International Society for Traumatic Stress Studies

Pre-Meeting Institutes (PMI)

Pre-Meeting Institutes are full or half day sessions that provide opportunities for intensive training on topics integral to the conference program, presented by leaders in the field.

NOTE: Presenter names are BOLDED, Discussant names are UNDERLINED

FULL DAY INSTITUTES
8:30 a.m. – Noon, 1:30 – 5:00 p.m.

PMI – 01: Treating Sleep Problems Associated with Trauma and PTSD

PMI – 02: Assessing and Treating Racial Trauma 


PMI – 03: Treatment of Complex Childhood Trauma: Comparative Application of Case Material to Four Leading Intervention Models 


HALF DAY INSTITUTES - MORNING
8:30 a.m. – Noon

PMI – 04: An Introduction to the Network Toolbox (Part One)


PMI – 05: Yoga for Individuals with PTSD and Clinicians who Treat Them: State of the Science to Clinical Practice to Self-Care 

PMI – 06: Using Prolonged Exposure and Cognitive Processing Therapy to Treat Moral Injury-Based PTSD  

PMI – 07: The SIX C's Guidelines for Immediate Psychological First Aid - The Israeli PFA National Model 


PMI – 08: Integration of Military Culture into Provider Education to Promote More Effective Care for Service Members, Veterans, and their Families


HALF DAY INSTITUTES - AFTERNOON
1:30 – 5:00 p.m. 

PMI  09:  An Overview of the Network Toolbox (Part Two)


PMI – 10: Cognitive Processing Therapy and Crisis Response Planning for Clients with PTSD and Suicidal Behaviors  

PMI – 11: Hands-on Skills for Using Apps and Online Programs for Veterans with PTSD and Related Issues 

PMI  12: Advanced Workshop in Prolonged Exposure: Clinical Considerations in the Provision of Prolonged Exposure with Public Service Personnel 

PMI - 13 
Using Child Trauma Case Studies to Inspire Interprofessional Practice among Front-line Providers

 

Wednesday, November 7, 2018
Full Day Institutes
(8:30 a.m. – Noon and 1:30 – 5:00 p.m.)

PMI  - 01                                  

Treating Sleep Problems Associated with Trauma and PTSD


Keyword: Clinical Practice
Secondary Keywords: Biological/Medical; Cognitive Processes/Interventions; Sleep
Population Type: Adult
Presentation Level: Advanced
Region: Industrialized Countries

DeViva, Jason, PhD1; McCarthy, Elissa, PhD2
1VA Connecticut Healthcare System and Yale University, West Haven, Connecticut, USA
2National Center for PTSD, Executive Division, West Haven, Connecticut, USA

Sleep difficulties have been part of the diagnostic criteria of posttraumatic stress disorder (PTSD) since the diagnosis was first established, and they are among the most commonly reported symptoms among individuals exposed to trauma. Individuals exposed to trauma or diagnosed with PTSD are more likely to experience difficulties initiating and maintaining sleep, nightmares, sleep breathing disorders, and REM sleep behavior disorders. There is also evidence suggesting that sleep difficulties may play an important role in the development of PTSD, and impaired sleep is associated with many of the problems with health and functioning commonly seen in PTSD. Effective treatments for sleep problems are not widely available, potentially making trauma-exposed individuals more vulnerable to later difficulties. Sleep problems may persist after otherwise successful response to PTSD treatment and treatment of some sleep problems may improve PTSD symptoms.

