Expanding Access to Perinatal Trauma Care: A Dual-Model Evaluation of Perinatal Narrative Exposure Therapy Training

Abstract

Objective.

Perinatal posttraumatic stress disorder (PTSD) is a highly prevalent and undertreated public health concern contributing to significant risk for maternal and neonatal outcomes. As treatment gaps for perinatal PTSD persist, so do gaps in training for professionals who regularly serve these individuals. This paper evaluates two approaches for delivering training in perinatal-focused Narrative Exposure Therapy (NET), offering a preliminary blueprint for expanding access to high-quality training for perinatal PTSD treatment.

Method.

Using a multi-cohort design, we examined training-related perceptions and outcomes. Study 1 included psychology trainees (n = 21) who participated in a clinical rotation embedded within an academic graduate training program and completed pre- and post-training evaluations. Study 2 included interdisciplinary professionals and trainees (n = 57) who participated in a 3-day professional development workshop and completed evaluations at pre-, immediately post-, 6-months post-, and 12-months post-training.

Results

Training was rated favorably, and participants indicated perinatal-focused NET was acceptable, appropriate, and feasible across both studies. Participants in both studies indicated sustained improvements in perceived competence and abilities over time (ps < .05).

Conclusions

Both training approaches show promise for expanding training opportunities for perinatal PTSD. Findings have important preliminary implications for designing and delivering clinical training in various settings and populations.

Perinatal posttraumatic stress disorder (PTSD) is a highly prevalent and serious psychiatric condition that affects approximately 3–4% of pregnant and postpartum individuals, with rates rising to nearly 30% among high-risk, racially and economically marginalized perinatal populations (Cook et al., 2018a; Yildiz et al., 2017). Perinatal PTSD refers to the occurrence of PTSD symptoms during the perinatal period – spanning pregnancy, labor and delivery, and the period postpartum (generally defined as the first year after birth). Although the perinatal period does introduce the potential for varying trauma experiences specific to pregnancy and the postpartum context, such as obstetric emergencies (e.g., hemorrhage, eclampsia, uterine rupture), pregnancy loss or stillbirth, and/or traumatic childbirth, perinatal PTSD is not limited to perinatal-specific trauma experiences. In fact, most individuals enter pregnancy and postpartum with preexisting PTSD related to prior trauma exposure (e.g., childhood maltreatment, medical trauma) that is especially susceptible to reactivation during the perinatal period. For instance, the bodily experience of pregnancy, aspects of prenatal care (medical exams and procedures), anticipation of labor, delivery experience, and concerns about parenting often serve as trauma reminders for perinatal individuals with salient trauma histories. Concerningly, the perinatal period is especially vulnerable because physiological and psychological changes can intensify intrusive re-experiencing, hyperarousal, negative cognitions, and avoidance behaviors (Cook et al., 2018a; Yildiz et al., 2017).

Untreated perinatal PTSD is especially concerning as symptoms often impose intergenerational health risks, underscoring the need for perinatal-specific trauma treatment approaches (Cook et al., 2018a; Yildiz et al., 2017). Research further indicates that perinatal individuals with PTSD prefer responsive treatments that specifically acknowledge perinatal-related triggers and address distress related to pregnancy, childbirth, and parenting (Bergner et al., 2008; Freeman et al., 2025; Seng et al., 2002). Despite the cascading effects of perinatal PTSD and patient treatment preferences, most perinatal individuals will not receive perinatal-specific trauma screening and intervention, at least in part due to limited training opportunities among healthcare professionals who routinely serve perinatal populations (Becker et al., 2004; Martin et al., 2021; Sansen et al., 2019).

