Last Briana S, Johnson Christina, Dallard Natalie, Fernandez-Marcote Sara, Zinny Arturo, Jackson Kamilah, Cliggitt Lauren, Rudd Brittany N, Mills Chynna, Beidas Rinad S
Department of Psychology, Stony Brook University, Stony Brook, NY, USA.
Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
Implement Res Pract. 2023 Sep 11;4:26334895231199467. doi: 10.1177/26334895231199467. eCollection 2023 Jan-Dec.
In 2012, Philadelphia's Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) developed an initiative to implement an evidence-based treatment for posttraumatic stress disorder (PTSD), trauma-focused cognitive behavioral therapy (TF-CBT), across the city's behavioral health system. This report evaluates the initiative's 10-year implementation and effectiveness outcomes. The Exploration, Preparation, Implementation, and Sustainment framework guided our implementation evaluation. The implementation outcomes include adoption, reach, and sustainment; these were obtained during regular evaluation data collection from publicly funded behavioral health agencies participating in the TF-CBT initiative. We analyze effectiveness outcomes (i.e., changes in PTSD symptoms) from a subset of patients receiving TF-CBT, which were collected in 6-month intervals by our research team between 2013 and 2021. From 2012 to 2021, DBHIDS trained 478 clinicians in TF-CBT across 20 behavioral health agencies. During this time, 23,401 youths were screened for potentially traumatic events and PTSD symptoms, and 7,550 youths received TF-CBT. Through the TF-CBT initiative, the city expanded the network of TF-CBT providers from 3 to 20 agencies. DBHIDS sustained this network by maintaining the participation of 16 behavioral health agencies over the course of a decade. The subset of 202 youths who were evaluated to assess TF-CBT effectiveness was drawn from 94 therapists and 20 agencies across Philadelphia. All participating youths completed a baseline assessment, and 151 (75%) completed at least one follow-up assessment. Linear mixed-effects models accounting for observations nested within participants and nested within clinicians found that treatment significantly reduced PTSD symptoms. Between 2012 and 2021, DBHIDS successfully implemented and sustained TF-CBT across the city's behavioral health system. Adoption, reach, and sustainment of TF-CBT were high. Despite the considerable adverse experiences faced by youths seeking treatment in Philadelphia's behavioral health system, TF-CBT was effective. Future directions to improve TF-CBT implementation in the next iteration of the initiative are described.
2012年，费城行为健康与智力残疾服务部（DBHIDS）发起了一项倡议，在全市行为健康系统中实施基于证据的创伤后应激障碍（PTSD）治疗方法——创伤聚焦认知行为疗法（TF-CBT）。本报告评估了该倡议10年的实施情况和有效性结果。探索、准备、实施和维持框架指导了我们的实施评估。实施结果包括采用率、覆盖范围和维持情况；这些结果是在对参与TF-CBT倡议的公共资助行为健康机构进行定期评估数据收集期间获得的。我们分析了接受TF-CBT治疗的部分患者的有效性结果（即PTSD症状的变化），这些数据由我们的研究团队在2013年至2021年期间每6个月收集一次。2012年至2021年期间，DBHIDS在20家行为健康机构对478名临床医生进行了TF-CBT培训。在此期间，对23401名青少年进行了潜在创伤事件和PTSD症状筛查，7550名青少年接受了TF-CBT治疗。通过TF-CBT倡议，该市将TF-CBT提供者网络从3家扩展到20家机构。DBHIDS通过在十年间维持16家行为健康机构的参与，维持了这一网络。从费城的94名治疗师和20家机构中抽取了202名青少年作为评估TF-CBT有效性的样本。所有参与的青少年都完成了基线评估，151名（75%）完成了至少一次随访评估。考虑到参与者内部和临床医生内部嵌套观察的线性混合效应模型发现，治疗显著减轻了PTSD症状。2012年至2021年期间，DBHIDS在全市行为健康系统中成功实施并维持了TF-CBT。TF-CBT的采用率、覆盖范围和维持情况都很高。尽管在费城行为健康系统寻求治疗的青少年面临着相当多的不良经历，但TF-CBT仍然有效。文中还描述了在该倡议的下一阶段改进TF-CBT实施的未来方向。
