February 2020

In This Issue: Advancements in VA Primary Care
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Primary Care-based PTSD Intervention: Clinician-Supported PTSD Coach

Feature Article

Takeaway: If this treatment is effective at reducing PTSD symptoms and increasing the use of mental healthcare, it will provide a tremendous positive impact on Veterans with PTSD seen in VA primary care.

PTSD is highly prevalent in Veterans seen in VA primary care; however, there is a lack of evidence-based brief PTSD interventions that can be delivered in this setting. Therefore, Veterans with PTSD are offered referrals to specialty mental healthcare where evidence-based psychotherapies are available. Unfortunately, many patients refuse such referrals or, if accepted, infrequently attend enough sessions to receive adequate treatment. Consequently, a significant gap exists between the need for and engagement in effective PTSD treatment for Veterans seen exclusively in VA primary care. Innovative technology could help address this need by increasing access to and quality of PTSD treatment. VA's National Center for PTSD has developed PTSD Coach—an evidence-informed, self-management mobile app that offers PTSD psycho-education, symptom monitoring, coping skills, and links to social support and professional resources. Incorporating PTSD Coach in VA primary care involves primary care mental health integration (PCMHI) providers delivering four 20- to 30-minute sessions (in-person or via phone) over eight weeks. The clinician-supported PTSD Coach (CS PTSD Coach) intervention is focused on instructions for app use, setting symptom reduction goals, and assigning specific PTSD Coach activities (e.g., assessments, management strategies, psycho-educational readings) for the participant to complete between sessions.

The primary objective of this ongoing HSR&D study (October 2016 – September 2020) is conducting a randomized controlled trial of a PTSD Coach intervention for Veterans with PTSD treated in VA primary care. Specific aims are to examine the:

• Impact of CS PTSD Coach on PTSD symptom severity;
• Impact of CS PTSD Coach on engagement in two sessions of specialty mental healthcare; and
• Patient and provider satisfaction with the intervention.

Investigators also aim to explore potential mediators (i.e., objective app use, coping self-efficacy) and moderators (i.e., baseline PTSD symptom severity, comorbid psychiatric symptoms) of outcomes. In addition, they will explore trajectories of PTSD symptom change over the follow-up period to assess whether engagement in specialty MH treatment and continued app use affect symptom change. Assessments will include well-established clinical interviews and self-report measures that will take place at pre-treatment (baseline), post-treatment, and at 16- and 24-week follow-up.

Preliminary Findings

To date, 161 Veterans have been randomized to either CS PTSD Coach or treatment as usual (i.e., primary care mental health integrated care). While outcomes are not yet available, this project has the potential to improve the quality of care for Veterans with PTSD presenting in VA primary care by establishing the effectiveness of an innovative and highly scalable PTSD intervention.

Impact

The long-term goal of this study is to establish effective, innovative, easily disseminated mobile health interventions for Veterans with PTSD. Bringing CS PTSD Coach into primary care could be an initial step in a stepped-care approach to provide patient-centered treatment that facilitates shared decision-making on treatment options, reduces PTSD symptoms, and prepares Veterans for more intensive treatments, if needed. If this treatment is found to be effective at reducing PTSD symptoms and increasing the use of mental healthcare, it will provide a tremendous positive impact on Veterans with PTSD seen in VA primary care.

Principal Investigators: Eric Kuhn, PhD, is part of the National Center for PTSD and HSR&D's Center for Innovation to Implementation (Ci2i) in Palo Alto, CA, and Kyle Possemato, PhD, part of VA Center for Integrated Healthcare in Syracuse, New York.

Publications

Owens J, Kuhn E, Jaworski B, et al. VA mobile apps for PTSD and related problems: Public health resources for Veterans and those who care for them. mHealth. July 2018;4:28.

View study abstract