Limited training opportunities to build foundational trauma-focused competencies contribute to critical workforce gaps and unmet patient needs among trauma-exposed perinatal populations (Abu-Odah et al., 2022; Charney et al., 2019). Across disciplines, limited confidence in conducting trauma-focused evidence-based care is consistently indicated as a primary implementation barrier (Cook et al., 2014; Knight, 2015; van Minnen et al., 2010). Even within standard psychology training across the United States, approximately only half of all internship training programs offer supervised trauma-focused training opportunities, and social work, medical, and psychiatric training programs do not universally require trauma-focused training, leading to wide variation in trauma-related competencies (Charney et al., 2019; Garbarino et al., 2019; Knight, 2015).

Without training in effective evidence-based treatments for trauma-related diagnoses, which typically involve exposure-based techniques designed to reduce avoidance and facilitate adaptive processing, professionals may lack skills to identify and treat PTSD. Concerningly, lack of specialized perinatal-specific trauma training often leads providers to overestimate the “risks” of exposure treatment and avoid trauma-focused care during pregnancy and postpartum, despite evidence that exposure therapies can reduce the negative implications of cumulative stress (Pawluski & Dickens, 2019). In sum, the absence of specialized training in perinatal PTSD leaves most traumatized perinatal individuals interacting with care systems not equipped to treat distress during this vulnerable period (Huggins et al., 2020). As such, efforts to expand patient access to effective PTSD care during pregnancy and postpartum must directly address workforce training limitations alongside treatment availability.

Importantly, tailoring PTSD treatment to the perinatal context does not require a departure from established evidence-based trauma therapies, but rather an application of core PTSD treatment principles with a particular focus on the unique psychological and relational experiences inherent to pregnancy and postpartum. As such, growing evidence indicates that established exposure-based, trauma-focused psychotherapies can be safely delivered during pregnancy and postpartum and show preliminary effectiveness at reducing PTSD symptoms (Baas et al., 2021; Miller et al., 2024; Nillni et al., 2023; Padin et al., 2025; Stevens et al., 2020). Findings collectively suggest the importance of providing PTSD care during this period; yet, opportunities for formal training in exposure-based, trauma-focused therapy targeted for perinatal populations remain rare. In turn, this limits the implementation of perinatal PTSD treatments in real-world settings. Thus, targeted perinatal trauma training that addresses both trauma treatment principles and perinatal-specific considerations is warranted.

Narrative Exposure Therapy (NET; Schauer, 2011), a time-limited, exposure-based trauma intervention, may be particularly useful to train professionals serving perinatal populations. NET is particularly well-suited for perinatal populations and adaptable to real-world settings compared to other trauma-focused treatments, like Cognitive Processing Therapy, Prolonged Exposure, as it is brief (effective in as few as 4 sessions), allows for processing of multiple trauma exposures, low burden, developed from an ethno-racial healing framework, and tested among perinatal populations (Raghuraman et al., 2021; Miller et al., 2024; Steuwe et al., 2016). NET also uses a life-span approach to trauma processing, which is particularly valuable in perinatal care, as past stressors often resurface and intensify current reproductive stressors (Cook et al., 2018; Kessler et al., 2017; Yildiz et al., 2017). Additionally, NET lends itself well to training interdisciplinary professionals and paraprofessionals, as it does not require extensive time, specialized mental health training, and has been effectively delivered by mental health and lay counselors (Neuner et al., 2008; Volpe et al., 2017). Despite these strengths, without targeted training opportunities, even well-suited interventions for vulnerable populations lack reach.

Thus, to ultimately expand the perinatal PTSD workforce and increase effective perinatal trauma care access, we developed Perinatal NET (PNET). PNET refers to an adaptation of the NET intervention to address pregnancy and postpartum-specific considerations (e.g., perinatal-related trauma exposures, clinical/safety concerns), as well as the structured training approaches designed to prepare professionals to deliver this adapted intervention (see Program Development Overview for more details). Aligned with early phase implementation research, the purpose of this study was to examine feasibility, acceptability, and perceived competence as necessary steps to inform future implementation and dissemination. More specifically, the present study evaluated two PNET training formats delivered across multiple cohorts to reflect the norms and constraints of different training settings. Study 1 examined a 6 to 12-month supervised PNET training for clinical psychology students in an academic medical center, consistent with standard models of clinical training and supervision. Study 2 evaluated a 3-day professional development PNET training workshop delivered to perinatal professionals and trainees, reflecting continuing education structures.

