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

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

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.

Study Overview

• Status: Completed
• Conditions: Post Traumatic Stress Disorder; Post Traumatic Stress Injury
• Intervention / Treatment: Behavioral: Distance-delivered NET

• Study Type: Interventional
• Enrollment (Actual): 19
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • New Brunswick
    • Fredericton, New Brunswick, Canada, E3B5A3
      • University of New Brunswick

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 19 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

Participants must meet the following criteria to be eligible to move on to Consent

1. Be at least 19 years of age
2. Be able to understand spoken and written English at a Grade 8 level
3. Be employed, or have been employed, by the fire service or be current or past fire service volunteers.
4. Fulfill the criteria of full or subclinical PTSD/I according to the PCL-5.
5. Have access to a computer with Internet.
6. Live in Atlantic Canada or Ontario.
7. Consent to be audio- (for consent and interview) and video-recorded (for intervention sessions).

Exclusion Criteria:

1. Having a psychotropic medication change in the past three weeks.
2. Are currently engaged in or have previously been engaged in exposure therapy for PTSD/I.
3. Meet criteria for current mania or psychosis.
4. Endorse suicidal ideation with plan or intent.
5. Experience high levels of dissociation (as assessed by a score of >18.5 on the Shutdown Dissociation Scale).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NA
• Interventional Model: SINGLE_GROUP
• Masking: NONE

Number of Arms

1

Arms and Interventions

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

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: IWK Health Centre
• Collaborators: Canadian Institutes of Health Research (CIHR); University of New Brunswick

Study record dates

Study Major Dates

• Study Start (ACTUAL): June 29, 2020
• Primary Completion (ACTUAL): March 31, 2021
• Study Completion (ACTUAL): December 31, 2021

Study Registration Dates

• First Submitted: May 8, 2020
• First Submitted That Met QC Criteria: May 12, 2020
• First Posted (ACTUAL): May 13, 2020

Study Record Updates

• Last Update Posted (ACTUAL): March 31, 2022
• Last Update Submitted That Met QC Criteria: March 29, 2022
• Last Verified: March 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Trauma and Stressor Related Disorders; Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
• Other Study ID Numbers: 22081

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No