Context Matters: Team and Organizational Factors Associated with Reach of Evidence-Based Psychotherapies for PTSD in the Veterans Health Administration

Sayer, Nina A.; Rosen, Craig S.; Bernardy, Nancy C.; Cook, Joan M.; Orazem, Robert J.; Chard, Kathleen M.; Mohr, David C.; Kehle‐Forbes, Shannon M.; Eftekhari, Afsoon; Crowley, Jill J.; Ruzek, Josef I.; Smith, Brandy N.; Schnurr, Paula P.

doi:10.1007/s10488-017-0809-y

Cited by 72 publications

(97 citation statements)

References 43 publications

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“…This suggests that gaining more clinical experience in the safe context of a rotating team may lead to better implementation of TFT in clinical practice. This finding is also in line with EMDR therapists reporting that a so-called buddy would help them in the implementation of EMDR in their clinical practices (Grimmett & Galvin, 2015) and a study showing that contextual factors, such as a shared trauma-focused team vision, are related to more use of TFTs (Sayer et al, 2017). …”

Section: Discussionsupporting

confidence: 77%

Therapist rotation: a novel approach for implementation of trauma-focused treatment in post-traumatic stress disorder

Minnen

Hendriks

Kleine

et al. 2018

European Journal of Psychotraumatology

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Background: Trauma-focused treatments (TFTs) for patients with post-traumatic stress disorder (PTSD) are highly effective, yet underused by therapists.Objective: To describe a new way of implementing (adequate use of) TFTs, using a therapist rotation model in which one patient is treated by several therapists.Method: In this article, we will present two examples of working with therapist rotation teams in two treatment settings for TFT of PTSD patients. We explore the experiences with this model from both a therapist and a patient perspective.Results: Our findings were promising in that they suggested that this novel approach reduced the therapists’ fear of providing TFT to PTSD patients, increased perceived readiness for TFT, and decreased avoidance behaviour within TFT sessions, possibly leading to better implementation of TFT. In addition, the therapeutic relationship as rated by patients was good, even by patients with insecure attachment styles.Conclusions: We suggest that therapist rotation is a promising novel approach to improve implementation of TFT for PTSD.

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Section: Discussionsupporting

confidence: 77%

Therapist rotation: a novel approach for implementation of trauma-focused treatment in post-traumatic stress disorder

Minnen

Hendriks

Kleine

et al. 2018

European Journal of Psychotraumatology

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show abstract

“…Hence, while regional service directors are ultimately responsible for improving quality, the Department has launched national initiatives to improve quality of care and reduce disparities in mental health care, notably through the implementation of the Uniform Mental Health Services Handbook 87 and the deployment of mental health care managers in primary care settings to promote integrated care. The Department has also sponsored the national implementation of evidence-based psychotherapy for post-traumatic stress disorder 88 .…”

Section: Innovations In Mental Health Care Quality Measurement and Immentioning

confidence: 99%

Measuring and improving the quality of mental health care: a global perspective

et al. 2018

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Mental disorders are common worldwide, yet the quality of care for these disorders has not increased to the same extent as that for physical conditions. In this paper, we present a framework for promoting quality measurement as a tool for improving quality of mental health care. We identify key barriers to this effort, including lack of standardized information technology-based data sources, limited scientific evidence for mental health quality measures, lack of provider training and support, and cultural barriers to integrating mental health care within general health environments. We describe several innovations that are underway worldwide which can mitigate these barriers. Based on these experiences, we offer several recommendations for improving quality of mental health care. Health care payers and providers will need a portfolio of validated measures of patient-centered outcomes across a spectrum of conditions. Common data elements will have to be developed and embedded within existing electronic health records and other information technology tools. Mental health outcomes will need to be assessed more routinely, and measurement-based care should become part of the overall culture of the mental health care system. Health care systems will need a valid way to stratify quality measures, in order to address potential gaps among subpopulations and identify groups in most need of quality improvement. Much more attention should be devoted to workforce training in and capacity for quality improvement. The field of mental health quality improvement is a team sport, requiring coordination across different providers, involvement of consumer advocates, and leveraging of resources and incentives from health care payers and systems.

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“…However, even with such a large-scale, top-down approach, penetration of front-line protocol treatments such as PE and CPT has been found to be low in some VHA settings (Sayer et al, 2017). Taken together, the ongoing work in the VHA suggests that implementation and sustainability of evidence-based protocols are enhanced by an overarching organizational mission, infrastructure, and operations that encourage and reinforce the use of protocol treatments across the broader health care system (Sayer et al, 2017), and that theoretical implementation science frameworks can help us organize findings from a number of studies in order to glean the most effective strategies for improving uptake and use of evidence-based protocols in large-scale systems. As a result, researchers have been increasing the focus on understanding other systemslevels contexts necessary to support the implementation of such protocols, and are trying to categorize findings from such studies based on broader implementation science models in order to develop ways to implement treatments more effectively within these contexts.…”

Section: Systems-level Infrastructurementioning

confidence: 99%

Evidence‐based protocols: Merits, drawbacks, and potential solutions.

Asnaani¹,

Gallagher²,

Foa³

2018

Clinical Psychology: Science and Practice

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Considerable evidence supports the utility of evidence-based protocols in clinical practice in treating a range of psychological symptoms. However, there are significant barriers to their use. We briefly review theoretical models underlying evidencebased practice and how these relate to use of evidence-based treatment protocols. We then discuss the merits of evidence-based protocols. Common concerns about limitations to using evidence-based protocols in clinical practice follow. Challenges in dissemination and implementation of evidence-based protocols are then reviewed. In addition, current/potential solutions are presented alongside these challenges, to provide suggested avenues for improving the integration of evidence-based protocols into routine clinical practice in a broader range of practice settings moving forward. K E Y W O R D Sdissemination, drawbacks, empirically supported treatments (ESTs), evidence-based protocols, implementation, merits 2 of 13 | ASNAANI et Al.

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Context Matters: Team and Organizational Factors Associated with Reach of Evidence-Based Psychotherapies for PTSD in the Veterans Health Administration

Cited by 72 publications

References 43 publications

Therapist rotation: a novel approach for implementation of trauma-focused treatment in post-traumatic stress disorder

Therapist rotation: a novel approach for implementation of trauma-focused treatment in post-traumatic stress disorder

Measuring and improving the quality of mental health care: a global perspective

Evidence‐based protocols: Merits, drawbacks, and potential solutions.

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