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Evaluation ViewAttendees 3

Primary Care / Integrated Care
Symposia

Symposium 106 - Integrated Care and Trauma: Considerations for Screening and Treating Trauma and Related Symptoms in Primary Care Settings

Saturday, November 16, 2024
4:30 PM – 6:00 PM EST
Location: Franklin 1, Level 4, Downtown Marriott
CE: 1.5

Keywords: Primary Care, Trauma, PTSD (Posttraumatic Stress Disorder)
Level of Familiarity: Basic to moderate
Recommended Readings: Rauch, S. A. M., Cigrang, J., Austern, D., Evans, A., & STRONG STAR Consortium (2017). Expanding the Reach of Effective PTSD Treatment Into Primary Care: Prolonged Exposure for Primary Care. Focus (American Psychiatric Publishing), 15(4), 406–410. https://doi.org/10.1176/appi.focus.20170021,   Spottswood, M., Davydow, D. S., & Huang, H. (2017). The Prevalence of Posttraumatic Stress Disorder in Primary Care: A Systematic Review. Harvard review of psychiatry, 25(4), 159–169. https://doi.org/10.1097/HRP.0000000000000136,   van den Berk-Clark, C., Gallamore, R., Barnes, J., Oberle, A., Meyer, D., Schneider, F. D., & Ambulatory Research Community Health Network (ARCHNet). (2021). Identifying and overcoming barriers to trauma screening in the primary care setting. Families, Systems, & Health, 39(2), 177–187. https://doi.org/10.1037/fsh0000593,   Roberts, Susan Jo DNSc, ANP, FAAN (Professor)1; Chandler, Genevieve E. PhD, RN (Associate Professor)2; Kalmakis, Karen PhD, MPH, FNP-BC, FAANP (Associate Professor)2. A model for trauma-informed primary care. Journal of the American Association of Nurse Practitioners 31(2):p 139-144, February 2019. | DOI: 10.1097/JXX.0000000000000116,   Kantor, V., Knefel, M., & Lueger-Schuster, B. (2017). Perceived barriers and facilitators of mental health service utilization in adult trauma survivors: A systematic review. Clinical psychology review, 52, 52–68. https://doi.org/10.1016/j.cpr.2016.12.001

While exposure to potentially traumatic events may be relatively common, the development of posttraumatic stress disorder (PTSD) after trauma exposure is less so (6.8% for U.S. adults; APA, 2022). PTSD is associated with negative health outcomes, including increased risk of suicide, physical health problems, and mental health comorbidities (Sareen, 2014). Research suggests early identification and intervention may be effective in attenuating the effects of trauma, including PTSD and related consequences (Birk et al., 2019; Qi et al., 2016). Primary care settings have been identified as key points of intervention in the detection and treatment of trauma and related symptoms (Green et al., 2016; Spottswood et al., 2017).

There is a critical need to examine trauma prevalence and related symptoms among primary care patients, including those seen for general concerns, behavioral health concerns, and the management of more severe and/or chronic illnesses. Evidence for the treatment of trauma and related symptoms is also of high importance. In this symposium, we highlight work consistent with the conference’s annual goal of promoting community engagement, advocacy, and innovation for the advancement of cognitive behavioral therapies. The studies described herein rely on community engagement strategies to elucidate trauma prevalence in diverse primary care samples with variable demographic characteristics and presenting concerns. We also examine a brief, innovative cognitive-based prolonged exposure intervention for implementation in primary care settings.

The first speaker will present on data examining adverse childhood experiences and adult health in a family practice setting. The second speaker will present on the prevalence of trauma exposure, trauma-related symptoms, and psychiatric distress in integrated behavioral health care utilizers. The next speakers will present longitudinal data on the prevalence and impacts of trauma exposure among utilizers of a public HIV health clinic. Our final speaker will present outcomes data of Prolonged Exposure for Primary Care (PE-PC) and examine predictors of treatment trajectory. An expert in integrated primary care and trauma treatments will serve as the discussant.

