Supporting the implementation of written exposure therapy for posttraumatic stress disorder in an obstetrics-substance use disorder clinic in the Northeastern United States
Pregnant people with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) constitute a highly vulnerable population. PTSD and SUD confer risks to both the pregnant person and the fetus, including a host of physical and mental health consequences. When PTSD and SUD co-occur,...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-12-01
|
| Series: | SSM - Mental Health |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666560323000713 |
| _version_ | 1797385051984363520 |
|---|---|
| author | Sarah E. Valentine Laura B. Godfrey Resham Gellatly Emilie Paul Caitlin Clark Karissa Giovannini Kelley A. Saia Yael I. Nillni |
| author_facet | Sarah E. Valentine Laura B. Godfrey Resham Gellatly Emilie Paul Caitlin Clark Karissa Giovannini Kelley A. Saia Yael I. Nillni |
| author_sort | Sarah E. Valentine |
| collection | DOAJ |
| description | Pregnant people with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) constitute a highly vulnerable population. PTSD and SUD confer risks to both the pregnant person and the fetus, including a host of physical and mental health consequences. When PTSD and SUD co-occur, potential negative impacts are amplified, and the symptoms of each may exacerbate and maintain the other. Pregnancy often increases engagement in the healthcare system, presenting a unique and critical opportunity to provide PTSD and SUD treatment to birthing people motivated to mitigate risks of losing custody of their children. This paper presents implementation process outcomes of Written Exposure Therapy (WET), a brief, scalable, and sustainable evidence-based PTSD treatment delivered to pregnant persons receiving care in an integrated obstetrical-addiction recovery program at Boston Medical Center. Trial participants (N = 18) were mostly White, non-Hispanic (61.1%), not currently working (77.8%), had a high school or lower level of education (55.5%), had an annual household income less than $35,000 (94.4%), and were living in a substance use residential program (55.6%). We examined intervention feasibility, acceptability, appropriateness, adoption; barriers and facilitators to implementation; and feedback on supporting uptake and sustainability of the intervention using coded qualitative sources (consultation field notes [N = 47] and semi-structured interviews [N = 5]) from providers involved in trial planning and treatment delivery. Results reflected high acceptability, appropriateness, and adoption of WET. Participants described system-, provider-, and patient-level barriers to implementation, offered suggestions to enhance uptake, but did not raise concerns about core components of the intervention. Findings suggest that WET is an appropriate and acceptable PTSD treatment for this difficult-to-reach, complex population, and has the potential to positively impact pregnant persons and their children. |
| first_indexed | 2024-03-08T21:48:33Z |
| format | Article |
| id | doaj.art-e4827d21b8204c99acd4741384a15b86 |
| institution | Directory Open Access Journal |
| issn | 2666-5603 |
| language | English |
| last_indexed | 2024-03-08T21:48:33Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | SSM - Mental Health |
| spelling | doaj.art-e4827d21b8204c99acd4741384a15b862023-12-20T07:39:04ZengElsevierSSM - Mental Health2666-56032023-12-014100256Supporting the implementation of written exposure therapy for posttraumatic stress disorder in an obstetrics-substance use disorder clinic in the Northeastern United StatesSarah E. Valentine0Laura B. Godfrey1Resham Gellatly2Emilie Paul3Caitlin Clark4Karissa Giovannini5Kelley A. Saia6Yael I. Nillni7Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA; Department of Psychiatry, Boston Medical Center, Boston, MA, USA; Corresponding author. 810 Massachusetts Avenue, Suite 400, Boston, MA, 02118, USA.Department of Psychiatry, Boston Medical Center, Boston, MA, USADepartment of Psychiatry, Boston Medical Center, Boston, MA, USA; Immigrant and Refugee Health Center, Boston Medical Center, Boston, MA, USADepartment of Psychiatry, Boston Medical Center, Boston, MA, USADepartment of Obstetrics & Gynecology, Boston Medical Center, Boston, MA, USADepartment of Obstetrics & Gynecology, Boston Medical Center, Boston, MA, USADepartment of Obstetrics & Gynecology, Boston Medical Center, Boston, MA, USA; Department of Obstetrics & Gynecology, Boston University School of Medicine, Boston, MA, USADepartment of Psychiatry, Boston University School of Medicine, Boston, MA, USA; National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, USAPregnant people with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) constitute a highly vulnerable population. PTSD and SUD confer risks to both the pregnant person and the fetus, including a host of physical and mental health consequences. When PTSD and