Firefighters Accessing Care for Trauma: A Clinical Case Series of Distance NET for PTSD/I Symptoms

Study Overview
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Brief Summary
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Repeated exposure to trauma is an unavoidable part of the job for firefighters. Because of this, many Canadian firefighters screen positive for posttraumatic stress disorder/injury (PTSD/I). Unfortunately, like the general population, firefighters face many barriers to accessing mental health care. As a result, additional efforts are needed to increase timely access to effective PTSD/I services that are delivered in a way that reduces confidentiality and stigma risk. This research study will test the preliminary efficacy and feasibility of distance-delivered Narrative Exposure Therapy (NET) delivered by a paraprofessional for firefighters with PTSD/I. NET is an evidence-based intervention approach developed specifically for PTSD/I resulting from repeated and continuous trauma. The intervention will be conducted via videoconference with a trained paraprofessional supervised by a clinical psychologist. The NET intervention will consist of 12 weekly 90-minute videoconference sessions. Approximately 25 firefighters will be recruited to participate in the study. To test the efficacy of the intervention, participants will complete self-report questionnaires about PTSD/I and other mental health symptoms pre- and post-intervention as well as two- and six-months following intervention completion. Participants will also complete an open-ended interview at the end of the intervention to assess feasibility and participant satisfaction.

Official Title
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Firefighters Accessing Care for Trauma: A Clinical Case Series Testing the Efficacy of Distance-Delivered Narrative Exposure Therapy in Reducing PTSD/I Symptoms

Conditions
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Post Traumatic Stress Disorder, Post Traumatic Stress Injury

Intervention / Treatment
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* Behavioral: Distance-delivered NET


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participants must meet the following criteria to be eligible to move on to Consent Be at least 19 years of age Be able to understand spoken and written English at a Grade 8 level Be employed, or have been employed, by the fire service or be current or past fire service volunteers. Fulfill the criteria of full or subclinical PTSD/I according to the PCL-5. Have access to a computer with Internet. Live in Atlantic Canada or Ontario. Consent to be audio- (for consent and interview) and video-recorded (for intervention sessions). Exclusion Criteria: Having a psychotropic medication change in the past three weeks. Are currently engaged in or have previously been engaged in exposure therapy for PTSD/I. Meet criteria for current mania or psychosis. Endorse suicidal ideation with plan or intent. Experience high levels of dissociation (as assessed by a score of >18.5 on the Shutdown Dissociation Scale).

Ages Eligible for Study
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Minimum Age: 19 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Narrative Exposure Therapy<br>Firefighters will receive distance-delivered NET administered by a paraprofessional. | Behavioral: Distance-delivered NET<br>* One-on-one intervention delivered by a paraprofessional; 12 weekly videoconference sessions at 90 minutes.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in PTSD/I symptoms | PTSD/I symptoms are measured with the PTSD Checklist - 5 (PCL-5) | Baseline, Immediately Post- intervention, 2 month follow up, 6 month follow up | 
| Change in depressive symptoms | Depression symptoms will be measured using the Patient Health Questionnaire (PHQ-9) | Baseline,Immediately Post-intervention, 2 month follow up, 6 month follow up | 
| Disability | Disability will be measured with the Sheehan Disability Scale | Baseline, Immediately Post-intervention, 2 month follow up, 6 month follow up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Anxiety Symptoms | Anxiety symptoms will be measured using the Generalized Anxiety Disorder - 7 item (GAD-7) | Baseline, Immediately Post-intervention, 2 month follow up, 6 month follow up | 
| Physical Health | Physical health will be measured with the Patient Health Questionnaire Physical Symptoms (PHQ-15) | Baseline, Immediately Post-intervention, 2 month follow up, 6 month follow up | 
| Health Service Use | Health service use will be measured using a series of questions regarding participant's use of health services as well as frequency and intensity of service use | Baseline, Immediately Post-intervention, 2 month follow up, 6 month follow up | 
| Recruitment Rates | Recruitment rates will be tracked by research staff throughout the study | Baseline | 
| Intervention Adherence | Intervention adherence will be measured via attendance records of participants kept by their coach. These attendance records will be used to measure the average number of completed sessions and the percentage of participants who did not complete the intervention. | Immediately Post-Intervention | 
| Coach Alliance | Coach alliance will be measured using the Working Alliance Inventory - Short Form Revised (WAI-SR) | Immediately Post-Intervention | 
| Intervention Perceptions and Satisfaction | Intervention perceptions and satisfaction will be measured via open-ended questions administered through a post-intervention interview | Immediately Post-Intervention |