While the primary aim was to evaluate attendee experiences and perceptions of the PNET training (i.e., participant satisfaction, impact, and intervention acceptability, feasibility, and appropriateness), an additional exploratory aim was to assess whether the training had a positive impact on participants’ sense of professional connection to the perinatal trauma community over time. We hypothesized that attendees would report high levels of satisfaction with the training and a significant increase in perceived confidence and abilities pre-to-post-training. Further, we hypothesized PNET participants would find the intervention to be acceptable, feasible, and appropriate for their patient population. Together, findings were expected to inform the design and delivery of flexible, context-responsive training approaches for expanding the perinatal PTSD workforce.

MATERIALS AND METHODS

Program Development Overview.

To develop and refine the PNET training protocol, we collaborated with vivo international, a nongovernmental, nonprofit organization that researches traumatic stress and the implementation of NET in communities worldwide (www.vivo.org). This adapted training protocol preserves the core components of NET (i.e., assessment, lifeline construction, exposure, testimony reading; Schauer, 2011), while integrating perinatal-specific considerations related to trauma exposure and intervention (i.e., perinatal PTSD psychoeducation, ethics). Broadly, the training protocol consists of didactic sessions focused on perinatal PTSD, live skills demonstrations facilitated by NET experts, and pair-based practice that is supervised by established NET providers. The emphasis on pair-based peer practice was intentionally integrated into the development of this training protocol in response to consistent feedback from previous NET training session, where low readiness to apply NET following traditional small-group (4–6 people) practice was indicated. Participants also receive several optional videos and reading materials that provide opportunities for deeper learning, including more demonstration videos, research articles, and the NET therapist manual. See Table 1 for an overview and comparison of each PNET Training.

Table 1.

Overview and Comparison of Study 1 and Study 2 PNET Training.

Domain	Study 1	Study 2
Setting	Rotational 6 to 12-month internship training	Live, 3-day virtual workshop
Participant Type	Clinical psychology graduate students	Interdisciplinary perinatal providers
Sample Size	N = 21	N = 57
Training Format	Didactic sessions, skills demo and practice + weekly supervised NET practice	Asynchronous pre-work + live workshop with didactic and supervised skills dyad practice
Ongoing Support	Weekly required supervision	Monthly optional consultation

Measures	Pre	Post	Pre	Immediately Post	6-month Post	12-month Post
AIM		x		x
FIM		x		x
IAM		x		x
EBI Competence	x	x	x		x	x
EBI Abilities	x	x	x		x	x
Connectedness	x	x	x	x	x	x

Note: AIM = Acceptability of Intervention Measure, IAM = Intervention Appropriateness Measure, FIM = Feasibility of Intervention Measure, EBI = Evidence-Based Intervention.

Study 1: PNET Training Embedded in Graduate Clinical Training

Setting and Participant Background.

Study 1 PNET training took place from July 2021 to January 2025 (seven training cohorts) at an urban academic medical center in the Midwestern United States that specializes in providing outpatient PTSD services. Participants (n = 21) were exclusively clinical psychology graduate students who were in their 4th, 5th, or 6th year of training. All participants were pre-doctoral clinical psychology trainees (M_age = 29.5) who were completing a 6- to 12-month rotation in the Traumatic Stress Clinic during their internship year. Participants identified as white (n = 13, 61.9%), Black (n = 2, 9.5%), Asian/Pacific Islander (n = 2, 9.5%), as well as those who preferred not to answer/ did not complete the pre-evaluation (n = 4, 19%). On average, trainees reported high levels of compassion satisfaction (M = 43.75, SD = 3.72), and low levels of burnout (M = 19.33, SD = 4.62) and secondary trauma (M = 17.08, SD = 2.97) prior to training.