SUD co-occur, potential negative impacts are amplified, and the symptoms of each may exacerbate and maintain the other. Pregnancy often increases engagement in the healthcare system, presenting a unique and critical opportunity to provide PTSD and SUD treatment to birthing people motivated to mitigate risks of losing custody of their children. This paper presents implementation process outcomes of Written Exposure Therapy (WET), a brief, scalable, and sustainable evidence-based PTSD treatment delivered to pregnant persons receiving care in an integrated obstetrical-addiction recovery program at Boston Medical Center. Trial participants (N = 18) were mostly White, non-Hispanic (61.1%), not currently working (77.8%), had a high school or lower level of education (55.5%), had an annual household income less than $35,000 (94.4%), and were living in a substance use residential program (55.6%). We examined intervention feasibility, acceptability, appropriateness, adoption; barriers and facilitators to implementation; and feedback on supporting uptake and sustainability of the intervention using coded qualitative sources (consultation field notes [N = 47] and semi-structured interviews [N = 5]) from providers involved in trial planning and treatment delivery. Results reflected high acceptability, appropriateness, and adoption of WET. Participants described system-, provider-, and patient-level barriers to implementation, offered suggestions to enhance uptake, but did not raise concerns about core components of the intervention. Findings suggest that WET is an appropriate and acceptable PTSD treatment for this difficult-to-reach, complex population, and has the potential to positively impact pregnant persons and their children.http://www.sciencedirect.com/science/article/pii/S2666560323000713PregnancyTraumaPosttraumatic stress disorder (PTSD)PerinatalImplementation |
| spellingShingle | Sarah E. Valentine Laura B. Godfrey Resham Gellatly Emilie Paul Caitlin Clark Karissa Giovannini Kelley A. Saia Yael I. Nillni Supporting the implementation of written exposure therapy for posttraumatic stress disorder in an obstetrics-substance use disorder clinic in the Northeastern United States SSM - Mental Health Pregnancy Trauma Posttraumatic stress disorder (PTSD) Perinatal Implementation |
| title | Supporting the implementation of written exposure therapy for posttraumatic stress disorder in an obstetrics-substance use disorder clinic in the Northeastern United States |
| title_full | Supporting the implementation of written exposure therapy for posttraumatic stress disorder in an obstetrics-substance use disorder clinic in the Northeastern United States |
| title_fullStr | Supporting the implementation of written exposure therapy for posttraumatic stress disorder in an obstetrics-substance use disorder clinic in the Northeastern United States |
| title_full_unstemmed | Supporting the implementation of written exposure therapy for posttraumatic stress disorder in an obstetrics-substance use disorder clinic in the Northeastern United States |
| title_short | Supporting the implementation of written exposure therapy for posttraumatic stress disorder in an obstetrics-substance use disorder clinic in the Northeastern United States |
| title_sort | supporting the implementation of written exposure therapy for posttraumatic stress disorder in an obstetrics substance use disorder clinic in the northeastern united states |
| topic | Pregnancy Trauma Posttraumatic stress disorder (PTSD) Perinatal Implementation |
| url | http://www.sciencedirect.com/science/article/pii/S2666560323000713 |
| work_keys_str_mv | AT sarahevalentine supportingtheimplementationofwrittenexposuretherapyforposttraumaticstressdisorderinanobstetricssubstanceusedisorderclinicinthenortheasternunitedstates AT laurabgodfrey supportingtheimplementationofwrittenexposuretherapyforposttraumaticstressdisorderinanobstetricssubstanceusedisorderclinicinthenortheasternunitedstates AT reshamgellatly supportingtheimplementationofwrittenexposuretherapyforposttraumaticstressdisorderinanobstetricssubstanceusedisorderclinicinthenortheasternunitedstates AT emiliepaul supportingtheimplementationofwrittenexposuretherapyforposttraumaticstressdisorderinanobstetricssubstanceusedisorderclinicinthenortheasternunitedstates AT caitlinclark supportingtheimplementationofwrittenexposuretherapyforposttraumaticstressdisorderinanobstetricssubstanceusedisorderclinicinthenortheasternunitedstates AT karissagiovannini supportingtheimplementationofwrittenexposuretherapyforposttraumaticstressdisorderinanobstetricssubstanceusedisorderclinicinthenortheasternunitedstates AT kelleyasaia supportingtheimplementationofwrittenexposuretherapyforposttraumaticstressdisorderinanobstetricssubstanceusedisorderclinicinthenortheasternunitedstates AT yaelinillni supportingtheimplementationofwrittenexposuretherapyforposttraumaticstressdisorderinanobstetricssubstanceusedisorderclinicinthenortheasternunitedstates |