PCORI funds implementation projects that integrate evidence developed through PCORI-funded studies, in the context of the body of related evidence, into practice. This project focuses on implementing findings on several kinds of therapy and medicines that can reduce or stop symptoms for people with posttraumatic stress disorder (PTSD).
1. What is the eligible evidence proposed for implementation?
Skills Training in Affect and Interpersonal Regulation with Narrative Therapy (STAIR-NT) is a treatment for PTSD with demonstrated efficacy in several randomized control trials (RCTs) and across many populations exposed to trauma. Additionally, it has been recognized as a strong evidence-based treatment by PCORI and the International Society for Traumatic Stress Studies. It includes components focused on psychoeducation about the impact of trauma, emotion regulation skills (focused on body, cognitions and behaviors), compassion for self and others, social/interpersonal skills, and exposure review of various traumas and life stressors with adaptive reappraisal of the meaning of events. Evidence also supports the delivery of the treatment in a variety of formats including STAIR without narrative exposure (STAIR standalone), Brief STAIR (five to six sessions), Group STAIR and webSTAIR. During a previous engagement project, STAIR programs were selected as the preferred treatment by a learning community of clinicians, directors, patients and other student life professionals from two universities due to its flexibility, theoretical foundation, and ability to address developmental and cultural needs of college students. STAIR programs offer structured trauma treatment that is responsive to the patient-, provider- and system-level factors associated with the delivery of trauma-focused mental health challenges for college students.
2. What is the goal of this implementation project?
The project team’s goal is to implement STAIR in 31 university counseling centers (UCCs) across the United States. Based on the Replicating Effective Programs Framework (REP), each UCC site will participate in implementation activities from pre-implementation, implementation, and maintenance and evolution stages of implementation work. The specific aims of this project are to:
- Collaborate with UCC directors, clinicians and other stakeholders to utilize multicomponent strategies to implement STAIR programs in a network of UCCs
- Embed ongoing evaluation in UCCs to assess clinical and implementation outcomes to inform and promote use of STAIR in UCCs
- Establish pathways to scale up the implementation of STAIR across UCCs in the United States
3. What is the project team doing?
The leadership team, composed of dual principal investigators Tiffany Artime, Ph.D., (Pacific Lutheran University) and Katherine Buchholz, Ph.D., (Wellesley Centers for Women) along with other experts including STAIR developer Marylene Cloitre, Ph.D., (National Center for PTSD Dissemination and Training Division) will refine adaptations to STAIR previously made during an engagement project to facilitate its uptake at UCCs (highlighting culturally informed identity exploration, low-cost and campus-friendly activity scheduling). The STAIR Institute will provide training workshops and virtual consultation over two years to clinicians and trainees at the sites who will deliver STAIR to students with PTSD who seek services from the UCC. Additionally, the leadership team will create and disseminate a Campus Psychoeducation Package, a compilation of brief psychoeducation materials (videos, flyers, social media campaigns) that will share information about trauma and its effects and give an overview of STAIR, highlighting its availability on their campus. These will be provided to site partners to be shared with students, faculty, staff and administrators. The principal investigators will provide logistical support, implementation consultation and evaluation to UCCs through site visits, regular communication, surveys and interviews. At the 31 UCCs, this project plans to train 345 UCC providers who will offer STAIR to 6,540 student clients.
4. How is the team evaluating this project?
The evaluation plan for the team’s implementation of STAIR is guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Implementation outcome measures will be measured by treatment utilization tracking, surveys, qualitative interviews with UCC clinicians and other stakeholders, and participation rates in training and consultation activities. Patient outcomes will be measured by pre-/post-session and follow-up symptom checklists of mental health and academic functioning outcomes. This project intends to enhance the well-being of trauma-exposed college students and aid in academic persistence by making an evidence-based trauma treatment feasible and available within UCCs across all regions of the United States.
5. How is the team involving patients and others in making sure the findings reach people who can use them?
This project was built on a foundation of engagement during the preconditions phase of REP where a learning community composed of UCC clinicians, directors, students and student life professionals examined challenges and assets at UCCs, selected and adapted STAIR-NT and its variants, and piloted STAIR-NT in their UCCs. This project continues similar engagement through establishing a Student Advisory Council and a UCC Professional Advisory Council which will meet regularly and provide oversight of implementation and evaluation activities. Additionally, the STAIR Institute (research, training and consultation) and Hunter Learning (webSTAIR developer) will participate in STAIR adaptation and consult on developing infrastructure for the sustainability and scale-up of STAIR implementation.
6. How will this project help ensure future uptake and use of the evidence?
The project is designed to be sustained and to scale up within each UCC and to other schools. A train-the-trainer program will be established to maintain training and consultation to new providers and trainees at each site and to extend STAIR implementation to other sites through regional and national training and consultation, in partnership with the STAIR Institute. Partners from professional organizations will assist in developing other necessary infrastructure for scaling up STAIR implementation through the dissemination of implementation process and successes and through establishing a permanent access point for training/treatment resources.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.