Adolescent Trauma Recovery and Stress Disorders Collaborative Care (ATRSCC) Model Program Trial

Goal 1: To coordinate care from EMS systems to primary care for injured adolescents.

Objective 1: To increase rates of connection to primary care providers to 55% for model
program adolescents, compared to an anticipated connection rate of 25% in adolescents
assigned to standard care, by 2010.

Goal 2: To reduce alcohol consumption over the course of the year after injury.

Objective 2: To reduce rates of alcohol consumption by 25% in adolescents assigned to the
model program, compared to adolescents assigned to the standard care, by 2010.

Goal 3: To reduce adolescent PTSD symptoms over the course of the year after injury.

Objective 3: To achieve statistically significant reductions in PTSD symptoms in model
program patients, compared to adolescents assigned to standard care, by 2010.

Activities Undertaken to Meet Project Goals:

We propose to implement and evaluate an innovative model program, the adolescent trauma
support service, that aims to improve the quality of care for injured adolescents with
problematic alcohol use and high levels of PTSD symptoms by enhancing coordination of care
between EMS systems and primary care and community services. All injured adolescents ages
12-18 presenting to the Harborview Medical Center with injuries so severe that they require
inpatient admission and/or 24 hour observation in the emergency department, will be screened
for alcohol use and PTSD. Adolescents who screen into the study will be randomly assigned to
the adolescent trauma support service or standard care. Two trauma support specialists will
meet each injured adolescent and available family members by the ED gurney or inpatient
bedside in order to elicit and address each patient/family's unique constellation of
post-injury concerns. Next, the adolescent trauma support specialist will help to coordinate
care received within the EMS system with primary care providers. The trauma support
specialists will also have the capacity to deliver evidence-based motivational interviewing
interventions targeting reductions in adolescent alcohol use. The trauma support specialists
will link patients and families to evidence-based PTSD treatment through primary care and
community resources. Program evaluation will include a comparison of the outcomes of
adolescents randomly assigned to the adolescent trauma support program with those of
adolescents assigned to standard care. Adolescents in the model program and standard care
will be compared on the presence or absence of post-injury primary care visits and reductions
in alcohol use and PTSD symptoms over the course of the year after injury. Nationwide
dissemination activities of program evaluation results will include the publication of
manuscripts in peer reviewed journals and presentations at national meetings by members of
the interdisciplinary collaborative group that includes pediatric, mental health and surgical
providers.

Inclusion Criteria:

- The investigators will screen all English speaking female and male adolescents ages
12-18, who present to Harborview Medical Center with injuries so severe that they
require inpatient admission and/or > 24 hour observation in the emergency department.

- All dyads where both parents consent and adolescents assent to the study will be
enrolled in the study and randomized.

Exclusion Criteria:

- Adolescents who have suffered head, spinal cord, or other severe injuries that prevent
participation in the baseline interview will be excluded from the protocol.

- Patients who require immediate intervention (e.g., self-inflicted injury, active
psychosis, mania, and victims of family abuse) will be excluded and referred to the
Harborview Inpatient Psychiatric Consult Service.

- Patients who are currently incarcerated or are likely to face criminal charges will be
excluded.