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| ID | Type | Description | Link |
|---|---|---|---|
| 137012 | Other Grant/Funding Number | Canadian Institutes of Health Research (CIHR) | |
| R01MH106506-01 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| Stanford University | OTHER |
| Canadian Institutes of Health Research (CIHR) | OTHER_GOV |
| National Institute of Mental Health (NIMH) | NIH |
| Palo Alto Veterans Institute for Research |
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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Fidelity-oriented Learning Community | Experimental | The Fidelity-oriented Learning Community arm will receive fidelity consultation (adherence and competence) feedback by a CPT expert via online meetings. |
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| Quality Improvement Learning Community | Experimental | 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. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Quality Improvement Learning Community | Behavioral | Consultation with CPT experts to effectively use evidence-based psychotherapy. |
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| Measure | Description | Time Frame |
|---|---|---|
| Change in PTSD Symptoms over 6 months (PCL-5 measure) | The PCL-5 is a 20-item self-report measure that assesses the 20 DSM-5 symptoms of PTSD. Each item is measured on a 5-point Likert scale. The PCL will track change from baseline to the 3 month follow up. | Participants will be followed for an expected duration of 12 weeks of therapy. PCL-5 will be measured at baseline, at Weeks 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, post-treatment week, and at 3-month follow-up. |
| Measure | Description | Time Frame |
|---|---|---|
| Fidelity Measure | The fidelity measure examines clinicians' adherence and competence to specific CPT interventions prescribed in each session. Clinicians are rated on their adherence to the protocol (on a 0-2 Likert-type scale), as well as their competence in delivery of these elements (rated on a 7-point, Likert-type scale). | At baseline, at 12 and 24 months |
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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
Exclusion Criteria:
Ineligible patient participants are those having
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| Name | Affiliation | Role |
|---|---|---|
| Candice Monson, PhD | Toronto Metropolitan University | Principal Investigator |
| Shannon Wiltsey Stirman, PhD | National Center for PTSD | Principal Investigator |
| Norman Shields, PhD | Royal Canadian Mounted Police | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| VA Palo Alto Healthcare System | Menlo Park | California | 94024 | United States | ||
| UTHSCSA |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 36370226 | Derived | Thomas FC, Loskot T, Mutschler C, Burdo J, Lagdamen J, Sijercic I, Lane JEM, Liebman RE, Finley EP, Monson CM, Wiltsey-Stirman S. Initiating Cognitive Processing Therapy (CPT) in Community Settings: A Qualitative Investigation of Therapist Decision-Making. Adm Policy Ment Health. 2023 Jan;50(1):137-150. doi: 10.1007/s10488-022-01229-8. Epub 2022 Nov 12. | |
| 28264720 | Derived | Wiltsey Stirman S, Finley EP, Shields N, Cook J, Haine-Schlagel R, Burgess JF Jr, Dimeff L, Koerner K, Suvak M, Gutner CA, Gagnon D, Masina T, Beristianos M, Mallard K, Ramirez V, Monson C. Improving and sustaining delivery of CPT for PTSD in mental health systems: a cluster randomized trial. Implement Sci. 2017 Mar 6;12(1):32. doi: 10.1186/s13012-017-0544-5. |
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No plan to share IPD.
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| ID | Term |
|---|---|
| D013313 | Stress Disorders, Post-Traumatic |
| D014947 | Wounds and Injuries |
| ID | Term |
|---|---|
| D040921 | Stress Disorders, Traumatic |
| D000068099 | Trauma and Stressor Related Disorders |
| D001523 | Mental Disorders |
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| OTHER |
| National Center for PTSD | FED |
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| Fidelity-oriented Learning Community | Behavioral | The Fidelity-oriented Learning Community arm will receive fidelity consultation (adherence and competence) feedback by a CPT expert via online meetings. |
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| Content-Level and Context-Level Adaptation | Using a framework and coding system of modifications and adaptations made to EBPs, sessions will be rated to identify 11 potential content-level adaptations, as well as 5 context-level modifications. | At baseline, at 12 and 24 months |
| CPT Activity Reporting | All clinicians will report monthly on CPT activity: caseload size, frequency, duration and satisfaction with the LC over the past month, number of new CPT patients, clinician confidence rating in their CPT delivery. | monthly for up to 1 year |
| San Antonio |
| California |
| 78229 |
| United States |
| Ryerson University | Toronto | Ontario | M5B 2K3 | Canada |