Link for Injured Kids and Trauma Education: A Comparative Effectiveness Study of Two Parent-Based Interventions to Support Children After Traumatic Injury

Background: A comparative effectiveness trial tested two parent-based interventions in improving the psychosocial recovery of hospitalized injured children: 1) Link for Injured Kids (Link), a program of psychological first aid that teaches parents motivational interviewing and stress screening skills, and 2) Trauma Education, based on an informational booklet about trauma, its impacts and resources. Methods: A randomized controlled trial was conducted in four children’s hospitals in the Midwestern United States. 10-17 year old children admitted for an unintentional injury and a parent were recruited and randomly assigned to Link or Trauma Education between 1/2015-7/2017. Link parents were trained in motivational interviewing based communication and screening skills; Trauma Education parents received an educational booklet. Parents and children completed questionnaires at baseline, six weeks, three months, and six months post-hospitalization. Using an intent to treat analysis, changes in child-reported symptoms of posttraumatic stress (PTSS), depression, quality of life and child behaviors were compared between intervention groups.  This study is registered at ClinicalTrials.gov (ID: NCT02323204, Unique Protocol ID: 201111728). The trial is currently closed. Findings: Of 795 injured children, 314 children and their parents were enrolled into the study (40%). Link and Trauma Education improved PTSS, depression and pediatric quality of life at similar rates over time. However, unlike those in Trauma Education, children in the Link group had notable improvement of child emotional behaviors, and mild improvement of conduct and peer behaviors.  Link was also slightly more effective than Trauma Education in improving conduct behaviors in rural compared to urban children. Interpretation: Although both programs improved post-trauma symptoms, Link, which interacted with parents to teach communication and referral skills, was more effective in reducing problem behaviors. Trial Registration: This study is registered at ClinicalTrials.gov (ID: NCT02323204, Unique Protocol ID: 201111728). Funding Statement: The Patient-Centered Outcomes Research Institute (PCORI) funded this research. Declaration of Interests: All authors have no reported conflicts of interest. Ethics Approval Statement: Study procedures conducted at the University of Iowa Stead Family Children’s Hospital and Children’s Mercy Hospital Kansas City were approved by the University of Iowa Institutional Review Board (IRB ID# 201111728, reliance IRB#: 14110518). Study procedures conducted at Blank Children’s Hospital and Children’s Minnesota were approved by their respective Institutional Review Boards (ID number IM2014-029, IRB number 1602-010).