Enhancing the population impact of collaborative care interventions: mixed method development and implementation of stepped care targeting posttraumatic stress disorder and related comorbidities after acute trauma - 10/08/11
, Frederick Rivara, M.D., M.P.H. b, Gregory Jurkovich, M.D. c, Joan Russo, Ph.D. d, Sarah Geiss Trusz, B.A. e, Jin Wang, Ph.D. f, Amy Wagner, Ph.D. g, Kari Stephens, Ph.D. e, Chris Dunn, Ph.D. a, Edwina Uehara, Ph.D. h, Megan Petrie, B.A. e, Charles Engel, M.D., M.P.H. i, Dimitri Davydow, M.D. d, Wayne Katon, M.D. dAbstract |
Objective |
The objective of the study was to develop and implement a stepped collaborative care intervention targeting posttraumatic stress disorder (PTSD) and related comorbidities to enhance the population impact of early trauma-focused interventions.
Method |
We describe the design and implementation of the Trauma Survivors Outcomes and Support study. An interdisciplinary treatment development team was composed of trauma surgical, clinical psychiatric and mental health services “change agents” who spanned the boundaries between frontline trauma center clinical care and acute care policy. Mixed method clinical epidemiologic and clinical ethnographic studies informed the development of PTSD screening and intervention procedures.
Results |
Two hundred seven acutely injured trauma survivors with high early PTSD symptom levels were randomized into the study. The stepped collaborative care model integrated care management (i.e., posttraumatic concern elicitation and amelioration, motivational interviewing and behavioral activation) with cognitive behavioral therapy and pharmacotherapy targeting PTSD. The model was feasibly implemented by frontline acute care masters in social work and nurse practioner providers.
Conclusions |
Stepped care protocols targeting PTSD may enhance the population impact of early interventions developed for survivors of individual and mass trauma by extending the reach of collaborative care interventions to acute care medical settings and other nonspecialty posttraumatic contexts.
Le texte complet de cet article est disponible en PDF.Keywords : PTSD, Stepped collaborative care, Acute care, Population impact, Traumatic injury
Plan
| ☆ | This work was funded by grants MH073613 and MH086814 from the National Institute of Mental Health. The authors thank Jeffrey Love, B.A., for his assistance with the preparation of the manuscript. The views expressed in this article are those of the authors and do not reflect official policy or position of the Department of the Army, The Department of Defense, or any other U.S. Government agency or department. |
Vol 33 - N° 2
P. 123-134 - mars 2011 Retour au numéro
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