Training Content and Format.

Trainees learned a variety of assessment and evidence-based treatments with the broader goal of treating PTSD and trauma-related disorders. One specific training experience included PNET training for addressing perinatal PTSD. As part of the training, participants were introduced to the core elements of PNET, received didactic content, and weekly supervision to ensure treatment fidelity.

Data Collection and Study Procedures.

Trainees completed pre- and post-surveys about their experience of training in and implementing NET (see Table 1 for data collection timing and assessment tools). Participants were asked to complete questionnaires before starting their clinical experience and completed post-surveys after their pre-doctoral internship year to reduce feelings of coercion. Additionally, while surveys were linked to examine pre-/post-scores, surveys were anonymous in that no identifying information was included in their responses. Online study data were collected by the REDCap electronic data capture tool, a secure, web-based application designed for research and hosted by the University (Harris et al., 2009). All procedures were approved by the University Institutional Review Board, and electronic informed consent was collected by the completion and return of the pre-assessment.

Attrition.

Although 21 trainees completed the PNET training, because training evaluation was intentionally not mandatory and completed at the end of the training experience, approximately (n = 7, 33%) did not complete the post-training assessment. Additionally, three trainees began their rotation before completing the pre-training evaluation, so they were unable to complete the pre-training evaluation, but did complete the post-training evaluation.

Study 2: PNET Training Delivered as a Professional Development Workshop

Setting and Participant Background.

Study 2 PNET training took place from March 2023 to January 2024 (six training cohorts) via a virtual workshop format, hosted by an urban academic medical center in the Midwestern United States (separate from Study 1) that specializes in providing outpatient PTSD services. Training cohorts were intentionally limited to a maximum of 13 participants to allow for in-depth participant engagement and hands-on skills practice. Participant demographic data (i.e., age, race) were not collected as part of this study to maintain participant confidentiality and comfort with providing transparent feedback. However, attendees (n = 57) did report on professional identities and represented a variety of disciplines, including 19% Social Workers, 19% Mental Health Graduate Trainees, 18% Psychologists, 14% Clinical Mental Health Counselors, 12% Doulas, 12% Physicians/ Nurses, and 5% Home Visitor/Parent Educators. Attendees possessed varying levels of perinatal-specific experience, ranging from < 1 year to 21+ years, with the majority of the sample having 7 to 10 years of experience. To be eligible for the program, participants had to demonstrate that they currently provide direct services to perinatal clients with a history of trauma in any of the following services: Psychotherapy/counseling, psychiatric medication management, home-visiting, doula services, medical management of pregnancy (i.e., nurses, physicians, midwives, etc.) OR be engaged in a professional training program of any of the above. Participants paid to attend the program; limited scholarships were available to those for whom cost presented a barrier to participation. On average, trainees reported high levels of compassion satisfaction (M = 42.43, SD = 5.58), and low levels of burnout (M = 20.04, SD = 4.15) and secondary trauma (M = 19.66, SD = 4.76) prior to training.

Training Content and Format.

Participants completed approximately 2 hours of asynchronous, pre-learning material, which reviews the basic theory and structure of PNET and provides a demonstration of the PNET practices. The professional development workshop then occurred over three days (approximately 16 training hours) and was led by several clinical psychologists with expertise in PNET. Half of the online training hours each day consisted of didactic lectures, group discussions on assessments for diagnostic and intervention planning purposes as well as live demonstrations of PNET skills. The other half of the total training was dedicated to supervised partner practice of the core elements of PNET under the direct supervision of experienced PNET practitioners. Participants were encouraged to use examples from their own lives during supervised skills practice to enhance their understanding of the PNET patient experience, intentionally examine areas of transference and countertransference and simultaneously explore societal, professional, and personal stigma around trauma in community with fellow trauma practitioners. This training also incorporated the troubleshooting required for the technology-assisted implementation of PNET (i.e., patient safety and confidentiality while engaging remotely; Robjant et al., 2020). Following their participation in the three-day workshop, participants were given the optional opportunity to attend monthly consultation sessions to discuss treatment questions or case examples with an expert trainer.

