Stepped collaborative care versus American College of Surgeons Committee on Trauma required screening and referral for posttraumatic stress disorder: Clinical trial protocol

BACKGROUND

Each year in the US, approximately 1.5-2.5 million individuals are so severely injured that they require inpatient hospital admissions. The American College of Surgeons Committee on Trauma (College) now requires that trauma centers have in place protocols to identify and refer hospitalized patients at risk injury psychological sequelae. Literature review revealed no investigations that have identified optimal screening, intervention, and referral procedures in the wake of the College requirement.

METHODS

The single-site pragmatic trial investigation will individually randomize 424 patients (212 intervention and 212 control) to a brief stepped care intervention versus College required mental health screening and referral control conditions. Blinded follow-up interviews at 1-, 3-, 6-, and 12-months post-injury will assess the symptoms of PTSD and related comorbidity for all patients. The emergency department information exchange (EDIE) will be used to capture population-level automated emergency department and inpatient utilization data for the intent-to-treat sample. The investigation aims to test the primary hypotheses that intervention patients will demonstrate significant reductions in PTSD symptoms and emergency department/inpatient utilization when compared to control patients. The study incorporates a Rapid Assessment Procedure-Informed Clinical Ethnography (RAPICE) implementation process assessment.

CONCLUSIONS

The overarching goal of the investigation is to advance the sustainable delivery of high-quality trauma center mental health screening, intervention, and referral procedures for diverse injury survivors. An end-of-study policy summit will harness pragmatic trial data to inform the capacity for US trauma centers to implement high-quality acute care mental health screening, intervention and referral services for diverse injured patient populations.

TRIAL REGISTRATION

Clinicaltrials.govNCT05632770.

Interorganizational relationships among family support organizations and child mental health agencies

This study examined: (1) qualitative aspects of close working relationships between family support organizations and child mental health agencies, including effective and ineffective characteristics of the relationship and aspects that they would change, and (2) the impact of the working relationship upon the family support organization. Semi-structured interviews were conducted with 40 directors of family support organizations characterized as having a close working relationship with a child mental health agency. Three main themes emerged regarding the quality of the working relationship: (a) interactional factors, including shared trust, communication, collaboration and service coordination; (b) aspects of the inner context of the family support organization, mental health agency, or both, including alignment of goals and values and perceptions of mental health services; and (c) outer contextual factors external to the organizations, such as financial and county regulations. Responses to the perceived impact of the relationship was divided into two themes: positive impacts (e.g. gained respect, influence and visibility), and negative impacts (e.g. lack of trust). This study lays the foundation for future research to better understand the mechanisms underlying interorganizational relationships in communities among different types of providers to create a more seamless continuum of services for families of children with mental health conditions.

Human sleep-wake cycles in the high Arctic: effects of unusual photoperiodicity in a natural setting

Studies of human circadian rhythms are typically conducted in artificial environments that are low in ecological validity. In the current study, six subjects and the field director lived in temporal isolation in a completely natural environment with constant daylight (a high Arctic research camp) for six weeks. Detailed daily sleep logs were kept. In keeping with past findings, five of the six subjects developed a free-running sleep-wake cycle longer than 24 hours. Unlike past results, the isolated subjects did not exhibit any synchronicity in their rhythins. There was a high degree of intersubject variability in circadian patterns. The findings have important implications for the comparison of the results of laboratory and field investigations of sleep-wake cycles.

Conceptions of prenatal care among Somali women in San Diego

Studies have shown that culturally sensitive prenatal care improves access to and utilization of that care. Focus groups were used to explore the beliefs and attitudes toward prenatal care among Somali women in San Diego, particularly in regard to their perinatal experiences following immigration. The women were very well informed about healthy prenatal practices, including nutrition and exercise, and very compliant in following such practices, having found ways and means to accommodate these practices into their new American lifestyle. The women were generally pleased with the care that they have received in San Diego and tolerant of most diagnostic and therapeutic interventions. The women preferred to be seen by a female doctor/health care practitioner who is informed about the female circumcision practiced in Somalia and who is conservative in the decision to perform cesarean section deliveries.

Nurse-midwifery services in one multi-ethnic, underserved community

Through a nurse-midwifery service in a mixed urban and rural agricultural community, we compared maternal risk factors, prenatal care, labor and delivery, and adverse birth outcomes in low-income Mexican-American Hispanic, white (Caucasian), and Southeast Asian women--a three-way analysis rarely reported in the literature. Southeast Asian women were older and had more children. Hispanic women bore children at a younger age. Both Southeast Asians and Hispanics made fewer prenatal visits than did Caucasian women, and used less analgesia and anesthesia during delivery. The incidence of Cesarean section (7.7 percent) and low birthweight (5.9 percent) was compared to local, state, and national reference statistics. Prospective case-controlled studies and cost/benefit analyses of nurse-midwifery services could yield more definitive information. But until more precise data are collected for birth certificates, these studies will be difficult.