This workshop will begin by examining research on the relationships among trauma, posttraumatic stress, insomnia, sleep breathing disorders, and other sleep disorders. A basic behavioral model of the development of insomnia will be presented, and specific aspects of posttraumatic stress that may precipitate or perpetuate insomnia will be identified. The majority of the workshop will focus on assessment and treatment. The use of established, evidence-based assessment of both posttraumatic symptoms and sleep will be emphasized. Guidelines for when to refer to sleep clinics will be presented. The current levels of evidence supporting treatments for PTSD, insomnia, nightmares, sleep breathing disorders, and other sleep disorders will be reviewed. Strategies for sequencing treatments based on symptom presentation and patient willingness will be discussed. The workshop will place particular emphasis on cognitive-behavioral therapy for insomnia (CBT-I), the gold standard treatment for insomnia, and its use when patients have been diagnosed with PTSD. Evidence supporting the use of CBT-I when comorbid PTSD is present will be examined, and potentially beneficial modifications to CBT-I will be reviewed. The workshop will also provide suggestions for how to address PTSD symptoms when patients choose to treat sleep disorders, and for how to address residual sleep difficulties after otherwise effective PTSD treatment. Suggestions for increasing adherence to treatment will be presented, with emphasis on treatment of sleep breathing disorders. Options for using technology to augment assessment and treatment will also be discussed. De-identified case material will be presented to illustrate treatment concepts and recommendations.

PMI - 02                                  

Assessing and Treating Racial Trauma

Keyword:
Culture/Diversity
Secondary Keywords: Clinical Practice
Population Type: Adult
Presentation Level: Introductory
Region: N/A

Wetterneck, Chad, PhD1; Williams, Monnica, T., PhD2; Carlson, Marie, D., PhD3
1Rogers Memorial Hospital, Oconomowoc, Wisconsin, USA
2University of Connecticut, Storrs, Connecticut, USA
3University of Texas at Austin, Austin, Texas, USA


Survivors of violent acts or disasters, emergency responders, abuse victims, and combat veterans are often associated with the risk of developing PTSD and many clinicians are well-equipped to provide services for those populations. When trauma and PTSD are related to experiences involving racial discrimination and systemic racism, the mental health community is less prepared.

In this full day pre-meeting institute, the presenters will explain trauma that results from experiences of racism and how people of color can develop PTSD from events that may include:

  • Racial profiling and police violence
  • Workplace discrimination and harassment
  • Community violence
  • Distressing medical/childbirth experiences
  • Incarceration
  • Difficult immigration experiences
  • Ethnic cleansing and torture


The presenters will provide an overview of the cultural factors relevant to the most common ethnic and racial minority groups, with an emphasis on understanding and assessing PTSD caused by racial trauma.  Using research findings to date, they will describe the various facets of racial trauma, including the experience of historical, cultural, and individual trauma, and how these may or may not fit into a DSM-5 framework. They will provide techniques attendees can utilize to assess race-based stress and trauma, including validated self-report measures and clinical interviews. The presenters will share case examples and provide time for participants to discuss their own cases. Attendees will also learn about the disparities in mental health treatment for people of color and how racial trauma can impact the therapeutic relationship. Finally, the presenters will review the research on the treatment of racial trauma and discuss their own research in this area, including an RCT underway.

Presenters will learn how to:

  • Define racial trauma and the cultural considerations in treating race-based PTSD.
  • Describe how racial trauma may develop and be maintained.
  • Utilize techniques to assess race-based stress and trauma.
  • Identify the various facets of racial trauma, including the experience of historical, cultural, and individual trauma.
  • Discuss the impact of racial trauma on the therapeutic relationship.

PMI - 03                                  


Treatment of Complex Childhood Trauma: Comparative Application of Case Material to Four Leading Intervention Models

Keyword: 
Clinical/Intervention Research
Secondary Keywords: Community/Social Processes/Interventions; Complex Trauma 
Population Type: Child/Adolescent
Presentation Level: Intermediate
Region: Industrialized Countries

Brown, Adam, PsyD1Blaustein, Margaret, PhD2; Saxe, Glenn, MD1; Lanktree, Cheryl, PhD3Griffin, Jessica, PsyD4
1New York University Langone Medical Center, New York, New York, USA
2Trauma Center at Justice Resource Institute, Brookline, MAssachusetts, USA
3University of Southern California, Torrance, California, USA
4University of Massachusetts Medical School, Worcester, Massachusetts, USA


