Clinician Documentation on Receipt of Trauma-Focused Evidence-Based Psychotherapies in a VA PTSD Clinic

Lu, Mary; Plagge, Jane M.; Marsiglio, Mary C.; Dobscha, Steven K.

doi:10.1007/s11414-013-9372-9

Cited by 44 publications

(50 citation statements)

References 31 publications

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“…The lack of EBTs in usual practice remains the case even after providers receive intensive training and consultation (Lu, Plagge, Marsiglio, & Dobscha., 2013; Shiner et al, 2013). In response to this gap, implementation researchers have begun to answer important questions about why EBTs do not easily translate into real-world settings (e.g., Brownson, Colditz, & Proctor, 2012; Drake et al, 2001).…”

mentioning

confidence: 99%

Providers’ perspectives of factors influencing implementation of evidence-based treatments in a community mental health setting: A qualitative investigation of the training–practice gap.

Marques¹,

Dixon²,

Valentine³

et al. 2016

Psychological Services

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The present study aimed to elucidate relations between provider perceptions of aspects of the Consolidated Framework for Implementation Research (CFIR; Damshroder et al., 2009) and provider attitudes towards the implementation of evidence-based treatments (EBTs) in an ethnically diverse community health setting. Guided by directed content analysis, we analyzed 28 semi-structured interviews that were conducted with providers during the pre-implementation phase of a larger implementation study for Cognitive Processing Therapy for Posttraumatic Stress Disorder (CPT-C for PTSD, Resick et al., 2008). Our findings extend the existing literature by also presenting provider-identified client-level factors that contribute to providers' positive and negative attitudes towards EBTs. Provider-identified client-level factors include: client motivation to engage in treatment, client openness to EBTs, support networks of family and friends, client use of community and government resources, the connection and relationship with their therapist, client treatment adherence, client immediate needs or crises, low literacy or illiteracy, low levels of education, client cognitive limitations, and misconceptions about therapy. These results highlight the relations between provider perceptions of their clients, provider engagement in EBT training, and subsequent adoption of EBTs. We present suggestions for future implementation research in this area.

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mentioning

confidence: 99%

Providers’ perspectives of factors influencing implementation of evidence-based treatments in a community mental health setting: A qualitative investigation of the training–practice gap.

Marques¹,

Dixon²,

Valentine³

et al. 2016

Psychological Services

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“…Almost half of the studies (N=12) utilized some version of a retrospective chart review. Usually, these studies relied primarily on medical record data, but four studies (31,32,35,40) included reviews of VA chart progress notes for key terms related to TC-CBT treatment in VA PTSD clinics.…”

Section: Participantsmentioning

confidence: 99%

Factors Associated With Receipt of Cognitive-Behavioral Therapy or Prolonged Exposure Therapy Among Individuals With PTSD

Berk‐Clark

Moore

Secrest

et al. 2019

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The aim of this study was to systematically review variables associated with initiation of trauma-centered cognitive-behavioral therapy (TC-CBT) among individuals with posttraumatic stress disorder (PTSD). Methods: PubMed, PsycINFO, Web of Science, Published International Literature on Traumatic Stress (PILOTS), and Scopus were searched in a systematic manner up to 2018, and 26 relevant studies were recovered and analyzed. Results: The average weighted initiation rate was 6% in larger hospital systems with a high rate of trauma and 28% in outpatient mental health settings (range 4%-83%). Older age (odds ratio [OR]=1.56, 95% confidence interval [CI]= 0.51-1.61), female gender (OR=1.18, 95% CI=1.08-1.27), black or other racial-ethnic minority group (OR=1.

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“…Despite the resources the Veterans Health Administration (VHA) has invested in these two therapies, Veteran access to and engagement in EBPs for PTSD remain a challenge (4). Relatively few Veterans with PTSD (9%) receive these EBPs (5)(6)(7), and approximately half who initiate these treatments terminate prematurely and do not receive a full course of therapy (8,9). Notable barriers to accessing and engaging in EBPs include logistic issues such as taking time off work or school, arranging child or elder care, physical limitations, and transportation and travel costs (10,11).…”

Section: Introductionmentioning

confidence: 99%

Video to Home Delivery of Evidence-Based Psychotherapy to Veterans With Posttraumatic Stress Disorder

et al. 2019

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Background: The Veterans Health Administration (VHA) has pioneered the implementation of video to home (VTH) technology to increase access to mental health treatments for Veterans facing barriers to receiving in-person care, particularly for posttraumatic stress disorder (PTSD). Randomized controlled trials have established the noninferiority of evidence-based psychotherapies (EBPs) for PTSD delivered through VTH, compared to in-person delivery. Less is known about the use of VTH to deliver EBPs for PTSD in routine clinical practice. Objective: We examined the provision of EBPs for PTSD delivered via VTH at a large Southwestern VHA PTSD outpatient clinic. Methods: Data were obtained from chart review of the electronic medical records of Veterans receiving at least one session of Cognitive Processing Therapy or Prolonged Exposure via VTH in the VHA PTSD clinic during the study time frame. Results: Fourteen providers (including six psychology trainees) delivered EBPs for PTSD via VTH between 2016 and 2018. Providers treated 74 Veterans (33.8% women) from diverse sociocultural backgrounds who ranged in age from 25 to 79. Each provider treated about 3.08 (± 2.18) Veterans using VTH, not including one provider who saw more than 30. A hybrid approach, in which VTH-delivery was coupled with in-person delivery, was used with 70.3% of Veterans across treatment (including sessions completed before initiation and after termination of the EBP). This demonstrates the versatility of VTH for meeting individual patient needs. Most EBP sessions (85.4%) were conducted over VTH. Despite Veterans attending an average of 6.85 (± 4.88) EBP sessions, 50% terminated before session 7. This dropout rate is consistent with national and local EBP completion averages within the VHA. Veterans receiving Cognitive Processing Therapy via VTH were more likely to complete treatment than those receiving Prolonged Exposure. No other patient factors predicted attrition.

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Clinician Documentation on Receipt of Trauma-Focused Evidence-Based Psychotherapies in a VA PTSD Clinic

Cited by 44 publications

References 31 publications

Providers’ perspectives of factors influencing implementation of evidence-based treatments in a community mental health setting: A qualitative investigation of the training–practice gap.

Providers’ perspectives of factors influencing implementation of evidence-based treatments in a community mental health setting: A qualitative investigation of the training–practice gap.

Factors Associated With Receipt of Cognitive-Behavioral Therapy or Prolonged Exposure Therapy Among Individuals With PTSD

Video to Home Delivery of Evidence-Based Psychotherapy to Veterans With Posttraumatic Stress Disorder

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