A review of the referral process for evidence-based psychotherapies for PTSD among veterans.

Abstract

This study reviews current literature regarding referral to evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD) within U.S. Veterans Affairs (VA). The referral process for EBPs for PTSD impacts care, but this process has not been the focus of much research. The current literature suggests that patient, provider, and structural factors all play a role in rates of referral to EBPs for PTSD. Patient factors include PTSD severity and comorbid diagnoses. Provider factors include provider role and provider beliefs about EBPs for PTSD. Structural factors include screening and diagnosis practices/procedures, availability of trained providers, use of care managers, and disparities in care. Notably, we found that summarizing the literature on the referral process is challenging because this process varies greatly across Veterans Affairs sites. We provide recommendations for future research and ways to address barriers to successful referrals to EBPs for PTSD, with a focus on education for referring providers, patient education, increasing availability of web-based and briefer EBPs, and procedural/administrative changes. Public Significance StatementThe present study reviews existing studies on Veterans Health Administration referrals to evidencebased psychotherapies for posttraumatic stress disorder (PTSD)-synthesizing findings, highlighting gaps in the literature, and providing recommendations to enhance patient outcomes. Our goal is to contribute to better understanding of this referral process and to help shape practices and policies to increase access to evidence-based care for PTSD.

Rates and reasons for veteran mental health service utilization following completion of evidence-based trauma-focused treatment for PTSD.

“…While wait times for initiating mental health care are shorter in VA than community settings, waits for those establishing care can exceed 1 month and are variable across medical centers (Feyman et al, 2022). Furthermore, there are often multistep processes that one must go through to be eligible for TFT (Ranney et al, 2022). Thus, it is possible that concerns about losing one’s spot within the mental health system soon after navigating the process to access TFT may drive some patients to keep up with regular mental health appointments “just in case.” Education about pathways and timelines for reestablishing care may be effective in easing some of these concerns, given VA policies that facilitate easy reentry to care for prior patients (e.g., retaining a mental health treatment coordinator for 2 years after a mental health visit).…”

“…While wait times for initiating mental health care are shorter in VA than community settings, waits for those establishing care can exceed 1 month and are variable across medical centers (Feyman et al, 2022). Furthermore, there are often multistep processes that one must go through to be eligible for TFT (Ranney et al, 2022). Thus, it is possible that concerns about losing one's spot within the mental health system soon after navigating the process to access TFT may drive some patients to keep up with regular mental health appointments "just in case."…”