Evaluating a community-based training program for evidence-based treatments for PTSD using the RE-AIM framework.

Abstract

Community mental health providers increasingly serve veterans with posttraumatic stress disorder (PTSD).

Initiating Cognitive Processing Therapy (CPT) in Community Settings: A Qualitative Investigation of Therapist Decision-Making

“…To date, community-based providers have been an understudied population in the implementation science literature even though they regularly provide care to those with PTSD. Better understanding barriers to delivering EBPs in routine care is of considerable importance, given evidence suggesting CPT implementation in community settings is lower than those found in VA settings (Dondanville et al, 2021a ; Finley et al, 2018 ; Hundt et al, 2018 ).…”

“…Therapists in community settings tend to have less experience and training in EBPs for PTSD (Finley et al, 2019 ), making it likely that implementation rates of CPT are even lower in the community than in institutional settings (Hundt et al, 2018 ). Utilization of EBPs in community settings may remain low even after therapists have received training and consultation (Dondanville et al, 2021a ; Finley et al, 2018 ). A recent survey study examined initiation rates of EBPs in community settings serving veterans following a training program for CPT and PE.…”

“…A recent survey study examined initiation rates of EBPs in community settings serving veterans following a training program for CPT and PE. CPT patient initiation rates ranged from 30 to 35% over a 5-month follow-up period (Dondanville et al, 2021a ). In another study that examined implementation barriers of a community-based training program, half of the clinicians who received CPT training reported having implementation challenges including referral issues, patient disinterest in the treatment, and low confidence in delivery of CPT (Dondanville et al, 2021b ).…”

“…CPT patient initiation rates ranged from 30 to 35% over a 5-month follow-up period (Dondanville et al, 2021a ). In another study that examined implementation barriers of a community-based training program, half of the clinicians who received CPT training reported having implementation challenges including referral issues, patient disinterest in the treatment, and low confidence in delivery of CPT (Dondanville et al, 2021b ). However, in light of low utilization rates, there are likely a variety of other reasons why therapists may not deliver CPT.…”

A national survey of patient completion of cognitive behavioral therapy for chronic pain: The role of therapist characteristics, attempt rates, and modification.

“…Prior research has indicated penetration is often low, even in specially trained EBP providers. For instance, work regarding EBPs for posttraumatic stress disorder (PTSD) both within the Veterans Health Administration (VHA; Finley et al, 2015), and among community providers (Dondanville et al, 2018) demonstrated therapists often fail to provide or offer EBPs to patients. Importantly for the present study, attempting to offer or initiate a given EBP to a patient is a prerequisite for the patient to receive the EBP; therefore, the percentage of patients with whom the EBP is attempted is an important measure of penetration.…”