Abstract
Posttraumatic Stress Disorder (PTSD) following a traumatic injury is a significant public health concern impacting approximately a third of traumatically injured patients. In 2018, the American College of Surgeons (ACS) Committee on Trauma recommended implementation of PTSD screening and brief intervention in level 1 trauma centers to meet the mental health needs of this underserved population. In March 2022, ACS revised its standards to include a requirement for mental health screening and referral process in level 1 and level 2 trauma centers. However, implementation of these programs has been limited. One barrier to implementation has been the lack of cross-trained trauma and health psychologists to support the development and implementation of trauma-focused programs in acute and critical care settings. This paper is a call to action to bring together experts in the fields of trauma and health psychology to effectively address training gaps in post-injury PTSD and medical traumatic stress. Through development of trauma and health psychology cross-training models, the field of psychology can collaborate to meet the increasing demand for trauma-focused psychologists in acute and critical care settings.
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References
Adams, S. A., & Riggs, S. A. (2008). An Exploratory Study of vicarious trauma among therapist trainees. Training and Education in Professional Psychology, 2, 26–34. https://doi.org/10.1037/1931-3918.2.1.26
American Board of Professional Psychology (n.d.) Clinical health psychology specialty specific requirements. Retrieved March 13, 2022, from: https://abpp.org/Applicant-Information/Specialty-Boards/Clinical-Health-Psychology/Application,-Specialty-Specific-Fees.aspx
American College of Surgeons (2018, February 1) Statement on post-traumatic stress disorder in adults. Retrieved February 1, 2018, from https://www.facs.org/about-acs/statements/109-adult-ptsd
American College of Surgeons Committee on Trauma. (2022). Resources for optimal care of the injured patient (7th ed.). American College of Surgeons.
American Psychological Association, Commission on Accreditation. (2015). Standards of Accreditation for Health Service Psychology. Retrieved January 25, 2022, from http://www.apa.org/ed/accreditation/about/policies/standards-of-accreditation.pdf.
Asch, S. M., Kerr, E. A., Keesey, J., Adams, J. L., Setodji, C. M., Malik, S., & McGlynn, E. A. (2006). Who is at greatest risk for receiving poor-quality health care? The New England Journal of Medicine, 354, 1147–1156. https://doi.org/10.1056/NEJMsa044464
Barnett, J., Vasileiou, K., Djemil, F., Brooks, L., & Young, T. (2011). Understanding innovators’ experiences of barriers and facilitators in implementation and diffusion of healthcare service innovations: A qualitative study. BMC Health Services Research, 11, 342. https://doi.org/10.1186/1472-6963-11-342
Bluestein, D., & Cubic, B. A. (2009). Psychologists and primary care physicians: A training model for creating collaborative relationships. Journal of Clinical Psychology in Medical Settings, 16, 101–112. https://doi.org/10.1007/s10880-009-9156-9
Bulger, E. M., Johnson, P., Parker, L., Moloney, K. E., Roberts, M. K., Vaziri, N., Seo, S., Nehra, D., Thomas, P., & Zatzick, D. (2022). Nationwide survey of trauma center screening and intervention practices for posttraumatic stress disorder, firearm violence, mental health, and substance use disorders. Journal of the American College of Surgeons, 234, 274–287. https://doi.org/10.1097/XCS.0000000000000064
Centers for Disease Control and Prevention. Web-Based Injury Statistics Query and Reporting System (WISQARS). 2010 Data. Retrieved April 3, 2022, from https://wisqars-viz.cdc.gov:8006/non-fatal/home
Cook, J. M., Schnurr, P. P., Biyanova, T., & Coyne, J. C. (2009). Apples don’t fall far from the tree: Influences on psychotherapists’ adoption and sustained use of new therapies. Psychiatric Services, 60(5), 671–676. https://doi.org/10.1176/appi.ps.60.5.671
Cook, J. M., Newman, E., & Simiola, V. (2019). Trauma training: Competencies, initiatives, and resources. Psychotherapy, 56, 409–421. https://doi.org/10.1037/pst0000233
Cook, J. M., Simiola, V., Ellis, A. E., & Thompson, R. (2017). Training in trauma psychology: A national survey of doctoral graduate programs. Training and Education in Professional Psychology, 11, 108–114. https://doi.org/10.1037/tep0000150
Darnell, D., O’Connor, S., Wagner, A., Russo, J., Wang, J., Ingraham, L., Sandgren, K., & Zatzick, D. (2017). Enhancing the reach of cognitive-behavioral therapy targeting posttraumatic stress in acute care medical settings. Psychiatric Services (washington, D.c.), 68, 258–263. https://doi.org/10.1176/appi.ps.201500458
Darnell, D. A., Parker, L. E., Wagner, A. W., Dunn, C. W., Atkins, D. C., Dorsey, S., & Zatzick, D. F. (2019). Task-shifting to improve the reach of mental health interventions for trauma patients: Findings from a pilot study of trauma nurse training in patient-centered activity scheduling for PTSD and depression. Cognitive Behaviour Therapy, 48, 482–496. https://doi.org/10.1080/16506073.2018.1541928
