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Pathology and Laboratory Procedures. Medicine Services and Procedures. Evaluation and Management Services. Last Reviewed on Dec. Call or have a career counselor call you. Resources Toggle Menu. Overview Hot Topics. Get Real-world Coding Experience Improve coding skills across multiple specialties coding actual medical charts Practicode. Looking for Exhibiting Opportunities or Group Discounts? Contact us at Which certification is right for you? Which eNewsletters are right for you? Call to speak with a specialist now.
Which books are right for you? Call to speak to a representative. Roache4 , Patricia A. Chronic Stress Volume 3: 1— Michelle J. Bovin, Erika J. Wolf and Patricia A. Frontiers in Psychiatry doi: Chard, K. An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse.
Journal of consulting and clinical psychology , 73 5 , Kirsten H. Dillon, Willie J. Hale, Stefanie T. LoSavio Duke, Jennifer S. Wachen, Kristi E. Pruiksma, Jeffrey S. Yarvis, Jim Mintz, Brett T. Litz, Alan L. Behavior Therapy 51 — Katherine A. Dondanville, Abby E. Blankenship, Alma Molino, Patricia A. Yarvis, Brett T. Litz, Elisa V. Borah, John D. Hembree, Alan L. Qualitative examination of cognitive change during PTSD treatment for active duty service members.
Behaviour Research and Therapy. Hale, Jim Mintz, John D. Roache, Cody Carson, Brett T. Litz, Jeffrey S. Peterson, Patricia A.
Journal of Traumatic Stress. April , 32, — Galovski, T. Journal of Consulting and Clinical Psychology , 80 6 , Does cognitive-behavioral therapy for PTSD improve perceived health and sleep impairment? Journal of Traumatic Stress, 22, Iverson, K. L, Resick, P. K, Smith, K. Cognitive-behavioral therapy for PTSD reduces risk for intimate partner violence.
Journal of Consulting and Clinical Psychology, 79, Vanessa M. October , 32, — Karlin, B. Dissemination of evidence-based psychological treatments for posttraumatic stress disorder in the Veterans Health Administration. Journal of Traumatic Stress, 23, Kelly, K. The impact of sudden gains in cognitive behavioral therapy for posttraumatic stress disorder. Macdonald, A. Identifying patterns of symptom change during a randomized controlled trial of cognitive processing therapy for military-related posttraumatic stress disorder.
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However, these findings could be strengthened by documenting improvements in client acceptability—data which we lack at this stage of pilot testing.
Consistent with the iterative nature of formative evaluation, there are also likely additional factors that may warrant further adaptation of the manual, such as provider modifications to delivery of CPT.
Future studies should examine how providers make in-session modifications to manuals, because these data could identify areas in need of further adaptation.
Further, given that implementation researchers are interested in increased adoption as well as fidelity to EBTs, more research is needed on the way that providers modify EBTs to fit their own style of practice and the needs of their clients.
Training of providers in community health centers, particularly those with some resistance to delivering EBTs, may be enhanced by adaptations that are guided by feedback from providers. For example, having providers identify terminology to describe key CPT concepts that is more congruent with their own beliefs regarding diagnosis and treatment of mental health problems may increase adoption as well as fluidity with CPT principles.
Although not a primary aim of this study, the training workshop for the Spanish CPT Manual—Version 2 included modified language of some terms that providers deemed too pathologizing or invalidating to clients e. Cultural adaptations that enhance provider adoption of interventions warrant further exploration. Another limitation of the current study is that only one provider was trained in both versions of the Spanish manual, so data directly comparing the two manuals is limited.
Interestingly, though, the Spanish CPT Manual—Version 2 did not emerge as a major barrier to implementation in subsequent interviews. This finding suggests that the manual revision improved the acceptability and appropriateness of CPT, as intended. Future studies may benefit from head-to-head comparisons of culturally adapted versus original EBTs; this research is needed to justify ongoing support of translational research.
