Reducing the Disproportionate Burden of Orofacial Injury

University Of California Los Angeles, Los Angeles CA

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Abstract

DESCRIPTION (provided by applicant): 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.