A Randomized Effectiveness Trial of a Systems-Level Approach to Stepped Care for War-Related PTSD
Annual rept. 1 Sep 2010-31 Aug 2011
RAND CORP SANTA MONICA CA
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The purpose of the STEPS UP STepped Enhancement of PTSD Services Using Primary Care trial is to compare centralized telephonic care management with preference-based stepped PTSD and depression care to optimized usual care. We hypothesize that the STEPS UP intervention will lead to improvements in 1 PTSD and depression symptom severity primary hypothesis 2 anxiety and somatic symptom severity, alcohol use, mental health functioning, work functioning 3 costs and cost-effectiveness. We further hypothesize that qualitative data will show 4 patients, their family members, and participating clinicians find that the STEPS UP intervention is an acceptable, effective, and satisfying approach to deliver and receive PTSD and depression care STEPS UP is a six-site, two parallel arm N 1,500 randomized controlled effectiveness trial with 3-month, 6-month, and 12-month follow-up comparing centralized telephonic stepped-care management to optimized usual PTSD and depression care. In addition to the existing PTSD and depression treatment options, STEPS UP will include web-based cognitive behavioral self-management, telephone cognitive-behavioral therapy, continuous nurse care management, and computer-automated care management support. Both arms can refer patients for mental health specialty care as needed, preferred and available. The study will use sites currently running RESPECT-Mil, the Initiating PI s existing military primary care-mental health services practice network, to access site health care leaders and potential study participants at the 6 study sites. If effective, we expect that STEPS UP will increase the percentage of military personnel with unmet PTSD- and depression-related health care needs who get timely, effective, and efficient PTSD and depression care.
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