The systematic inclusion of suggested revisions to the Spanish CPT Manual appears to have improved acceptability and appropriateness of the intervention, which, in turn, reduced the degree to which the manual was a barrier to implementation. Our qualitative findings suggest that attending to cultural context beyond simply organizational culture within implementation trials may improve implementation outcomes such as acceptability and appropriateness of EBTs.
In addition, our findings highlight the utility of formative evaluation in both implementation science and cultural adaptation research. Future studies should further investigate the intersection between cultural adaptation and implementation science by examining the tension between latitude and fidelity.
Because previous studies have found that culturally adapted interventions may be more effective among Latino clients, implementation scientists should aim to test how EBTs can be culturally adapted without reducing the potency of the intervention.
Our findings suggest that community mental health providers are less likely to adopt EBTs that are perceived as cumbersome or ill-fitting to their clients; thus, cultural adaptation may be necessary to move EBTs from research to usual care settings. We recommend a full-scale mixed-methods clinical trial of the Spanish CPT Manual—Version 2 to facilitate a more extensive culturally-informed modifications to the Spanish language manual, and b provide quantitative data supporting the efficacy of the adapted intervention.
We would like to thank the hospital administration, the providers, and the patients who participated in this trial and provided invaluable feedback necessary for this manuscript. Sarah E. Christina P. Adin S. Patricia A. J Clin Psychol. Author manuscript; available in PMC Mar 1.
Valentine , Christina P. Borba , Louise Dixon , Adin S. Find articles by Luana Marques. Author information Copyright and License information Disclaimer. Phone: Fax: Copyright notice.
The publisher's final edited version of this article is available at J Clin Psychol. Results Data-driven refinements included adaptations related to cultural context i. Conclusion Our study reinforces the need for dual application of cultural adaptation and implementation science to address the PTSD treatment needs of Spanish-speaking clients. Keywords: implementation, cultural adaptation, posttraumatic stress disorder, Latinos, cognitive processing therapy.
Methods Participants This study is part of a larger implementation trial that evaluated the feasibility and acceptability of CPT for PTSD in a diverse community health center. Table 1 Demographics for Stage 3, 4, and 5 providers and clients. Open in a separate window.
Procedures Modifications to the CPT Manual are presented according to the five-stage theoretical model for cultural adaptations Barrera et al. Stage 1: Information Gathering Information gathering in Stage 1 involves literature review, pre-adaptation interviews, and other means of determining whether or not an adaptation is needed and which components of the intervention should be altered during the adaptation.
Stage 2: Preliminary Adaptation Design Information gathered in Stage 1 was used to inform preliminary adaptation design, including changes to the original intervention. Qualitative Data Analysis The coding team consisted of four undergraduate research assistants, supervised by the principal investigator of the study. Data collection Study procedures were the same as Stage 3. Qualitative Data Analysis The coding team consisted of two undergraduate research assistants and one bachelor's level research assistant, supervised by a doctoral-level researcher.
Many providers perceived the manual as difficult to use, even if they had already used the English language version. Based on the qualitative data integration, several terms used in the original CPT Spanish language manual were identified as either being poor translations e. Difficult to use. Some providers perceived the Spanish CPT Manual—Version 2 as difficult to use, although there were far fewer comments about challenges using this iteration of the manual than there were about using the Spanish CPT Manual—Version 1.
Manual layout. Providers reported that one of the strengths of the English language manual is its visual organization. For example, each section is well-organized, with section headings, a readable font size, and other visual cues that assist in material comprehension.
The Spanish language manual was adapted to mirror these aspects of the English language manual. Additionally, we added delineated checklists for session agendas, and separated therapist considerations from the bulk of the session material. These changes were made to facilitate provider administration of the intervention to clients. In addition, providers felt that many specific concepts from the manual were difficult to explain in Spanish or lacked suitable Spanish translations.
