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The Principal Investigator left the institution
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Homelessness and associated traumas disproportionately impact women relative to men. Women who have experienced homelessness (WEH) universally face traumatic stress, often before becoming homeless and while experiencing homelessness.
For WEH who are incarcerated, additional trauma may occur while in correctional settings. Black WEH are disproportionately impacted by trauma, homelessness, and incarceration, as is related to structural and individual racism and discrimination (racial trauma).
Homelessness and associated traumas disproportionately impact women relative to men. Women who have experienced homelessness (WEH) universally face traumatic stress, often before becoming homeless and while experiencing homelessness. For WEH who are incarcerated, additional trauma may occur while in correctional settings. Black WEH are disproportionately impacted by trauma, homelessness, and incarceration, as is related to structural and individual racism and discrimination (racial trauma). In our stepwise, multi-year research process, across hundreds of interviews, WEH identified trauma as their priority health issue. In response to a dearth of culturally acceptable trauma care models, our team pilot tested Narrative Exposure Therapy (NET)-a brief, human rights-informed treatment for complex PTSD in resource-limited settings. In this randomized controlled trial (RCT), we seek to understand whether supplementing nurse-delivered NET with peer/program support will strengthen its effects on PTSD, co-occurring symptoms, and social determinants of health outcomes compared to an attentional control, while optimizing implementation outcomes.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| NurseNET-Narrative Exposure Therapy | Experimental | Nurse-Delivered Narrative Exposure Therapy (NurseNET). Narrative Exposure Therapy (NET) is a brief, low-cost, trauma-focused treatment modality that is effective in treating mobile populations with complex PTSD. In NurseNET, NET is facilitated by a clinically experienced nurse, while peers/program support specialists offer scaffolded support, fostering trust, engagement, and retention. NurseNET begins with administration of a "diagnostic battery" and psychoeducation. Then, in subsequent NurseNET sessions, using gradual imaginative exposure, the nurse guides the participant to verbally express and re-frame their personal trauma narratives to shift unhelpful beliefs/symptoms around trauma. NurseNET utilizes a racism-conscious approach to create relational spaces in which narratives of WEH are positioned to challenge dominant social narratives. Each NurseNET session offers a brief soulfulness-based stress reduction activity to prompt emotional/affective grounding. |
|
| PAL: Peer Active Listening | Active Comparator | Peer Active Listening (PAL). In the PAL active comparator/control, peers/program support specialists meet individually with participants in "active listening sessions", along the same visit sequence as NurseNET. During PAL sessions, peers/program support specialists allow participants to set each conversational agenda while practicing the tenets of active listening, including attending to body language, paraphrasing the participant's verbal expressions, reflecting feelings, and using tactful repetition. PAL sessions are not intended to center on topics of trauma, but rather designed to offer a supportive relationship (attentional control). |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| NurseNET | Behavioral | Nurse-Delivered Narrative Exposure Therapy (NurseNET). Narrative Exposure Therapy (NET) is a brief, low-cost, trauma-focused treatment modality that is effective in treating mobile populations with complex PTSD. In NurseNET, NET is facilitated by a clinically experienced nurse, while peers/program support specialists offer scaffolded support, fostering trust, engagement, and retention. NurseNET begins with administration of a "diagnostic battery" and psychoeducation. Then, in subsequent NurseNET sessions, using gradual imaginative exposure, the nurse guides the participant to verbally express and re-frame their personal trauma narratives to shift unhelpful beliefs/symptoms around trauma. NurseNET utilizes a racism-conscious approach to create relational spaces in which narratives of WEH are positioned to challenge dominant social narratives. Each NurseNET session offers a brief soulfulness-based stress reduction activity to prompt emotional/affective grounding. |
| Measure | Description | Time Frame |
|---|---|---|
| Posttraumatic Stress Disorder (PTSD) symptoms | PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 (PCL-5). Higher score = worse outcome. Range: 0-80. | Eligibility Screening; Pre-/Post-Assessment (week 4); Follow-up Assessments (weeks 10 and 16) |
| Measure | Description | Time Frame |
|---|---|---|
| Depressive symptoms | Patient Depression Questionnaire (PHQ-9). Higher score = worse outcome. Range: 0-27. | Pre-Assessment (week 0), Post-Assessment (week 4); Follow-up Assessments (weeks 10 and 16) |
| Anxiety |
| Measure | Description | Time Frame |
|---|---|---|
| Healthcare access | Barriers to Access to Care Evaluation Scale (BACE). Higher score = worse outcome (greater barrier to seeking treatment). Range: 0-90. 30-items, 12-item subscale measures the extent to which stigma and discrimination are barriers to care. | Pre-Assessment (week 0), Post-Assessment (week 4) |
| Perceived social support |
Inclusion Criteria:
Exclusion Criteria:
• impaired decisional capacity (UC-San Diego Brief Assessment ≤14.5)
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| Name | Affiliation | Role |
|---|---|---|
| Kirsten A Dickins, PhD, FNP-C | Rush University Medical Center | Principal Investigator |
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| ID | Term |
|---|---|
| D013313 | Stress Disorders, Post-Traumatic |
| ID | Term |
|---|---|
| D040921 | Stress Disorders, Traumatic |
| D000068099 | Trauma and Stressor Related Disorders |
| D001523 | Mental Disorders |
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| PAL | Other | Peer Active Listening (PAL). In the PAL active comparator/control, peers/program support specialists meet individually with participants in "active listening sessions", along the same visit sequence as NurseNET. During PAL sessions, peers/program support specialists allow participants to set each conversational agenda while practicing the tenets of active listening, including attending to body language, paraphrasing the participant's verbal expressions, reflecting feelings, and using tactful repetition. PAL sessions are not intended to center on topics of trauma, but rather designed to offer a supportive relationship (attentional control). |
|
Generalized Anxiety Disorder (GAD-7). Higher score = worse outcome. Range: 0-21.
| Pre-Assessment (week 0), Post-Assessment (week 4); Follow-up Assessments (weeks 10 and 16) |
| Sleep symptoms | Regensburg Insomnia Scale (RIS). Higher score = worse outcome. Range: 0-40. | Pre-Assessment (week 0), Post-Assessment (week 4); Follow-up Assessments (weeks 10 and 16) |
| Somatization | Somatic Symptoms Scale (SSS-8). Higher score = worse outcome. Range: 0-32. | Pre-Assessment (week 0), Post-Assessment (week 4); Follow-up Assessments (weeks 10 and 16) |
| Substance use | Tobacco, Alcohol, Prescription medications, and other Substance (TAPS) tool. TAPS-1, is a four-item screening that asks about substance use in the past 12 months. | Pre-Assessment (week 0), Post-Assessment (week 4); Follow-up Assessments (weeks 10 and 16) |
Multidimensional Scale of Perceived Social Support Scale (MSPSS). Higher score = better. Range: 0-60. |
| Pre-Assessment (week 0), Post-Assessment (week 4); Follow-up Assessments (weeks 10 and 16) |
| Discrimination | Everyday/Major Experiences of Discrimination Scale (EDS/MDS). This measure contains nine elements that assess the participant's perception of major experiences of discrimination, followed by a follow-up question about what the person believes was the reason for that discrimination (no numeric scoring). | Pre-Assessment (week 0), Post-Assessment (week 4) |
| Racial trauma | Racial Trauma Scale (RTS) (short form research version). Higher score = worse. Range: 9-36. | Pre-Assessment (week 0), Post-Assessment (week 4) |