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A Review of Studies on the System-Wide Implementation of Evidence-Based Psychotherapies for Posttraumatic Stress Disorder in the Veterans Health Administration

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Abstract

Since 2006, the Veterans Health Administration (VHA) has instituted policy changes and training programs to support system-wide implementation of two evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD). To assess lessons learned from this unprecedented effort, we used PubMed and the PILOTS databases and networking with researchers to identify 32 reports on contextual influences on implementation or sustainment of EBPs for PTSD in VHA settings. Findings were initially organized using the exploration, planning, implementation, and sustainment framework (EPIS; Aarons et al. in Adm Policy Ment Health Health Serv Res 38:4–23, 2011). Results that could not be adequately captured within the EPIS framework, such as implementation outcomes and adopter beliefs about the innovation, were coded using constructs from the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework (Glasgow et al. in Am J Public Health 89:1322–1327, 1999) and Consolidated Framework for Implementation Research (CFIR; Damschroder et al. in Implement Sci 4(1):50, 2009). We highlight key areas of progress in implementation, identify continuing challenges and research questions, and discuss implications for future efforts to promote EBPs in large health care systems.

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Acknowledgments

This review was supported by the U.S. Department of Veterans Affairs, including the National Center for PTSD and the Mental Illness Quality Enhancement Research Initiative. The opinions are those of the authors and do not reflect the position of the U.S. Department of Veterans Affairs.

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Authors and Affiliations

  1. Dissemination & Training Division, National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (334-PTSD), Menlo Park, CA, 94025, USA

    C. S. Rosen, S. Wiltsey Stirman, S. Landes, J. Crowley, A. Eftekhari, A. L. Rodriguez, J. I. Ruzek, B. N. Smith & L. Trent

  2. Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA

    C. S. Rosen, S. Wiltsey Stirman, J. I. Ruzek & L. Trent

  3. School of Social Work, Saint Louis University, Saint Louis, MO, USA

    M. M. Matthieu

  4. Evaluation Division, National Center for PTSD, VA Connecticut Health Care System, West Haven, CT, USA

    J. M. Cook

  5. Yale School of Medicine, NEPEC/182, 950 Campbell Avenue, West Haven, CT, USA

    J. M. Cook

  6. Executive Division, National Center for PTSD, Veterans Affairs Medical Center, White River Junction, VT, USA

    N. C. Bernardy, J. L. Hamblen & J. M. Harik

  7. Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA

    N. C. Bernardy, J. L. Hamblen & B. V. Watts

  8. Cincinnati Department of Veterans Affairs (VA) Medical Center, Cincinnati, OH, USA

    K. M. Chard

  9. University of Cincinnati College of Medicine, Cincinnati, OH, USA

    K. M. Chard

  10. South Texas Veterans Health Care System, San Antonio, TX, USA

    E. P. Finley

  11. The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    E. P. Finley

  12. Women’s Health Sciences Division at VA Boston Healthcare System, National Center for PTSD, Boston, MA, USA

    S. M. Kehle-Forbes

  13. Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, USA

    S. M. Kehle-Forbes, L. A. Meis & P. E. Osei-Bonsu

  14. Department of Medicine, University of Minnesota, Minneapolis, MN, USA

    S. M. Kehle-Forbes, L. A. Meis & P. E. Osei-Bonsu

  15. Ralph H. Johnson VA Medical Center, Charleston, SC, USA

    K. J. Ruggiero

  16. Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA

    K. J. Ruggiero

  17. Palo Alto University, Palo Alto, CA, USA

    J. I. Ruzek

  18. Veterans Affairs Medical Center, White River Junction, VT, USA

    B. V. Watts

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  1. C. S. Rosen
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  2. M. M. Matthieu
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  20. L. Trent
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  21. B. V. Watts
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Correspondence to C. S. Rosen.

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Rosen, C.S., Matthieu, M.M., Wiltsey Stirman, S. et al. A Review of Studies on the System-Wide Implementation of Evidence-Based Psychotherapies for Posttraumatic Stress Disorder in the Veterans Health Administration. Adm Policy Ment Health 43, 957–977 (2016). https://doi.org/10.1007/s10488-016-0755-0

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