An implementation science approach to optimizing evidence-based treatments for posttraumatic stress disorder (PTSD) for non-specialty settings

项目总结 背景：估计有33%-46%的客户接受城市低收入初级保健或行为健康服务 诊所目前诊断为创伤后应激障碍(PTSD)，但只有13%的人患有创伤后应激障碍 治疗。此外，在接受创伤后应激障碍护理的人中，只有57%的人获得了最低剂量的 心理治疗。缺乏训练有素的心理健康专家，导致人们对获得和获得心理健康服务的不平等现象感到担忧。 低收入社区环境中的护理质量。解决劳动力短缺和客户短缺问题 偏爱，该领域的领导者倡导开发分步护理方法，从 在进入强化治疗之前进行简短的、以患者为中心的干预。不顾承诺，踏上了 目前还没有针对成年创伤后应激障碍患者的治疗方法。具体目标：这项当前的研究适用于 复制有效的计划框架，以指导“第一步”的提炼和预实施 初级保健中创伤后应激障碍的循证治疗。全面的分步护理方法将在 未来R01(步骤1：非专业环境中的简短、低强度EBT；步骤2：专业环境中的高强度EBT 设置)。目标1：基于调查和半结构化的混合方法形成性评价 访谈(N=25；10名社会工作者和社区卫生工作者干预者；15名初级保健人员 利益攸关方)确定当地综合初级保健环境的特点，并确定扩大到 干预、协议或实施蓝图。目标2：优化干预和操作 程序和最终确定正式执行蓝图(基于目标1的调查结果和与 社区咨询委员会[CAB]；N=10)。目的3：进行非随机化杂交1 实施-有效性试点(N=60个客户)，以评估以下项目的可行性、有效性和实施 初级保健诊所适应的创伤后应激障碍干预(v.照常治疗)。应聘者：这位导师 以患者为导向的研究职业发展奖(K23)建立在候选人之前的基础上 临床研究的经验侧重于暴露于暴力或暴力后的心理适应 多个少数群体之间的歧视。候选人的长期目标是成为一名无党派人士 实施科学家专注于优化EBTS和创伤后应激障碍的护理提供模式。培训 目标：(1)为在非专业环境下提供循证技术制定实施方案； (2)在实用的临床试验设计和混合方法数据分析和整合方面的高级培训；以及 (3)精神卫生服务提供的综合初级保健和分级护理模式。培训活动： 培训将通过专家(A·拉尼·埃尔维博士、丽莎·福图纳博士、玛丽莲·克洛伊特博士、 艾丽莎·林肯、马克·鲍尔、玛格丽塔·阿雷格里亚和宾杜·卡莱桑)，波士顿大学的正式课程 公共卫生学院、研讨会、培训、会议和研讨会。

PROJECT SUMMARY Background: An estimated 33-46% of clients seen in urban low-income primary care or behavioral health clinics have a current diagnosis of posttraumatic stress disorder (PTSD), yet only 13% receive PTSD treatment. Further, only 57% of those who access care for PTSD receive a minimally adequate dose of therapy. The shortage of trained mental health specialists has led to concerning inequities in access to and quality of care in low-income community settings. To address workforce shortages, as well as client preferences, leaders in the field have advocated for the development of stepped care approaches that begin with brief, patient-centered interventions before progressing to intensive treatments. Despite promise, stepped approaches have not been developed for adults with PTSD. Specific Aims: This current study applies the Replicating Effective Programs Framework to guide the refinement and pre-implementation of a “Step 1” evidence-based treatment (EBT) for PTSD in primary care. A full stepped care approach will be tested in a future R01 (Step 1: brief, low intensity EBT in a non-specialty setting; Step 2: high intensity EBT in a specialty setting). Aim 1: To conduct a mixed-methods formative evaluation based on surveys and semi-structured interviews (N=25; 10 social worker and community health worker interventionists; 15 primary care stakeholders) to characterize the local integrated primary care setting and identify the need for augmentation to the intervention, protocol, or implementation blueprint. Aim 2: To optimize the intervention and operational procedures and to finalize the formal implementation blueprint (based on Aim 1 findings and consultation with the community advisory board [CAB]; N=10). Aim 3: To conduct a nonrandomized hybrid type 1 implementation-effectiveness pilot (N=60 clients) to assess the feasibility, effectiveness, and implementation of the adapted PTSD intervention (v. treatment as usual) in a primary care clinic. Candidate: This Mentored Patient-Oriented Research Career Development Award (K23) builds upon the candidate’s previous experiences in clinical research focused on psychological adjustment following exposure to violence or discrimination among multiple minority populations. The candidate’s long-term goal is to be an independent implementation scientist focused on optimizing EBTs and care delivery models for PTSD. Training Objectives: (1) The development of implementation packages for delivery of EBTs in non-specialty settings; (2) Advanced training in pragmatic clinical trial design and mixed-methods data analysis and integration; and (3) Integrated primary care and stepped care models for mental health service delivery. Training Activities: Training will be achieved through mentorship by experts (Drs. A. Rani Elwy, Lisa Fortuna, Marylene Cloitre, Alisa Lincoln, Mark Bauer, Margarita Alegria, and Bindu Kalesan), formal coursework at Boston University School of Public Health, seminars, trainings, conferences, and workshop attendance.