Across the first three studies in this symposium, researchers found trauma exposure prevalence in primary care patients was high, ranging 58-88%. Prevalence was higher in medically compromised samples than in general populations of primary care patients. Generally, demographic variables were not associated with trauma exposure. Trauma-exposed primary care patients suffer more physically and psychologically compared to non-exposed patients, both concurrently and prospectively. Findings suggest it is critical to screen for trauma exposure in all primary care patients. Further, the fourth presentation provides evidence that trauma can be treated in primary care settings in as few as four 30-minute sessions. Trauma-focused treatment in primary care is most appropriate for patients with moderate symptoms/functional impairment. More severe symptoms/impairment may require more intensive modes of treatment. Evidence supports the treatment of trauma in primary care settings for a large portion of patients.

Learning Objectives:

At the end of this session, the learner will be able to:
  1. Investigate the relationship between resiliency, ACEs and mental and physical health symptoms.
  2. Examine trauma exposure and trauma-related symptom endorsement among integrated behavioral health care utililizers.
  3. Explain the role of PTSD and psychopathology in medication adherence and immune health outcomes in the context of HIV care.
  4. Describe effective brief PTSD treatments that can be provided in primary care.
  5. Describe the limitations of trauma treatments in primary care.

Presentations:

  • 4:30 PM – 6:00 PM EST
    (SYM 106) Examining Adverse Childhood Experiences and Adult Health in a Family Practice Setting

    Speaker: Alesia Jones, Ph.D. – University of Illinois at Chicago

  • 4:30 PM – 6:00 PM EST
    (SYM 106) Examining Trauma Exposure and Related Symptoms in Integrated Behavioral Health Care Utilizers: Implications for Screening in Primary Care Settings

    Speaker: Marley F. Fradley, B.S. (she/her/hers) – University of Arkansas

    Co-author: Ella Eureste (she/her/hers) – University of Arkansas

    Co-author: Joyce Ho (she/her/hers) – University of Arkansas

    Co-author: Alyssa Hartley (she/her/hers) – University of Arkansas

    Co-author: Marbely Rivas (she/her/hers) – University of Arkansas

    Co-author: Mattie Berry (she/her/hers) – University of Arkansas

    Co-author: Mia Iandolo (she/her/hers) – University of Arkansas

    Co-author: Gavin Miller (he/him/his) – University of Arkansas

    Co-author: Emily Allen, MA (she/her/hers) – University of Arkansas

    Co-author: Dulce Diaz Benitez, MA (she/her/hers) – University of Arkansas

    Co-author: Christin A. Mujica, M.A. – University of Arkansas

  • 4:30 PM – 6:00 PM EST
    (SYM 106) Untangling Threads: A Longitudinal Examination of Trauma Exposure and Posttraumatic Distress in a Public HIV Care Clinic

    Speaker: Yumei Chen, M.S. (she/her/hers) – University of Miami

    Co-author: Norik Kirakosian, B.S. (they/them/theirs) – University of Miami

    Co-author: Maria Llabre, PhD (she/her/hers) – University of Miami

    Co-author: Hanna Vasconcello, BS – University of Miami

    Co-author: Allan Rodriguez, MD – University of Miami

    Co-author: Steven A. Safren, ABPP, Ph.D. (he/him/his) – University of Miami

  • 4:30 PM – 6:00 PM EST
    (SYM 106) Who Benefits from Prolonged Exposure for Primary Care?

    Speaker: Sheila Rauch, ABPP, Ph.D. (she/her/hers) – Emory University SOM/Atlanta VAMC

    Co-author: H. Myra Kim, ScD (she/her/hers) – CSCAR, University of Michigan

    Co-author: Ronald Acierno, Ph.D. (he/him/his) – UTHealth Houston

    Co-author: Carly Ragin, B.A. – Atlanta VA Medical Center

    Co-author: Bethany Wangelin, PhD (she/her/hers) – Tailored Brain Health and previously Ralph H. Johnson VA Medical Center and Medical University of South Carolina

    Co-author: Kimberly Blitch, M.A., LPC, Other – Ralph H. Johnson VA Healthcare System

    Co-author: Wendy Muzzy, MRA, MLIS (she/her/hers) – MUSC/Ralph H Johnson VA Health Care System

    Co-author: Stephanie Hart, M.P.H. – Ralph H. Johnson VA Health Care System

    Co-author: Grace Ingham, B.A. – Atlanta VAHCS/Emory SOM