Multiple key terms e. Fit with literacy and education level of clients. I'm not familiarized with all these terms. We added example dialogue that might be more related to the types of trauma often experienced by clients in community health centers, such as community violence, domestic violence, physical assault, and gang violence.
Worksheets and handouts were also revised accordingly. Although no providers explicitly reported poor fit with regard to client literacy and education levels of the Spanish CPT Manual—Version 2, there were a few mentions of clients being confused by session materials and homework assignments.
It requires a little interpretation. To address prominent concerns regarding literacy level of the material, we integrate another adaptation of the CPT manual, developed for use with clients with low education and literacy. Handouts and worksheets. Homework difficulty and compliance was one of the biggest barriers to implementation of CPT Spanish in this trial. In order to address the concerns of the providers and clients in this study, we revised client handouts and worksheets to be more easily understood, both visually and linguistically.
In addition to changing the terminology, as discussed previously, we altered the formatting of the worksheets, and provided visual cues so that clients would be able to more easily complete homework outside of session. Cultural relevance of Clinical Examples. The English CPT Manual provides several client dialogue examples that pertain exclusively to veterans.
Although some therapists may be able to create novel and relatable examples for their clients based on these veterans examples, many providers expressed difficulty with this task.
Provider fluency Providers repeatedly discussed concerns regarding their own Spanish-language fluency, when attempting to implement the Spanish CPT Manual—Version 1. Due to provider-level difficulties with the language, one provider described how she shifted between both the English and Spanish version during session, I kind of liked doing it [with the English and Spanish Manuals] side by side, because I found more [self-] efficacy She described how training in English made it challenging for her to gain fluidity with the CPT terminology that she would later be used in sessions with Spanish-speaking clients, Personally Client education and literacy level Providers described various experiences where they perceived that clients had a difficult time understanding the concepts taught through CPT.
As one provider described, I wonder though too, because it's a [literacy] level thing. Another provider noted, The other part is [that]- I, myself as a [native] Spanish fluent speaker, some of the wording on the worksheet is definitely not basic wording.
Another provider noted how one of her clients was able to comprehend therapy content, despite challenges with the level of the language, And I mean, I think it [CPT] can be done, honestly, in Spanish, because [my client] only has a third grade level and she's been able to move along very nicely in this.
One provider suggested, But I do know from reading the worksheets and seeing them struggle that definitely the language is complicated for them, and, um pause and I wonder if we can, um adapt the language to make it simpler for when they go home, [so then] they can remember what we're discussing and working on.
Another provider noted, I know she [my supervisee] talked about, you know, the complicated nature of doing that [adapting the Spanish manual] and I was thinking it would almost be like somebody who works in this community and works with our population would Terminology Beyond challenges with client literacy and provider fluency, providers also noted that some of the terminology was not relevant to dialects of clients seen at the clinic.
Manual Burden and Low Adoption Over the course of the trial, providers discussed how challenges with the manual, especially the Spanish CPT Manual—Version 1, decreased their desire to continue using the treatment. Table 3 Key Terminology. As one provider noted, And I really liked the new first homework assignment where trying to get the person to imagine what their life could be like if their symptoms were lower. This provider noted, Um, we added some [stuck points to the log] while we were in session, but I felt that the session is not long enough to cover all the material in a way that More specifically, the provider stated that, The pacing is better.
Conclusion The systematic inclusion of suggested revisions to the Spanish CPT Manual appears to have improved acceptability and appropriateness of the intervention, which, in turn, reduced the degree to which the manual was a barrier to implementation. Acknowledgements We would like to thank the hospital administration, the providers, and the patients who participated in this trial and provided invaluable feedback necessary for this manuscript.
Contributor Information Sarah E. Evidence-based practice implementation and staff emotional exhaustion in children's services. Behaviour Research and Therapy. Hispanic Journal of Behavioral Science. Clinical Psychology Review. Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychological Services. Community health center provider and staff's Spanish language ability and cultural awareness.
