Implementation of multi-tier approach to psychological intervention after traumatic injury (MAP-IT) model

Injury survivors face elevated risk of developing psychopathology, underscoring the urgent need for screening and treatment of behavioral health concerns. This study examines the implementation of the Multi-tier Approach to Psychological Intervention after Traumatic Injury (MAP-IT) model for delivering behavioral health services to individuals with traumatic injuries.

The study was a retrospective cohort analysis at a midwestern, urban Level 1 Trauma Center. The Exploration, Preparation, Implementation, and Sustainment (EPIS) framework guided the implementation evaluation. During the program evaluation between 2019 and 2022, 11,059 patients were admitted for traumatic injuries. The MAP-IT model is a tiered intervention that includes screening using the Injured Trauma Survivor Screen (Tier 1), referral to consult for those at-risk (Tier 2), assessment of symptoms (Tier 3) and ongoing follow-up care (Tier 4). Feasibility, fidelity to program model, penetration, and sustainment were assessed.

Initial implementation occurred 2019-2020 and sustainment was evaluated from 2021 to 2022. In the implementation period, 2518 of the 5196 patients (48.46%) were screened, and 3770 patients (67.5%) were screened during the sustainment period. Consult volume grew from 163 in 2019 to 546 in 2022. Tier 4 care occurred with 52.69% (n = 303) of patients in 2019-2020 and 39.56% (n = 436) of patients in 2021-2022. Sustainability was also demonstrated by rates of hiring and retention as well as the increase in volume at each tier.

Between 2019 and 2022, the MAP-IT model was tracked to assess how behavioral health services were adopted, implemented, and sustained at a Level 1 trauma center. Data indicate the program can be sustained and is effective on patient-level outcomes.