Abstract
Objective
Based on feedback received during post-training consultation within a Prolonged Exposure (PE) implementation initiative, additional assessment training was added to help community providers identify patients who met criteria for posttraumatic stress disorder (PTSD) symptom severity and were considered appropriate for PTSD treatment. The current study investigated the rates of trauma exposure and PTSD in the community sample, as well as the percentage of individuals deemed “appropriate” for PE by community therapists.
Method
Clinicians involved in the PE Initiative administered the Post-traumatic Diagnostic Scale for DSM-5 (PDS-5) to 10,260 individuals across 13 community agencies. Clinicians were also asked to report whether patients were perceived as appropriate for PE.
Results
Consistent with our hypothesis, the rates of potential PTSD in Philadelphia community mental health (58.2% of our total sample) far exceeded national averages (8.3%). Contrary to our hypothesis, 100% of patients who scored above the clinical cutoff for PTSD were considered appropriate for PE by their community clinician.
Conclusions
The results of this study emphasize the high prevalence of PTSD among individuals presenting for treatment to community mental health centers. Despite common misconceptions that patients are often perceived as ineligible or not appropriate for PE, 100% of patients in the PE Initiative who scored above the clinical cutoff for PTSD were considered good candidates for treatment according to their clinicians. This suggests that with sufficient training and post-training consultation, as provided in this community initiative, community clinicians may be more likely to perceive PE as an appropriate treatment option.
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References
Becker, C. B., Zayfert, C., & Anderson, E. (2004). A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD. Behaviour Research and Therapy, 42(3), 277–292. https://doi.org/10.1016/S0005-7967(03)00138-4
Betancourt, T. S., & Chambers, D. A. (2016). Optimizing an era of global mental health implementation science. JAMA Psychiatry, 73, 99–100. https://doi.org/10.1001/jamapsychiatry.2015.2705
Chambers, D., Glasgow, R. E., & Strange, K. C. (2013). The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implementation Science. https://doi.org/10.1186/1748-5908-8-117
Cook, J. M., Dinnen, S., Simiola, V., Thompson, R., & Schnurr, P. P. (2014). VA residential provider perceptions of dissuading factors to the use of two evidence-based PTSD treatments. Professional Psychology, Research and Practice, 45(2), 136–142. https://doi.org/10.1037/a0036183
Cusack, K. J., Frueh, B. C., & Brady, K. T. (2004). Trauma history screening in a community mental health center. Psychiatric Services, 55(2), 157–162. https://doi.org/10.1176/appi.ps.55.2.157 PMID: 14762240.
Davis, R. G., Ressler, K. J., Schwartz, A. C., Stephens, K. J., & Bradley, R. G. (2008). Treatment barriers for low-income, urban African Americans with undiagnosed posttraumatic stress disorder. Journal of Traumatic Stress, 21(2), 218–222. https://doi.org/10.1002/jts.20313
Fergusson, D. M., McLeod, G. F. H., & Horwood, J. (2013). Childhood sexual abuse and adult developmental outcomes: findings from a 30-year longitudinal study in New Zealand. Child Abuse and Neglect, 37(9), 664–674. https://doi.org/10.1016/j.chiabu.2013.03.013
Foa, E. B., Davidson, J. R., & Frances, A. (1999). Expert consensus panels for PTSD. The Expert Consensus Guideline Series: Treatment of posttraumatic stress disorder. Journal of Clinical Psychiatry, 60, 3–76.
