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.
Posttraumatic stress disorder (PTSD) is a significant public health problem that greatly increases the risk of suicidal behavior as well as the likelihood of developing multiple, often severe comorbid disorders However, suicidal and severely comorbid individuals with PTSD are least likely to have access to effective PTSD treatment. The present project aims to address this critical need by evaluating the effectiveness of a treatment developed for this high-risk and underserved population in community agencies.
