Combat veterans with posttraumatic stress disorder (PTSD) demonstrate less robust improvement following treatments than do civilians with PTSD. This paper discusses a theoretical model for evaluating treatment response based on the extent of change in biological markers of symptom severity or resilience between treatment initiation and termination. Such analysis permits a determination of biological change associated with the liberal criteria commonly used to determine treatment response in combat PTSD, and a comparison of this to the biological change associated with clinical response determined according to the conservative definition more appropriate to civilian PTSD. Interim data supporting the utility of this approach is presented based on preliminary analyses from our work in progress. We propose that future studies consider the unique consequences of combat trauma and develop treatments that incorporate the complex nature of the exposure and response characteristic of a veteran population.
Adolescent partial hospitalization programs (PHP) provide specialized, intensive, interdisciplinary day treatment for youth with significant psychopathology warranting a higher level of care than outpatient therapy, but less intensive than admission to an inpatient unit. Although partial hospital programs are becoming increasingly utilized for youth with severe psychiatric disorders (Del Conte et al., 2016; Leffler et al., 2017), there is scarce research on the effectiveness of these programs and little is known about the extent to which evidence-based practices (EBPs) for youth are typically provided through these programs. Shortened lengths of stay, fluctuating patient acuity, diagnostic heterogeneity, and clinical complexity are significant and enduring barriers to successful implementation of EBPs in acute care facilities. As such, process descriptions of initiatives to implement EBPs in acute care settings are limited in the literature. Consequently, it is of importance to the field to elucidate the challenges of adapting EBPs for acute care contexts, strategies for managing these hurdles, strengths from which to build upon, and specific examples of what facilitates successful implementation. This article focuses on the lessons learned through a team’s efforts using an implementation science framework to implement EBPs for youth anxiety in an adolescent partial hospitalization program in the context of a large academic medical center situated in a metropolitan area of the northeast. Reflecting on steps and missteps, the article offers seven considerations that may be informative for teams preparing to integrate EBPs into acute psychiatric care settings.
Background Anxiety disorders are garnering increasing attention for their contribution to high-risk issues and functional impairment. Adolescents are typically admitted to partial hospitalization programs (PHPs) due to high-risk presentations. However, the frequency of anxiety disorders in PHPs is not well-established, in part because anxiety can be overlooked in acute settings due to limited lengths of stay and focus on stabilization. Objective This study aims to evaluate the frequency and severity of anxiety disorders among a sample of adolescent PHP patients to assess the need for anxiety-specific assessment and interventions in higher acuity settings. Methods Participants were 158 youths ages 13 to 19 years old ( M = 15.49 years, SD = 1.50) who were admitted to an adolescent PHP and their caregivers. Clinician-reported diagnostic information was collected from the youth’s electronic medical record, and self- and caregiver-rated severity of anxiety was collected using the Screen for Child Anxiety Related Emotions Disorders (SCARED-C/P). Frequency of anxiety and related disorder diagnoses and self- and caregiver-reported severity were assessed using descriptive statistical methods. Results 75% of participants were diagnosed with an anxiety disorder (n = 118). On average, participants with anxiety disorders had elevated SCARED-C scores. Youths with depressive disorders had elevated SCARED-C scores even when they did not carry anxiety disorder diagnoses. Caregiver ratings of the youth’s anxiety symptoms on the SCARED-P were elevated when youths had anxiety disorders. Conclusions These findings suggest that anxiety is common in an adolescent PHP setting and support investing in evidence-based assessment and treatment of anxiety in high-acuity settings.
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