A Quantitative Test of an Implementation Framework in 38 VA Residential PTSD Programs

Abstract

This study examines the implementation of two evidence-based psychotherapies, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT), in the Department of Veterans Affairs residential Posttraumatic Stress Disorder treatment programs. Two hundred and one providers from 38 programs completed an online survey concerning implementation of PE delivered on an individual basis and CPT delivered in individual and group formats. For PE, a supportive organizational context (dedicated time and resources, and incentives and mandates) and overall positive view of the treatment were related to its implementation. For both group and individual CPT, only the supportive organizational context was significantly associated with outcome. Implications for implementation efforts are discussed.

Identifying the organizational innovation‐specific capacity needed for exposure therapy

“…As many of these organizational characteristics may be mutable targets, findings have implications for designing organizational implementation strategies to be tested in future studies. First, consistent with prior studies looking more broadly at implementation climate (e.g., Cook et al, 2015), leadership may benefit from fostering expectations and support related to use of exposure therapy. Organizational efforts could communicate to therapists that exposure is expected to be the first‐line intervention for clients with an anxiety or related disorder (i.e., the default) relative to other treatment strategies (e.g., relaxation).…”

“…However, little work has identified contextual variables critical for facilitating clinician exposure delivery (Becker‐Haimes, Franklin et al, 2017). Work in this area primarily consists of empirical work linking broad facets of organizational culture and climate with trauma‐based treatments that include exposure elements (Cook et al, 2015; Sayer et al, 2017) and qualitative work examining constraints of community organizations (Chu et al, 2015; Ringle et al, 2015).…”

“…Prior work has demonstrated that general organizational variables important for EBP implementation (e.g., proficient culture, implementation climate, and transformational leadership) are related to improved overall adherence to EBPs in community settings (e.g., Beidas et al, 2014; Cook et al, 2015; Farahnak, Ehrhart, Torres, & Aarons, 2019; Sayer et al, 2017; Williams, Glisson, Hemmelgarn, & Green, 2017). However, they are unrelated to clinician use of in vivo exposures (Becker‐Haimes, Okamura et al, 2017).…”

Advancing Implementation Research and Practice in Behavioral Health Systems

“…Outer context variables include funding, engagement with treatment developers, and leadership. A growing body of empirical work supports the importance of the contextual factors specified in the EPIS framework (e.g., Aarons, Ehrhart, Farahnak, & Hurlburt, 2015; Beidas et al, 2015, 2016; Cook et al, 2015; Glisson & Williams, 2015; Isett et al, 2007). We will organize our discussion of the manuscripts in this special issue according to the phase(s) of the EPIS they best map on to, though some manuscripts span multiple phases.…”

Maintenance and Reach of Exposure Psychotherapy for Posttraumatic Stress Disorder 18 Months After Training

“…Several theories note the importance of organizational context in the implementation of new practices (Aarons, Hurlburt, & Horwitz, ; Greenhalgh, Robert, Macfarlane, Bate, & Kyriakidou, ). A study of organizational factors in VHA residential PTSD treatment programs found that the use of CPT and PE was predicted by dedicated resources and mandates to provide these treatments, and (for PE) by clinicians’ positive view of the treatment (Cook, Dinnen, Thompson, et al., ). Less is known about organizational influences in outpatient clinics, where most veterans get their care.…”