Posttraumatic stress disorder (PTSD) is prevalent in the general population. In physician offices, one in four patients may suffer from PTSD. PTSD is difficult and costly to treat because it often requires both traditional mental health treatment and other types of care in the community to address the trauma in patients' lives. PTSD is even more common among low-income African Americans, who are also less likely to receive care for mental health problems, in large part because of barriers such as mistrust in healthcare providers, skepticism about the benefits of treatment, and beliefs about the inability to cope with PTSD. There are also practical barriers including limited access to care and lack of transportation, childcare, and financial resources that make it difficult for low-income patients to get care for PTSD. Accumulating evidence has established that collaborative care for PTSD in primary care settings is effective, but only when patients engage in the intervention with the care manager. Successful engagement may be attributed in large part to the use of active strategies to connect patients to care and motivational interviewing for goal setting and teaching coping skills. Therefore, consistent with the Institute of Medicine's priority for effective delivery approaches that engage individuals with PTSD into care, a trauma-informed approach that addresses social psychological and logistical barriers may better engage patients, enhance collaborative care, and ultimately, improve outcomes. The objective of this proposal is to test whether an enhanced collaborative care intervention that targets social psychological and practical barriers can improve care for low-income African Americans with PTSD. We propose to optimize, culturally adapt, and pilot test a collaborative care intervention that uses a trauma- informed approach to identify the active ingredients that improve treatment engagement, and reduce PTSD diagnosis and symptoms in primary care settings that serve low-income African Americans. Specifically, we will compare PTSD collaborative care (PCM) with a minimally enhanced usual (MEU) care approach for underserved African Americans. We will recruit patients at two FQHCs in New Orleans, LA to assess the feasibility, tolerability, and acceptability of PCM. We will conduct a pilot randomized trial of the optimized and adapted PCM intervention compared with MEU with 40 African American patients to evaluate its impact on social psychological target mechanisms ? outcome expectancy, coping efficacy, and trust in facilitating treatment engagement. We will also evaluate the effectiveness of the PCM intervention (compared with MEU) on outcomes ? PTSD outcomes and use of mental health care and non-medical community services and resources either directly or indirectly as mediated by the target mechanisms before and one year after the start of the intervention. Preliminary data from this pilot study will pave the way for a larger-scale intervention.
This proposed pilot effectiveness trial is relevant to public health because PTSD is a significant problem, particularly among low-income African American patients seen in the Nation's safety net health centers. However, we still do not know enough about how to improve care in this population. Our goal is to improve engagement in collaborative care interventions and ultimately, reduce PTSD diagnoses and symptoms among patients seen in safety net health care settings. We propose to improve public health by testing an optimized to collaborative care intervention that is culturally adapted to the low-income African American population to engage and retain patients in care for PTSD. This research will also identify the key social psychological mechanisms that can increase the impact of collaborative care.
