually, traumatic injuries affect roughly 3 million people in the US and account for over $650B in costs.
Many patients are resilient and recover well emotionally, but over 20% (~600,000 people per year) develop
mental health problems such as posttraumatic stress disorder and depression, both major risk factors for social
and occupational impairment; poor physical health and quality of life; and lost productivity, work, and financial
resources. Most trauma centers do not address the mental health recovery of patients after a traumatic injury.
This gap in the quality of patient care, combined with unique barriers to mental health services that traumatic
injury patients face, necessitates a cost-effective intervention that meets the needs of these patients at each
stage of the recovery process. We will test the Trauma Resilience and Recovery Program (TRRP), a scalable,
sustainable technology-enhanced intervention to support the mental health recovery of patients who have
experienced a traumatic injury. The model includes education, risk screening, and brief intervention at the
bedside (Step 1); symptom self-monitoring and continued education via a daily text messaging system (Step
2); mental health screening at 30 days via chatbot or telephone (Step 3); and, when appropriate, mental health
treatment referrals (Step 4). Our previous work has provided strong support for the acceptability and feasibility
of TRRP: (1) 98% of patients approached at Step 1 by TRRP staff at the bedside enroll in mental health follow-
up, (2) more than 2 in 3 patients enroll in the symptom self-monitoring system (Step 2), and (3) 75% of patients
who screen positive for PTSD or depression at the 30-day call (Step 3) accept treatment referrals (Step 4).
TRRP staff has provided mental health follow-up to over 8,000 patients to date, only about 400 of whom would
have received mental health follow-up services under usual-care conditions based on the results of our needs
assessment. We are implementing TRRP in 12 trauma centers in the Carolinas, 4 of which already have fully
implemented it. This experience has informed the approach we propose to use in partnership with George
Washington University (GWU) hospital. We will conduct a randomized controlled trial with 1-year follow up of
TRRP vs. enhanced usual care with 350 patients at GWU, which serves a diverse population of ~2000
traumatic injury patients per year (15% penetrating mechanism). Engagement in mental health services and
clinical and functional outcomes will be assessed 3, 6, and 12 months post-baseline by trained interviewers
blind to study condition. Qualitative interviews will be conducted with 20 TRRP patients who have experienced
violent trauma as well as 15 African American and 15 Latinx patients who have experienced non-violent
trauma. These data will inform improvements to the TRRP model as well as the implementation process in
preparation for a future hybrid implementation-effectiveness trial with 8 trauma centers. This body of work is
critical to informing the field as it continues to move toward national standards and recommendations.