Background: LGBTQ+ people experience significantly higher rates of stress and trauma exposure than the general population, and this is often related to their gender or sexual orientation. Common examples include familial rejection, physical assault, sexual assault, verbal abuse, and bullying. These experiences are associated with substantial rates of PTSD, which are two-fold that of the general population. Despite the availability of effective PTSD treatments, there has been no comparative effectiveness research among LGBTQ+ individuals to determine which among several available evidence-based PTSD interventions might be acceptable, relevant to LGBTQ+ concerns, and optimally effective. The goal of the current proposal is to build capacity to conduct PTSD CER in clinics that focus on LGBTQ+ mental health to close the gap between this identified need and the availability of effective treatments.
Proposed Solution to the Problem: This project will bring together LGBTQ+ stakeholders to create a learning community that will identify patient needs regarding trauma-related problems and share information regarding benefits and challenges in delivering and evaluating PTSD treatments. The proposal is submitted by a highly collaborative work group that has developed partnerships critical to launching a capacity-building project and identified activities, processes, and products that will provide the resources and skills to support future CER. The work group is comprised of Alliance Health Project (AHP), an LGBTQ+ clinic currently evaluating trauma-focused care, a trauma research clinician, the lead of a PCORI-funded engagement project focused on trauma treatment, and leadership from PRIDEnet, a PCORI Patient Powered Research Network (PPRN), which will facilitate engagement of various stakeholder groups.
Objectives: The proposed project will create a trauma-focused care learning collaborative (TFC-LC). The TFC-LC will be comprised of patient, clinician, administrator (health systems), and research stakeholders from five LGBTQ+ clinical services associated with PRIDEnet. The TFC-LC will collect and share information about attitudes, beliefs, and principles among LGBTQ+ individuals concerning trauma treatment research and identify evidenced-based PTSD interventions appropriate to LGBTQ+ needs and preferences. From the information gathered, the TFC-LC will develop a toolkit for LGBTQ/trauma-sensitive implementation of CER and companion videos of LGBTQ+ community research ambassadors supporting the toolkit. Given the COVID-19 pandemic, special attention will be given to developing partnerships, resources, and tools that can be shared virtually to ensure the long-term value of the research capacity established (e.g., virtual meetings, telehealth delivery formats, online resources).
- Create a TFC-LC comprised of patient, clinician, administrator, and researcher stakeholders who will lead the work described below
- Conduct a national survey (N=500) among LGBTQ+ individuals with trauma exposure regarding treatment needs, preferred treatment approaches, and valued outcomes, in collaboration with The PRIDE study, the research arm of PRIDEnet
- Discuss, identify, and document the benefits to and challenges of implementing PTSD CER for LGBTQ+ individuals
- Develop an “LGBTQ+ Research Ready Resource” toolkit that supports the creation of trauma/LGBTQ+ sensitive CER
- Create three to five videos with LGBTQ+ research ambassadors on various topics such as: the impact of trauma in the LGBTQ+ community, the importance of conducting PTSD CER studies for the affected members of the LGBTQ+ community, and how-to videos supporting the use of the toolkit
Projected Outcomes and Outputs:
- Short Term: Dynamic and reciprocal sharing of patient, clinician, administrator, and researcher perspectives and expertise to increase knowledge about trauma-informed care and end users’ needs, values, motivations as well as information about structural and process facilitators and barriers in implementing PTSD CER
- Medium Term: An LGBTQ+/trauma-informed CER toolkit and companion videos by LGBTQ+ research ambassadors
- Long Term: An engaged and motivated community of stakeholders that participate in and build a CER infrastructure to evaluate PTSD treatments
Patient and Stakeholder Engagement Plan: Patient stakeholders are LGBTQ+ individuals who have experienced trauma. The TFC-LC will be comprised of 15 patient, clinician, administrator, and research stakeholders. The stakeholders will be drawn primarily from PRIDEnet mental health providing clinics, and a commitment from five mental health clinics has been obtained. The Alliance Health Project (AHP), one of the five PRIDEnet clinics committed to the proposal, has been delivering trauma-informed therapy and receiving feedback from patients and clinicians for the last year. AHP helped establish the initial resources, energy, and interest to launch this CER capacity-building project. The PRIDE Study, the research arm of PRIDEnet, will reach LGBTQ+ trauma-exposed individuals to participate in the patient survey and liaise with PRIDEnet community engagement leadership to identify research ambassadors. The TFC-LC will meet five times during the first year and three times in the second; survey participants will be engaged once and LGBTQ+ research ambassadors will participate in video development in the last six months of the project.
Annesa Flentje, PhD
James Dilley, MD
Martha Shumway, PhD
Tiffany Artime, PhD