Effectiveness of PTSD treatment for suicidal and multi-diagnostic clients

 描述(申请人提供)：创伤后应激障碍(PTSD)对公众健康的影响是巨大的。创伤后应激障碍极大地增加了自杀念头和自杀企图的风险，以及发展成多种、通常是严重的共病障碍的可能性。尽管已发现几种基于证据的创伤后应激障碍治疗方法在社区环境中有效，并越来越多地为消费者提供，但只有少数患有创伤后应激障碍的患者被提供这些治疗。特别是，有自杀倾向和严重共患创伤后应激障碍的人，他们可能招致最高的个人和社会成本，最不可能获得有效的创伤后应激障碍治疗。辩证行为疗法延长暴露(DBT PE)方案旨在整合到标准的辩证行为疗法(DBT)中，以治疗自杀、严重和多诊断患者中的创伤后应激障碍，在研究环境中实施时已显示出有效性的证据。特别是，DBT+DBT PE综合治疗显著改善了创伤后应激障碍，同时减少了自杀和自我伤害行为、抑郁、焦虑、分离、内疚、羞耻以及社会和全球损害。目前的试点项目旨在评估这种干预措施在社区机构实施时的可行性、可接受性、安全性和有效性，并开发和测试成功将干预措施转化为常规临床实践所需的方法。该项目将与社区行为健康(CBH)合作进行，社区行为健康(CBH)是一家大型非营利性管理保健组织，为费城40多万医疗补助接受者管理行为健康服务。在初步战略规划阶段，CBH系统中的研究人员和关键利益攸关方将协作评估机构、提供者和客户的需求，并努力确定和解决实施的潜在障碍。然后，这些反馈将被用来根据目标系统的需要调整干预、培训材料和研究程序。最后，这些培训和实施程序将在四个CBH机构进行的试点可行性研究中进行评估，并将以先前在研究环境中进行的DBT+DBT PE研究中获得的结果为基准。还将评估培训结果的组织级、提供者级和客户级预测因素，以及治疗结果的情感机制。在试点可行性研究期间收集的信息将被用来为设计和进行随后的全面有效性试验提供信息。这项研究有可能通过增加一些最高风险和最严重的精神卫生服务消费者获得有效的创伤后应激障碍治疗来显著影响公共健康。

 DESCRIPTION (provided by applicant): The public health impact of posttraumatic stress disorder (PTSD) is enormous. PTSD greatly increases the risk of suicidal ideation and attempts as well as the likelihood of developing multiple, often severe comorbid disorders. Although several evidence-based treatments for PTSD have been found to be effective in community settings and are increasingly available to consumers, only a select group of clients with PTSD are offered these treatments. In particular, suicidal and severely comorbid individuals with PTSD who are likely to incur among the highest individual and societal costs are the least likely to have access to effective PTSD treatment. The Dialectical Behavior Therapy Prolonged Exposure (DBT PE) protocol, which is designed to be integrated into standard Dialectical Behavior Therapy (DBT) to treat PTSD among suicidal, severe, and multi- diagnostic clients, has shown evidence of efficacy when implemented in research settings. In particular, the integrated DBT+DBT PE treatment significantly improves PTSD while simultaneously reducing suicidal and self-injurious behavior, depression, anxiety, dissociation, guilt, shame, and social and global impairment. The present pilot project aims to evaluate the feasibility, acceptability, safety, and effectiveness of this intervention when implemented in community agencies, as well as develop and test the methods needed to successfully transfer the intervention into routine clinical practice. The project will be conducted in collaboration with Community Behavioral Health (CBH), a large, nonprofit managed care organization that manages behavioral health services for Philadelphia County's more than 400,000 Medicaid recipients. During an intial strategic planning phase, researchers and key stakeholders in the CBH system will collaboratively assess agency, provider, and client needs and work to identify and address potential barriers to implementation. This feedback will then be used to tailor the intervention, training materials, and research procedures to the needs of the target system. Finally, these training and implementation procedures will be evaluated in a pilot feasibility study conducted in four CBH agencies and outcomes will be benchmarked to those obtained in prior studies of DBT+DBT PE conducted in research settings. Organizational-, provider-, and client-level predictors of training outcomes, as well as affective mechanisms of treatment outcome, will also be evaluated. Information gathered during the pilot feasibility study will be used to inform the design and conduct of a subsequent full-scale effectiveness trial. This research has the potential to significantly impact public health by increasing access to effective PTSD treatment for some of the most high-risk and severe consumers of mental health services.