Adolescent injury: intervening to prevent posttraumatic stress and substance use outcomes - Project Summary Adolescents exposed to traumatic events, including traumatic injury, are more vulnerable to develop substance use-related problems. In 2022 the American College of Surgeons Committee on Trauma (ACS-CoT) began requiring mental health screening for trauma patients during the hospital admission. Improving mental health screening and intervention within pediatric trauma centers has the potential to increase patient and parent recognition of and response to trauma-related sequalae, including substance use/misuse, following discharge. The long-term goal of this line of research is to address the adoption of this new trauma center requirement to establish best practices of screening for acute stress and intervening to prevent PTSD and substance use. While best practices exist for appropriate screening instruments for the adolescent population, more work is necessary to guide the delivery of interventions for adolescent patients who may be at risk for experiencing adverse trauma- related sequalae including PTSD and risky substance use. Specifically, it is critical to provide education to both parents and adolescents about the potential development of trauma-related symptoms, the link between trauma and substance use, use of adaptive coping skills, and harm reduction/prevention strategies. We will develop and pilot test the Adolescent Stress and Substance Intervention Subsequent to Trauma (ASSIST) video intervention that builds upon ACS-COT guidelines to improve mental health care during and after hospitalization for traumatic injury. This will be accomplished through the following primary aims: 1) Develop and refine two ASSIST video interventions for adolescents and parents admitted to a level 1 pediatric trauma center and 2) Evaluate the feasibility, acceptability, and implementation potential of the ASSIST video interventions. In Phase I of the proposed study, we will develop and refine two ASSIST video interventions [parent and adolescent versions], offered in English and Spanish, through consultation with content experts, qualitative interviews pediatric trauma patients (12-17 years) and their parents, and key stakeholders. After finalizing the ASSIST video interventions, we will evaluate their feasibility, acceptability and implementation through a pilot test (Phase II) with 30 pediatric trauma patients (12-17 years) and their parents. These dyads will receive the ASSIST interventions during their trauma center admission and complete follow up assessments over a 3 month period around interest/satisfaction, knowledge regarding post-trauma mental health symptoms/substance use, incidence (quantity/frequency) of substance use, self-efficacy in having discussions about mental health symptoms/ substance use, self-efficacy around connecting their child to mental health and/or addiction resources, and (when appropriate) engagement with a provider for mental health and/or addiction care. Additionally, utilizing an expert panel of pediatric trauma center clinicians and pilot data from our institution, we will refine our implementation protocol that will be tested in a subsequent fully powered R01 hybrid implementation-efficacy trial.
