title: Enhancing the population impact of collaborative care interventions: mixed method development and implementation of stepped care targeting posttraumatic stress disorder and related comorbidities after acute trauma.
abstract: OBJECTIVE
  The objective of the study was to develop and implement a stepped collaborative care intervention targeting posttraumatic stress disorder (PTSD) and related comorbidities to enhance the population impact of early trauma-focused interventions.
  
  
  METHODS
  We describe the design and implementation of the Trauma Survivors Outcomes and Support study. An interdisciplinary treatment development team was composed of trauma surgical, clinical psychiatric and mental health services "change agents" who spanned the boundaries between frontline trauma center clinical care and acute care policy. Mixed method clinical epidemiologic and clinical ethnographic studies informed the development of PTSD screening and intervention procedures.
  
  
  RESULTS
  Two hundred seven acutely injured trauma survivors with high early PTSD symptom levels were randomized into the study. The stepped collaborative care model integrated care management (i.e., posttraumatic concern elicitation and amelioration, motivational interviewing and behavioral activation) with cognitive behavioral therapy and pharmacotherapy targeting PTSD. The model was feasibly implemented by frontline acute care masters in social work and nurse practioner providers.
  
  
  CONCLUSIONS
  Stepped care protocols targeting PTSD may enhance the population impact of early interventions developed for survivors of individual and mass trauma by extending the reach of collaborative care interventions to acute care medical settings and other nonspecialty posttraumatic contexts.
authors: Department of Psychiatry and Behavioral Sciences, Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, WA 98104, USA. dzatzick@u.washington.edu
authors: Douglas
authors: D
authors: Zatzick
authors: Frederick
authors: F
authors: Rivara
authors: Gregory
authors: G
authors: Jurkovich
authors: Joan
authors: J
authors: Russo
authors: Sarah Geiss
authors: SG
authors: Trusz
authors: Jin
authors: J
authors: Wang
authors: Amy
authors: A
authors: Wagner
authors: Kari
authors: K
authors: Stephens
authors: Chris
authors: C
authors: Dunn
authors: Edwina
authors: E
authors: Uehara
authors: Megan
authors: M
authors: Petrie
authors: Charles
authors: C
authors: Engel
authors: Dimitri
authors: D
authors: Davydow
authors: Wayne
authors: W
authors: Katon
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