Journal of Health Care for the Poor and Underserved. Cultural adaptations of behavioral health interventions: A progress report. Journal of Consulting and Clinical Psychology. Controlled trial of psychotherapy for Congolese survivors of sexual violence. New England Journal of Medicine. Cultural adaptation and implementation of evidence-based parent-training: A systematic review and critique of guiding evidence.
Children And Youth Services. Culturally adapted psychotherapy and the legitimacy of myth: A direct-comparison meta-analysis. Journal of Counseling Psychology. Cultural adaptation of treatments: A resource for considering culture in evidence-based practice. Professional Psychology: Research and Practice.
The role of language in training psychologists to work with Hispanic clients. Professional Psychology: Research And Practice. A two-way street: Bridging implementation science and cultural adaptations of mental health treatments. Implementation Science. Crisis visits and psychiatric hospitalizations among patients attending a community clinic in rural southern California. Community Mental Health Journal.
Challenges of providing mental health services in Spanish. Does cognitive-behavioral therapy for PTSD improve perceived health and sleep impairment? Journal of Traumatic Stress, 22, Iverson, K. L, Resick, P. K, Smith, K. Cognitive-behavioral therapy for PTSD reduces risk for intimate partner violence. Journal of Consulting and Clinical Psychology, 79, Vanessa M.
October , 32, — Karlin, B. Dissemination of evidence-based psychological treatments for posttraumatic stress disorder in the Veterans Health Administration. Journal of Traumatic Stress, 23, Kelly, K.
The impact of sudden gains in cognitive behavioral therapy for posttraumatic stress disorder. Macdonald, A. Identifying patterns of symptom change during a randomized controlled trial of cognitive processing therapy for military-related posttraumatic stress disorder. Journal of Traumatic Stress, 24, Stefanie T. LoSavio, Robert A. Murphy, and Patricia A. Shannon R. Miles, Kirsten H. Dillon, Vanessa M. Jacoby, Willie J.
Hale, Katherine A. Yarvis, Alan L. Peterson, Jim Mintz, Brett T. Monson, C. Change in posttraumatic stress disorder symptoms: Do clinicians and patients agree?
Psychological Assessment, 20, Changes in social adjustment with cognitive processing therapy: Effects of treatment and association with PTSD symptom change. Journal of Traumatic Stress,25 5 , Treating combat PTSD through cognitive processing therapy. Federal Practitioner, 22, Cognitive processing therapy for veterans with military-related posttraumatic stress disorder.
Journal of consulting and clinical psychology , 74 5 , John C. Moring, Katherine A. Dondanville , Brooke A. LoSavio, Stephanie Y. Wells, Leslie A. Morland, Debra Kaysen, Tara E. Galovski, and Patricia A. Moring, Erica Nason , Willie J. Dondanville, Casey Straud, Brian A. Moore, Jim Mintz, Brett T.
Conceptualizing comorbid PTSD and depression among treatment-seeking, active duty military service members. Journal of Affective Disorders — Kristi E. Peterson, Elisa V. Borah, Brett T. Litz, Patricia A. Temporary codes describing new services and procedures can remain in Category III for up to five years.
If the services and procedures they represent meet Category I criteria — which includes FDA approval, evidence that many providers perform the procedures, and evidence that the procedures have proven effective — they will be reassigned Category I codes.
Conversely, Category III codes can be eliminated if providers do not use them. First, as you might imagine, procedural coding necessitates a solid grasp of anatomy and medical terminology. One procedure might have numerous variations, differing only slightly, and selecting the right code will require an ability to comprehend the clinical documentation and code description — to understand what a given procedure is, how the physician performed it, and which code descriptor captures the highest specificity of the procedure performed.
The codes a provider can report are not limited by the specialty in which they practice. For example, X-ray codes are listed under radiology, but a primary care coder will be required to assign an appropriate X-ray code if the primary care physician interprets an X-ray. This is the best way to ensure coding accuracy and optimal reimbursement for your employer. A modifier consists of two numbers, two letters, or a number and a letter. For example, some modifiers show that a procedure was performed on the right side of the body, versus the left side or both sides.