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, 218–222. https://doi.org/10.1002/jts.20313
deRoon-Cassini, T. A., Hunt, J. C., Geier, T. J., Warren, A. M., Ruggiero, K. J., Scott, K., George, J., Halling, M., Jurkovich, G., Fakhry, S. M., Zatzick, D., & Brasel, K. J. (2019). Screening and treating hospitalized trauma survivors for posttraumatic stress disorder and depression. The Journal of Trauma and Acute Care Surgery, 87, 440–450. https://doi.org/10.1097/TA.0000000000002370
Edmondson, D. (2014). An enduring somatic threat model of posttraumatic stress disorder due to acute life-threatening medical events. Social and Personality Psychology Compass, 8, 118–134. https://doi.org/10.1111/spc3.12089
Fauerbach, J. A., Gehrke, A. K., Mason, S. T., Gould, N. F., Milner, S. M., & Caffrey, J. (2020). Cognitive behavioral treatment for acute posttrauma distress: A randomized, controlled proof-of-concept study among hospitalized adults with burns. Archives of Physical Medicine and Rehabilitation, 101, S16–S25. https://doi.org/10.1016/j.apmr.2018.11.027
Fishbain, D. A., Pulikal, A., Lewis, J. E., & Gao, J. (2017). Chronic pain types differ in their reported prevalence of post -traumatic stress disorder (PTSD) and there is consistent evidence that chronic pain is associated with PTSD: An evidence-based structured systematic review. Pain Medicine (malden, Mass.), 18, 711–735. https://doi.org/10.1093/pm/pnw065
Giummarra, M. J., Lennox, A., Dali, G., Costa, B., & Gabbe, B. J. (2018). Early psychological interventions for posttraumatic stress, depression and anxiety after traumatic injury: A systematic review and meta-analysis. Clinical Psychology Review, 62, 11–36. https://doi.org/10.1016/j.cpr.2018.05.001
Guess, K. E., Fifolt, M., Adams, R. C., Ford, E. W., & McCormick, L. C. (2019). Life after trauma: A survey of level 1 trauma centers regarding posttraumatic stress disorder and acute stress disorder. Journal of trauma nursing : the official journal of the Society of Trauma Nurses, 26(5), 223–233.
Hardin, A. (2021, June 23). Fee or free? The Services Hospital-based psychologists provide are 'priceless'. STAT. Retrieved April 28, 2022, from https://www.statnews.com/2021/04/02/fee-or-free-the-services-hospital-based-psychologists-provide-are-priceless/
Kiely, J. M., Brasel, K. J., Weidner, K. L., Guse, C. E., & Weigelt, J. A. (2006). Predicting quality of life six months after traumatic injury. Journal of Trauma: Injury, Infection and Critical Care, 61, 791–797. https://doi.org/10.1097/01.ta.0000239360.29852.1d
Lamparyk, K., Williams, A. M., Robiner, W. N., Bruschwein, H. M., & Ward, W. L. (2021). Interprofessional education: Current state in psychology training. Journal of Clinical Psychology in Medical Settings. https://doi.org/10.1007/s10880-021-09765-5
Leventhal, G., Stamm, K. E., Washburn, J. J., Rolston, C., Yozwiak, J. A., Hamp, A., Cash, E. D., Ward, W. L., Hong, B. A., Williams, A. M., & Robiner, W. N. (2021). Patterns of psychologists’ interprofessional collaboration across practice settings. Journal of Clinical Psychology in Medical Settings, 28, 844–867. https://doi.org/10.1007/s10880-021-09802-3
Litz, B. T., Gray, M. J., Bryant, R. A., & Adler, A. B. (2002). Early intervention for trauma: Current status and future directions. Clinical Psychology: Science and Practice, 9, 112–134. https://doi.org/10.1093/clipsy.9.2.112
McBain, S. A., Sexton, K. W., Palmer, B. E., & Landes, S. J. (2019). Barriers to and facilitators of a screening procedure for PTSD risk in a level I trauma center. Trauma Surgery & Acute Care Open, 4, e000345. https://doi.org/10.1136/tsaco-2019-000345
McDaniel, S. H., Grus, C. L., Cubic, B. A., Hunter, C. L., Kearney, L. K., Schuman, C. C., Karel, M. J., Kessler, R. S., Larkin, K. T., McCutcheon, S., Miller, B. F., Nash, J., Qualls, S. H., Connolly, K. S., Stancin, T., Stanton, A. L., Sturm, L. A., & Johnson, B. S. (2014). Competencies for psychology practice in primary care. The American Psychologist, 69, 409–429. https://doi.org/10.1037/a0036072
McKibben, J. B. A., Bresnick, M. G., Wiechman Askay, S. A., & Fauerbach, J. A. (2008). Acute stress disorder and posttraumatic stress disorder: A prospective study of prevalence, course, and predictors in a sample with major burn injuries. Journal of Burn Care & Research, 29, 22–35. https://doi.org/10.1097/BCR.0b013e31815f59c4
Pan, T. Y., Bruschwein, H. M., & Ward, W. L. (2021). Interprofessional education: Psychology trainee experiences and perspectives on team skills. Journal of Clinical Psychology in Medical Settings. https://doi.org/10.1007/s10880-020-09756-y
Parker, A. M., Sricharoenchai, T., Raparla, S., Schneck, K. W., Bienvenu, O. J., & Needham, D. M. (2015). Posttraumatic stress disorder in critical illness survivors: A meta-analysis. Critical Care Medicine, 43, 1121–1129.
