Lead/Presenter: Rebecca Sripada, COIN - Ann Arbor
All Authors: Sripada RK (VA Center for Clinical Management Research), Walters HM (VA Center for Clinical Management Research) Smith, K (University of Michigan) Rauch, SAM (Emory University)
Objectives:
Healthcare workers (HCWs) on the frontlines of the COVID-19 pandemic are experiencing unprecedented levels of stress and trauma exposure, resulting in exceptionally high rates (27-57%) of posttraumatic stress disorder (PTSD). PTSD in HCWs leads to burnout, absenteeism, decreased work performance, decreased functioning, and lower quality of life. However, only 18-26% of frontline HCWs with COVID-19 related distress currently receive mental health treatment, and over half desire additional support. Employee Assistance Programs (EAPs), employer-supported programs designed to alleviate employee distress, have expanded their offerings to support HCWs during the pandemic. However, EAPs operate on a brief treatment model, and do not have the capacity to provide evidence-based treatments for PTSD such as Prolonged Exposure (PE), a time-intensive treatment that requires specialized training. To address this problem, our team has adapted PE from a 12-session format into a 4-6 session format (PE for Primary Care; PE-PC) and demonstrated the efficacy of this adapted treatment in active-duty military. What remains lacking is a way to systematically provide efficacious PTSD treatment to HCWs. Thus, there is an urgent need to test the effectiveness and subsequently implement brief, efficacious PTSD treatment by leveraging the healthcare system EAP.
Methods:
The goal of this pilot study is to demonstrate the feasibility of delivering PE-PC in healthcare system EAPs. To date, we have trained 12 EAP counselors across 4 Michigan healthcare systems. Another five counselors are currently in the four-month consultation phase. Counselors collected PTSD symptom scores from their HCW clients. Counselors were surveyed on PE-PC’s acceptability, appropriateness, and feasibility for their setting.
Results:
Eighteen individuals to date have received PE-PC from their EAP counselors. In the intent-to-treat analysis, mean reduction on the PTSD checklist for DSM-5 (PCL-5) is 11 points (SD = 9). Among the 9 individuals with at least four sessions, mean reduction on the PCL-5 is 17 points (SD = 10). A reduction of 10 points on the PCL-5 is considered to be clinically significant. Among EAP counselors, on a scale of 1-5, mean acceptability rating is 4.4, mean appropriateness rating is 3.7, and mean feasibility rating is 4.0. Data collection for the current cohort of counselors is ongoing.
Implications:
These data support the feasibility, acceptability, and appropriateness of PE-PC for HCWs, as delivered by EAP counselors. We are in the process of refining our PE-PC training and consultation programs to better fit the healthcare system EAP context. This study will provide pilot data for a fully-powered randomized controlled trial to test the effectiveness of PE-PC as compared with EAP Treatment as Usual. If demonstrated to be effective, this line of research will contribute to the field a point-of-care intervention for frontline HCWs with COVID-19 related PTSD, which will alleviate PTSD symptoms related to the current pandemic and future public health emergencies.
Impacts:
This project addresses the HSRandD priority area of COVID-related research as well as Quality, Safety, and Value of Health Care. Findings from this study can be applied to VA EAPs to improve VA HCW mental health and reduce burnout.