Improving engagement and retention to treatment within VHA PTSD specialty care: Evolution of an outpatient program design.

Abstract

The Veteran's Health Administration (VA) and Department of Defense (DoD) posttraumatic stress disorder (PTSD) clinical practice guidelines (2017) recommend individual, trauma-focused therapy as the gold standard of treatment for PTSD (i.e., evidence-based practices [EBP]). Moreover, these guidelines encourage the use of individual shared decision-making (SDM) to increase engagement and completion of EBPs for PTSD in line with current literature. This study retrospectively evaluated three models of program design of a VA PTSD specialty clinic over the past 8 years. In line with previous literature, the study hypothesized that leveraging individualized SDM in the clinic design would lead to increased completion of EBPs for PTSD. Analyses indicated an impact as the models shifted from a group-based model to an individualized model. Specifically, as compared to veterans who completed a group-based design, a greater proportion of those enrolled in the clinic were more likely to complete an EBP. These results may suggest that individualized, patient-centered treatment planning may be related to patient engagement in EBPs for PTSD in contrast with group-based models. Other programmatic changes, such as changes in treatment options presented to patients, a movement to focus on EBPs for PTSD, and expanded clinic hours and telehealth options, possibly impacted veteran engagement and completion in EBPs. The study highlights the potential impacts of a changing patient population within the clinic over a relatively short period. The observations are discussed, and limitations are highlighted. The study shares the hope for additional randomized prospective studies of program designs. Impact StatementThis study examines the evolution of an outpatient VA PTSD clinical team as practices moved from group-based model to a more individualized, veteran-centric model. This study underscores the positive impact of a programmatic shift toward individualized care that occurred in concurrence with additional demographic shifts in the veteran clinical population, and availability of remote care options delivered via telehealth. Further clinical research is needed.

“Paper in a day”: A model to encourage psychology collaboration and participation in research/program evaluation.

“…As highlighted in abstracts presented in the , several of the published studies involved novel clinically driven innovations (e.g., an interdisciplinary sexual health rehabilitation for spinal cord injury, Brundage et al, 2020; a fully individualized addictions team to treat those often untreated in other programs, Keating et al, 2021). Other studies reported on evidence-based treatments implemented in real-world settings with unselected populations and clinically relevant questions (e.g., questions such as whether a group suicide prevention intervention would be effective in a clinic setting, Simons et al, 2019; whether cognitive processing therapy would work well within an integrated residential model, Shepard et al, 2022; whether noncompletion of treatment differs between posttraumatic stress disorder and depression, Larsen et al, 2023; and whether individualized shared decision-making would enhance clinic outcomes, Hessinger et al, 2022). Finally, two publications were case studies, which by their nature utilize clinical insights from single cases to generate research or educational insights (e.g., hypersexual behavior as a symptom of posttraumatic stress disorder, Larsen, 2019; cognitive impairment resulting from chemotherapy tested with neuropsychology, Fischer, 2019).…”