Disseminating Evidence-Based Practices for Adults With PTSD and Severe Mental Illness in Public-Sector Mental Health Agencies

Posttraumatic stress disorder (PTSD) remains largely untreated among adults with severe mental illnesses (SMI). The treatment of psychotic symptoms usually takes precedence in the care of adults with SMI. Such oversight is problematic in that PTSD in SMI populations is common (19-43%), contributes a significant illness burden, and hinders mental health care. Yet, few public-sector mental health agencies routinely provide specialized services for PTSD. The purpose of the paper is to describe strategies and efforts to disseminate trauma-focused empirically-based practices (EBPs) in a public-sector mental health system. Identified challenges include limited resources and commitment; knowledge deficits, attitudes, and biases; and limited practice accountability at provider, facility, and system levels. Proposed strategies for overcoming these challenges are: set clear goals; nurture broad-based organizational commitment and key stakeholder involvement; implement specialty training efforts to provide information and change attitudes; provide on-going supervision; conduct fidelity monitoring; and ensure accountability to the extent possible

Therapist fidelity with an exposure-based treatment of ptsd in adults with schizophrenia or schizoaffective disorder

This study examined therapists’ fidelity to a manualized multi-component cognitive-behavioral intervention for posttraumatic stress disorder (PTSD), including exposure therapy, among public sector patients with a psychotic disorder. Therapists’ competence and adherence was assessed by clinicians at the master’s level or higher who rated 20% of randomly selected audiotaped sessions (n = 57 sessions, coded by two independent raters, with strong interrater agreement). Adherence ratings indicated that therapists complied well with the protocol, and competency ratings typically averaged above “very good” (6 on 7-point Likert scale). Findings suggest that therapists can effectively deliver a manualized cognitive-behavioral intervention for PTSD, with exposure therapy, to patients with severe mental illness without compromise to the structure of sessions and/or to the therapeutic relationship. These data add needed support for the implementation of cognitive-behavioral interventions, including exposure therapy, as effective treatments for PTSD in complicated patient populations such as those with severe forms of mental illness

Exposure-based cognitive-behavioral treatment of PTSD in adults with schizophrenia or schizoaffective disorder: A pilot study

In an open trial design, adults (n = 20) with posttraumatic stress disorder (PTSD) and either schizophrenia or schizoaffective disorder were treated via an 11-week cognitive-behavioral intervention for PTSD that consisted of education, anxiety management therapy, social skills training, and exposure therapy, provided at community mental health centers. Results offer preliminary hope for effective treatment of PTSD among adults with schizophrenia or schizoaffective disorder, especially among treatment completers (n = 13). Data showed significant PTSD symptom improvement, maintained at 3-month follow-up. Further, 12 of 13 completers no longer met criteria for PTSD or were considered treatment responders. Clinical outcomes for other targeted domains (e.g., anger, general mental health) also improved and were maintained at 3-month follow-up. Participants evidenced high treatment satisfaction, with no adverse events. Significant improvements were not noted on depression, general anxiety, or physical health status. Future directions include the need for randomized controlled trials and dissemination efforts

The Effect of Minority Status and Rural Residence on Actions to Control High Blood Pressure in the U.S.

Objective. We examined actions to control high blood pressure (HBP) and health-care provider recommendations for blood pressure control among adults by racial/ethnic group and rural/urban residence. Methods. We examined data from 45,024 participants with HBP in the 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey. We used multiple logistic regression analyses to assess the independent association between current actions to control HBP and health-care provider recommendations for blood pressure control by race/ethnicity and rural/urban status after accounting for confounders. Results. Black people, regardless of rural or urban residence, were more likely to report reducing salt and alcohol intake, changing eating habits, and taking medications than both white urban and white rural adults. Black people, regardless of rural or urban status, were more likely to be advised to cut down on salt, reduce alcohol use, and change eating habits. Black rural adults were also more likely to report being advised to take medications than white urban adults, while white rural adults were less likely to be advised to exercise than white urban adults. Conclusions. Race/ethnicity and rural/urban status have a differential effect on actions to control HBP and provider advice to control HBP. </jats:sec