Symposia
Trauma and Stressor Related Disorders and Disasters
Zachary Adams, Ph.D.
Assistant Professor of Psychiatry and Clinical Psychology
Indiana University
Carmel, Indiana
Brigid Marriott, Ph.D.
Postdoctoral Fellow
Indiana University School of Medicine
Indianapolis, Indiana
Swathi Karra, M.S.
Clinical Research Specialist
Indiana University School of Medicine
Indianapolis, Indiana
Elizabeth Linhart-Musikant, BS
Clinical Research Specialist
Indiana University School of Medicine
Indianapolis, Indiana
Introduction: The U.S. opioid crisis – named a public health emergency in 2017 – resulted in record high overdose deaths in 2021, leading to calls for novel intervention strategies. Traumatic injury increases risk for behavioral health disorders, and many trauma patients receive opioid pain medications that can increase addiction risk. Yet routine monitoring of patients’ mental health and substance use post-hospital discharge is rare. The Telehealth Resilience and Recovery Program (TRRP), a technology-facilitated stepped-care program developed to target posttraumatic stress and depression, may be adapted to address this gap. This study 1) used an iterative, user-guided approach to adapt TRRP to address opioid and substance use in addition to mental health concerns, and 2) evaluated the novel content and procedures developed in an open feasibility trial.
Methods: Semi-structured interviews were conducted with young people discharged from trauma centers (n=20) and trauma healthcare providers (n=15) and analyzed to guide new TRRP substance use content and procedures. Adolescents and young adults (aged 12-30) from Level 1 Trauma Centers were recruited to participate in open trial of the program.
Results: Themes identified in the qualitative interviews (i.e., gaps in care, automation), guided TRRP enhancements: 1) expanded education on recovery including a multimedia, web-based, mobile education application on opioid use disorder-related topics; 2) daily text message check-ins for 60 days to monitor behavioral health recovery; 3) 30-, 60-, 90-, and 180-day mental health and substance use screens; and 4) providing treatment referral if indicated. Ninety-one adolescents (n = 79) and young adults (n = 12) enrolled in the TRRP program (step 1). Most participants completed more than half of the daily text messages (71.4%; step 2). Around 87% of participants completed at least one mental health screen (step 3), with 45.1% screening positive on one of the mental health or substance use screens (36.3% PTSD, 29.7% for depression, 26.4% anxiety, 4.4% substance use). Almost all participants who screened positive (92.7%) engaged in follow-up calls about resources and referrals (step 4).
Conclusions: This iterative, user-guided approach yielded novel TRRP content and procedures to target opioid and substance use risk in addition to mental health concerns. Findings showed comparable rates of engagement in the enhanced program to previous studies. Implications for using stepped-care programs to target substance use will be discussed