This full-day pre-meeting workshop will begin with developers of four leading evidence-based models for complex trauma intervention introducing participants to their models: ARC (Attachment, Self-Regulation and Competency), ITCT-A (Integrative Treatment of Complex Trauma for Adolescents), TF-CBT (Trauma Focused Cognitive Behavioral Therapy, and TST (Trauma Systems Therapy). Model developers will describe key facets of each model, including the processes and techniques through which each model addresses the core components of complex trauma intervention. These model overviews will be followed by introduction of complex trauma case material by the moderator. Model developers will then discuss how they would approach assessment and intervention from the perspective of their model. The afternoon session will involve audience members presenting complex case material and/or challenging moments or situations in treatment, which each model developer will then address.  Ensuing panel discussion will be audience-driven, and will focus on examination of the shared and unique elements of each treatment model, and consider model fit based on client-specific and contextual factors, including developmental stage, treatment setting, care-giving system and cultural considerations.

 

Wednesday, November 7, 2018
Half-Day Institutes
(8:30 a.m. – Noon)

PMI - 04                                  

An Introduction to the Network Toolbox (Part One)

Keyword: 
Research Methodology
Secondary Keywords: Assessment/Diagnosis; Research Methodology; Technology; Theory
Population Type: Lifespan
Presentation Level: Introductory
Region: Global

Sigurdardóttir, Hannah Rós, MscLeertouwer, IJsbrand, Msc; Cramer, Angélique, PhD
Tilburg University, Tilburg, Netherlands

Since the introduction of psychopathology as a network of interacting symptoms, tools to investigate network structures based on clinical data have rapidly evolved. In this workshop we will discuss state of the art methods of estimating and analyzing network models, and caveats for interpretations based on these models.
 
The morning session will cover an introduction to networks in the context of PTSD research, basic programming skills needed to perform a network analysis, and a tutorial on estimating cross-sectional networks. The afternoon session will cover more advanced topics such as estimating the accuracy of cross-sectional networks, and estimating networks based on n=1 time-series data. By the end of the workshop, attendees will have the basic skills needed to perform network analysis on their data, and will be able to locate resources for more complex analyses.
 
We will provide exercises based in the statistical software R. We therefore request attendees to bring a laptop with R and R studio installed. Prior experience is not required, however we encourage attendees to get acquainted with these programs using the following materials:
 
https://cran.r-project.org/doc/contrib/Torfs+Brauer-Short-R-Intro.pdf,
https://cran.r-project.org/doc/contrib/Paradis-rdebuts_en.pdf
 

 PMI - 05

Yoga for Individuals with PTSD and Clinicians who Treat Them: State of the Science to Clinical Practice to Self-Care

Keyword: 
Clinical Practice
Secondary Keywords: (Neuro)Biological Processes/Interventions; Vicarious Traumatization and Therapist Self-Care
Population Type: Adult
Presentation Level: Introductory
Region: Global

Kelly, Ursula, PhD, RN1; Davis, Luanne, PsyD2; Catiis, Alissa, LCSW3
1Atlanta VAMC/Emory University, Decatur, Georgia, USA
2Roudebush VA Medical Center, Indianapolis, Indiana, USA
3Womencare Counseling Center, Evanston, Illinois, USA

