Screening & Secondary Prevention Screening & Secondary Prevention of Traumatic Stress after Injury of Traumatic Stress after Injury Flaura Winston, MD, PhD Nancy Kassam-Adams, PhD Angela Marks, MSEd TraumaLink, Children’s Hospital of Philadelphia Funded by: Maternal & Child Health Bureau (MCHB) Emergency Medical Services for Children Program (EMSC)
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Screening & Secondary Prevention Screening & Secondary Prevention of Traumatic Stress after Injuryof Traumatic Stress after Injury
Flaura Winston, MD, PhD
Nancy Kassam-Adams, PhD
Angela Marks, MSEd
TraumaLink, Children’s Hospital of Philadelphia
Funded by:
Maternal & Child Health Bureau (MCHB)
Emergency Medical Services for Children Program (EMSC)
Easy-to-use (89%), Length OK (97%) Discomfort with asking perceived life threat (33%)
Validity: In ED, general injury population?
NoLessons learned: In-patient screening doesn’t translate to ED Format OK Review wording
2. Systematic follow-up2. Systematic follow-up
Transition to primary care when emergency / acute care is complete Mail info with discharge letter Automated electronic alerts as part of EMD
Goals for child’s next primary care encounter Ask: How are you doing now? Provide info and anticipatory guidance Monitor or refer as appropriate
Primary MD trainingPrimary MD training
2a. Trauma d/c letter2a. Trauma d/c letterTrauma surgeon as educator Included with trauma d/c letter
Paragraph “I would like to highlight the importance of addressing traumatic stress in all injured patients…”
Brochure & patient handout
Lessons learned: Well-received by MDs
2b. Prompted screening via EMR2b. Prompted screening via EMR
Products developed: Primary Care MD alert to recent injury Template with prompts, dx, & handoutLessons learned: Alerts not noticed (generic problem with EMR) Too long (time pressure), Unease (limited referrals) Shorten length, limit role of MD, clear action plan
Generally well-functioning child and family
UNIVERSAL
SELECTIVESome risk factors present
Persistent distress
MH intervention
INDICATED
Minimize potentially traumatic aspects of medical care Provide general support & information Promote child / family positive coping Screen (in healthcare setting) for indicators of higher risk
Follow-up several wks post-injury Anticipatory guidance Referral if distress / risk persists