Data Collection and Study Procedures.

Table 1 includes an overview of data collection timing and assessment tools. Participants provided data about their professional background and clinical experience at the time of training registration (i.e., pre-training). At the conclusion of the workshop, participants provided feedback about their PNET training experience and completed questionnaires at three additional timepoints: immediately post-training, 6-months post-training, and 12-months post-training. Study 2 data were collected via REDCap (Harris et al., 2009). Additionally, while surveys were linked in REDCap to examine responses across time, surveys were anonymous in that no identifying information was included in their responses. All workshop attendees consented to participate in the PNET training evaluation research. Study procedures were approved by the University Institutional Review Board.

Attrition.

Although 57 trainees completed the PNET training and pre-training evaluation, because training evaluations were not a mandatory component of training, approximately (n = 9, 16%) did not complete the immediate post-training assessment, (n = 22, 38%) did not complete the 6-month post-training assessment, and (n = 33, 58%) did not complete the 12-month post-training assessment.

Measures

Professional Quality of Life.

The Professional Quality of Life Over Time (ProQOL Version 5; Stamm, 2009) was used at baseline to characterize the professional functioning of the training samples prior to participation, providing descriptive context for interpreting training experiences and outcomes. The ProQOL is a 30-item measure intended for helping professions (e.g., health care professionals, social service workers, teachers) to evaluate negative and positive effects of working with those who have experienced trauma. ProQOL asks participants about the frequency of certain experiences related to themselves and their work in the last 30 days to determine their scores for the subscales Compassion Satisfaction (e.g., “I get satisfaction from being able to help people”), Burnout (e.g., “I feel trapped by my job as a helper”), and Secondary Traumatic Stress (e.g., “I am preoccupied with more than one person I help”). Higher scores indicate experiencing more of each domain for all 3 subscales, such as greater compassion satisfaction, as well as greater risk for burnout and secondary traumatic stress. Extensive studies have demonstrated strong measure reliability and validity (Stamm, 2009). Internal consistency estimates were examined at baseline for Study 1(α =.78) and Study 2 (α = .77).

Post-Training Program Evaluations.

The Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM; Weiner et al., 2017) was used to assess if training was acceptable, appropriate, and feasible to participants. Following training, participants were asked to use a 5-point Likert scale to respond to how much they agree/disagree (1= Completely disagree, 5 = Completely agree) with the items on each 4-item subscale (AIM, IAM, and FIM). Higher scores indicate greater acceptability, appropriateness, and feasibility. Strengths of this measure include the ability to adapt the language to any intervention and ease of use with readability at the 5^th grade level. Psychometric properties, including content validity, discriminant content validity, and reliability, have been demonstrated as strong (Weiner et al., 2017). Internal consistency estimates were examined post-training for Study 1(AIM α = .93; IAM α = .97; FIM α =.84) and Study 2 (AIM α = .98; IAM α = .98; FIM α =.94).

PNET-Specific Perceived Evidence-Based Interventions (EBI) Abilities and Competence.

