Stepped Collaborative Care for PTSD

The University of Washington Institutional Review Board approved all study procedures prior to initiating the protocol. Between April 2006 and September 2009, injured trauma survivors admitted to the University of Washington’s Harborview Level I trauma center were approached at bedside for participation. After providing written informed consent, potential participants were screened twice for high PTSD symptom levels with the PTSD Checklist Civilian Version (PCL-C),³⁴ once while surgical inpatients (median hospital days = 4, interquartile range (IQR) = 7), and again in the early days and weeks after hospital discharge (median days after index injury event = 13, IQR = 17), either in the outpatient surgery clinic or over the telephone. It was determined that with 100 patients randomized to each group, loss to follow-up of 20%, and a two-tailed α = 0.05, there would be > 80% power to detect an effect size of ≥0.4 when analyzing PTSD symptoms as a continuous variable.^{35 (link)}Two-hundred seven patients who screened positive at both time points were randomized to the stepped collaborative care intervention (n = 104) or usual care control (n = 103) conditions. All patients received evaluations of PTSD, depression, and alcohol consumption, as well as functional impairments and health service utilization, at baseline in the surgical ward before randomization, and again after randomization at one-, three-, six-, nine-, and twelvemonths post-discharge.