The proposed study extends data from our precursor studies showing that orofacial injury disproportionately affects vulnerable populations with great personal and health care consequences. Although the injury commonly derives from antecedent behaviors, particularly substance use, little screening or intervention is attempted as part of conventional trauma care. By weaving antecedent behavior-specific interventions into the fabric of orofacial injury care, we may be able to decrease adverse consequences, reduce the high rates of repeat injury, and preserve limited health care resources. We propose to conduct a two-arm randomized controlled study to test the effectiveness of an innovative personalized motivational intervention aimed at reducing substance use, improving treatment outcomes, and decreasing recurrent injury. The intervention will be tailored to the service needs of each patient and will employ motivational intervention techniques to effect behavioral change. In addition, it will be culturally appropriate and feasible to implement in a trauma center context. Approximately 720 orofacial injury patients evidencing substance use and other risky behaviors will be assigned to either a Personalized Motivational Intervention (PMI) Treatment group or a Health Information (HI) """"""""attention control"""""""" group.
Specific aims are as follows: 1) test the effectiveness of a personalized motivational intervention (PMI) in promoting recovery from the initial injury, reducing antecedent behavioral problems, and reducing psychological distress; 2) test the effectiveness of the PMI in decreasing occurrence and severity of re-injury and increasing time to any re-injury; 3) determine whether the PMI's effects on re-injury are mediated by recovery from the initial injury, reduced behavioral problems, and reduced psychological distress; 4) perform a cost-offset analysis of the PMI and, in the absence of cost-neutrality, perform a cost-effectiveness analysis. We hypothesize that by integrating into trauma care a personalized assessment of alcohol drug, psychological, and other service needs, plus active service referrals in a motivational intervention approach, we will significantly reduce the adverse consequences of orofacial injury, improve treatment outcomes, and decrease rates of re-injury, thus off-setting-intervention costs.
| Shetty, Vivek; Murphy, Debra A; Zigler, Corwin et al. (2011) Randomized controlled trial of personalized motivational interventions in substance using patients with facial injuries. J Oral Maxillofac Surg 69:2396-411 |
| Zigler, Corwin M; Belin, Thomas R (2011) THE POTENTIAL FOR BIAS IN PRINCIPAL CAUSAL EFFECT ESTIMATION WHEN TREATMENT RECEIVED DEPENDS ON A KEY COVARIATE. Ann Appl Stat 5:1876-1892 |
| Shetty, Vivek; Yamaguchi, Masaki (2010) Salivary biosensors for screening trauma-related psychopathology. Oral Maxillofac Surg Clin North Am 22:269-78 |
| Shetty, Vivek; Marshall, Grant N (2010) Preface: collaborative care of the facial injury patient. Oral Maxillofac Surg Clin North Am 22:ix-xii |
| Murphy, Debra A (2010) Substance use and facial injury. Oral Maxillofac Surg Clin North Am 22:231-8 |
| Murphy, Debra A; Shetty, Vivek; Zigler, Corwin et al. (2010) Willingness of facial injury patients to change causal substance using behaviors. Subst Abus 31:35-42 |
| Wong, Eunice C; Marshall, Grant N (2010) Barriers to the collaborative care of patients with orofacial injury. Oral Maxillofac Surg Clin North Am 22:247-50 |
| Belin, Thomas R (2009) Missing data: what a little can do, and what researchers can do in response. Am J Ophthalmol 148:820-2 |
| Murphy, Debra A; Shetty, Vivek; Resell, Judith et al. (2009) Substance use in vulnerable patients with orofacial injury: prevalence, correlates, and unmet service needs. J Trauma 66:477-84 |
| Gironda, Melanie W; Der-Martirosian, Claudia; Belin, Thomas R et al. (2009) Predictors of depressive symptoms following mandibular fracture repair. J Oral Maxillofac Surg 67:328-34 |
Showing the most recent 10 out of 17 publications
