A pragmatic feasibility trial of the Primary Care Intervention for PTSD: A health service delivery model to reduce health disparities for low-income and BIPOC youth

• Published in: Behaviour research and therapy 2023-06, Vol.165, p.104310-104310, Article 104310
• Main Authors: Ng, Lauren C., Miller, Alexandria N., Bowers, Gray, Cheng, Yuhan, Brigham, Rebecca, Tai, Ming-Him, Smith, Ash M., Mueser, Kim T., Fortuna, Lisa R., Coles, Mandy
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anxiety Disorders; Child; Early intervention; Feasibility Studies; Female; Health Services; Humans; Integrated care; Pediatric primary care; Primary Health Care; PTSD; Stress Disorders, Post-Traumatic - therapy; Trauma; Young Adult
• ISSN: 0005-7967; 1873-622X
• DOI: 10.1016/j.brat.2023.104310

This study is a non-randomized pragmatic trial to assess the feasibility and acceptability of the Primary Care Intervention for Posttraumatic stress disorder (PCIP) (Srivastava et al., 2021), an Integrated Behavioral Health Care treatment for PTSD in adolescents. Following routine clinic procedures, youth who were suspected of having trauma-related mental health symptoms were referred by their primary care providers to integrated care social workers for evaluation. The integrated care social workers referred the first 23 youth whom they suspected of having PTSD to the research study. Twenty youth consented to the study and 19 completed the pre-assessment (17 female; mean age = 19.32, SD = 2.11; range 14–22 years). More than 40% identified as Black and a third as Hispanic/Latinx. PCIP mechanisms and clinical outcomes were assessed pre- and post-treatment, and at one-month follow-up. Participants and therapists completed post-treatment qualitative interviews to assess feasibility and acceptability, and treatment sessions were audio recorded to assess fidelity. Findings suggest high acceptability, satisfaction, and feasibility of the PCIP delivered in “real-life” safety net pediatric primary care. Integrated care social workers had high treatment fidelity. Despite the small sample size, there was significant improvement in symptom scores of anxiety (g = 0.68, p = 0.02) and substance use (g = 0.36, p = 0.04) from pre to post, and depression symptoms (g = 0.38, p = 0.04) from pre to follow-up. Qualitative data from patients who completed exit interviews and integrated social workers indicated high satisfaction with the treatment, with some participants reporting that the integrated intervention was more acceptable and less stigmatizing than seeking mental health care outside of primary care. The PCIP may improve treatment engagement and access for vulnerable youth. Promising findings of high acceptability, feasibility, and initial clinical effectiveness suggest that PCIP warrants larger-scale study as part of routine care in pediatric integrated care. •The PCIP may overcome barriers to the timely treatment of PTSD, which disproportionately impacts low-income and BIPOC youth.•The PCIP may allow youth to receive PTSD care immediately upon identification, improving treatment engagement and access.•As an integrated care treatment, the PCIP is a “real-life” model to reduce disparities amongst youth at higher risk for PTSD.