Supervisory Neglect, Non-Accidental Trauma, Brief Intervention, and Treatment Referral (SunBrite)

SunBrite is a novel, evidence-based intervention for non-accidental trauma (NAT) that has not, as yet, been implemented in any health care setting. Current programs targeting NAT vary widely, and there is insufficient research to conclude that these efforts have reduced re-admission rates(12,13). EDs primarily screen for risk factors associated with child abuse, focusing on their role in reporting and developing forensic evidence for investigations but not on risk reduction. While such efforts as embedding child protection teams in trauma programs are a starting point, much more needs to be done to develop a standard of care and empirically demonstrate efforts that reduce the risk of subsequent injury.

The overlap between non-accidental trauma (NAT) and inadequate caregiver supervision provides an opportunity to identify and intervene during earlier health care visits for children at risk for severe or fatal injury. Because head injuries account for over 80% of all suspected non-accidental injuries and over 90% of fatalities in the pediatric population, this intervention specifically targets all children ages 0-2 years who present in the Phoenix Children's Hospital (PCH) ED with a diagnosed head injury of any kind not resulting from a motor vehicle collision (MVC). These injuries include, but ae not limited to, abrasions, contusions, hematoma, ischemia, fractures, swelling or bruising. In this way, SunBrite expands the scope of detection for NAT to include injuries resulting from supervisory neglect.

PCH will implement the SunBrite pilot protocol in collaboration with key community partners who will be extensively involved in project design, implementation, and evaluation. In preparation for study recruitment, PCH and its partners will formalize the SunBrite process, create a curriculum, draft training tools to support the fidelity of SunBrite, finalize study materials (e.g., worksheets, data collection forms, interview scripts, consent documentation, and logic model), and conduct professional training. Once development is complete, pediatric patient families will be enrolled into the pilot program.

SunBrite study will utilize a simple, randomized, prospective study design, with 221 eligible pilot study participants randomized upon triage to one of two study arms: the control arm (73 families) or the treatment arm (148 families). Families in the control group will receive treatment as usual (TAU), which includes reporting to child welfare agencies when appropriate. In the treatment group, the patient/family will receive the SunBrite protocol, whose components include a screening, a brief intervention based in motivational interviewing (MI) techniques, and referral to treatment. All abuse and neglect, no matter the study arm, will be reported in accordance with hospital policy, federal and state laws.

All self-identified primary caregivers (legal guardians or parents) of children ages 0-2 who present in the PCH ED with a diagnosed intracranial injury will be automatically screened for eligibility. Caregivers will be initially screened by ED clinicians (e.g., physicians, nurse-practitioners) for eligibility based on age, injury (head), and method of injury (MOI) (non-MVC) using a standard clinical interview currently in place. All caregivers who screen positive based on these three criteria will then be deemed eligible for SunBrite. A trauma social worker will be notified by the ED that they have an eligible patient for consult. The social worker will meet the family and briefly describe the study and their eligibility. If they are willing to participate, the social worker will then obtain informed consent. All patient families will be fully consented in person in English or Spanish.