Other modifiers indicate that a physician took extra time and effort to perform a service or procedure. A short list of modifiers goes a long way in expanding the ability to report the unique circumstances of services and procedures performed. Examples of services, supplies, and items with HCPCS Level II codes include orthotic and prosthetic procedures, hearing and vision services, ambulance services, medical and surgical supplies, drugs, nutrition therapy, and durable medical equipment.
An example of a diagnosis and service meeting medical necessity is when a patient comes into a medical office complaining of stomach pain, and the physician conducts a physical examination. The stomach pain diagnosis justifies the reason for the examination service.
Cpt manual pdf.AMA CPT Professional 2024 - eBook
During this stage, we conducted a preliminary adaptation test using the Spanish CPT Manual—Version 1 and then gathered feedback from stakeholders. Feedback on the Spanish CPT Manual—Version 1 came from multiple qualitative data sources, including CPT sessions, provider field notes following each CPT session, weekly consultation meetings, and researcher field notes on CPT sessions written by trained bilingual-bicultural undergraduate-level research assistants.
What did not go well during this session? What are some of the barriers to the CPT protocol that you experienced during this session? What would make it easier to administer CPT the next time you see this client?
Do you have any other impressions of the session or important things to note? At the end of the consultation period, providers participated in 1-hour follow-up interviews with a member of the study staff to discuss their experiences with training in CPT, receiving CPT consultation, and implementing CPT in their practice. Two bilingual-bicultural research assistants recorded daily researcher field notes on qualitative data from CPT session audio to document needed changes to the CPT manual based on the following criteria: A direct feedback from providers as part of provider field notes and consultation qualitative data, B observation of common challenges documented through audio review of CPT sessions, and C own recommendations of linguistic modifications needed to better fit the Latino population at the urban community health center.
The coding team consisted of four undergraduate research assistants, supervised by the principal investigator of the study. Two coders were assigned to code qualitative data gathered through CPT sessions and provider field notes, and two coders were assigned to code data gathered through consultation team meetings. Each coding pair followed the procedures of conventional content analysis, whereby coding categories were developed as data were reviewed.
In order to generate coding categories, all four coders independently coded 10 transcripts. The coders then met and discussed these themes as a team in order to generate an initial codebook. Each member of the coding team then used this initial codebook to code an additional 10 transcripts from their respective data sources. When the coders met, they discussed any emerging themes or disagreements.
Each coder had to agree on how a transcript should be coded. This process proceeded until theoretical saturation was reached and no new themes emerged. Researcher field notes were integrated with clinical observations of the principal investigator.
Data were triangulated to form firm recommendations for revisions. The development of the Spanish CPT Manual—Version 2 was spearheaded by our bilingual-bicultural research assistants, under the close supervision of two doctoral-level research staff with extensive clinical experience with CPT.
To verify improvement, one provider who participated in Stage 3 continued to enroll clients at Stage 5. This provider is the only provider to deliver both versions of the Spanish CPT Manual as part of the implementation trial.
The coding team consisted of two undergraduate research assistants and one bachelor's level research assistant, supervised by a doctoral-level researcher. Each coding pair followed the procedures of directed content analysis, whereby an existing codebook developed during Stage 3 was used to code the data.
When asked about specific conditions for which they would like to receive EBT training, these same providers overwhelmingly favored PTSD. Providers and administrators perceived that a high percentage of their clients experienced trauma and likely met criteria for PTSD per self-report. Our review of the literature revealed several factors to consider when adapting interventions for Latinos seen in community health settings, including ways of adapting inventions to fit education and literacy levels of clients.
