Youth with PTSD get relief from proven treatment

Only 31% of efforts to integrate proven treatments into health care systems are successful, recent data has found.

A team of clinic administrators, clinicians, policymakers and scientists who led a newly published 10-year study across Philadelphia behavioral health centers beat those odds by successfully implementing an evidence-based form of cognitive behavioral therapy for young people suffering from post-traumatic stress disorder (PTSD).

Many young Philadelphians live below the poverty line and/or are Medicaid-insured. They’re often exposed to significant interpersonal violence (child sexual, physical and emotional abuse)  and community violence, are more likely to develop PTSD from these experiences and less likely to recover from PTSD compared to socioeconomically advantaged youth.

The team of scientists — originally at the University of Pennsylvania (Penn) but now at Northwestern University and Stony Brook University — began working with Philadelphia's Department of Behavioral Health and Intellectual disAbility Services in 2012 to incorporate the use of trauma-informed cognitive behavioral therapy, an evidence-based treatment for young people with PTSD, across the city's behavioral health system.

The study was successful in two ways: First, patients who received the trauma-informed cognitive behavioral therapy saw their PTSD symptoms decline an average of 30% from baseline to termination. But the overarching success of the study was in how well the city was able to implement and sustain the therapy’s adoption and reach over 10 years.

“It is mission critical that we learn from effective implementations so that other settings can engage in similar processes to come up with an implementation blueprint that works for their context, clinicians, patients and the ‘thing’ that they are implementing,” said Northwestern implementation scientist Rinad Beidas, who led the evaluation of the study at Penn and is now the chair of the department of medical social sciences at Northwestern University Feinberg School of Medicine. “This is a success story with regard to both implementation and effective sustained outcomes and the power of partnership with the community.”

The study was recently published in the journal Implementation Research and Practice.

It is one of the longest-standing evaluations of an implementation of an evidence-based treatment for young people with PTSD. The city of Philadelphia just received a third round of funding to continue to learn how to sustain these efforts.

“Up until recently, the implementation process has been a black box,” said corresponding author Briana Last, who led the work at Penn. “But our study proved partnerships among the city, researchers, community organizations, clinicians and young people and their families are all crucial to ensuring that large-scale efforts to implement evidence-based treatments actually reach those who need them.”

This is a success story with regard to both implementation and effective sustained outcomes and the power of partnership with the community.”

Trauma rates in young people in Chicago and across the country are high. The study offers a model for what other cities might consider when trying to implement treatment programs to meet the needs of their communities, the authors said. Although every city is different, the study authors said it is possible to learn from the experience of the Philadelphia system and tailor them to other metropolitan areas, such as Chicago or New York.

It is important to note Philadelphia clinicians involved in the study were rigorously trained in understanding PTSD and how to implement this evidence-based practice, which is not always the case, the study authors said.

“These youths have not only experienced significant traumatic events, but they also face the chronic stressors associated with economic disadvantage,” said Last, who is currently an inclusion, diversity, equity and access fellow in the department of psychology at Stony Brook University. “Having a clinician who really understands what you’re going through and has the skills to support you can make the world of a difference.”

Additionally, much of what made Philadelphia’s implementation effort successful was its unique public financing structure that funds its mental health treatment efforts, Last said.

Since its inception in 2012, the study has provided training and support for this trauma-informed cognitive behavioral therapy to 478 therapists from 20 public behavioral health agencies. Roughly 30 to 40 clinicians participate each year. Since 2012, 23,401 youths in the study have been screened for exposure to potentially traumatic events and PTSD symptoms; 7,550 of them received the trauma-informed cognitive behavioral therapy.