Interest in and utilization of complementary and integrative health modalities by the general public has increased in recent years. One of these modalities – yoga - is increasingly used in the treatment of a variety of physical and mental health conditions, including PTSD. Yoga, defined here as a combination of physical forms, focused breathing, and mindfulness, is a promising complement, potential precursor, or alternative to evidence-based psychotherapy. A trio of presenters (nurse scientist and psychiatric/mental health nurse practitioner; clinical research psychologist/yoga practitioner and meditation teacher; and yoga teacher/psychotherapist) describe the current state of the science of yoga interventions for PTSD and teach participants techniques to integrate trauma-informed yoga in clinical work and clinician self-care. Podium presentations include a 1) psycho-physiological model of the effects of yoga on PTSD symptoms; 2) summary of objective research outcome measures (biological markers and psychophysiological data) of the effectiveness of yoga for PTSD; 3) description of the principles of Trauma Center-Trauma Sensitive Yoga (TC-TSY); 4) overview of yoga interventions used in PTSD research; and 5) summary of the current quantitative and qualitative evidence supporting yoga as an intervention for PTSD. The workshop also provides experiential segments during which participants are introduced to yoga practices, including TC-TSY, which they can use in their clinical work with clients and for clinicians’ self-care. Experiential yoga segments will include breathing techniques that are grounded to body sensations and reduce rather than activate the sympathetic nervous system. TC-TSY aims to cultivate awareness of the mind-body connection and to build self-regulation skills to address the way that trauma is held in the body in a way that psychotherapy does not. TC-TSY is yoga that focuses on building safety so student(s) can practice interoception, making choices, and taking effective action.  It can be used as an adjunctive treatment for trauma that is non-prescriptive and also creates a shared experience between the student(s) and teacher
 

PMI - 06                                  
Using Prolonged Exposure and Cognitive Processing Therapy to Treat Moral Injury-Based PTSD

Keyword: 
Clinical Practice
Secondary Keywords: Clinical Practice; Cognitive Processes/Interventions; War – Military/Peacekeepers/Veterans
Population Type: Adult
Presentation Level: Intermediate
Region: N/A

Evans, Wyatt, PhD1Held, Philip, PhD2Wachen, Jennifer, PhD3; Chard, Kathleen, PhD4; Rauch, Sheila, PhD, ABPP5
1University of Texas Health Science Center at San Antonio, Fort Hood, Texas, USA
2Rush University Medical Center, Chicago, Illinois, USA
3National Center for PTSD / Boston University, Boston, MAssachusetts, USA
4Cincinnati VA Medical Center, Cincinnati, Ohio, USA
5Emory University School of Medicine/Atlanta Veteran's Administrtation, Atlanta, Georgia, USA


Moral injury is a relatively nascent construct that has recently received increased attention. Mounting research suggests that morally injurious events may result in different symptom presentations compared to traumatic experiences that are primarily based on intense fear (i.e., life threat; e.g., Stein et al., 2012; Litz et al., 2018). It has also been suggested that existing evidence-based treatments for PTSD, such as Prolonged Exposure and Cognitive Processing Therapy, may not sufficiently address moral injury (e.g., Gray et al. 2012; Steenkamp et al. 2013), although these assumptions have not yet been evaluated. However, growing clinical evidence demonstrates how these evidence-based treatments may be aptly targeted to address moral injury among veterans with PTSD (Held et al., 2017; Rauch et al., 2013; Smith et al., 2013, Wachen et al., 2017).

The objective of this institute is to demonstrate how to treat moral injury-based PTSD in service members and veterans using Prolonged Exposure and Cognitive Processing Therapy. Although it is sometimes assumed that adaptations or modifications to the respective treatment protocols are necessary in the context of moral injury, experts in the respective therapies will demonstrate how existing Cognitive Processing Therapy and Prolonged Exposure treatment protocols may be utilized to effectively treat moral injury-based PTSD. Institute attendees will learn how to 1) distinguish moral injury-based PTSD from PTSD that results from non-morally injurious events, 2) identify appropriate moral injury-based treatment targets, and 3) apply Prolonged Exposure and Cognitive Processing therapy to effectively treat moral injury-based PTSD.

Case examples taken from diverse treatment settings will be presented by to illustrate specific treatment processes that are critical to effectively addressing moral injury in the context of evidence-based PTSD treatment. Special emphasis will be placed on identifying index traumas, as well as the application of the Prolonged Exposure and Cognitive Processing Therapy models specifically for moral injury. In Cognitive Processing Therapy this includes challenging moral injury-based cognitions through cognitive restructuring. In Prolonged Exposure this includes processing the meaning of the trauma and reducing avoidance behaviors. Along with outcome data, presenters will include audio recordings or exemplar session transcriptions to enhance attendees' learning. Other non-specific factors, such as provider bias, that may impact the treatment process will also be discussed and attendees will have the opportunity to ask questions about the use of Prolonged Exposure and Cognitive Processing Therapy to treat moral injury-based PTSD.
 

