Cognitive Behaviour Therapy A peer reviewed, multidisciplinary journal devoted to the application of behavioural and cognitive sciences to clinical psychology and psychotherapy.
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Text by: Doyanne Darnell
Each year in the U.S. 1.5-2.5 million people suffer traumatic injury requiring inpatient hospitalization. The nation’s trauma care system is highly effective in saving lives, being well-coordinated within geographic regions to provide a full continuum of medical care and responsive to best-practice guidelines based on up-to-date research and expert opinion (see the American College of Surgeons Committee on Trauma’s Resources for Optimal Care of the Injured Patient). Our team conducts research to inform best practices for addressing the mental health sequelae common after suffering traumatic injury, such a posttraumatic stress disorder (PTSD) and depression.
Current guidelines recommend screening trauma patients for PTSD and depression and providing relevant specialty referrals. Research is needed to identify effective early interventions that can be initiated from the trauma center, which is critically important to both prevent worsening of symptoms and better reach trauma patients, who are known to experience challenges accessing specialty mental health services after trauma. Engaging routine trauma center providers, such a nurses and social workers, in the delivery of brief early mental health interventions – in addition to making specialty referrals- is a promising approach to providing a full continuum of needed mental health care. In fact, such a task shifting approach has been used successfully in the global health context. According to the World Health Organization, task shifting is the process of moving specific tasks to health workers with shorter training and fewer qualifications, when appropriate (see the WHO’s report, Task Shifting: Global Recommendations and Guidelines).
In the present study, we demonstrate that it is feasible to train trauma nurses to deliver a brief behavioral intervention known as activity scheduling that can be used to help patients reduce avoidance/withdrawal behavior that is common after injury that serves to maintain symptoms of PTSD and depression. The activity scheduling intervention, informed by Behavioral Activation and developed by the study team, includes collaboratively identifying a pleasurable and/or meaningful activity that a patient can do and developing a homework assignment (i.e., goal-setting) to ensure the patient will effectively engage in the activity. The provider checks back and builds on the assignment so that the patient begins to increase their overall activity level and engagement in reinforcing activities. The study team has since implemented the activity scheduling training with routine trauma center providers as part of an ongoing 25-site clinical trial of a collaborative care early intervention for PTSD and related comorbidities funded by the National Institutes of Health (http://rethinkingclinicaltrials.org/demonstration-projects/uh3-project-a-policy-relevant-u-s-trauma-care-system-pragmatic-trial-for-ptsd-and-comorbidity-trauma-survivors-outcomes-and-support-tsos/). Findings from the full-scale trial will help determine whether the activity scheduling training is associated with skill improvement and inform efforts to task shift mental health care to routine trauma center providers.
Read the full paper: Darnell, D. A., Parker, L. E., Wagner, A. W., Dunn, C. W., Atkins, D. C., Dorsey, S., & Zatzick, D. F. (in press). Task-shifting to improve the reach of mental health interventions for trauma patients: Findings from a pilot study of trauma nurse training in patient-centered activity scheduling for PTSD and depression. Cognitive Behaviour Therapy. doi: 10.1080/16506073.2018.1541928
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