TY - JOUR
T1 - The effects of a prolonged exposure workshop with and without consultation on provider and patient outcomes
T2 - a randomized implementation trial
AU - Foa, Edna B.
AU - McLean, Carmen P.
AU - Brown, Lily A.
AU - Zang, Yinyin
AU - Rosenfield, David
AU - Zandberg, Laurie J.
AU - Ealey, Wayne
AU - Hanson, Brenda S.
AU - Hunter, Lora Rose
AU - Lillard, Ivett J.
AU - Patterson, Thomas J.
AU - Rosado, Julio
AU - Scott, Valerie
AU - Weber, Charles
AU - Wise, Joseph E.
AU - Zamora, Charles D.
AU - Mintz, Jim
AU - Young-Mccaughan, Stacey
AU - Peterson, Alan L.
N1 - Funding Information:
This work was supported by the US Department of Defense through the US Army Medical Research and Materiel Command, Congressionally Directed Medical Research Programs [grant number W81XWH-12-2-0116 (Edna B. Foa)]. The funding source had no involvement in the study design, the collection, analysis and interpretation of data, the writing of this report, or the decision to submit this article for publication.
Funding Information:
Dr. Foa reports having received research funding from the Department of Defense, Department of Veterans Affairs, and National Institutes of Health. In addition, Dr. Foa published books on PTSD treatment for which she receives royalties and also conducts PTSD trainings for which she receives an honorarium. Dr. McLean reports having received research funding from the Department of Defense. Dr. Brown reports having received research funding from the Department of Defense and National Institutes of Health. Dr. Rosenfield reports having received research funding from the National Institutes of Health, National Institute on Drug Abuse, and Department of Defense. Dr. Mintz reports having received research funding from the Department of Defense, Department of Veterans Affairs, and National Institutes of Health. Dr. Young-McCaughan reports having received research funding from the Department of Defense, Department of Veterans Affairs, and National Institutes of Health. Dr. Peterson reports having received research funding from the Department of Defense, Department of Veterans Affairs, National Institutes of Health, and Robert Wood Johnson Foundation. No other disclosures were reported.
Publisher Copyright:
© 2020 The Author(s).
PY - 2020/7/29
Y1 - 2020/7/29
N2 - Background: Prolonged exposure therapy (PE) is an evidence-based treatment for posttraumatic stress disorder (PTSD) that is underutilized in the military health system. Standard workshop training in PE may not be sufficient to alter provider behavior, but post-workshop consultation requires significant resources. Therefore, it is important to determine the incremental utility of post-workshop consultation. Methods: This study used a hybrid type III randomized implementation trial at 3 US Army installations. Providers were randomized to receive a 4-day prolonged exposure workshop (Standard training condition, n = 60), or the prolonged exposure workshop followed by 6-8 months of post-workshop expert case consultation (Extended training condition, n = 43). The effects training condition were examined on provider attitudes (self-efficacy in delivering PE, expectations for patient improvement, and beliefs about PE), use of PE and PE components, and clinical outcomes of patients with PTSD (using the Clinician-Administered PTSD Scale (CAPS-5)). Results: Extended condition providers reported greater improvements in self-efficacy, b =.83, 95% CI [.38, 1.27], t(79) = 3.71, p =.001, and d =.63. A greater proportion of patients in the Extended condition (44%) than in the Standard condition (27%) received at least 1 PE session, b =.76, t(233) = 2.53, p =.012, and OR = 2.13. Extended condition providers used more PE components (M =.9/session) than did Standard condition providers (M =.5/session), b =.54, 95% CI [.15,.93], t(68) = 2.70, p =.007, and d =.68. Finally, decrease in patients' PTSD symptoms was faster for patients of Extended condition providers than for patients of Standard condition providers, b = - 1.81, 95% CI [- 3.57, -.04], t(263) = - 2.02, p =.045, and d =.66, and their symptoms were lower at the second assessment, b = - 5.47, 95% CI [- 9.30, - 1.63], t(210) = - 2.81, p =.005, and d =.66. Conclusions: Post-workshop consultation improved self-efficacy for delivering PE, greater use of PE, faster PTSD reduction, and lower PTSD severity at the second assessment. To our knowledge, this is the first demonstration that post-workshop case consultation for PE improves patient outcomes. Trial registration: Clinicaltrials.gov, NCT02982538.
AB - Background: Prolonged exposure therapy (PE) is an evidence-based treatment for posttraumatic stress disorder (PTSD) that is underutilized in the military health system. Standard workshop training in PE may not be sufficient to alter provider behavior, but post-workshop consultation requires significant resources. Therefore, it is important to determine the incremental utility of post-workshop consultation. Methods: This study used a hybrid type III randomized implementation trial at 3 US Army installations. Providers were randomized to receive a 4-day prolonged exposure workshop (Standard training condition, n = 60), or the prolonged exposure workshop followed by 6-8 months of post-workshop expert case consultation (Extended training condition, n = 43). The effects training condition were examined on provider attitudes (self-efficacy in delivering PE, expectations for patient improvement, and beliefs about PE), use of PE and PE components, and clinical outcomes of patients with PTSD (using the Clinician-Administered PTSD Scale (CAPS-5)). Results: Extended condition providers reported greater improvements in self-efficacy, b =.83, 95% CI [.38, 1.27], t(79) = 3.71, p =.001, and d =.63. A greater proportion of patients in the Extended condition (44%) than in the Standard condition (27%) received at least 1 PE session, b =.76, t(233) = 2.53, p =.012, and OR = 2.13. Extended condition providers used more PE components (M =.9/session) than did Standard condition providers (M =.5/session), b =.54, 95% CI [.15,.93], t(68) = 2.70, p =.007, and d =.68. Finally, decrease in patients' PTSD symptoms was faster for patients of Extended condition providers than for patients of Standard condition providers, b = - 1.81, 95% CI [- 3.57, -.04], t(263) = - 2.02, p =.045, and d =.66, and their symptoms were lower at the second assessment, b = - 5.47, 95% CI [- 9.30, - 1.63], t(210) = - 2.81, p =.005, and d =.66. Conclusions: Post-workshop consultation improved self-efficacy for delivering PE, greater use of PE, faster PTSD reduction, and lower PTSD severity at the second assessment. To our knowledge, this is the first demonstration that post-workshop case consultation for PE improves patient outcomes. Trial registration: Clinicaltrials.gov, NCT02982538.
KW - Consultation
KW - PTSD
KW - Prolonged exposure
KW - Provider training
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U2 - 10.1186/s13012-020-01014-x
DO - 10.1186/s13012-020-01014-x
M3 - Article
C2 - 32727509
AN - SCOPUS:85088852979
SN - 1748-5908
VL - 15
JO - Implementation Science
JF - Implementation Science
IS - 1
M1 - 59
ER -