This study-specific measure was tailored to assess competence in delivering core components of PNET. While the structure could be adapted for other EBIs, in its current form it is intended to assess (1) abilities to assess and manage perinatal patients with PTSD or trauma-related distress and (2) participant skill/abilities level across the six core EBI components¹ as an indication of acceptability. Participants used a 7-point Likert scale that was adapted from core principles of competency-based education and assessment rubrics to indicate their level of ability and skill (0=None or no skill at all; 1=Vague knowledge, skills or competence; 2=Slight knowledge, skills or competence; 3=Average among my peers; 4=Competent; 5=Very competent; 6= Expert, teach others; see Rice et al., 2022 for more information on Likert scale development). In the first section, an 8-item scale assessed participants’ abilities to identify, treat, and manage perinatal patients (e.g., “How would you describe your ability to educate and motivate perinatal patients with PTSD to engage in evidence-based intervention?”). In the second section, a 6-item scale assessed competence level on all six identified core EBI components. A sum score was created for each subscale, with higher scores indicating more competence and expertise in managing perinatal patients and administering evidence-based interventions. Internal consistency estimates were examined post-training for Study 1 (Abilities α = .97; Competence α = .95) and Study 2 (Abilities α = .94; Competence α =.91).

Professional Connectedness.

This 2-item study-specific measure assessed connectedness to the professional communities that treat trauma, PTSD, and/or perinatal individuals. A 5-point Likert scale was used to indicate how strongly a participant felt connected to these communities, with higher scores indicating stronger feelings of connection (5=Strongly agree, 4=Agree, 3=Neither disagree or agree, 2=Disagree, 1=Strongly disagree). Participants reported their perceived connectedness to their professional community via two items: 1) “I feel connected to the trauma / PTSD treatment community” and 2) “I feel connected to the perinatal healthcare community.” These two items were summed and then averaged, with higher scores indicating a greater sense of professional connectedness.

Statistical Analysis.

All analyses were conducted using SPSS Version 29.0. Descriptive statistics were computed for all study variables outlined above. For Study 1, paired-samples t-tests were conducted to assess changes from pre- to post-training. For Study 2, repeated measures analyses of variance (ANOVA) were conducted to assess changes over time across time-points (pre, post, 6-months post, 12-months post). Post hoc pairwise comparisons with Bonferroni correction were used to examine changes between specific time points. Cohen’s d was calculated to estimate the effect sizes for t-test results and partial eta squared were calculated to estimate the effect sizes for ANOVA results. Missing data were handled using listwise deletion, meaning that only participants with complete data at each time-point being assessed were included. Notably, we intentionally elected not to implement multiple imputation for the present analyses for several methodological and conceptual reasons.

RESULTS

Study 1: PNET Training Embedded in Graduate Clinical Training

Attendee Satisfaction.

Most trainees reported high training satisfaction levels, with 93% indicating that they were “extremely satisfied” with the training. Further, 86% indicated they would recommend the training experience to others.

Perceived Gains in Ability and Competence.

Results also indicated a significant increase in attendees’ perceived abilities to assess and manage perinatal PTSD from pre- (M = 15.29, SD = 12.98) to post-training (M = 32.71, SD = 9.93), t(6) = −3.90, p = .01. Further, results revealed a significant increase in attendees’ perceived competence to deliver the intervention from pre- (M = 19.50, SD = 2.81) to post-training (M = 27.00, SD = 5.06), t(5) = −3.64, p = .015. Both outcomes were associated with large within-group effect sizes (Cohen’s d = 1.47 – 1.48), suggesting perceived gains in ability and competence following the training.

PNET Intervention Acceptability, Feasibility, and Appropriateness.

On average, most trainees found the PNET intervention to be acceptable (M = 4.7, SD = .46), appropriate (M = 3.8, SD = .62), and feasible (M = 4.6, SD = .92).

Sense of Professional Connection.

No significant differences were detected in professional connectedness from pre- (M = 3.17 SD = .60) to post-training (M = 3.42, SD = .66), t(5) = −.65, p = .54 (See Table 2 for Study 1 results).

Table 2.

Descriptive Statistics and Independent-Samples t-Test Results for Study 1 Comparing Pre- and Post- Training Outcomes.

Outcome Measure	n	M (SD)	t (df)	p	Cohen’s d
EBI Abilities	7		−3.90 (6)	.01	1.47
Pre		15.29 (12.98)
Post		32.71 (9.93)
EBI Competence	6		−3.64 (5)	.01	1.48
Pre		19.50 (2.81)
Post		27.00 (5.06)
Connectedness	6		−.65 (5)	.54	.27
Pre		3.17 (.60)
Post		3.42 (.66)

Note: EBI = Evidence-Based Intervention.