PMI - 07         

The SIX C's Guidelines for Immediate Psychological First Aid - The Israeli PFA National Model

Keyword:
Prevention/Early Intervention
Secondary Keywords: Acute/Single Trauma; Affective Processes/Interventions; Anxiety; Cognitive Processes/Interventions 
Population Type: Adult 
Presentation Level: Intermediate
Region: Global

Svetlitzky, Vlad, PhD1; Farchi, Moshe, PhD2
1Bar-Ilan University, Ramat Gan, Israel
2Tel-Hai College, Upper Galilee, Israel

Psychosocial responses to traumatic events at the individual and community level have received growing attention in recent years and are gaining momentum in light of recent mass traumatic events worldwide including conflicts, terrorist attacks and natural disasters.

Unlike routine life, traumatic or emergency situations are unexpected, unstructured events. First response in these situations is of utmost importance: immediate, focused and efficient interventions are beneficial for the reduction of acute stress reactions and a return to normal functioning as well as decreasing the risk for future onset of post-traumatic symptoms.

The aim of this Pre-Meeting Institute is to present the SIX C's model - a new psychological first aid approach – immediate cognitive-functional psychological first aid – for the global nonprofessional community as well as for first respondents. The model addresses the need to standardize interventions during an Acute Stress Reaction and intends to help shift the person from helplessness & passiveness into active effective function, within minutes, in the immediate aftermath of the traumatic event.  The model is based on four theoretical and empirically tested concepts: (1) Hardiness, (2) Sense of Coherence,; (3) Self-Efficacy, and (4) on the Neuro-bio-psychology of the stress response, focusing on the interaction between the limbic system and the prefrontal cortex during stressful events.

The maim guidelines of the model all start with the letter "C" are:
Cognitive-Communication, Challenge, Control, Commitment, Continuity.

Preliminary results on the effectiveness of the SIX C's model in terms of increasing resiliency, reducing anxiety and improving perceived self-efficacy are presented. To date, this approach has been recognized by the Israeli Ministry of Health as the Israeli national model for psychological first aid.  This model has also been ado[ted and implemented by the Israeli ministry of education, and during 2018-2019 all the educational system un Israel will be trained according to the SIX C's model.

This  Pre-Meeting Institute will train the participants in using the SIX C's guidelines in deferent scenarios ( EQ School shooting, car accidents, nature disaster )  and   deferent population (EQ Adult, children, toddlers).

The session will include video demonstrations, case studies & hands on training.
Pocket notebooks & stickers of the SIX C's model will be provided to all participants.

PMI - 08                                  

Integration of Military Culture into Provider Education to Promote More Effective Care for Service Members, Veterans, and their Families

Keyword: 
Culture/Diversity
Secondary Keywords: Clinical Practice; War – Military/Peacekeepers/Veterans 
Population Type: Adult 
Presentation Level: Intermediate
Region: Industrialized Countries

Watson, Patricia, PhD1; McCaslin, Shannon, PhD2; Ermold, Jenna, PhD3Tkachuck, Mathew, MA4
1National Center for PTSD, Executive Division, White River Junction, Vermont, USA
2National CVenter for PTSD - Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
3Center for Deployment Psychology, Rockville, Maryland, USA
4University of Mississippi, University of Mississippi, USA

This half-day pre-meeting institute will focus on improving access and quality of treatment for Service members and Veterans by integrating research and knowledge of military culture into patient care, with a focus on the following tools for providers:

1. Approaches to fostering communication regarding contextual / environmental barriers to care, including perceptions of cultural differences (e.g., communication with providers, navigating services/resources for care, stigma, lifestyle preference).

