Taking efficacious treatments for posttraumatic stress beyond the bedside: Exploration of successes and challenges in training community and lay providers across the globe

Abstract

Although there is considerable data to support the efficacy of several treatments for trauma-related disorders, the traumatic stress field continues to struggle with adequate implementation and uptake of such treatments in real-world settings, which greatly contributes to persistent health disparities in these disorders. Task-shifting, or the ability to train frontline providers in evidence-based treatments for psychological disorders following traumatic events in various local and global community settings, may be one avenue to improve the translatability, scalability, and sustainability of effective traumatic stress treatments. In this paper, we describe a range of implementation and training efforts to bring efficacious treatments for trauma-related disorders beyond the bedside and directly into the communities that could benefit the most. Our descriptions cover the training methodologies utilized and the fidelity measurement of efforts to train frontline providers in several distinct global settings, namely Chile, Portugal, Greece, the Caribbean, and Somaliland. In addition, we describe a large-scale, city-wide implementation and evaluation of providers’ fidelity to evidence-based traumatic stress treatment within a major U.S. city for further exemplification around how task-shifting can happen at a larger, systemic, top-down level. In our descriptions, we also critically examine the challenges our teams have encountered when doing such work and highlight successful strategies that could facilitate the reduction of inequities in traumatic stress treatment worldwide.