Sustaining and Improving Clinicians' Use of Evidence-Based Psychotherapy (EBP) for PTSD

Toronto Metropolitan University

Status: Active, not recruiting

Conditions: Post Traumatic Stress Disorder

Treatments: Behavioral: Quality Improvement Learning Community; Behavioral: Fidelity-oriented Learning Community

Study type: Interventional

Funder types: Other; Other U.S. Federal agency; NIH

Identifiers

NCT02449421

REB: 2014-345

137012 (Other Grant/Funding Number)

R01MH106506-01 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

The purpose of the study is to compare the impact of two strategies to sustain and improve the delivery of an evidence-based psychotherapy for PTSD, Cognitive Processing Therapy (CPT) in three different mental health systems. These approaches are based on two different theories of what is necessary to promote successful implementation. We will examine whether these strategies lead to improved patient outcomes, clinician skill, proportion of clients who receive CPT, and other outcomes that are relevant to the implementation of evidence-based psychosocial treatments. By examining these questions in 3 different mental health systems, we will also examine whether the implementation strategies yield different results in different systems.

Full description

This project will compare two different methods of post-training support to promote sustained and improved CPT delivery: Fidelity-oriented learning community (FID-LC) and Continuous Quality Improvement Learning Community (CQI-LC). Clinics in which clinicians have previously received CPT training will be randomly assigned to one of these conditions. Outcomes will be observed changes in patient symptoms during and following treatment, independent expert assessment of clinician fidelity and adaptations in delivering the psychotherapy (via audio-recordings), proportion of eligible caseloads that receive CPT, and capacity to deliver CPT. Data will also be collected to assess clinician and setting characteristics that may contribute to the success of each strategy. The study results will help inform how best to support the ongoing implementation and benefits of evidence-based psychotherapy (e.g., CPT) in routine clinical settings. This is a knowledge translation project in partnership with 3 systems; VA Canada, U.S. Veterans Health Care System and the National Centre for PTSD.

Enrollment: 90 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• All clinicians that provide psychotherapy to patients with PTSD

• Agree to provide CPT to 6 patients over 2 years

• Consent to be randomized to one of two study conditions

• Are willing to record therapy sessions

• Continue to have computer/internet access.

• Patients will be clients of clinician participants that

  1. Are 18 years or older
  2. Have a diagnosis of PTSD
  3. Are willing to have their sessions audiorecorded

Exclusion criteria

• Ineligible patient participants are those having

  1. Current uncontrolled psychotic or bipolar disorder
  2. Unremitted substance dependence
  3. Current imminent suicidality or homicidality that requires imminent attention
  4. Significant cognitive impairment

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

---

90 participants in 2 patient groups

Fidelity-oriented Learning Community

Experimental group

Description:

The Fidelity-oriented Learning Community arm will receive fidelity consultation (adherence and competence) feedback by a CPT expert via online meetings.

Treatment:

Behavioral: Fidelity-oriented Learning Community

Quality Improvement Learning Community

Experimental group

Description:

The Quality Improvement Learning Community arm will include clinicians who set goals related to CPT delivery, execute a plan, study results, refine plan, and continue each cycle until goals are met.

Treatment:

Behavioral: Quality Improvement Learning Community