Evaluation of an Implementation Model: A National Investigation of VA Residential Programs
- 534 Downloads
This national investigation utilizes qualitative data to evaluate an implementation model regarding factors influencing provider use of two evidence-based treatments for posttraumatic stress disorder (PTSD). Semi-structured qualitative interviews with 198 mental health providers from 38 Department of Veterans Affairs’ (VA) residential treatment programs were used to explore these issues regarding prolonged exposure (PE) and cognitive processing therapy (CPT) in VA residential PTSD programs. Several unique and some overlapping predictors emerged. Leadership was viewed as an influence on implementation for both CPT and PE, while a lack of dedicated time and resources was viewed as a deterrent for both. Compatibility of CPT with providers’ existing practices and beliefs, the ability to observe noticeable patient improvement, a perceived relative advantage of CPT over alternative treatments, and the presence of a supportive peer network emerged as influential on CPT implementation. Leadership was associated with PE implementation. Implications for the design and improvement of training and implementation efforts are discussed.
KeywordsImplementation Evidence-based practice Posttraumatic stress disorders
This project described was supported by Award Number RC1 MH088454 from the National Institute of Mental Health (NIMH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH, the National Institutes of Health or the Department of Veterans Affairs.
- Cook, J. M., O’Donnell, C. O., Dinnen, S., Bernardy, N., Rosenheck, R., & Desai, R. (2013). A formative evaluation of two evidence-based psychotherapies for PTSD in VA residential treatment programs. Journal of Traumatic Stress, 26, 56–63.Google Scholar
- Curran, G. M., Sullivan, G., Mendel, P., Craske, M. G., Sherbourne, C. D., Stein, M. B., …, & Roy-Byrne, P. (2012). Implementation of the CALM intervention for anxiety disorders: a qualitative study. Implementation Science, 7, 14.Google Scholar
- Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4, 50–59.CrossRefPubMedCentralPubMedGoogle Scholar
- Department of Veterans Affairs. (2013). Dissemination and education within the VA. Washington, DC: Author. Retrieved from http://www.ptsd.va.gov/about/major-initiatives/education/dissemination_education_within_the_va.asp.
- Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of the literature. Tampa, FL: The National Implementation Research Network, Louis de la Parte Florida Mental Health Institute, University of South Florida.Google Scholar
- Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences—Therapist guide. New York: Oxford University Press.Google Scholar
- Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.Google Scholar
- Karlin, B. E., Ruzek, J. I., Chard, K. M., Eftekhari, A., Monson, C. M. Hembree, E. A., …, & Foa, E. B. (2010). Dissemination of evidence-based psychological treatments for posttraumatic stress disorder in the Veterans Health Administration. Journal of Traumatic Stress, 23, 663–673.Google Scholar
- Panzano, P. C., Seffrin, B. A., Chaney-Jones, S., Roth, D., Massatti, R., …, & Carstens, C. (2004). The innovation and adoption research project (IDARP): Moving from the diffusion of research results to promoting the adoption of evidence-based innovations in the Ohio mental health system. In D. Roth & W. Lutz (Eds.), New research in mental health. Columbus, OH: Office of Program Evaluation and Research, Ohio Department of Mental Health.Google Scholar
- Proctor, E. K., Knudsen, K. J., Fedoravicius, N., Hovmand, P., Rosen, A., & Perron, B. (2007). Implementation of evidence-based practice in community behavioral health: Agency director perspectives. Administration and Policy in Mental Health and Mental Health Services Research, 34, 479–488.CrossRefPubMedGoogle Scholar
- Proctor, E. K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C., & Mittman, B. (2009). Implementation research in mental health services: An emerging science with conceptual, methodological, and training challenges. Administration and Policy in Mental Health and Mental Health Services Research, 36, 24–34.CrossRefPubMedGoogle Scholar
- Resick, P. A., & Schnicke, M. (1996). Cognitive processing therapy for rape victims: A treatment manual. Newbury Park: Sage Publications.Google Scholar
- Rogers, E. M. (1962). Diffusion of innovations. New York: Free Press.Google Scholar
- Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York: Free Press.Google Scholar
- Shiner, B., D’Avolio, L. W., Nguyen, T. M., Zayed, M. H., Young-Xu, Y., Desai, R. A., …, Watts, B. V. (2013). Measuring use of evidence based psychotherapy for posttraumatic stress disorder. Administration and Policy in Mental Health Services Research, 40, 311–318.Google Scholar
- Stirman, S. W., Gutierrez-Colina, A., Toder, K., Esposito, G., Barg, F., …, & Crits-Christoph, P. (2013). Clinicians’ perspectives on cognitive therapy in community mental health settings: Implications for training and implementation. Administration and Policy in Mental Health and Mental Health Services Research, 40, 274–285.Google Scholar
- VA/DoD Clinical Practice Guideline Working Group. (December 2010). Management of post-traumatic stress. Washington, DC: Veterans Health Administration, publication 10Q-CPG/PTSD-03.Google Scholar