More specifically, our review of the literature highlighted that poor English skills, minimal education, lack of familiarity with Western psychological concepts and culturally specific idioms of distress e. Moreover, research indicates that differences in cultural values e. Because it was publicly available, we used the existing Spanish CPT Manual—Version 1 as our preliminary adaptation design. Avendano; per P. Resick, personal communication, September 28, During Stage 3 of the study, four providers used the Spanish CPT Manual—Version 1 with a total of 10 clients each provider enrolled 2 or 3 clients.
Clients who received treatment with the Spanish CPT Manual—Version 1 evidenced difficulties understanding directions on homework assignments, key terminology, and the relevance of the trauma vignettes provided in the manual.
Triangulated data from this stage also see Table 2 suggests that the Spanish CPT Manual—Version 1 was a poor fit for clients and providers alike. That's not even mentioned in the Spanish one. Bilingual providers noted specific challenges they faced as they tried to compensate for the shortcomings of the Spanish CPT Manual—Version 1. For example, providers noted how they attempted to translate from English to Spanish as well as from language in Spanish Manual— Version 1 to the client's dialect while in session.
One provider highlighted concerns regarding the equivalence of the CPT that was delivered to Spanish- versus English-speaking clients.
It's like a different procedure. Providers repeatedly discussed concerns regarding their own Spanish-language fluency, when attempting to implement the Spanish CPT Manual—Version 1. Due to provider-level difficulties with the language, one provider described how she shifted between both the English and Spanish version during session,.
I kind of liked doing it [with the English and Spanish Manuals] side by side, because I found more [self-] efficacy I feel like my fluency Another provider a non-native Spanish speaker noted vocabulary difficulties when attempting to explain concepts in Spanish, as she had been able to do in English.
She described how training in English made it challenging for her to gain fluidity with the CPT terminology that she would later be used in sessions with Spanish-speaking clients,. I feel like I'm not doing a good job teaching them because they're not the ones [terms] I've learned [in training] Providers described various experiences where they perceived that clients had a difficult time understanding the concepts taught through CPT.
Providers expressed their belief that client education and literacy level likely contributed beyond language to some challenges observed in session. As one provider described,. I wonder though too, because it's a [literacy] level thing. Like even if you got the grammar completely right, I think sometimes I felt like there was a disconnect with I felt The other part is [that]- I, myself as a [native] Spanish fluent speaker, some of the wording on the worksheet is definitely not basic wording.
Some of the language is complicated. It's not Another provider noted how one of her clients was able to comprehend therapy content, despite challenges with the level of the language,. And I mean, I think it [CPT] can be done, honestly, in Spanish, because [my client] only has a third grade level and she's been able to move along very nicely in this.
Providers were strong proponents of adapting the language in the manual to the literacy level as well as the dialect of the clients seen in the clinic. One provider suggested,. But I do know from reading the worksheets and seeing them struggle that definitely the language is complicated for them, and, um pause and I wonder if we can, um adapt the language to make it simpler for when they go home, [so then] they can remember what we're discussing and working on.
I know she [my supervisee] talked about, you know, the complicated nature of doing that [adapting the Spanish manual] and I was thinking it would almost be like somebody who works in this community and works with our population would Beyond challenges with client literacy and provider fluency, providers also noted that some of the terminology was not relevant to dialects of clients seen at the clinic.
So I could use some coaching around that. I remember just trying to describe the concept of a pattern. The word that is used, patron , they didn't understand and so then I was trying to think of other words. How do you explain the concept of a pattern? And it was really hard, I took awhile. Over the course of the trial, providers discussed how challenges with the manual, especially the Spanish CPT Manual—Version 1, decreased their desire to continue using the treatment.
Thus, these issues were identified as barriers to implementation. I'm a hard worker, but this was labor intense. The CPT-DRC manual preserved core elements of the original intervention, but simplified language to increase comprehension and retention for low-literacy and illiterate participants.
