Stepped collaborative care for pain and posttraumatic mental health in the Victorian regionalised trauma system

While Victoria’s regionalised trauma system has improved survival rates and functional outcomes after traumatic injury, my research evaluating recovery trajectories after major trauma has shown that two thirds of people report persistent or worsening problems with mental health and pain over the first two years post-injury, and most do not receive timely treatment for those problems. Pain and mental health conditions are among the most prevalent primary causes of disability post-injury and often lead to secondary problems including distress, suicidality, substance abuse, inappropriate health service use (e.g., ambulance and emergency admissions), and socioeconomic disadvantage making them key national health research priorities.

The need for preventive interventions for mental health and pain is well established. My project will trial a stepped care case management intervention developed by my collaborator Professor Zatzick (Uni. of Washington) that has been so successful in the US trauma system that it is now being trialled nationally. In brief, the intervention provide centralised case management to facilitate proactive and timely treatment of mental health for "at risk" patients after traumatic injury. I am seeking to demonstrate whether the US model will work in the Victorian trauma system through this proof of concept project before seeking funding for a large scale project.

Recently I evaluated regional patterns of treatment access for mental health and pain after transport injury and found that, although we know that the major trauma incidence is 1.5 times higher for Victorians living in regional areas compared with metropolitan areas, treatment access rates were about half the rate for regional Victorians versus urban dwellers. In fact residents in several regions did not access pain or mental services at all.

As a quarter of major trauma patients live in regional areas, and areas of socioeconomic disadvantage, it is important that early interventions optimise accessibility regardless of geographic, socioeconomic and psychological barriers by providing treatment in the patient’s community, and using eHealth (e.g., telehealth) where service availability or accessibility is a barrier.

Through partnership with key trauma system stakeholders, and engagement with trauma registries and health system experts, my project seeks to generate evidence to trial an intervention that has high potential for adoption in the Victorian trauma system, which will prepare a competitive NHMRC partnership, synergy, or investigator grant, as CIA, to undertake a multisite trial involving major trauma, metropolitan trauma and regional trauma services.

This project aims to:
1. Establish partnerships and resources to implement and evaluate stepped care case management.
2. Demonstrate intervention effectiveness onpain & posttraumatic stress symptoms, feasibility, acceptability, and reach for Victorian major trauma services.