Supporting the implementation of written exposure therapy for posttraumatic stress disorder in an obstetrics-substance use disorder clinic in the Northeastern United States

Bibliographic Data

ID21257403
AuthorsSarah E Valentine (0000-0002-4856-9269, Boston University, corresponding author), Laura B Godfrey (0000-0002-9696-0377, Boston Medical Center), Resham Gellatly (0000-0003-3214-620X, Boston Medical Center), Emilie Paul (Boston Medical Center), Caitlin Clark (0000-0002-0252-302X, Boston Medical Center), Karissa Giovannini (Boston Medical Center), Kelley A Saia (Boston University), Yael I Nillni (0000-0001-8876-0415, Boston University)
Year2023
Volume4
Pages100256
Publication date2023-12-01
Open AccessYes
TypeARTICLE
VenueSSM - Mental Health (JOURNAL)
Journal identifiersISSN: 2666-5603 • E-ISSN: 2666-5603
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.ssmmh.2023.100256
PMID38645900
OpenAlexW4386056934
LanguageEN
References cited38

Pregnant people with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) constitute a highly vulnerable population. PTSD and SUD confer risks to both the pregnant person and the fetus, including a host of physical and mental health consequences. When PTSD and SUD co-occur, potential negative impacts are amplified, and the symptoms of each may exacerbate and maintain the other. Pregnancy often increases engagement in the healthcare system, presenting a unique and critical opportunity to provide PTSD and SUD treatment to birthing people motivated to mitigate risks of losing custody of their children. This paper presents implementation process outcomes of Written Exposure Therapy (WET), a brief, scalable, and sustainable evidence-based PTSD treatment delivered to pregnant persons receiving care in an integrated obstetrical-addiction recovery program at Boston Medical Center. Trial participants (N = 18) were mostly White, non-Hispanic (61.1%), not currently working (77.8%), had a high school or lower level of education (55.5%), had an annual household income less than $35,000 (94.4%), and were living in a substance use residential program (55.6%). We examined intervention feasibility, acceptability, appropriateness, adoption; barriers and facilitators to implementation; and feedback on supporting uptake and sustainability of the intervention using coded qualitative sources (consultation field notes [N = 47] and semi-structured interviews [N = 5]) from providers involved in trial planning and treatment delivery. Results reflected high acceptability, appropriateness, and adoption of WET. Participants described system-, provider-, and patient-level barriers to implementation, offered suggestions to enhance uptake, but did not raise concerns about core components of the intervention. Findings suggest that WET is an appropriate and acceptable PTSD treatment for this difficult-to-reach, complex population, and has the potential to positively impact pregnant persons and their children

Addiction · Environmental health · Family medicine · Mental health · Population · Psychiatry · Substance abuse · Clinical Psychology · Grief, Bereavement, and Mental Health · Maternal Mental Health During Pregnancy and Postpartum · Medicine · Prenatal Substance Exposure Effects · Psychology

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