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

Not Applicable

Completed

• Conditions: Post Traumatic Stress Injury; Post Traumatic Stress Disorder
• Interventions: Behavioral: Distance-delivered NET

• Registration Number: NCT04386330
• Lead Sponsor: IWK Health Centre

Brief Summary

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.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2020-05-08
• Study First Submitted QC: 2020-05-12
• Study First Posted: 2020-05-13
• Study Start: 2020-06-29
• Primary Completion: 2021-03-31
• Study Completion: 2021-12-31
• Status Verified: 2022-03
• Last Update Submitted: 2022-03-29
• Last Update Posted: 2022-03-31

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 19

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 & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Narrative Exposure Therapy	Distance-delivered NET	Firefighters will receive distance-delivered NET administered by a paraprofessional.

Primary Outcome Measures

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

Secondary Outcome Measures

Name	Time	Method
Physical Health	Baseline, Immediately Post-intervention, 2 month follow up, 6 month follow up	Physical health will be measured with the Patient Health Questionnaire Physical Symptoms (PHQ-15)
Intervention Perceptions and Satisfaction	Immediately Post-Intervention	Intervention perceptions and satisfaction will be measured via open-ended questions administered through a post-intervention interview
Health Service Use	Baseline, Immediately Post-intervention, 2 month follow up, 6 month follow up	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
Recruitment Rates	Baseline	Recruitment rates will be tracked by research staff throughout the study
Anxiety Symptoms	Baseline, Immediately Post-intervention, 2 month follow up, 6 month follow up	Anxiety symptoms will be measured using the Generalized Anxiety Disorder - 7 item (GAD-7)
Intervention Adherence	Immediately Post-Intervention	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.
Coach Alliance	Immediately Post-Intervention	Coach alliance will be measured using the Working Alliance Inventory - Short Form Revised (WAI-SR)

Trial Locations

Locations (1)

University of New Brunswick; 🇨🇦 Fredericton, New Brunswick, Canada