Improving Engagement in Post-Injury Mental Health Care Through Community Health Worker-Enhanced Trauma Recovery Services - Each year, traumatic injuries such as gunshot wounds and motor vehicle accidents cost the U.S. more than $2 trillion in medical expenses and lost productivity, disproportionately affecting working-aged adults (25–64). Between 20–40% of survivors develop posttraumatic stress disorder (PTSD) or depression within the first year, which is associated with poor recovery, impaired functioning, and reduced quality of life. Survivors with exposure to the following negative factors: housing, food, and transportation insecurity, and financial strain, experience greater risks and persistent disparities. In our prior work, nearly 70% of trauma survivors reported at least one unmet social need, which was linked to elevated distress at bedside. Despite American College of Surgeons (ACS) best practice guidelines requiring psychosocial screening and follow-up, over 70% of U.S. trauma centers lack resources to support behavioral health engagement post-discharge, and even fewer conduct screening for these aforementioned factors. As a result, critical social and behavioral needs remain unaddressed, potentially resulting in poor outcomes. The Trauma Resilience and Recovery Program (TRRP), developed by our team and adopted in 12 Level I–II trauma centers, is an evidence-based stepped-care model aligned with ACS guidelines. TRRP provides bedside behavioral health screening, psychoeducation, and referral to stepped mental health services. While feasible and acceptable, TRRP follow-up engagement declines among patients who experience these factors (30% at 30-days) compared with those who do not (60%). To address this gap, we propose TRRP+, an enhanced model that integrates Community Health Worker (CHW) delivered support into TRRP to promote behavioral health engagement and recovery. TRRP+ prioritizes resolution of basic social needs as a foundation for higher-order health and recovery goals. This approach aligns with the NIMHD Research Framework by addressing multiple domains (healthcare system) and levels (individual, interpersonal, community). Aim 1 will assess feasibility and acceptability of TRRP+ through an open trial with 100 adult trauma survivors with acute distress and ≥1 unmet social needs. Outcomes include recruitment, retention, service engagement, acceptability, and preliminary behavioral health outcomes. Aim 2 will identify challenges and facilitators influencing TRRP+ adoptionand scalability using the Consolidated Framework for Implementation Research (CFIR) through qualitative interviews with patients, CHWs, and trauma staff. TRRP+ has potential to reduce disparities in behavioral health recovery by simultaneously addressing social and behavioral needs. This R21 will provide critical feasibility data to support a subsequent multi-site hybrid effectiveness-implementation R01, offering a scalable solution for trauma centers nationwide.
