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

项目摘要 背景：据估计，33-46%的客户在城市低收入初级保健或行为健康 目前有一家诊所被诊断为创伤后应激障碍（PTSD），但只有13%的人患有PTSD 治疗此外，只有57%的创伤后应激障碍患者接受了最低限度的足够剂量的治疗。 疗法训练有素的心理健康专家的短缺导致了令人担忧的获得和治疗方面的不平等， 低收入社区的护理质量。为了解决劳动力短缺问题， 偏好，该领域的领导人主张制定阶梯式护理方法，开始 在进行强化治疗之前，进行简短的、以患者为中心的干预。尽管承诺， 还没有为患有PTSD的成年人开发方法。具体目标：本研究采用 复制有效方案框架，指导“步骤1”的完善和预实施 循证治疗（EBT）在初级保健中的PTSD。一个完整的阶梯式护理方法将在一个 未来R 01（第1步：非专业设置中的简短低强度EBT;第2步：专业设置中的高强度EBT 设置）。目标1：进行基于调查和半结构化的混合方法的形成性评价 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 利益相关者），以描述当地综合初级保健环境的特点，并确定是否需要加强， 干预、协议或实施蓝图。目标2：优化干预和业务 （根据目标1的调查结果，并与 社区咨询委员会[CAB]; N=10）。目的3：进行非随机化杂交1型 执行效果试点（N=60个客户），以评估可行性、有效性和执行情况， 在初级保健诊所进行的适应性PTSD干预（与常规治疗相比）。标签：This Mentored 以患者为导向的研究职业发展奖（K23）建立在候选人的前 临床研究的经验侧重于遭受暴力后的心理调整，或 多个少数民族之间的歧视。这位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EBT和PTSD的护理提供模式。培训 目标：（1）为在非专业环境中提供EBT制定实施方案; (2)实用临床试验设计和混合方法数据分析和整合的高级培训; (3)精神卫生服务提供的综合初级保健和阶梯式保健模式。培训活动： 培训将通过专家指导（A.拉尼埃尔维，丽莎福图纳，玛丽琳克罗伊特， Alisa林肯、Mark Bauer、Margarita阿莱格里亚和Bindu Kalesan），波士顿大学正式课程 公共卫生学院，研讨会，培训，会议和讲习班出席。

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.