Implementation of a stepped care program to address posttraumatic stress disorder and depression in a Level II trauma center

• Published in: Injury Vol. 54; no. 9; p. 110922
• Main Authors: Espeleta, Hannah C., Litvitskiy, Nicole S., Higgins, Kristen, Ridings, Leigh E., Bravoco, Olivia, Jones, Seon, Ruggiero, Kenneth J., Davidson, Tatiana
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-09-2023
• Subjects: Adult; Depression - epidemiology; Depression - prevention & control; Engagement; Humans; Level II; Mental Health; Referral and Consultation; Stepped-care; Stress Disorders, Post-Traumatic - epidemiology; Stress Disorders, Post-Traumatic - prevention & control; Trauma center; Trauma Centers; Engagement; Stepped-care; Trauma center; Mental health; Level II
• ISSN: 0020-1383; 1879-0267; 1879-0267
• DOI: 10.1016/j.injury.2023.110922

•Trauma patients have significant unmet mental health needs.•Mental health services must be tested for trauma center scalability and sustainability.•The Trauma Resilience and Recovery Program (TRRP) is a stepped-care mental health model.•Patient engagement in TRRP at a Level II trauma center was moderate to high for people experiencing mental health concerns.
The Trauma Resilience and Recovery Program (TRRP) is a technology enhanced model of care that includes education, screening, and service referrals to address posttraumatic stress disorder and depression following traumatic injury. TRRP has shown high rates of engagement at a Level I trauma center, but Level II centers have fewer resources and face more challenges to addressing patients’ mental health needs.
We utilized clinical administrative data to examine engagement in TRRP in a Level II trauma center with 816 adult trauma activation patients.
Most patients (86%) enrolled in TRRP, but only 30% completed screens during a 30-day follow-up call. Three-quarters of patients who endorsed clinically significant symptoms accepted treatment recommendations/referrals.
Engagement at each step of the model was lower than previously reported in a Level I center. Differences likely correspond to lower rates of mental health symptoms in the trauma patients at this setting. We discuss program adaptations that may be needed to improve patient engagement.