PTSD One Page Assessment and Treatment Path

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Michael Changaris

This handout explores one system of care for triaging the treatment path for PTSD in primary care.

Gesundheit & Medizin

Trauma Informed Primary Care
Treatment Pathway and Risk Levels
Trauma and PTSD Assessment
Contra CostaHealth Trauma Treatment Path
Contra CostaHealth Trauma Treatment PCP – Interventions
Contra CostaHealth Trauma Treatment PCP – MedManagement Tips
1. Trauma Screen: PC-PTSD > 2 Mod. Risk, PC-PTSD > 3 High Risk
2. Nightmares: Presence > 3 Days per Week
3. Allostatic Load Measures: Syst BP > 148, Diast BP > 83; HBA1c >7.1;
HDL <37; Chol. Tot to HDL Ratio > 5.92, Urinary CORT >25.7 ug/g, Urinary Ep >5 ug/g,
Urinary Nor Ep > 48 ug/g, HDL Chol <= 37, DEHA </= 350 ng/ml
4. TBI Comorbid: Head inj w LOC is good predictor
1. Health Coaching/Behavioral Health: Assessment and brief intervention
2. TBI (LOC): Ref to Neuropsych
3. ACCESS Line: Long-term 1 yr + Psychotherapy
4. ACCESS Line: Addiction services
5. Trauma Focused Groups: Seeking Safety @ MHC, PHC and WCHC
6. Symptom Focused Groups: DMII, Pain, Mood Management, Stress, Addiction
7. Medication Management: SSRIs/SNRIs, Alpha-Adren. Blockers (Prazosin Dreams),
Catapres/Propranolol Phys. Sympt. Anx., Mood Stabilizers
8. Consult Liaison Psychiatry: Support and med management (AM I ON)
1. Trauma Informed Treatment: Med. Management of Trauma, Addressing Allostatic
Loading Indicators, Expect Unpredictable Medication Effects.
2. Trauma Relational Skills: Use skills that increase felt sense of safety and health
containment.
Regulate Self - Regulate Pt - Attune - Reason
3. Share the Care: Extend Impact through sharing tx with other disciplines, inform team
of core goals, and collaborate towards goals.
1. Start Low and Go Slow
2. Normalize side effects ‘felt reactions’
3. Expect Unexpected Reactions
4. Relationship = Safety = Adherence
5. Health Psychology – Share the care approaches to adherence

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