Transitioning a technology-assisted stepped-care model for traumatic injury patients to a fully remote model in the age of COVID-19

ABSTRACT

Each year nearly three million individuals require inpatient hospitalization following a traumatic injury (e.g. gunshot wounds, injuries sustained in motor vehicle collisions, burns) in the United States. Approximately 20–40% of these individuals go on to develop posttraumatic stress disorder and/or depression one-year post-hospitalization. Despite the high rate of psychological morbidity in this population, the vast majority of hospitals do not address the emotional or behavioral health needs of this population. The Trauma Resilience and Recovery Program, a technology-assisted stepped-care program, was developed to address these needs in one hospital system and to create a scalable model. Telepsychotherapy is a key part of this model due to the unique needs of this population, including trauma center catchment area and barriers due to physical injury. This manuscript describes the use of telepsychotherapy to deliver evidence-based interventions to traumatic injury patients across the lifespan, presents challenges created by the COVID-19 outbreak, as well as efforts to address these challenges, adaptations to our training model, and considerations for the use of telepsychotherapy in the age of COVID-19 and beyond. The goal is to present a model for remote screening and treatment of individuals that can be applied to other settings and populations.

KEYWORDS:

• Telepsychotherapy
• traumatic injury
• posttraumatic stress
• depression

Acknowledgments

The Trauma Resilience and Recovery Program is supported by funding from the Medical University of South Carolina Center for Telehealth and South Carolina Telehealth Alliance . The development of this publication also was supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services as part of the National Telehealth Center of Excellence Award (U66 RH31458-01-00). Dr. Ruggiero is supported by the SmartState South Carolina Centers of Economic Excellence. Dr. Davidson is supported by an award from The Duke Endowment (*removed for blind review*).

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Duke Endowment [6657-SP]; Health Resources and Services Administration [U66 RH31458-01-00].

Notes on contributors

Margaret T. Anton

Dr. Margaret T. Anton is a postdoctoral scholar in the Technology Applications Center for Healthful Lifestyles at the Medical University of South Carolina. Dr. Anton’s research broadly focuses on the use of digital technology to improve access and quality of youth mental health care. She is interested in understanding how to improve the implementation and sustainability of technology-enhanced interventions and examine the impact of these tools on broader mental health service delivery.

Leigh E. Ridings

Dr. Leigh E. Ridings is a licensed clinical psychologist and Assistant Professor at the Medical University of South Carolina. She is the Associate Director for Child and Family Services for the Trauma Resilience and Recovery Program at MUSC. Her research focuses on development and evaluation of scalable, sustainable health interventions to address the mental health, well-being, and recovery needs of children and families affected by traumatic events.

Yulia Gavrilova

Dr. Yulia Gavrilova is a postdoctoral scholar in the Department of Surgery and Trauma Resilience and Recovery Program at MUSC. Dr. Gavrilova’s research focuses on development, evaluation, and dissemination of culturally-tailored interventions for populations that underutilize mental health services. She is interested in technology-assisted evidence-based interventions aimed to increase access to services for underserved populations and improve outcomes.

Olivia Bravoco

Olivia Bravoco, B.S., is a Program Manager at the Medical University of South Carolina. She manages clinical operations and staff training for the Trauma Resilience and Recovery Program. She also provides support to several grant funded research projects within the College of Nursing that center around the development and evaluation of technology supported mental health resources for adults and children.

Kenneth J. Ruggiero

Dr. Ken J. Ruggiero is Professor and SmartState Endowed Chair at the Medical University of South Carolina, where he serves as Director of the Technology Applications Center for Healthful Lifestyles. His work centers on improving access and quality of mental health care to vulnerable and underserved populations, particularly children and adults who have been affected by traumatic events such as disasters, serious injury, child abuse, and occupational incidents. This includes research on self-help apps for disaster victims, technology-enhanced treatments for survivors of traumatic injury, and resources for firefighters who experience critical incidents. We also work closely with a number of community mental health service agencies to help mental health providers improve their quality of care with children.

Tatiana M. Davidson

Tatiana M. Davidson, Ph.D., isAssociate Professor of Nursing at the Medical University of South Carolina. Dr. Davidson is Co-Director of the Trauma Resilience and Recovery Program, which provides screening and direct mental health care services, including telehealth, to individuals who have experienced traumatic injury.Dr. Davidson’s research has focused on maximizing reach and receipt of evidence-based mental health treatments among trauma-affected populations through the development, evaluation, and dissemination of innovative, technology-enhanced resources.