Stepped Care Case-Finding Intervention Can Provide Cost Effective Care For PTSD After a Disaster Interview with:


Dr. Cohen

Gregory H. Cohen, MPhil, MSW
Statistical Analyst
Department of Epidemiology
School of Public Health
Boston University What is the background for this study? What are the main findings?

Response: We simulated a stepped care case-finding approach to the treatment of posttraumatic stress in New York City, in the aftermath of Hurricane Sandy.

Stepped care includes an initial triage screening step which identifies whether a presenting individual is in need of Cognitive Behavioral Therapy, or can be adequately treated at a lower level of care.

Our simulation suggests that a stepped care approach to treating symptoms of posttraumatic stress in the aftermath of a hurricane is superior to care as usual in terms of reach and treatment-effectiveness, while being cost-effective. What should clinicians and patients take away from your report?

Response: The manner in which existing mental health services are arranged and deployed at a systems level can profoundly influence treatment effectiveness, reach and cost. What recommendations do you have for future research as a result of this study?

Response: We recommend real-world testing and implementation of stepped care approaches in the context of natural disasters. Such approaches have been used in primary care for decades, and are overdue for study in disaster settings. Is there anything else you would like to add?

Response: In the absence of empirical studies, simulations provide a powerful means to estimate the effects of hypothetical interventions, when valid and appropriate data inputs are available. No disclosures to report. Thank you for your contribution to the community.


Cohen GH, Tamrakar S, Lowe S, Sampson L, Ettman C, Linas B, Ruggiero K, Galea S. Comparison of Simulated Treatment and Cost-effectiveness of a Stepped Care Case-Finding Intervention vs Usual Care for Posttraumatic Stress Disorder After a Natural Disaster. JAMA Psychiatry. Published online October 04, 2017. doi:10.1001/jamapsychiatry.2017.3037

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.


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Last Updated on October 11, 2017 by Marie Benz MD FAAD