Study 2: PNET Training Delivered as a Professional Development Workshop

Attendee Satisfaction.

Most attendees reported high satisfaction levels, with 83% indicating that they were “extremely satisfied” with the training and 98% of attendees reporting that they would recommend the training to others.

Perceived Gains in Ability and Competence.

Results revealed a significant effect of time on perceived abilities to assess and manage perinatal PTSD across all three measurement timepoints (pre-, 6-month post, and 12-month post-training), F(2, 32) = 9.96, p <.001. Results also showed a significant effect of time on provider competence to deliver the intervention, F(2, 32) = 17.75, p <.001. Post hoc comparisons with Bonferroni correction indicated that scores significantly increased from pre- to 6-months and were sustained at 12-month follow-up for both perceived abilities and competence. Both outcomes were associated with large within-group effect sizes (η²= .38 – .53), suggesting perceived gains in ability and competence following the training.

PNET Intervention Acceptability, Feasibility, and Appropriateness.

The majority of participants found PNET to be an acceptable (M = 4.6, SD = .50), appropriate (M = 4.4, SD = .76) and feasible (M = 4.5, SD = .62) trauma-informed approach to use within their practice.

Sense of Professional Connection.

Lastly, a repeated-measures ANOVA revealed no significant effect of time on professional connectedness across all four timepoints (pre-, immediately post, 6-month post, and 12-month post-training), F(3, 36) = .59, p =.62 (see Table 3 for Study 2 results).

Table 3.

Descriptive Statistics Comparing Pre-, Post-, 6-months Post, and 12-months Post Scores and Repeated ANOVA Examining the Effect of Time for Study 2.

Outcome Measure (Effect of Time)	N	M (SD)	F (df)	p	η2
EBI Abilities	17		9.96 (2, 32)	<.001	.38
Pre		28.12 (9.61)
6 months Post		35.41 (7.99)
12-months Post		35.24 (5.88)
EBI Competence	17		17.75 (2, 32)	<.001	.53
Pre		21.12 (4.65)
6 months Post		26.94 (5.53)
12-months Post		27.71 (4.70)
Professional Connectedness	13		.59 (3, 36)	.62	.05
Pre		4.04 (.66)
Post		4.31 (.43)
6 months Post		4.15 (.80)
12-months Post		4.23 (.63)

Note: EBI = Evidence-Based Intervention.

DISCUSSION

Our dual-model evaluation of PNET, a targeted program designed to support professionals and trainees in addressing PTSD during pregnancy and postpartum, showed initial promise for building the professional perinatal workforce. We present two training models, one aligned with established clinical psychology training practices (long-term training with ongoing supervision) and another consistent with professional development workshops (brief training with optional consultation) to highlight the generalizability and flexibility of our findings. Across both approaches–the 6 to 12-month training (Study 1) and the professional development 3-day training (Study 2) –attendees reported positive perceptions of the training experience and increased perceived skill in delivering evidence-based care for treating perinatal PTSD. Thus, our findings serve as a critical step towards training more professionals in quality PTSD care for perinatal populations.

Medium to large effect size estimates for both groups suggest that PNET training can be successfully tailored to both short-term workshops and longer-term professional development training experiences without sacrificing quality and satisfaction among attendees. The successful delivery of PNET across both a long-term clinical psychology training rotation and a shorter, skills-focused, virtual professional development workshop demonstrates its flexibility and potential for integration into a range of clinical and educational contexts following larger-scale evaluation. Notably, core elements of the PNET model (didactics, experiential learning, clinical application) were preserved across training formats. However, it should be noted that larger-scale evaluation is needed to determine the extent to which these gains translate into clinical practice and patient outcomes.