Further details provided in supplementary appendix to Bass et al. Prior to the cultural adaptation trial, we also consulted with CPT experts to ensure fidelity of the revised manual to the basic principles of CPT. Feedback and revisions to the manual are presented in Table 2. In addition, we integrated new terms that were found to be a better fit for the variations of Spanish used by clients at the community mental health center see Table 3.
We then met with native Spanish-speaking providers and researchers to discuss the initial acceptability of key terminology and the revised manual. Generally speaking, qualitative data from Stage 5 included markedly fewer mentions of the Spanish CPT Manual—Version 2, as well as more positive feedback.. As one provider noted,. And I really liked the new first homework assignment where trying to get the person to imagine what their life could be like if their symptoms were lower.
It was really hard for my patient to imagine anything being different, but Providers also reported some ongoing challenges related to client comprehension of a narrow set of CPT concepts, although they reported notably fewer challenges with client comprehension compared to the previous set of providers. One provider stated that it took longer to get through the materials in Spanish compared to English , and that she wished that the clinic would accommodate more time for these types of treatments.
This provider noted,. Um, we added some [stuck points to the log] while we were in session, but I felt that the session is not long enough to cover all the material in a way that I feel that we could have spent a little bit more time on finding those stuck points and writing them down, and processing them.
Another provider described her own limited fluency, but noted that the client was able to understand the terminology in the Spanish CPT Manual—Version 2. We did discuss it [the concept], but we didn't do it in the order, uh, indicated, and, um, I had a little trouble reading all the Spanish, it was a little bit Provider also described how they were working to improve their ability to determine if client's misunderstanding of key concepts was related to cognitive difficulties, avoidance, or simply due to the sophistication of CPT concepts.
The questions. I'm having a tough time interpreting it to the client and I'm not sure whether I'm doing as good of a job as I could be doing or if he's having other issues like avoidance or cognitive or — so I just don't know the language to use. More specifically, the provider stated that,. The pacing is better. It seems like some of the psycho ed [psychological education] is broken up more over the sessions.
It's not a mad dash to just like get through it all. And now we still call it avoidance, but the other two terms [were] changed So I feel like the psycho ed is spread out better, [and] the language is clearer and at a more accessible level for my patients. We detailed the cultural adaptation of the CPT manual to fit both client and provider preferences in community mental health settings.
Specifically, we describe both superficial and deep structure adaptations related to cultural context i. Our desired outcome for manual adaptation was to enhance implementation of CPT within the parent study.
Our manuscript expands upon the current literature by describing how cultural adaptation methodologies and implementation science outcomes were dually applied to address the PTSD treatment needs of Latino community mental health clients.
Initial pilot testing of the Spanish CPT Manual—Version 1, revealed several aspects of the manual related to poor acceptability of the manual by providers, and, subsequently poor adoption of the EBT for use with Spanish-speaking clients. This feedback suggests that the initial translation of the manual was a poor fit with regard to terminology, sociocultural context, education level, and health literacy.
Given that providers in this study were new to CPT, providers described experiencing marked difficulty generating varied ways of describing key concepts—concepts that they had recently learned themselves. Our findings also suggest that language match between translated interventions and clients is not sufficient, thus, we caution providers from using manuals that have been translated, but have not undergone cultural adaptation and pilot testing or simply do not match the regional dialect of clients.
Providers and clients reported a desire for case examples that reflected exposure to community violence, interpersonal violence including physical assault and rape , and violence experienced prior to immigration to the U.
Further, providers reported that their clients were often experiencing ongoing violence, whereas the examples in the manual referred to veterans who were no longer being exposed to combat in their daily lives.
Some providers expressed that the manual's inattention to ongoing trauma exposure made CPT for PTSD inherently less acceptable for their own clients. The need for culturally relevant intervention content has been demonstrated in prior studies of cultural adaptations of EBTs for Latinos Parra-Cardona et al.
Our findings also suggest that cultural adaptation may be necessary to increase provider adoption of EBTs for diverse clients. Due to significant challenges in using the Spanish CPT Manual—Version 1 in session, some providers decided to not use the manual to guide sessions.
