A Randomized Effectiveness Trial of a Systems-Level Approach to Stepped Care for War-Related PTSD

Abstract

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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Document Details

Document Type
Technical Report
Publication Date
Sep 01, 2011
Accession Number
ADA555684

Entities

People

  • Lisa Jaycox

Organizations

  • RAND Corporation

Tags

DTIC Thesaurus Topics

  • Anxiety Disorders
  • Contracts
  • Cost Effectiveness
  • Department Of Defense
  • Diseases And Disorders
  • Health
  • Health Care
  • Health Services
  • Management Personnel
  • Medical Personnel
  • Mental Health
  • Military Personnel
  • Psychiatry
  • Public Health
  • Therapy
  • Training
  • Traumatic Stress Disorder

Fields of Study

  • Medicine
  • Psychology

Readers

  • Medical or Health Care Field.
  • Mental Health of Military Veterans with Posttraumatic Stress Disorder (PTSD): Risk Factors, Prevalence, Symptoms, and Treatment.