A randomized controlled dismantling trial of post-workshop consultation strategies to increase effectiveness and fidelity to an evidence-based psychotherapy for Posttraumatic stress disorder

Abstract: Background: Posttraumatic Stress Disorder (PTSD) is a serious mental health condition with substantial costs to individuals and society. Among military veterans, the lifetime prevalence of PTSD has been estimated to be as high as 20%. Numerous research studies have demonstrated that short-term cognitive-behavioral psychotherapies, such as Cognitive Processing Therapy (CPT), lead to substantial and sustained improvements in PTSD symptoms. Despite known benefits, only a minority of clinicians provide these therapies. Transferring this research knowledge into clinical settings remains one of the largest hurdles to improving the health of veterans with PTSD. Attending a workshop alone is insufficient to promote adequate knowledge transfer and sustained skill; however, relatively little research has been conducted to identify effective post-training support strategies. Methods: The current study investigates whether clinicians receiving post-workshop support (six-month duration) will deliver CPT with greater fidelity (i.e., psychotherapy adherence and competence) and have improved patient outcomes compared with clinicians receiving no formal post-workshop support. The study conditions are: technology-enhanced group tele-consultation; standard group tele-consultation; and fidelity assessment with no consultation. The primary outcome is independent assessment (via audio-recordings) of the clinicians’ adherence and competence in delivering CPT. The secondary outcome is observed changes in patient symptoms during and following treatment as a function of clinician fidelity. Post-consultation interviews with clinicians will help identify facilitators and barriers to psychotherapy skill acquisition. The study results will inform how best to implement and transfer evidence-based psychotherapy (e.g., CPT) to clinical settings to attain comparable outcomes to those observed in research settings. Discussion: Findings will deepen our understanding of how much and what type of support is needed following a workshop to help clinicians become proficient in delivering a new protocol. Several influences on clinician learning and patient outcomes will be discussed. An evidence-based model of clinical consultation will be developed, with the ultimate goal of informing policy and influencing best practice in clinical consultation. Trial registration: ClinicalTrials.gov: NCT0186176

Initial outcomes of couple HOPES: A guided online couple intervention for PTSD and relationship enhancement

Couple HOPES (Helping Overcome PTSD and Enhance Satisfaction) is a guided, online couple intervention adapted from Cognitive-Behavioral Conjoint Therapy for posttraumatic stress disorder (PTSD). It was created to overcome a range of barriers to accessing evidence-based treatments for PTSD and the intimate relationship problems associated with it. This manuscript describes initial outcomes of the intervention in a series of 10 couples. Participants were military, veteran and first responders with probable PTSD and their intimate partners. Couples completed the program and measurements of PTSD, relationship satisfaction, and secondary outcomes at pre-, mid-, and post-intervention. Mean satisfaction for the program was high and it was completed by seven of ten couples. Participants with PTSD evidenced significant and large pre- to post-intervention effect size improvements in PTSD symptoms (g = 0.80) and perceived health (g = 1.13). They also exhibited non-significant but medium effect size pre- to post-intervention improvements in quality of life (g = 0.62), and depression (g = 0.53), and small effect size pre- to post-intervention improvements in argumentativeness (g = 0.43), anger (g = 0.31), and anxiety (g = 0.31). Partners reported significant and moderate pre- to post-intervention effect size improvements in relationship satisfaction (g = 0.68), and medium but not significant effect size improvements in accommodation of PTSD (g = 0.56). Results provide initial support for the feasibility, acceptability, and efficacy of Couple HOPES for improving PTSD and relationship satisfaction. However, more testing in larger samples, including with randomized controlled designs, is needed. •Couple HOPES is an online, self-help couple intervention for PTSD.•Feasibility, acceptability, and efficacy of Couple HOPES was tested with 10 couples.•10 couples with a military member/veteran/first responder with PTSD participated.•Couple HOPES was feasible, acceptable, and resulted in reductions in PTSD symptoms.•It improved relationship satisfaction for partners and several secondary outcomes

WELFARE REFORM: Recent Policy and Politics

Public policy research has not combined policy and political analysis as its pioneers imagined. Mostly, political scientists study just the policy process, abandoning prescriptions to policy specialists. A better approach is to combine policy and political analysis, using positions on issues to assess policymaking, and vice versa. This article illustrates that approach by applying it to recent welfare reform. I take raising work levels as the chief goal of reform and assess the Family Support Act (FSA) of 1988 and the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 against it. FSA was a timid compromise that achieved little while PRWORA was a conflicted measure that achieved more, but at unnecessary risk. I also ask how the tensions between best policy and politics might be resolved. This approach makes public policy research more relevant to the real stakes in policymaking. [142 words.] Copyright 2002 by The Policy Studies Organization.