Symposia
Trauma and Stressor Related Disorders and Disasters
Melissa J. Zielinski, Ph.D.
Assistant Professor
University of Arkansas for Medical Sciences
Little Rock, Arkansas
Background: Nearly all people in prison have experienced trauma and many meet criteria for PTSD. Untreated PTSD increases risk for drug and alcohol use problems following release—contributing to a cycle of trauma, addiction, and incarceration that has been well-documented. However, evidence-based, trauma-focused therapy for PTSD is rarely offered in prisons and there is little research that can guide implementation efforts.
Methods: In preparation for a Hybrid II pilot trial examining the implementation and effectiveness of group-delivered Cognitive Processing Therapy adapted for delivery in prisons (CPT-CJ), we conducted a formative evaluation using interviews structured according to the Consolidated Framework for Implementation Research, a well-established implementation science framework. Participants were members of the corrections centers’ leadership, therapeutic team, health care staff, and security staff (n = 21) and incarcerated persons (n = 13; 61.5% female). A subset of the interviewees subsequently engaged in four Evidence-Based Quality Improvement (EBQI) meetings to review anticipated implementation determinants and build consensus on strategies to support CPT-CJ implementation.
Results: Results revealed many potential implementation determinants. Inner Setting compatibility with the needs of the population, available physical resources, and existing programming was described as high and staff generally expressed positive beliefs about CPT-CJ. Participants who were incarcerated reported that there was a need for CPT-CJ among the resident population and that they believed it should be offered. Competing obligations, such as state-mandated programming, were acknowledged as were the potential for distractions/disruptions during groups and the potential for challenges related to power/control dynamics. In the EBQI meetings, we identified more than 15 strategies that would be used to support CPT implementation. Additional strategies were added early in CPT-CJ implementation in response to emergent needs as a part of implementation facilitation.
Conclusions: Expanding access to CPT in prisons may require a wide array of strategies to support implementation and long-term sustainment. Implementation facilitation—which emphasizes the development of supportive interpersonal relationships through which implementation strategies that are matched to the needs of the intervention, context, and recipients can be delivered—may be particularly well-suited to support uptake of CPT in prisons.