This is an application for a Mentored Patient-Oriented Research Career Development Award (K23) with a focus on the implementation of cognitive processing therapy (CPT)(1) for post-traumatic stress disorder (PTSD) within a diverse community mental health clinic (CMHC). The candidate proposes to build upon her experience treating diverse PTSD patients by obtaining training in implementation science with the long-term career goal of narrowing the research-practice gap and, consequently, decreasing health disparities. CPT is one of two first line empirically based treatments (EBTs) for PTSD. CPT has shown efficacy(1-3) and effectiveness(4) across trauma types, languages, and populations. However, most community mental health workers (CMHWs) receive little, if any, training in EBTs such as CPT or use them in daily practice. This study is an initial step in creating a framework to address this implementation gap in a systematic manner drawing on established implementation theory (e.g., (5-10)) to understand and address barriers to implementing CPT in CMHCs. Research Plan: The primary study has a mixed-method iterative design with data analysis from earlier implementation stages used to evaluate, and refine subsequent implementation efforts. Specifically, the current study blends three distinct implementation frameworks: (1)Replicating Effective Programs (REP) framework(5-8, 11-14);(2)Consolidated Framework for Implementation Research (CFIR;(9));and (3)Proctor et al., taxonomy for implementation outcome variables(10), to guide an iterative open pilot implementation study designed to address the following Specific Aims: 1)To identify, assess, and address organizational context and provider level barriers and facilitators of implementation using a mixed-methods approach prior to the pre-implementation of CPT in a diverse CMHC;2)Further adapt and pre-test intervention methods and materials with diverse providers and patients in English and Spanish;and 3)Train CMHWs and pilot test the feasibility and acceptability of the modified manualized implementation protocol, and to initially explore its effect on patient outcome. We plan to evaluate this final implementation protocol for generalizable utilization across diverse CMHCs in a future RO1. Environment: The study will be based at the Massachusetts General Hospital (MGH) and the MGH Chelsea Mental Health Clinic and will complement a program of training and supervised research under mentors Drs. Naomi Simon, Marty Charns, and Debra Kaysen, with consultation from experts in community based research, CPT, and cultural competency. Career Development Plan: Training in the following areas will emphasize skills necessary for the candidate's long-term objective to become an expert in the implementation of EBTs in diverse communities and will lay the foundation for future independent investigation: 1) implementation science methodology and theoretical frameworks;2) CPT implementation in CMHCs;3) therapist supervision/leadership;4) cultural competency in clinical trials;and 5) mixed-methods data analysis.

Public Health Relevance

Millions of Americans suffer from Posttraumatic Stress Disorder, yet many do not receive first line, effective evidence based psychotherapies such as Cognitive Processing Therapy (CPT) due to lack of training and implementation of these evidence based psychotherapies in community mental health settings. Challenges include the need to be able to implement these time limited, effective therapies in diverse populations and to increase access to these treatments in the community. This career development grant will focus on developing strategies to practically and successfully implement CPT for PTSD in a diverse community setting and will provide the candidate with the needed training in implementation science to become a translational researcher, focusing on moving evidence based psychotherapies for PTSD from research clinics to effective implementation in the community.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Mentored Patient-Oriented Research Career Development Award (K23)
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Dissemination and Implementation Research in Health Study Section (DIRH)
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Hill, Lauren D
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Massachusetts General Hospital
United States
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Robinaugh, Donald J; McNally, Richard J; LeBlanc, Nicole J et al. (2014) Anxiety sensitivity in bereaved adults with and without complicated grief. J Nerv Ment Dis 202:620-2