This article reports on a pragmatic randomized clinical trial at a level-I trauma center to determine the effectiveness of a stepped collaborative care intervention that targeted certain risk behaviors and symptoms; the authors report on their research methodology, outcomes, and implications for future research as well as policy practice.
Violence and injury risk behaviors, alcohol and drug use problems, and post-traumatic stress disorder (PTSD) and depressive symptoms occur frequently among adolescents presenting to acute care medical settings after traumatic physical injury. The objective of the research reported here was to test the effectiveness of a stepped collaborative care intervention targeting this constellation of risk behaviors and symptoms in randomly sampled hospitalized adolescents with and without traumatic brain injury. The authors conducted a pragmatic randomized clinical trial at a single U.S. level-I trauma center. Participants included 120 adolescents aged 12 to 18 years randomized to intervention and control conditions. Stepped collaborative care intervention included motivational interviewing elements targeting risk behaviors and substance use as well as medication and cognitive behavioral therapy (CBT) elements targeting PTSD and depressive symptoms. Adolescents were assessed at baseline before randomization and two, five, and 12 months after injury hospitalization. Standardized instruments were used to assess violence risk behaviors, alcohol and drug use, and PTSD and depressive symptoms. The investigation attained more than 95 percent adolescent follow-up at each assessment point. The intervention was equally effective in reducing the risk of weapon carrying among injured adolescents with and without traumatic brain injury. Other treatment targets, including alcohol and drug use problems and high levels of PTSD and depressive symptoms, occurred less frequently in the cohort relative to weapon carrying and were not significantly affected by the intervention. Collaborative care intervention reduced the risk of adolescent weapon carrying during the year after the injury hospitalization. The authors suggest that future investigation should replicate this preliminary observation; if the finding is replicated, orchestrated investigative and policy efforts could systematically implement and evaluate screening and intervention procedures targeting youth violence prevention at U.S. trauma centers. Publisher Abstract Provided