2. A military adaptation of four acculturation measures (orientation, psychological adaptation, sociocultural adaption, cultural distance) with discussion of how this assessment facilitates emphasis on functional assessment approach as opposed to solely symptom reduction.

3. Modules from seven VA/DOD online military cultural competence courses, which integrate research into clinical care recommendations.

4. Key information and resources from the NC-PTSD/VA Community Provider Toolkit relevant to screening for military service, military culture educational resources, as well as for working with diverse Veteran populations (e.g., women Veterans, LGBT).

5. Avatar-based learning program related to treatment of PTSD and sleep disorders common in Service members and Veterans that includes experiential exposure to aspects of military culture


Wednesday, November 7, 2018
Half-Day Institutes
(1:30 – 5:00 p.m.)

PMI - 09                        

An Overview of the Network Toolbox (Part Two)

Keyword: 
Research Methodology
Secondary Keywords: Assessment/Diagnosis; Research Methodology; Technology; Theory
Population Type: Lifespan
Presentation Level: Introductory
Region: Global

Sigurdardóttir, Hannah Rós, MscLeertouwer, IJsbrand, Msc; Cramer, AngéliquePhD
Tilburg University, Tilburg, Netherlands

Since the introduction of psychopathology as a network of interacting symptoms, tools to investigate network structures based on clinical data have rapidly evolved. In this workshop we will discuss state of the art methods of estimating and analyzing network models, and caveats for interpretations based on these models.
 
The morning session will cover an introduction to networks in the context of PTSD research, basic programming skills needed to perform a network analysis, and a tutorial on estimating cross-sectional networks. The afternoon session will cover more advanced topics such as estimating the accuracy of cross-sectional networks, and estimating networks based on n=1 time-series data. By the end of the workshop, attendees will have the basic skills needed to perform network analysis on their data, and will be able to locate resources for more complex analyses.
 
We will provide exercises based in the statistical software R. We therefore request attendees to bring a laptop with R and R studio installed. Prior experience is not required, however we encourage attendees to get acquainted with these programs using the following materials:
 
https://cran.r-project.org/doc/contrib/Torfs+Brauer-Short-R-Intro.pdf,
https://cran.r-project.org/doc/contrib/Paradis-rdebuts_en.pdf


 PMI - 10                                  

Cognitive Processing Therapy and Crisis Response Planning For Clients with PTSD and Suicidal Behaviors

Keyword: 
Clinical/Intervention Research
Secondary Keywords: Clinical/Intervention Research; Clinical Practice
Population Type: Adult
Presentation Level: Intermediate
Region: Industrialized Countries

Rosen, Valerie, MD1Rozek, David, PhD2Wilkinson-Truong, Charity, PsyD3Powch, Irene, PhD4Allard, Carolyn, PhD5
1UT Austin Dell Medical School and Seton Family of Hospitals, Austin, Texas, USA
2University of Utah, Salt Lake City, Utah, USA
3Stress and Anxiety Services of NJ, East Brunswick, New Jersey, USA
4PTSD Clinical Team, VA Healthcare Center, Portland, Oregon, USA
5Alliant International University, San Diego, California, USA


