Evaluation of the Implementation of a Modular Cognitive-Behavioral Treatment for Posttraumatic Stress, Depression, and Anxiety in U.S. Community Mental Health Settings

Roselyn Peterson, Doyanne Darnell, Maria Monroe-DeVita,

MacKenzie Hughes, Shannon Dorsey, Laura Murray, Lucy BerlinerUniversity of Washington & Johns Hopkins Bloomberg School of Public Health

INTRODUCTION• Common Elements Treatment Approach (CETA) is a modularized cognitive-

behavioral therapy (CBT) first piloted in low- and middle-income countries (LMIC): Southern Iraq and the Thailand/Burmese border

• Many trauma-exposed populations in the US and other high-income countries (HIC) lack access and resources to evidence-based CBTs for posttraumatic stress and related comorbidities

• While evidence-based treatments have been implemented in HIC, this was the first study of CETA being implemented in community mental health (CMH) settings in the United States

• Our original sample was N = 58, 8 dropped out of the Learning Collaborative consultation calls due to turnover, not enough time and the setting of the CMH agency not being a good fit for CETA

LEARNING COLLABORATIVE MODELRequired Components for Clinicians

1. Attend workshop and at least 9 of the 12 consultation calls

2. Complete training evaluation surveysClinician self-report of 17 CETA skills and implementation

3. Complete training case (using online EBP Toolkit)Had to document 6 sessions (at least)Complete outcomes measures at least two different times

PHQ-9 – depression GAD-7– anxiety PSS– posttraumatic stress disorder

CONCLUSION• This novel approach offers many opportunities to greatly impact the way

public health treats trauma-exposed populations such as prioritizing symptom reduction over the current crisis.

• Clinicians are learning to focus the majority of sessions on symptom reduction by doing CETA, then addressing life crises at the end of the session, showing that a structured CBT such as CETA can work in the public mental health context with difficult to treat populations.

FEASIBILITY DATA• Of the 50 providers:

• 37 (74%) providers attended at least 9 or more consultation calls

• 44 (88%) providers had at least 1-2 client cases

• 11.2 was the average number of CETA sessions providers reported with their clients

• 3.6 was the average number of time-points assessments were administered

LIMITATIONS/FUTURE DIRECTIONS

• Interest is high for an Evidence Based Practice that addresses multiple outcomes and can be individually tailored

• Attention will be needed to address challenges of applying a brief structured intervention within the larger context of public mental health

• Client outcome data is preliminary and based on training cases. The outcome supports the feasibility of CETA in public mental health. Future research is needed to establish the effectiveness of CETA in these settings.

18%

16%

11%11%

9%

9%

7%

7%4%

4%4%

Barriers

Doesn't agree/Struggled with components Insufficient time for dosing/finding a patientHard for non-English speaking clients Trauma exposureClient's issues unrelated to CETA Too many life crisesIncomplete homework OtherChronic symptoms prevent focus Poor attendanceAgency setting unfit for CETA

31%

17%15%

10%

8%

6%4%4%4%

Facilitators

Cognitive coping triangle Enjoyed structure of CETABehavioral activation, Cognitive restructuring Client engaged well, Address deeper issuesCETA offers hope and motivation Gradual exposureSimplicity & flexibility of CETA Consultation callsOther

Research supported by Washington StateContact: rsp3@uw.edu

References available on back of handout

Provider Demographic

Characteristics

Clinicians

(N = 40)

Supervisors

(N = 10)

Age 38.4 (11.6 SD) 42.2 (9.1 SD)

Female Gender 26 (65%) 8 (80%)

Years at Agency 3.5 (4.0 SD) 5.9 (3.0 SD)

Degree

MSW 17 (42.5%) 7 (70%)

Other Masters 14 (35%) 3 (30%)

4 Year College 6 (15%) -

Doctoral Degree 2 (5%) -

High School or 2 Year College 1 (2.5%) -

PARTICIPANT OUTCOME DATA• Of the 53 participants:

• 34 (64%) have a diagnosis of PTSD• 9 are diagnosed with Major Depression• 5 are diagnosed with GAD/Other Anxiety Dx• 5 are diagnosed with some Other Mental Health Dx

• Outcomes for the 53 participants generally decreased over time:

Client Demographic

Characteristics

Participants

(N = 53)

Age 44.5 (9.9 SD)

Female Gender 29 (54.7%)

Clinical Target  

Posttraumatic Stress 38 (71.7%)

Depression 12 (22.6%)

Anxiety 3 (5.7%)

Homeless/Live in Shelter 7 (13.2%)

Baseline Follow-Up2

4

6

8

10

12

14

16

18

CLIENT ASSESSMENT OUTCOMES

PHQ-9

GAD-7

PSS Total

PM: PTS

PM: Anxiety

PM: De-pression

Client Demographic

Characteristics (Cont.)

Participants

(N = 53)

Race/Ethnicity  

White 29 (54.7%)

Latino/Hispanic 6 (11.4%)

African American 4 (7.5%)

Asian 3 (5.7%)

Multiracial 2 (3.8%)

Not reported/Other 9 (16.9%)

PHQ-9 average N = 32 16.6 to 9.7

GAD-7 average N = 27 14.8 to 9.1

PSS average N = 37 9.4 to 7.1

PM PTS average N = 21 9.9 to 8.5

PM Anxiety average N = 21 4.1 to 3.14

PM Depression average N = 21 14.9 to 10.7