CLINICAL DIRECTORS NETWORK
&
RAND CORPORATION

Violence and Stress Assessment Project ( ViStA ) FACT SHEET

PROJECT BACKGROUND AND GOALS:
Primary care clinicians (PCCs) are often the first contact with the health care system for patients suffering from posttraumatic stress disorder (PTSD) or subthreshold PTSD because most people with common mental health disorders do not seek treatment from mental health specialists. The estimated lifetime prevalence of PTSD is 7.8% (with over 50% of people reporting some form of trauma experience) in the general population and is even higher for underserved populations that are at greater risk for PTSD from interpersonal, political, and community violence. Moreover, PTSD is poorly detected, under-treated, and debilitating. Unlike the maturing field of depression in primary care with successful quality improvement interventions, little is known about effectively treating PTSD in this setting.

Clinical Directors Network and the RAND Corporation have been funded by the National Institute of Mental Health (NIMH) to conduct a 2-year study to better understand primary care for adult Latino patients who are experiencing extreme stress reactions to personal, community, or war-related violence and who may suffer from post-traumatic stress disorder (PTSD). This study may help to identify promising strategies for improving the care of patients suffering from PTSD and trauma-related mental health and/or physical symptoms. The project aims are:

•  To describe primary care for PTSD and trauma-related mental health symptoms in a range of community centers from multiple stakeholder perspectives.

•  To identify structural and individual PCC predictors of PCC tendency to screen for, assess, refer, and manage trauma exposure, PTSD, and related symptoms and problems.

•  To elucidate potential intervention strategies based on data from Aims 1 and 2, to develop recommendations for intervention strategies that could be tested in a follow-up study to improve the quality of primary care for PTSD and trauma.

Five New York/New Jersey Community Health Centers that serve large numbers of immigrants and refugees will be selected to participate. These CHCs will represent a range of organizational structures that might affect PTSD care. In Year 1 semi-structured interviews through in-person site visits will be conducted with three types of key informants: 1) Medical Directors to understand how different Community Health Centers structures affect care, 2) Primary Care Clinicians ( PCCs) to understand how their knowledge, attitudes, practices, and perceived barriers and facilitators affect clinical decisions about trauma care, and 3) for patients with current trauma symptoms, to learn about their treatment needs and preferences.

In Year 2, surveys based on topical domains identified in Year 1 will be administered to: 1) a census of all NY/NJ CHC medical directors and 2) a random sample of Primary Care Clinicians, in order to formally test hypotheses about the structural and individual predictors of variation in the tendency of PCC's to identify and manage PTSD and subthreshold PTSD across differing organizational structures and patient populations. Medical Directors and Primary Care Clinicians will be invited to participate in a Stakeholder's Meeting at the end of the study.

Data obtained through the surveys and interviews will be used to identify potential interventions most likely to improve PTSD management, and will enable CDN and RAND to develop a follow-up study aimed at implementing and evaluating an intervention program for primary care-based PTSD treatment.

PROJECT TIME FRAME: March 1, 2005 – February 28, 2007

# OF PARTICIPATING CENTERS : Five (5)

FUNDING SOURCES: National Institute of Mental Health (NIMH)

CONTACT PERSONS:

PRINCIPAL INVESTIGATOR: Lisa Meredith, PhD RAND Corporation Health (M3W) 1776 Main Street Health (M3W) Santa Monica , CA 90407 TEL: (310) 393-0411 ext. 7365 FAX: (310) 260-8152 E-MAIL: seidel@rand.org	C0-PRINCIPAL INVESTIGATOR: David Eisenman, MD, MSHS RAND Corporation Health (M3W) 1776 Main Street Health (M3W) Santa Monica , CA 90407 TEL: (310) 393-0411 ext. 6429 FAX: (310) 260-8152 E-MAIL: David_Eisenman@rand.org	CO-INVESTIGATOR: Bonnie Green, PhD. Georgetown University Medical School Georgetown Center for Trauma & the Community 310 Kober Cogan Hall Washington , DC 20007 Tel: (202) 687-6529 FAX: 202-687-0694 E-MAIL: bgreen01@georgetown.edu
CO-INVESTIGATOR: Jonathan N. Tobin, PhD Clinical Directors Network, Inc. 5 West 37th Street , 10 th Floor New York , NY 10018 TEL: (212) 382-0699 ext. 234 FAX: (212) 382-0669 E-MAIL: jntobin@CDNetwork.org	PROJECT DIRECTOR: Andrea Cassells, MPH Clinical Directors Network, Inc. 5 West 37th Street , 10 th Floor New York , NY 10018 TEL: (212) 382-0699 ext. 227 FAX: (212) 382-0669 E-MAIL: acass@CDNetwork.org	PROJECT MANAGER: Lisa Harewood Clinical Directors Network, Inc. 5 West 37th Street , 10 th Floor New York , NY 10018 TEL: (212) 382-0699 ext. 233 FAX: (212) 382-0669 E-MAIL: lharewoo@CDNetwork.org