Results Summary
What was the research about?
Accidental injuries, such as serious burns or broken bones, are a major reason why children go to the hospital. After their bodies heal, children sometimes have social or emotional problems that remain. It can be hard for parents to know how to talk to their children to help them get better.
In this study, the research team compared two ways to help parents talk to their child after a serious injury:
- The Link for Injured Kids program. Before leaving the hospital, parents watched a video and received training about talking with their children about their injury.
- Trauma education. As they left the hospital, parents received a booklet with tips on talking with their children.
The team looked at children’s symptoms of posttraumatic stress disorder, or PTSD, and depression. They also looked at quality of life, emotional problems, and behaviors like how children act around their peers.
What were the results?
After six months, the two approaches didn’t differ in the children’s symptoms of PTSD and depression. In both approaches, children had fewer PTSD and depression symptoms.
Compared with children of parents who received trauma education, children of parents in the Link program had slightly fewer behavior problems. Quality of life was similar for both approaches.
Who was in the study?
The study included 314 parent-child pairs. Children were ages 10 to 17 and had been in the hospital because of an accident. Of the children, 86 percent were white, 4 percent were African American, 6 percent were another race or more than one race, and 3 percent didn’t report a race. Also, 8 percent were Hispanic. The average age was 14, and 63 percent were boys.
What did the research team do?
While parents were still at the hospital, the research team assigned parents by chance to either the Link program or trauma education. After six weeks, parents in the Link program received a follow-up training. Parents in the trauma education group got a new booklet if they needed one. Parents and children in both groups filled out surveys at the hospital and again at six weeks, three months, and six months later.
Patients, caregivers, doctors, and people working in community health gave input on the study.
What were the limits of the study?
This study took place in one state. Findings may differ in other places.
In future studies, researchers could look at other programs that help improve social and emotional problems for children with accidental injuries.
How can people use the results?
Hospitals and doctors can use these results when looking for ways to help parents talk to their child after an injury.
Professional Abstract
Objective
To compare the effectiveness of the Link for Injured Kids (Link) training program versus a trauma education booklet for preparing parents to help their children recover socially and emotionally after an unintentional injury
Study Design
| Design Elements | Description |
|---|---|
| Design | Randomized controlled trial |
| Population | 314 parent-child dyads; children were ages 10–17 years and hospitalized for an unintentional injury |
| Interventions/ Comparators |
|
| Outcomes |
Primary: child’s PTSD symptoms, child’s depression symptoms Secondary: child’s quality of life, emotional problems, conduct problems, behavior around peers, hyperactivity/inattention, prosocial behavior |
| Timeframe | 6-month follow-up for primary outcomes |
This randomized controlled trial compared two approaches for educating parents about how to support their children after hospitalization for an accidental injury:
- Link program. At the hospital, parents watched a video and received an in-person training conducted by a researcher. The training provided parents with techniques for speaking with their child after an injury, identifying signs of distress, and obtaining more care for their child if needed.
- Trauma education booklet. As they left the hospital, parents received an educational booklet with information about children’s normal reactions to accidents, how parents can cope and help their child cope, and a list of medical resources.
After six weeks, parents in the Link program received a follow-up training, and parents who received trauma education could get another booklet if needed.
The study included 314 parent-child dyads; children were ages 10–17 and had been admitted to one of four midwestern hospitals for an unintentional injury, such as a serious burn. Of the children, 86% were white, 4% were African American, 6% were another race or more than one race, and 3% did not report a race; 8% were Hispanic. The average age was 14, and 63% were male.
Researchers randomly assigned parents to one of the two approaches. Parents and children completed questionnaires at baseline and again at six weeks, three months, and six months posthospitalization.
Patients, caregivers, healthcare providers, and community health representatives provided input throughout the study.
Results
After six months, the two approaches did not differ significantly on the primary outcomes. Children of parents in both groups showed similar, statistically significant reductions in symptoms of posttraumatic stress disorder (PTSD) and depression.
Compared with children who received the trauma education booklet, children in the Link program had slightly better conduct (p=0.03) and peer behaviors (p=0.03). The two groups did not differ on any other secondary outcomes.
Limitations
Although children in both groups experienced symptom reductions, without including an untreated arm, this study could not establish that the changes from before to after the interventions were a result of those interventions. This study took place in one state; results may differ in other parts of the country.
Conclusions and Relevance
In this study, children in the two groups did not show differences in PTSD and depression symptoms. However, children of parents who received Link training had fewer conduct problems and fewer problems with peer relationships than those whose parents received the trauma education booklet.
Future Research Needs
Future research could explore other interventions that work to improve social and emotional problems, specifically PTSD, among children with unintentional injuries.
Final Research Report
View this project's final research report.
Journal Citations
Results of This Project
Related Journal Citations
Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:
- The reviewers said it was not clear whether either of the two interventions was more effective than no intervention. The researchers acknowledged the limited evidence for the efficacy of the interventions but noted that psychoeducation has been found to be more effective than no treatment in previous studies. The researchers added information about prior efficacy studies of psychoeducation and the Link for Injured Kids program to the background section of the report. They also noted that focus groups identified a need for more support for injured children and their parents, so doing nothing seemed insensitive since it was not guaranteed that children would recover naturally over time.
- The reviewers asked about the exclusion of various categories of trauma patients, such as those with intellectual disabilities, mental illness, or patients who did not speak English. The researchers acknowledged the limited racial and ethnic diversity of study participants, commenting that the homogeneity of participants was unsurprising given the Midwestern sites of the study. The study criteria excluded children with severe mental illness and intellectual disabilities because they might have not been able to complete the self-administered questionnaires, and their responses may not have been reliable. Spanish-speaking families were not included because materials had not been translated and tailored for them.
- The reviewers wondered if the sample size was adequate to test differences between rural and urban patients. The researchers said they did not meet their recruitment goals for the rural sample, and therefore, they did not have the statistical power to address all the questions they planned.
- The reviewers commented that the participation rate in the study was low and that the loss to follow-up was substantial. The researchers argued that the participation rate was reasonable based on the number of eligible subjects, and the rate of loss to follow-up was within the expected range for a trauma study.