Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2011 Mar-Apr;33(2):123-34.
doi: 10.1016/j.genhosppsych.2011.01.001. Epub 2011 Feb 18.

Enhancing the population impact of collaborative care interventions: mixed method development and implementation of stepped care targeting posttraumatic stress disorder and related comorbidities after acute trauma

Douglas Zatzick  1 , Frederick Rivara, Gregory Jurkovich, Joan Russo, Sarah Geiss Trusz, Jin Wang, Amy Wagner, Kari Stephens, Chris Dunn, Edwina Uehara, Megan Petrie, Charles Engel, Dimitri Davydow, Wayne Katon
Affiliations
Randomized Controlled Trial

Enhancing the population impact of collaborative care interventions: mixed method development and implementation of stepped care targeting posttraumatic stress disorder and related comorbidities after acute trauma

Douglas Zatzick et al. Gen Hosp Psychiatry. 2011 Mar-Apr.

Abstract

Objective: The objective of the study was to develop and implement a stepped collaborative care intervention targeting posttraumatic stress disorder (PTSD) and related comorbidities to enhance the population impact of early trauma-focused interventions.

Method: We describe the design and implementation of the Trauma Survivors Outcomes and Support study. An interdisciplinary treatment development team was composed of trauma surgical, clinical psychiatric and mental health services "change agents" who spanned the boundaries between frontline trauma center clinical care and acute care policy. Mixed method clinical epidemiologic and clinical ethnographic studies informed the development of PTSD screening and intervention procedures.

Results: Two hundred seven acutely injured trauma survivors with high early PTSD symptom levels were randomized into the study. The stepped collaborative care model integrated care management (i.e., posttraumatic concern elicitation and amelioration, motivational interviewing and behavioral activation) with cognitive behavioral therapy and pharmacotherapy targeting PTSD. The model was feasibly implemented by frontline acute care masters in social work and nurse practioner providers.

Conclusions: Stepped care protocols targeting PTSD may enhance the population impact of early interventions developed for survivors of individual and mass trauma by extending the reach of collaborative care interventions to acute care medical settings and other nonspecialty posttraumatic contexts.

PubMed Disclaimer

Figures

Figure 1
Figure 1. TSOS II Trial design
Figure 2
Figure 2. Care management intervention components
See this image and copyright information in PMC

References

    1. Bonnie RJ, Fulco CE, Liverman CT, editors. Reducing the burden of injury: Advancing prevention and treatment. Washington, DC: National Academy Press; 1999. - PubMed
    1. Kessler RC. Posttraumatic stress disorder: The burden to the individual and society. Journal of Clinical Psychiatry. 2000;61(suppl 5):4–14. - PubMed
    1. Kessler RC, Sonnega A, Bromet E, Hughs M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry. 1995;52:1048–1060. - PubMed
    1. McCaig LF. National hospital ambulatory medical care survey: 1992 emergency department summary. Vol. 245. Hyattsville: National Center for Health Statistics; 1994. - PubMed
    1. Rice DR, MacKenzie EJ. Associates: Cost of injury in the United States: A report to congress. San Francisco: Institute for Health and Aging, University of California, and Injury Prevention Center, Johns Hopkins University. 1989

Publication types