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Professional psychologists have an ethical obligation to engage in culturally competent service delivery within their research and practice. Although the American Psychological Association has published guidelines for multicultural competence within these areas, researchers continue to rely on convenience samples comprised primarily of majority population groups interspersed with individuals from various diverse populations. This leads to uncertainty regarding the generalizability and utility of existing psychological treatments. Given the growth in research and popularity of Acceptance and Commitment Therapy (ACT), this paper investigates the practice of cultural competence in ACT outcome research. A comprehensive review of published ACT outcome research revealed that ACT is being implemented and researched across a number of countries around the world, with a presumably diverse population. However, a notable percent of the outcome studies do not provide adequate descriptions of the demographic makeup of their samples, particularly related to ethnic or racial information. Studies that do report ethnic or racial infonnation provide preliminary evidence that suggests ACT may be effective with diverse groups. The implications of these fmdings are discussed, including recommendations for researchers and practitioners and potential directions for future research and practice.

Context:Stretching exercise regimens are routinely prescribed to increase range of motion (ROM) and diminish injuries.Objective:To examine the effect of a 3-minute passive stretch on ankle-dorsiflexion ROM in a nonpathological population.Setting:University laboratory.Design:Prospective, randomized, controlled study.Participants:24 apparently healthy volunteers.Interventions:Subjects stood with their heels suspended from the edge of a platform. The experimental subjects stretched for 3 minutes on 3 consecutive days.Main Outcome Measures:Passive ankle-dorsiflexion ROM.Results:Ankle-dorsiflexion ROM increased significantly (P< .0005) over the course of each day’s stretch. No significant gains in ankle-dorsiflexion ROM were realized over 3 days.Conclusions:These findings suggest the need for further research to determine the stretching frequency and duration that will result in lasting increases in ankle-dorsiflexion ROM

Technology can support the use of evidence-based behavioral health treatments, as well as serve as a link to care to improve patient engagement and adherence to treatment. While research suggests that mobile applications (apps) specifically have the potential to enhance the delivery of behavioral health treatment, little guidance exists on how clinicians can effectively and safely integrate mobile apps into their clinical practice. The purpose of this paper is to describe the Department of Defense Practice-Based Implementation (PBI) Network’s approach to implementation and present the results of the Technology (Tech) into Care pilot. The PBI Network conducted this pilot to address providers’ knowledge gaps regarding the integration of mobile apps into behavioral health care within the Military Health System (MHS) and examine the feasibility of widespread dissemination of the practice change in the MHS. A mixed-method design guided by the Promoting Action on Research Implementation in Health Services framework was used to evaluate the approach and identify facilitators and barriers to practice change. Positive preliminary support for the feasibility of the Tech into Care approach was demonstrated in improvements in providers’ knowledge, comfort, and perceived level of preparation to integrate mobile apps into care. Organizational challenges including time constraints and staff turnover negatively impacted implementation success. The PBI Network Tech into Care implementation approach is a feasible method to address knowledge gaps related to the integration of mobile apps into clinical practice within the MHS. Contextual factors, such as competing time demands, often impede providers’ ability to effectively integrate mobile apps into care.

Enterprise data indicates that U.S. service members (SMs) with posttraumatic stress disorder (PTSD) may not receive an evidence-based treatment (EBT) or may receive an EBT with low fidelity to the core components. Successful delivery of EBTs requires provider training and ongoing supervision/consultation, adjustment of clinic processes and structure, and leadership support. The Department of Defense (DoD) Practice-Based Implementation (PBI) Network is a dedicated team of implementation science specialists that support the integration of EBTs into clinical practice in the Military Health System (MHS). The PBI Network conducted a Cognitive Processing Therapy (CPT) pilot to investigate the acceptability and feasibility of a novel trauma specialist implementation approach proposed by South Texas Research Organizational Network Guiding Studies on Trauma and Resilience (STRONG STAR). This approach, CPT Trauma Specialist (CPT-TS), called for training designated behavioral health (BH) therapists as the primary CPT providers in their clinics. In collaboration with the Uniformed Services University Center for Deployment Psychology, the PBI Network provided training and consultation to 26 providers across 13 MHS BH clinics and supported ongoing facilitation. Despite provider interest and clinic leadership support, less than half of the pilot provider participants were able to meet the consultation and CPT delivery requirements for designation as a CPT trauma trained specialist. Prevalent implementation barriers included lack of adequate clinic resources, provider challenges balancing clinical and military-related duties, the need to focus on high-risk patients, and other military system-related constraints. These findings highlight the need for implementation scientists to examine alternatives to traditional training models and identify fidelity-consistent adaptations that allow for delivery of evidence-based care within highly constrained systems of care. Impact StatementThis article presents the evaluation of a pilot implementation of evidence-based psychotherapy for the treatment of posttraumatic stress disorder (PTSD) in the Military Health System (MHS). A team of implementation science specialists trained interested outpatient behavioral health (BH) providers as Cognitive Processing Therapy trauma specialists in their clinics. Multiple patient and system-level factors challenged the delivery of this evidence-based PTSD treatment. The results emphasize that rollout methods established in one health care system may not translate well to another and provide actionable information about the delivery of evidence-based psychotherapies within the MHS and strategies to improve the quality of BH delivered to U.S. service members.