Cognitive Processing Therapy (CPT) has strong evidence to support its use for PTSD (Resick, et al., 2017, Resick, et al. 2015, Resick, et al., 2012). Despite its 40-year history, myths about client readiness for trauma-focused therapy have endured and can result in clients with PTSD not receiving adequate treatment because they are considered to be at high risk. This can lead to clients who seek help receiving treatment that focuses only on mitigating risk or not receiving treatment that focuses on PTSD symptom reduction. However, symptom improvement in PTSD with CPT treatment is associated with reduced suicidal ideation (Bryan et al., 2017; Gradus et al., 2013). Additionally, Rudd and colleagues demonstrated that the use of brief cognitive behavioral therapy for suicide prevention (BCBT) reduced suicide attempts by 60% as compared to treatment as usual. Although BCBT is effective for suicidal behaviors, completing both CPT and BCBT is not logistically feasible for many clients and the overlap in skills learned is significant. Integrating empirically-supported techniques for suicide risk into trauma-focused therapy is needed. Crisis response planning (CRP), a technique from BCBT, is a personalized problem-solving tool with a focus on self-management of crises and has demonstrated efficacy. CRP has been shown to reduce suicide attempts by 76%, reduce suicidal ideation, and reduce psychiatric inpatient duration in comparison to treatment as usual (Bryan et al., 2017). Despite this, clients with PTSD and chronic suicidality and multiple, potentially lethal suicide attempts may not receive adequate treatment. Clinicians may unintentionally collude with clients’ avoidance of discussing traumatic events, fear treating patients with significant self-injurious behavior or suicidality, and/or not understand how to integrate suicide prevention techniques (i.e., CRP) into CPT leading clinicians to exclude clients from helpful treatment options. Four CPT trainers and an expert in CRP, treating both civilians and military populations will discuss integrating CRP into CPT for clients who engage in self harm or are considered at high risk for suicide. This integration offers a strong potential option for clinicians treating clients who have been referred to repeated stays in higher level of care or seen multiple therapists. Instruction in the use of CRP while using and maintaining fidelity to CPT will be provided. Specific topics in the application of CPT for clients with PTSD and suicide attempts or self-harming behaviors will also be shared with case examples highlighting unique difficulties within the field of suicidality.

 

PMI - 11

Hands-on Skills for Using Apps and Online Programs for Veterans with PTSD and Related Issues 

Keyword: 
Technology
Secondary Keywords: Clinical Practice; Culture/Diversity; Public Health; Training/Education/Dissemination
Population Type: Adult
Presentation Level: Intermediate
Region: Industrialized Countries

McGee-Vincent, Pearl, PsyD1Juhasz, Katherine, MS2; Owen, Jason, PhD, MPH2; Jaworski, Beth, PhD3Miller, Katherine, PhD4
1National Center for PTSD – Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
2National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California, USA
3National Center for PTSD, Menlo Park, California, USA
4National Center for PTSD, VA Palo Alto Health Care System/Stanford University School of Medicine, Menlo Park, California, USA


The Department of Veterans Affairs (VA) has developed a suite of free, publicly-available mobile applications (apps) designed to support the mental health needs of Veterans with PTSD and related concerns (e.g., insomnia, anger management). Treatment companion apps, such as PE Coach (for Prolonged Exposure therapy), are designed to aid in the delivery of evidence-based treatments. Self-management apps, such as PTSD Coach, can be used independently or in conjunction with treatment. Apps can improve access to psychosocial resources for Veterans, particularly those who might otherwise not access or complete treatment due to stigma, cultural beliefs about mental health care, geographical limitations, or other systemic barriers (DeViva et al., 2016; Martsolf et al., 2016; Sayer et al., 2017). Emerging evidence suggests that mobile apps may improve outcomes (see Kuhn et al., 2017; Miner et al., 2016; Possemato et al., 2016). Among individuals engaged in mental health treatment, these tools may improve treatment efficiency (Donker et al., 2013; Ventola, 2014), client engagement (Gaggioli & Riva, 2013) and accuracy of self-reports (Bush et al., 2013; Kuhn et al., 2014).

Although many providers and clients are interested in incorporating technology into treatment (Bush & Wheeler, 2015; Koffel et al., 2016; Miller et al., 2017), providers may not have received training in how to integrate these tools into care. As early leaders in the development, research, and clinical integration of these apps for Veterans, subject matter experts from the VA’s National Center for PTSD are uniquely positioned to train providers on methods of integrating these tools into mental health care. Since July 2017, the presenters have trained providers across VA and held over 35 interactive conference calls to collect feedback and lessons learned about integrating these tools into care with Veterans in a variety of clinical settings.

