Project Summary/Abstract My application for a Pathway to Independence Award represents the ideal next step toward reaching my goal of becoming a leading independent investigator focused on the development and evaluation of systems-based approaches for effectively delivering CIH interventions for common chronic conditions. The current application proposes the development and pragmatic pilot testing of a novel CIH-based stepped care approach for co- occurring chronic pain and PTSD. The aims of the proposal strategically align with my specific career development goals of gaining expertise in 1) systems-based care models for complex co-occurring physical and mental health conditions, 2) pragmatic clinical trial design for CIH interventions, and 3) user-centered design strategies for learning health systems. Also included is a professional development goal to 4) ensure my readiness to transition into an independent researcher and faculty member at the rank of Assistant Professor. In addition, the training plan includes 2 goals in the R00 phase of the award: 5) successfully transition into an Assistant Professor position and maintain a successful independent research program; and, 6) conduct a pilot randomized effectiveness trial and use pilot data to write and submit a competitive R01-level grant to NCCIH. The training plan includes an excellent research mentorship team with an established history of consistent independent federal funding and mentorship to ensure that these 6 goals are met. Dr. Steve Zeliadt (Primary Mentor) is an expert in pragmatic trial design, dissemination and implementation science, and quantitative data analysis; Dr. Kurt Kroenke (Co-Mentor) is an expert in systems-based and stepped care models within primary care settings for patients with chronic physical and mental health conditions; and Dr. Rhonda Williams (Co- Mentor) is an expert in pragmatic clinical trial design for CIH interventions and the development, treatment, and theoretical underpinnings of CIH interventions for individuals with complex symptom presentations. In Aim 1, we will use patient semi-structured interviews and clinic focus groups to identify provider strategies and patient perspectives relevant to treating co-occurring chronic pain and PTSD in a primary care clinic. Using proven stepped care approaches developed by mentor Dr. Kroenke for pain and by consultant Dr. Zatzick for PTSD as the foundation, our team will develop a CIH-based stepped care approach for co-occurring chronic pain and PTSD in primary care guided by current evidence of CIH interventions while including patient, provider, and clinic input. In Aim 2, we will iteratively refine the protoype using user-centered design strategies. In Aim 3, we will conduct a pragmatic pilot trial of our CIH-based stepped care approach v. treatment as usual in two primary care settings (one rural, one urban). The experiential components of each aim, combined with my mentorship plan, will ensure my readiness ...