Inpatient treatment of war‐related posttraumatic stress disorder: A 20‐year perspective

Coyne

et al. 2014

Adm Policy Ment Health

This national investigation utilizes qualitative data to evaluate an implementation model regarding factors influencing provider use of two evidence-based treatments for posttraumatic stress disorder (PTSD). Semi-structured qualitative interviews with 198 mental health providers from 38 Department of Veterans Affairs’ (VA) residential treatment programs were used to explore these issues regarding prolonged exposure (PE) and cognitive processing therapy (CPT) in VA residential PTSD programs. Several unique and some overlapping predictors emerged. Leadership was viewed as an influence on implementation for both CPT and PE, while a lack of dedicated time and resources was viewed as a deterrent for both. Compatibility of CPT with providers’ existing practices and beliefs, the ability to observe noticeable patient improvement, a perceived relative advantage of CPT over alternative treatments, and the presence of a supportive peer network emerged as influential on CPT implementation. Leadership was associated with PE implementation. Implications for the design and improvement of training and implementation efforts are discussed.

Section: Ebts For Posttraumatic Stress Disorder (Ptsd) In the Departmmentioning

confidence: 99%

Evaluation of an Implementation Model: A National Investigation of VA Residential Programs

Cook

Coyne

et al. 2014

Adm Policy Ment Health

“…Residential PTSD treatment has been a VA cornerstone for more than 40 years (Desai, Spencer, Gray, & Pilver, 2010; Rosenheck, Fontana, & Errera, 1997). It represents a small but significant faction of PTSD care, generally serving patients with more severe symptoms and longstanding problems and less community support than typical out-patients.…”

mentioning

confidence: 99%

VA residential provider perceptions of dissuading factors to the use of two evidence-based PTSD treatments.

Cook¹,

Professional Psychology: Research and Practice

Simiola

et al. 2014

106

Providers (N = 198) from 38 Department of Veterans Affairs residential posttraumatic stress disorder treatment programs across the United States completed qualitative interviews regarding implementation of 2 evidence-based treatments: prolonged exposure and cognitive processing therapy. As part of this investigation, providers were asked how they decide which patients are appropriate for these treatments. Many indicated that they did not perceive any patient factors that dissuade their use of either evidence-based treatment. However, 3 broad categories emerged surrounding reasons that patients were perceived to be less suitable candidates for the treatments: the presence of psychiatric comorbidities, cognitive limitations, and low levels of patient motivation. Interestingly, providers’ perceived reasons for limited or nonuse of a treatment did not correspond entirely to those espoused by treatment developers. Possible solutions to address provider concerns, including educational and motivational interventions, are noted.

“…The development of these services has been traced from long-stay inpatient programs of the mid 1970s through 1980s, to a national network of outpatient programs in the early 1990s, and most recently to a full continuum of treatment including evaluation and brief treatment and day hospitalization. Throughout all of these advancements in programming for PTSD, specialized residential treatment has been a cornerstone, treating individuals with some of the most significant mental health care needs (Rosenheck, Fontana, & Errera, 1997). …”

mentioning

confidence: 99%

Residential treatment for posttraumatic stress disorder in the Department of Veterans Affairs: A national perspective on perceived effective ingredients.

Cook

Traumatology: An International Journal

Simiola

et al. 2014

Self Cite

Thirty-eight U.S. Department of Veterans Affairs’s (VA) residential treatment programs for posttraumatic stress disorder took part in a formative evaluation of their programmatic services, including perceptions of effective treatment. From July 2008 through March 2011, face-to-face qualitative interviews were conducted with over 250 VA residential staff. A wide variety of perceived effective treatment elements were noted. The most frequently mentioned elements were evidence-based treatments, frequency and intensity of milieu, staff cohesion, varied programming, and individualized treatment. Implications for VA managers and policy-makers as well as non-VA health care systems and health care providers are discussed.