O1031: Creating a Pediatric Trauma Quality of Life Clinic for Firearm-injured Youth Using Community-Engaged Qualitative Research

Background: Our level 1 pediatric trauma center treats an increasing number of firearm-injured children. Despite their multidisciplinary healthcare needs post-injury, current outpatient workflows result in siloed care and unmet needs. We hypothesized that a Community Advisory Board (CAB) would provide patient-, family- and community-centered perspectives on how a multidisciplinary Pediatric Trauma Quality of Life Clinic (PedsTQOL) can support patients’ holistic recovery.

Methods: The CAB included youth victims of firearm injury and their families, with representatives from 10 community organizations whose work involve vulnerable youth in the region. Healthcare providers, adult TQOL clinic experts, and members of our hospital-based violence intervention program also attended. The CAB met for 90 minutes monthly over 6 months in late 2023 and early 2024. Meetings were recorded and transcribed, after which they were reviewed and edited for accuracy. Transcribed transcripts were independently coded by two authors, who met on multiple occasions to discuss codes, to address discrepancies, and to create and iteratively revise the codebook. Themes were identified though reflexive thematic analysis and stratified by provider and patient-centered themes. Member checking was completed to ensure accuracy. A blueprint for a Pediatric TQOL clinic then created, informed by the thematic analysis and CAB recommendations.

Results: Patient-focused themes highlighted trust, communication, flexibility, and automatic services after discharge as important aspects of follow up clinic design (Figure 1). Patient-focused themes included the importance of peer and family support, mental health services, the role for a patient liaison, resource awareness and law enforcement interactions (Figure 2). The final clinic blueprint included: 1) a dedicate liaison to facilitate the transition from inpatient to outpatient care, 2) pre-scheduled clinic appointments within 5-14 days after discharge; 3) facilitating clinic attendance with an Automatic Trauma Bundle to include flexible clinic times, transportation assistance, and more. 4) strategically involving community resources like school therapists in patient recovery while respecting privacy.

Conclusion: The CAB provided insight into the optimal blueprint for a Pediatric TQOL clinic focused on multidisciplinary holistic care, trust and communication, the inpatient to outpatient transition, mental health and both peer and family support, and facilitating community resource utilization. Ultimately, the clinic was successfully established, guided by the vision of the patient, family, and community.