Enhancing the population impact of collaborative care interventions: Mixed method development and implementation of stepped care targeting posttraumatic stress disorder and related comorbidities after acute trauma

Douglas Zatzick, Frederick Rivara, Gregory Jurkovich, Joan Russo, Sarah Geiss Trusz, Jin Wang, Amy Wagner, Kari Stephens, Chris Dunn, Edwina Uehara, Megan Petrie, Charles Engel, Dimitri Davydow, Wayne Katon

Research output: Contribution to journalArticle

48 Scopus citations


Objective: The objective of the study was to develop and implement a stepped collaborative care intervention targeting posttraumatic stress disorder (PTSD) and related comorbidities to enhance the population impact of early trauma-focused interventions. Method: We describe the design and implementation of the Trauma Survivors Outcomes and Support study. An interdisciplinary treatment development team was composed of trauma surgical, clinical psychiatric and mental health services "change agents" who spanned the boundaries between frontline trauma center clinical care and acute care policy. Mixed method clinical epidemiologic and clinical ethnographic studies informed the development of PTSD screening and intervention procedures. Results: Two hundred seven acutely injured trauma survivors with high early PTSD symptom levels were randomized into the study. The stepped collaborative care model integrated care management (i.e., posttraumatic concern elicitation and amelioration, motivational interviewing and behavioral activation) with cognitive behavioral therapy and pharmacotherapy targeting PTSD. The model was feasibly implemented by frontline acute care masters in social work and nurse practioner providers. Conclusions: Stepped care protocols targeting PTSD may enhance the population impact of early interventions developed for survivors of individual and mass trauma by extending the reach of collaborative care interventions to acute care medical settings and other nonspecialty posttraumatic contexts.

Original languageEnglish (US)
Pages (from-to)123-134
Number of pages12
JournalGeneral Hospital Psychiatry
Issue number2
StatePublished - Mar 1 2011
Externally publishedYes



  • Acute care
  • Population impact
  • Stepped collaborative care
  • Traumatic injury

ASJC Scopus subject areas

  • Psychiatry and Mental health

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