Qi, W., Gevonden, M., & Shalev, A. (2016). Prevention of post-traumatic stress disorder after trauma: Current evidence and future directions. Current Psychiatry Reports, 18, 20. https://doi.org/10.1007/s11920-015-0655-0
Robinson, P. J., & Reiter, J. T. (2016). Behavioral consultation and primary care: A guide to integrating services (2nd ed.). Springer International Publishing.
Rodin, G. (2018). From evidence to implementation: The global challenge for psychosocial oncology. Psycho-Oncology (chichester, England), 27, 2310–2316. https://doi.org/10.1002/pon.4837
Rothbaum, B. O., Kearns, M. C., Price, M., Malcoun, E., Davis, M., Ressler, K. J., Lang, D., & Houry, D. (2012). Early intervention may prevent the development of posttraumatic stress disorder: A randomized pilot civilian study with modified prolonged exposure. Biological Psychiatry, 72, 957–963. https://doi.org/10.1016/j.biopsych.2012.06.002
Simiola, V., Smothers, B., Thompson, R., & Cook, J. M. (2018). A national survey of trauma training in psychology internships. Journal of Aggression, Maltreatment and Trauma, 27, 309–322. https://doi.org/10.1080/10926771.2017.1311977
Trusz, S. G., Wagner, A. W., Russo, J., Love, J., & Zatzick, D. F. (2011). Assessing barriers to care and readiness for cognitive behavioral therapy in early acute care PTSD interventions. Psychiatry, 74, 207–223. https://doi.org/10.1521/psyc.2011.74.3.207
Vranceanu, A. M., Bannon, S., Mace, R., Lester, E., Meyers, E., Gates, M., Popok, P., Lin, A., Salgueiro, D., Tehan, T., Macklin, E., & Rosand, J. (2020). Feasibility and efficacy of a resiliency intervention for the prevention of chronic emotional distress among survivor-caregiver dyads admitted to the neuroscience intensive care unit: a randomized clinical trial. JAMA Network Open, 3, e2020807. https://doi.org/10.1001/jamanetworkopen.2020.20807
Walker, E. A., Katon, W., Russo, J., Ciechanowski, P., Newman, E., & Wagner, A. W. (2003). Health care costs associated with posttraumatic stress disorder symptoms in women. Archives of General Psychiatry, 60, 369–374. https://doi.org/10.1001/archpsyc.60.4.369
Wong, E. C., Marshall, G. N., Shetty, V., Zhou, A., Belzberg, H., & Yamashita, D. D. (2007). Survivors of violence-related facial injury: Psychiatric needs and barriers to mental health care. General Hospital Psychiatry, 29, 117–122. https://doi.org/10.1016/j.genhosppsych.2006.10.008
Zatzick, D., Jurkovich, G. J., Rivara, F. P., Wang, J., Fan, M. Y., Joesch, J., & Mackenzie, E. (2008). A national US study of posttraumatic stress disorder, depression, and work and functional outcomes after hospitalization for traumatic injury. Annals of Surgery, 248, 429–437. https://doi.org/10.1097/SLA.0b013e318185a6b8
Zatzick, D., Jurkovich, G., Rivara, F. P., Russo, J., Wagner, A., Wang, J., Dunn, C., Lord, S. P., Petrie, M., Oʼconnor, S. S., & Katon, W. (2013). A randomized stepped care intervention trial targeting posttraumatic stress disorder for surgically hospitalized injury survivors. Annals of surgery, 257(3), 390–399. https://doi.org/10.1097/SLA.0b013e31826bc313
Ziller, E. C., Anderson, N. J., & Coburn, A. F. (2010). Access to rural mental health services: Service use and out-of-pocket costs. The Journal of Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association, 26, 214–224. https://doi.org/10.1111/j.1748-0361.2010.00291.x
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Sarah Stoycos was supported by a grant from the National Institute of Mental Health (T32MH019836).
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SM, SS, and TD each contributed to the conceptualization of the manuscript, drafting the work, revising content, and editing the manuscript. SM oversaw development of the manuscript and final approval of the version to be published.
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Sacha McBain, Sarah Stoycos, and Tim Doenges declare that they do not have conflict of interest.
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McBain, S.A., Stoycos, S. & Doenges, T. Breaking Silos to Address Medical Trauma: The Need for Integration of Trauma and Health Psychology Training. J Clin Psychol Med Settings 30, 380–386 (2023). https://doi.org/10.1007/s10880-022-09897-2
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DOI: https://doi.org/10.1007/s10880-022-09897-2