Foa, E. B., Hembree, E. A., Cahill, S. P., Rauch, S. A. M., Riggs, D. S., Feeny, N. C., & Yadin, E. (2005). Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73(5), 953–964. https://doi.org/10.1037/0022-006X.73.5.953
Foa, E., McLean, C. P., Zang, Y., Zhong, J., Powers, M. B., Kauffman, B. Y., Rauch, S., Porter, S., & Knowles, K. (2016). Psychometric properties of the posttraumatic diagnostic scale for DSM-5 (PDS-5). Psychological Assessment, 28(10), 1166–1171. https://doi.org/10.1037/pas0000258
Fontana, A., & Rosenheck, R. (1997). Effectiveness and cost of the inpatient treatment of posttraumatic stress disorder: comparison of three models of treatment. American Journal of Psychiatry, 154(6), 758–765. https://doi.org/10.1176/ajp.154.6.758
Hamblen, J. L., Bernardy, N. C., Sherrieb, K., Norris, F. H., Cook, J. M., Louis, C. A., & Schnurr, P. P. (2015). VA PTSD clinic director perspectives: How readiness guides provision of evidence-based PTSD treatment. Professional Psychology, Research and Practice, 46(2), 90–96. https://doi.org/10.1037/a0038535
Hutchings, P. S., & Dutton, M. A. (1993). Sexual assault history in a community mental health center clinical population. Community Mental Health Journal, 29(1), 59–63. https://doi.org/10.1007/BF00760631
Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Freidman, M. J. (2017). National estimates of exposure to traumatic events and PTSD prevalence using DMS-IV and DSM-5 criteria. Journal of Traumatic Stress, 26, 537–547. https://doi.org/10.1002/jts.21848
Koenen, et al. (2017). Posttraumatic stress disorder in the World Mental Health Surveys. Psychological Medicine, 47(13), 2260–2274. https://doi.org/10.1017/S0033291717000708
Kubzansky, L. D., Koenen, K. C., Spiro, A. I. I. I., Vokonas, P. S., & Sparrow, D. (2007). Prospective study of posttraumatic stress disorder symptoms and coronary heart disease in the Normative Aging Study. Archives of General Psychiatry, 64(1), 109–116. https://doi.org/10.1001/archpsyc.64.1.109
Lauterbach, D., Vora, R., & Rakow, M. (2005). The relationship between posttraumatic stress disorder and self-reported health problems. Psychosomatic Medicine, 67(6), 939–947. https://doi.org/10.1097/01.psy.0000188572.91553.a5
Nathanson, A. M., Shorey, R. C., Tirone, V., & Rhatigan, D. L. (2012). The prevalence of mental health disorders in a community sample of female victims of intimate partner violence. Partner Abuse, 3(1), 59–75. https://doi.org/10.1891/1946-6560.3.1.59
Schwartz, A. C., Bradley, R., Penza, K. M., Sexton, M., Jay, D., Haggard, P. J., Garlow, S. J., & Ressler, K. J. (2006). Pain medication use among patients with posttraumatic stress disorder. Psychosomatics, 47(2), 136–142. https://doi.org/10.1097/01.psy.0000188572.91553.a5
Seng, J. S., Clark, M. K., McCarthy, A. M., & Ronis, D. L. (2006). PTSD and physical comorbidity among women receiving Medicaid: results from service-use data. Journal of Traumatic Stress, 19(1), 45–56. https://doi.org/10.1002/jts.20097
U.S. Department for Veterans Affairs. (2019). PTSD: National center for PTSD: Prolonged exposure for PTSD. Retrieved February 4, 2020, from https://www.ptsd.va.gov/professional/treat/txessentials/prolonged_exposure_pro.asp
van Minnen, A., Harned, M. S., Zoellner, L., & Mills, K. (2012). Examining potential contraindications for prolonged exposure therapy for PTSD. European Journal of Psychotraumotology. https://doi.org/10.3402/ejpt.v3i0.18805
van Minnen, A., Hendriks, L., & Olff, M. (2010). When do trauma experts choose exposure therapy for PTSD patients? A controlled study of therapist and patient factors. Behaviour Research and Therapy, 48(4), 312–320. https://doi.org/10.1016/j.brat.2009.12.003
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Pincus, L.E., Brown, L.A., Capaldi, S. et al. Trauma Exposure and PTSD in Philadelphia Community Mental Health. Community Ment Health J 58, 547–552 (2022). https://doi.org/10.1007/s10597-021-00853-2
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DOI: https://doi.org/10.1007/s10597-021-00853-2