Concussion
Conditions
Keywords
concussion, telehealth, access to care, children, adolescents
Brief summary
Specialty concussion care can help youth recover more quickly but many youth face barriers to accessing concussion specialists. A care delivery model whereby concussion specialists are available to co-manage injuries with primary care pediatricians via telehealth can close the gap that currently exists in delivering specialty care to more youth. The long-term objective and intended impact of this project is to disseminate a care delivery model and manualized behavioral health intervention that can be widely deployed to make specialty concussion care accessible to more youth and earlier following their head injury.
Detailed description
Youth who receive specialty concussion care recover more quickly. Unfortunately, specialty concussion care is not accessible to all children and adolescents. Initial studies suggest that delivering specialty concussion care via telehealth is feasible and effective, however, available studies have been conducted in specialty clinics. As noted, there are barriers accessing specialty concussion clinics and furthermore youth with concussion most frequently initiate care with their primary care provider. The objective of this study is to pilot an innovative care delivery model whereby a concussion specialist provides telehealth-based consultations to co-manage concussions with primary care pediatricians. The care delivery model is a manualized intervention for the first four weeks following pediatric concussion, called Specialist and Pediatrician Co-Management for Early and Effective Concussion Care Delivery to Hasten Your Recovery or SPEEDY Recovery. The intervention includes: 1) behavioral symptom management strategies including recommendations for headaches, sleep difficulty, emotional health/stress reduction, and cognitive symptoms, individualized for each youth based on their symptoms, 2) guidance to support school reintegration following concussion (e.g., study strategies, symptom management strategies for school, documentation for time-limited accommodations to support recovery), and 3) guidance to return to sports (if relevant). The aims of this project are to pilot the feasibility, acceptability, and credibility of the SPEEDY RECOVERY program as well as to determine potential implementation barriers and examine patient, caregiver, and pediatrician perceptions of the program. A pilot trial will recruit 10 pediatric patients with recent concussion (presenting to their primary care provider within 5 days of injury) from an urban, hospital-based pediatric primary care clinic that serves predominantly under-resourced youth and families and that does not have an affiliated concussion specialist. The intervention will be delivered via once weekly telehealth visits with a concussion specialist (neuropsychologist) until youth are recovered (youth and caregivers report resolution of concussion-related symptoms and return to normal state of health) or up to 4 weeks post injury (at which point recovery will be deemed prolonged and youth will be referred to appropriate rehabilitation services). Exit interviews will be conducted with youth and their caregivers at the final visit. Additionally, pediatricians in the practice will be surveyed at the end of the study regarding successes and opportunities for improving the program as well as reasons why they referred or did not refer patients. The youth, caregiver, and provider feedback will inform improvements and refinements to the design and implementation details to maximize the relevance and benefits of the program. The long-term objective is to disseminate a care delivery model and manualized behavioral health intervention that can be widely deployed to make specialty concussion care accessible to more youth and earlier following their head injury.
Interventions
BEHAVIORALSpecialist and Pediatrician Co-Management for Early and Effective Concussion Care Delivery to Hasten Your Recovery (SPEEDY Recovery)
The SPEEDY Recovery program is a novel, concussion-specialist telehealth consultation and co-management intervention for the first 4 weeks post injury. The program involves a concussion specialist (clinical neuropsychologist) meeting with a youth and caregivers once per week via telehealth to provide: 1) behavioral health symptom management strategies including recommendations for headaches, sleep difficulty, emotional health/stress reduction, and cognitive symptoms, individualized for each youth based on their symptoms, 2) guidance to support school reintegration following concussion (e.g., study strategies, symptom management strategies for school, documentation for time-limited accommodations to support recovery), and 3) guidance to return to sports (if relevant). The intervention is designed to be delivered via HIPPA compliant Zoom, which allows participants to join the virtual meetings/sessions from any internet-connected device (e.g., computer, tablet, smartphone).
Sponsors
University of Rhode Island
Hasbro Children's Hospital
Rhode Island Hospital
The Warren Alpert Medical School of Brown University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
8 Years to 17 Years
Healthy volunteers
No
Inclusion criteria
* youth aged 8 to 17 * At least one parent/caregiver present and willing to participate * English proficiency * access to an internet connected device, * within 5 days of injury
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| SCAT6 Symptom Questionnaire | Initial visit (within 5 days of injury), once per week through study completion (up to 4 weeks post injury) | The SCAT6 Symptom Evaluation(for youth 13 and older) is a self-report measure of the presence and severity of 22 symptoms associated with concussion. Scores can range from 0 to 132. Higher scores represent worse symptom severity. |
| ChildSCAT6 Symptom Questionnaire | Initial visit (within 5 days of injury), once per week through study completion (up to 4 weeks post injury) | The ChildSCAT6 Symptom Evaluation (for children ages 8 to 12) is a self-report measure of the presence and severity of 21 symptoms associated with concussion. Scores can range from 0 to 63. Higher scores represent worse symptom severity. |
| Credibility and Expectancy Questionnaire (CEQ) | Final Study Visit (up to 4 weeks post injury) | The Credibility and Expectancy Questionnaire (CEQ) assesses how believable, convincing, and logical patients perceive the treatment to be. Scores can range from 6 to 54. Higher score represent greater confidence and higher optimism in the treatment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| SCAT6 Cognitive Screening | Initial Visit (within 5 days of injury) and Final Visit (up to 4 weeks post injury) | The SCAT-6 Cognitive Screening (ages 13 and older) is a clinician-administered composed of 4 tasks: orientation, immediate memory, concentration, and delated memory. Scores can range from 0 to 50. Higher scores represent better cognitive functioning. |
| ChildSCAT6 Cognitive Screening | Initial visit (within 5 days of injury) and Final Study Visit (up to 4 weeks post injury) | The ChildSCAT-6 Cognitive Screening (ages 8 to 12) is a clinician-administered composed of 4 tasks: orientation, immediate memory, concentration, and delated memory. Scores can range from 0 to 50. Higher scores represent better cognitive functioning. |
| GAD-7 | Initial Visit (within 5 days of injury) and Final Visit (up to 4 weeks post injury) | The GAD-7 is a 7-item questionnaire assessing anxiety symptoms within the past 2 weeks. Youth aged 11 and older will provide their self-report. For children ages 8 to 10, caregivers will complete this measure indicating how often their child has exhibited the symptoms. Scores can range from 0 to 21. Higher scores represent more/worse anxiety. |
| PHQ-9 | Initial Visit (within 5 days of injury) and Final Visit (up to 4 weeks post injury) | The PHQ-9 is a 9-item questionnaire assessing depression symptoms within the past 2 weeks. Youth aged 12 and older will provide their self-report. For children ages 8 to 11, caregivers will complete this measure indicating how often their child has exhibited the symptoms. Score can range from 0 to 27. Higher scores represent more/worse depression. |
| Concussion Learning Assessment & School Survey, 3rd Edition (CLASS-3) | Initial Visit (within 5 days of injury) and Final Visit (up to 4 weeks post injury) | The Concussion Learning Assessment \& School Survey, 3rd Edition (CLASS-3) is a scale to assess and identify clinical problems and needs related to returning to school following concussion. There are self- and parent-report versions. Scores can range from 0 to 67. Higher scores represent greater levels of academic difficulty, distress, and impairment. |
Countries
United States
Contacts
CONTACTNathan Cook, Ph.D.
Outcome results
None listed