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

ABSTRACT

Despite high rates of posttraumatic stress disorder (PTSD) and depression among traumatically injured patients, engagement in session-based psychotherapy early after trauma is limited due to various service utilization and readiness barriers. Task-shifting brief mental health interventions to routine trauma center providers is an understudied but potentially critical part of the continuum of care. This pilot study assessed the feasibility of training trauma nurses to engage patients in patient-centered activity scheduling based on a Behavioral Activation paradigm, which is designed to counteract dysfunctional avoidance/withdrawal behavior common among patients after injury. Nurses (N = 4) and patients (N = 40) were recruited from two level II trauma centers. A portion of a one day in-person workshop included didactics, demonstrations, and experiential activities to teach brief intervention delivery. Nurses completed pre- and posttraining standardized patient role-plays prior to and two months after training, which were coded for adherence to the intervention. Nurses also completed exit interviews to assess their perspectives on the training and addressing patient mental health concerns. Findings support the feasibility of training trauma nurses in a brief mental health intervention. Task-shifting brief interventions holds promise for reaching more of the population in need of posttrauma mental health care.

KEYWORDS:

• Cognitive-behavioral
• training
• adherence
• trauma
• public health

Acknowledgments

This study was supported in part by the National Institutes of Health (NIH) Common Fund and National Institute of Mental Health (NIMH), through cooperative agreements (U54 AT007748, 1UH2MH106338-01/4UH3MH106338-02) from the Office of Strategic Coordination within the Office of the NIH Director, and in part by NIMH UH3MH106338-03S1. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH.

The investigators acknowledge Paul Inouye, MD and Elizabeth Stuebing, MD MPH, site project lead investigators at the Tacoma General (Dr. Inouye) and Providence Everett (Dr. Stuebing) Trauma Centers and staff at each trauma center who participated in the research project.

Disclosure statement

No potential conflict of interest was reported by the authors.

supplemental material

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Additional information

Funding

This work was supported by the National Institute of Mental Health [UH3MH106338-03S1]; National Institutes of Health [1UH2MH106338-01,4UH3MH106338-02,U54 AT007748].