Non-significant changes in perceived connectedness across both studies may reflect differences in training populations and settings, as well as limited power at later follow-up timepoints. Attendees in clinical training programs might face unique challenges in building professional connections, given their emerging professional identities and limited network during this phase of training. Similarly, in Study 2, while the opportunity for ongoing, optional consultation was made available to all participants, the limited and inconsistent uptake may reflect barriers that many professionals and trainees face, such as time constraints, competing demands, and varying levels of need or sustained interest. Together, findings highlight the need for intentional support for interdisciplinary collaboration and connection to trauma-informed professional networks, as well as future evaluation of the post-training support (Edelman, 2023; Killian, 2008).

Implications and Future Directions

Overall, our findings provide training-related perspectives necessary for early-stage implementation and future dissemination. Our feasibility, acceptability, and perceived competence findings have important implications for designing and delivering clinical training. First, we provided rigorous training and subsequent evaluation of best practices for how to assess, provide education on, and treat perinatal PTSD using an evidence-based exposure modality. Treatment for traumatized perinatal individuals remains a subject area that is rarely covered in any trainee education program, even though most adults will experience at least one traumatic event in their lifetime and up to 1 in 5 high-risk pregnant patients may be experiencing perinatal PTSD (Cook et al., 2018; Kessler et al., 2017; Yildiz et al., 2017). However, we have presented two acceptable, feasible, and effective training approaches for teaching critical information on perinatal PTSD and improving professional outcomes for providers. Critical next steps include more broadly disseminating the two training programs, with implementation flexible depending on professional structure, and further evaluating best practices to train healthcare professionals on how to help traumatized perinatal individuals.

Limitations

Given the exploratory design and modest sample sizes, these effect size patterns should be interpreted with caution and limitations should be acknowledged. First, participants self-selected into training by either choosing to join an elective rotation in their clinical training or paying to complete an optional training. Further studies are needed to understand if training and professional outcomes are the same for those who may be required to complete the training rather than electing to take it. Similarly, there may be bias in who opts into completing the evaluation portions of both trainings, potentially highlighting a subgroup of individuals who felt particularly engaged or satisfied with their experience. Furthermore, because the surveys were not mandatory and completed at the end of the training experience, not all participants completed the post-treatment assessment(s), contributing to the small sample size influenced by the use of listwise deletion. Thus, caution should be used when interpreting or generalizing the results. We suggest that larger-scale studies evaluating training effectiveness and clinical outcomes should incorporate more advanced missing data techniques. Further, to increase sample size and generalizability of results, future research should consider offering incentive to completion while being mindful of the power dynamics at play. All data was self-report rather than observed assessment (e.g., provider perception only versus patient input). Next steps should include data from patients and/or direct observation of participants’ skills in practice outside of training, as this would greatly help to understand how effective the training is in changing practice and patient outcomes. Lastly, several of the evaluation measures were created for the current study. While creation of these questionnaires helped to gather specific, necessary information that was not otherwise available in existing measures, additional research is needed on the psychometric properties of these measures outside of Cronbach’s alpha from this sample alone.

Conclusions

This dual-model evaluation showed initial support for the flexibility and scalability of the PNET training to inform strategies for addressing critical gaps in the professional workforce in perinatal PTSD. By demonstrating the feasibility, acceptability, and professional benefits across training intensities and formats, this work advances strategies for expanding access to evidence-based, trauma-informed training and ultimately, care for pregnant and postpartum individuals with PTSD.

Clinical Impact Statement.

This study demonstrated preliminary findings that suggest that a perinatal-focused trauma treatment training can be delivered flexibly through both traditional clinical psychology training programs and professional development workshops without sacrificing training quality and impact. Findings demonstrated high satisfaction and perceived professional benefits across training populations and formats. Ultimately, this work serves as a critical step towards expanding implementation and dissemination efforts and training multidisciplinary professionals and improving access to quality PTSD care for perinatal populations.