This highly interactive PMI will include live demonstration, brief video segments, small group activities, lecture, and discussion. Presenters will assume a basic understanding of CBT and PTSD. Real-world use cases from VA providers will be presented along with research findings to facilitate translation of knowledge into practice. Participants will be provided with tablets to gain hands-on practice. Topics covered will include technology and culturally competent care, empirical support for use of mobile and online tools in care, and treatment planning. Because the apps and online programs are publicly available and address several mental health concerns, we anticipate that this PMI will be relevant to a broad audience of community or VA providers that treat post-traumatic stress and its many related sequelae, such as insomnia, anger, and depression.

PMI - 12

Advanced Workshop in Prolonged Exposure: Clinical Considerations in the Provision of Prolonged Exposure with Public Service Personnel

Keyword: 
Clinical Practice
Secondary Keywords: Anxiety; Chronic/Repeated Trauma; Traumatic Grief; War – Military/Peacekeepers/Veterans
Population Type: Adult
Presentation Level: Advanced
Region: Industrialized Countries

Yusko, David, PsyD1McElheran, Megan, PsyD2Bellehsen, Mayer, PhD3Paul, David, PsyD4
1University of Pennsylvania, Philadelphia, Pennsylvania, USA
2Private Practice, Calgary, Alberta, Canada
3North Shore LIJ Health System, Bay Shore, New York, USA
4Private Practice, Edmonton, Alberta, Canada


Co-presenters for this workshop are certified trainers of Prolonged Exposure and are keen to provide this advanced workshop for practitioners of this therapy, particularly when working with military veterans and first responders.  Provision of Prolonged Exposure to public service personnel is often more clinically challenging than provision with civilian populations, as public service personnel are commonly exposed to varied traumatic events at rates greater than those experienced by civilian populations.  This workshop is ideally positioned to support those practitioners working with public service personnel, and who are eager to engage in an advanced workshop that will address clinical challenges that occur working with public service populations.

PMI - 13 

Using Child Trauma Case Studies to Inspire Interprofessional Practice among Front-line Providers

Keyword:                     
Training/Education/ Dissemination
Secondary Keywords: Child Physical Abuse/Maltreatment; Complex Trauma; Health Impact of Trauma; Prevention/Early Intervention
Population Type:          Child/Adolescent
Presentation Level:      Intermediate
Region:                          Industrialized Countries

Felter, Jeanne, PhD; DiDonato, Stephen, PhD, LPC-S
Thomas Jefferson University, Philadelphia, Pennsylvania

The overwhelming incidence and pervasive developmental and health impact of childhood adversity, coupled with the patient care benefits of interprofessional practice, demands the establishment of interprofessional, trauma-informed education for professionals across health and human service disciplines. Interprofessional education (IPE) aims to create more effective systems of interprofessional practice (IPP), defined as a higher form of practice wherein health care professionals from different disciplines make up a team unique to the patient, that works with the patient and family to develop a unified decision. Guided by the World Health Organization’s Framework for Action on Interprofessional Education and Practice (2010) and the Interprofessional Education Collaborative’s Core Competencies for Interprofessional Collaborative Practice (2016), faculty from Thomas Jefferson University’s Community and Trauma Counseling (CTC) program and Jefferson’s Center for Interprofessional Trauma Education (J-CITE) developed an interprofessional educational model for students, professionals and community members in an effort to more wholly address the comprehensive unmet needs of trauma-affected individuals being served in fragmented systems. The IPE model has two aims: (1) to enhance trauma skills and knowledge among participants, and (2) to increase readiness for interprofessional practice across child-serving disciplines and sectors. Initially developed for and delivered to graduate students across health disciplines by Jefferson faculty, the model was replicated for professionals and paraprofessionals across health, mental health, child welfare, education, and juvenile justice sectors at an interprofessional trauma training conference. This Pre-Meeting Institute will offer an intermediate level three-tiered training to practitioners working across child-serving sectors using a child trauma case study and a Team Based Learning approach. This institute will further provide rationale for the need for interprofessional training, methodology, and initial outcome data. Though designed for front-line providers, educators, policy makers, advocates, or researchers invested in the health and wellbeing of children are also encouraged to attend.