This study proposes to examine the rate, severity, and clinical course of psychiatric disorders, the rate of functional deficits, and the pattern of services, across service sectors, used by adolescents seeking emergency medical care for injuries. The main objective is to gain understanding of the extent of the unmet service need and barriers to service access for traumatized adolescents. The four specific aims are: 1) To examine differences between adolescents using the Emergency Room for injuries and adolescents using the ER for reasons other than injuries in the rate and severity of selected psychiatric symptoms and functional deficits; 2) To examine group differences in services used in the year prior to the event and track services used and it's relationship to psychiatric disorders in the year following the event; 3) To track group differences in the rates of violence recidivism and risk-taking and their relation to psychiatric disorders in the year following the event; 4) To examine parents' and children's attitudes and preferences about services in order to understand barriers to access. The design is a one-year tracking of three groups of 120 (Total 360) 12 to 17 year-olds seeking services at the Emergency Room of a large regional pediatric trauma center for three different reasons: a) physical injuries related to intentional violence; b) physical injuries secondary to unintentional events (""""""""accidents""""""""); and c) reasons other than injury (control). Structure interviews of the adolescent and of his/her parent will be done soon after the injury, after 6 months, and after 12 months (three interviews). The focus of interviews is to elicit information about psychiatric symptoms, indicators of functional deficits, recurrence of violence, risk behaviors, and services used. Another component includes focus groups of similar children and of their parents, to explore factors that may affect their decisions to seek mental health services. Guided by key concepts from clinical psychiatry, the Theory of reasoned Action, the Health Belief Model and the Behavioral Model for Service Use three main hypotheses emerge: 1) More psychiatric symptoms (e.g. PTSD), deficits in functioning will be observed among injured subjects; 2) More mental health services and other services will be used by injured subjects if subjects perceive themselves as in need of services, have an expectation that services will be beneficial, and perceive less access barriers; and, 3) More violence re-exposure and risk-taking will be observed among injured subjects. These comparisons will be also made between the intentionally and the unintentionally injured groups. By defining a high risk population that potentially could be targeted for interventions in the ER by understanding the needs, what services they get and what services they should get, the proposed study is likely to make a substantial contribution to the fields of trauma related adolescent clinical and mental health services research. The potential contribution is both practical and academic. The use of a prospective design with state of the art instrumentation and focus groups will provide a research database that will facilitate and stimulate intervention research.