The choice by some providers to abandon the manual altogether posed additional concerns regarding fidelity to CPT. A true strength of both cultural adaptation and implementation science methodology, in-depth interviews with providers allowed us to synthesize recommended revisions to the Spanish manual prior to training a second set of providers at the same community mental health center.
Providers gave specific feedback on changes to the manual beyond language and literacy adjustments that could facilitate implementation, such as improving the visual organization of therapy materials i. These adjustments are consistent with Cabassa and Baumann's recommendations for integrating key components of cultural adaptation and implementation science.
Journal of Traumatic Stress, 24, Stefanie T. LoSavio, Robert A. Murphy, and Patricia A. Shannon R. Miles, Kirsten H. Dillon, Vanessa M. Jacoby, Willie J. Hale, Katherine A. Yarvis, Alan L. Peterson, Jim Mintz, Brett T. Monson, C. Change in posttraumatic stress disorder symptoms: Do clinicians and patients agree?
Psychological Assessment, 20, Changes in social adjustment with cognitive processing therapy: Effects of treatment and association with PTSD symptom change. Journal of Traumatic Stress,25 5 , Treating combat PTSD through cognitive processing therapy. Federal Practitioner, 22, Cognitive processing therapy for veterans with military-related posttraumatic stress disorder.
Journal of consulting and clinical psychology , 74 5 , John C. Moring, Katherine A. Dondanville , Brooke A. LoSavio, Stephanie Y. Wells, Leslie A. Morland, Debra Kaysen, Tara E. Galovski, and Patricia A.
Moring, Erica Nason , Willie J. Dondanville, Casey Straud, Brian A. Moore, Jim Mintz, Brett T. Conceptualizing comorbid PTSD and depression among treatment-seeking, active duty military service members.
Journal of Affective Disorders — Kristi E. Peterson, Elisa V. Borah, Brett T. Litz, Patricia A. Resick, Daniel J. Yarvis, Carl R. Darnall, Katherine A. Dondanville, Elizabeth A. Amy E.
Ramage, Brett T. Resick, Mary D. Woolsey, Katherine A. Borah, Elisa V. Borah, Alan L. Peterson, Peter T. Regional cerebral glucose metabolism differentiates danger- and non-danger-based traumas in posttraumatic stress disorder. Social Cognitive and Affective Neuroscience, , — Patricia A. Resick, Stefanie T. Dillon, Erica E. One discrepancy to the expected order involves resequenced codes.
A resequenced code comes about when a new code is added to a family of codes but a sequential number is unavailable. This arrangement, as with resequenced codes, is designed for coding efficiency. Category II codes, consisting of four numbers and the letter F, are supplemental tracking and performance measurement codes that providers can assign in addition to Category I codes.
Providers use Category II codes — which track specific information about their patients, such as whether they use tobacco — to help deliver better healthcare and achieve better outcomes for patients. These codes are arranged as follows:. Category III codes are temporary codes that represent new technologies, services, and procedures.
Temporary codes describing new services and procedures can remain in Category III for up to five years. If the services and procedures they represent meet Category I criteria — which includes FDA approval, evidence that many providers perform the procedures, and evidence that the procedures have proven effective — they will be reassigned Category I codes.
Conversely, Category III codes can be eliminated if providers do not use them. First, as you might imagine, procedural coding necessitates a solid grasp of anatomy and medical terminology. One procedure might have numerous variations, differing only slightly, and selecting the right code will require an ability to comprehend the clinical documentation and code description — to understand what a given procedure is, how the physician performed it, and which code descriptor captures the highest specificity of the procedure performed.
The codes a provider can report are not limited by the specialty in which they practice. For example, X-ray codes are listed under radiology, but a primary care coder will be required to assign an appropriate X-ray code if the primary care physician interprets an X-ray. This is the best way to ensure coding accuracy and optimal reimbursement for your employer.
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